2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T6e9,This study aimed to investigate the relationship between a previously purpose-developed lifestyle behavior scale and health care cost savings related to low back pain (LBP). This longitudinal study used data from the Australian Twin Back (AUTBACK) study. LBP and lifestyle behavior measures were collected at baseline. Physical activity (PA) was objectively quantified via an accelerometer. A lifestyle behavior scale was created using variables of body mass index, PA, smoking status, and sleep quality. Weekly health care use for LBP was collected over one year. Health care costs were calculated by aggregating expenses for health care visits and medications, encompassing personal and Australia Medicare costs, and analyzed by two-part models. Individuals with lower lifestyle behavior scores, women, and those with a baseline episode of LBP were more likely to incur health care use costs (n = 307). A total of 2.6% of participants accounted for over 56% of the total expenditures. A one-point improvement in the lifestyle behavior scale was significantly associated with 23% decrease in overall health care costs for LBP (95% confidence interval [CI] 7%-36%; P = 0.006), 25% decrease in medication costs for LBP (95% CI 13%-35%; P < 0.001), and 27% decrease in health care visit costs for LBP (95% CI 14%-39%; P < 0.001). The predicted difference in yearly health care use costs between individuals with the lowest and highest lifestyle scores was AU$873. This study demonstrated the association between greater adherence to positive lifestyle behaviors and reduced health care costs related to LBP. Interventions aimed at improving lifestyle behaviors could yield substantial cost savings for individuals and the health care system, mitigating the burden of LBP.31:Ta43, Objective This study aimed to investigate the relationship between a previously purpose‐developed lifestyle behavior scale and health care cost savings related to low back pain (LBP). Methods This longitudinal study used data from the Australian Twin Back (AUTBACK) study. LBP and lifestyle behavior measures were collected at baseline. Physical activity (PA) was objectively quantified via an accelerometer. A lifestyle behavior scale was created using variables of body mass index, PA, smoking status, and sleep quality. Weekly health care use for LBP was collected over one year. Health care costs were calculated by aggregating expenses for health care visits and medications, encompassing personal and Australia Medicare costs, and analyzed by two‐part models. Results Individuals with lower lifestyle behavior scores, women, and those with a baseline episode of LBP were more likely to incur health care use costs (n = 307). A total of 2.6% of participants accounted for over 56% of the total expenditures. A one‐point improvement in the lifestyle behavior scale was significantly associated with 23% decrease in overall health care costs for LBP (95% confidence interval [CI] 7%−36%; P = 0.006), 25% decrease in medication costs for LBP (95% CI 13%−35%; P < 0.001), and 27% decrease in health care visit costs for LBP (95% CI 14%−39%; P < 0.001). The predicted difference in yearly health care use costs between individuals with the lowest and highest lifestyle scores was AU$873. Conclusion This study demonstrated the association between greater adherence to positive lifestyle behaviors and reduced health care costs related to LBP. Interventions aimed at improving lifestyle behaviors could yield substantial cost savings for individuals and the health care system, mitigating the burden of LBP. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Low Back Pain: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Low Back Pain (condition). Clinician-written summaries and actionable practice insights. 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The pathway included multidisciplinary assessment, with 2-week digitally supported physiotherapy-led follow-up (n=101) and semi-structured interviews (n=20).","key_result":"90% of patients (129/143) did not return to a public ED within 90 days. Significant improvements in pain/discomfort and usual activities were seen at 2 weeks (both p<0.001, effect sizes r=−0.88 and r=−0.76 respectively), but anxiety/depression scores did not improve. 5 cases of missed serious pathology were identified (3 fragility fractures, 1 herpes zoster, 1 spinal metastasis).","limitations":"- No control group, so ED re-presentation rates cannot be directly compared to standard ED care.\n- Selection bias in qualitative interviews: only patients highly engaged with digital follow-up were interviewed, excluding non-users (e.g., older adults, non-English speakers) whose experiences may differ.\n- Some EQ-5D-5L items (self-care, mobility) were administered incorrectly and excluded; no primary care records were captured to identify missed diagnoses outside hospital.","practice_takeaway":"For patients with non-serious LBP triaged away from the ED, diversion to a multidisciplinary community hub with 2-week digital follow-up appears safe and acceptable, with 90% avoiding ED return within 3 months. Clinicians should be alert to older patients (all 6 who were admitted were >65 years), who may need enhanced support and closer follow-up."}},{"doi":"10.1038/s41366-026-02130-2","pmid":"42374119","title":"Obesity-induced intervertebral disk degeneration: pathophysiology and clinical implications","journal_title":"International Journal of Obesity","journal_issn":"0307-0565","published_at":"2026-06-29T00:00:00.000Z","url":"https://doi.org/10.1038/s41366-026-02130-2","source_score":16,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-07T13:26:12.332Z","updated_at":"2026-07-07T13:26:12.332Z","tags":[{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"category","value":"Endocrinology & Metabolism","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"condition","value":"Intervertebral Disc Degeneration","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"condition","value":"Low Back Pain","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"condition","value":"Obesity","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"modality","value":"Anti-Inflammatory Pharmacotherapy","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"modality","value":"Bariatric Surgery","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"modality","value":"Lifestyle Modification","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"warning","value":"Full text was not available; structured data is derived from the abstract, publisher page, and reference list only—key findings may be more nuanced in the full paper.","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"warning","value":"No sample size tag is applicable as this is a review article with no single study population.","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"warning","value":"The review covers a broad age range across cited studies; the adult age group tag is an approximation based on context.","value_numeric":null},{"paper_doi":"10.1038/s41366-026-02130-2","tag_type":"warning","value":"This is a narrative review funded by ICMR; no systematic search protocol or PRISMA statement is described, raising potential for selection bias.","value_numeric":null}],"summaries":{"what_studied":"This narrative review examines the pathophysiological mechanisms linking obesity to intervertebral disk degeneration (IVDD), drawing on epidemiological studies, clinical trials, and animal models. It also evaluates interventions—lifestyle changes, dietary modifications, bariatric surgery, and pharmacological therapies—for mitigating obesity-related spinal harm.","key_result":"Obesity drives IVDD through two main pathways: (1) metabolic/inflammatory—visceral adipose tissue secretes pro-inflammatory cytokines (TNF-α, IL-6) and adipokines (leptin, resistin, visfatin, chemerin) that enhance disk catabolism and suppress repair; and (2) biomechanical—excess body weight increases mechanical loading on spinal structures, accelerating disk wear. Genetic factors (FTO, LEP, ADIPOQ, VDR polymorphisms) further modulate individual susceptibility.","limitations":"- Full text was not accessible; the summary is based solely on the abstract and publisher page, limiting depth of evidence appraisal.\n- As a narrative (not systematic) review, it is vulnerable to selection bias in included studies.\n- No quantitative pooling of effect sizes is reported, so the magnitude of obesity's contribution to IVDD risk cannot be precisely determined from this paper alone.","practice_takeaway":"Clinicians managing patients with obesity and back pain should consider weight reduction—via lifestyle changes or bariatric surgery—as a disease-modifying strategy for IVDD, not just symptom relief. Targeted anti-inflammatory approaches (e.g., modulating TNF-α, IL-6, or adipokine pathways) represent an emerging adjunct worthy of monitoring in future trials."}},{"doi":"10.3399/bjgp26x746049","pmid":"42350288","title":"Sex, violence, and moral ambiguity in\n Once Upon a Time in the West","journal_title":"British Journal of General Practice","journal_issn":"0960-1643","published_at":"2026-06-25T00:00:00.000Z","url":"https://doi.org/10.3399/bjgp26x746049","source_score":5,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-29T13:22:52.069Z","updated_at":"2026-06-29T13:22:52.069Z","tags":[{"paper_doi":"10.3399/bjgp26x746049","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"category","value":"Primary Health Care","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"condition","value":"Depression","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"condition","value":"Low Back Pain","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"condition","value":"Mental Health","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"condition","value":"Sickness Absence","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"study_design","value":"Opinion / Editorial","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"warning","value":"No primary data are presented; mortality statistics are referenced without full citation details in the extracted text.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"warning","value":"The 5× all-cause mortality figure is cited from observational studies without specifying study designs or adjustment for confounders — interpret with caution.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746049","tag_type":"warning","value":"The paper title in the HTML metadata is 'Sex, violence, and moral ambiguity in Once Upon a Time in the West' but the actual article content is 'Should general practice certify long-term sickness?' by Dipesh P Gopal — the HTML title appears to be a metadata error; content was processed as written.","value_numeric":null}],"summaries":{"what_studied":"This opinion piece examines whether GPs should continue to certify long-term sickness, outlining six arguments against the current system and reviewing alternative models (e.g., Swedish capacity notes, vocational advisors, work coaches in primary care).","key_result":"The author argues GPs should not certify long-term sickness, citing evidence that prolonged sickness absence is associated with up to **5× higher all-cause mortality** compared to those without sickness absence, including patients with pre-existing cancer and cardiovascular disease.","limitations":"This is an editorial/opinion piece with no primary data or systematic review; the mortality association cited is observational and drawn from UK and European studies without detailed appraisal; no evaluation of proposed alternative models is presented.","practice_takeaway":"GPs should be aware that sickness certification is not a neutral act — prolonged certification is linked to higher mortality and morbidity, not just welfare support. Advocate for multidisciplinary alternatives (occupational health, work coaches, vocational advisors) for long-term sickness cases rather than acting as sole arbiters."}},{"doi":"10.3399/bjgp26x746037","pmid":"42350275","title":"Should general practice certify long-term sickness?","journal_title":"British Journal of General Practice","journal_issn":"0960-1643","published_at":"2026-06-25T00:00:00.000Z","url":"https://doi.org/10.3399/bjgp26x746037","source_score":5,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-29T13:22:51.730Z","updated_at":"2026-06-29T13:22:51.730Z","tags":[{"paper_doi":"10.3399/bjgp26x746037","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"category","value":"Primary Health Care","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"condition","value":"Depression","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"condition","value":"Long-Term Sickness Absence","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"condition","value":"Low Back Pain","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"condition","value":"Mental Health Disorders","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"modality","value":"Occupational Health","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"modality","value":"Primary Care / General Practice","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"study_design","value":"Opinion / Commentary","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"warning","value":"The BBC survey cited (72% of 752 GPs never refused a fit note for mental health) is from a media report, not a peer-reviewed source.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"warning","value":"The 'practice_changing' impact flag reflects the policy debate and pending UK pilot programs described, not a clinical trial result.","value_numeric":null},{"paper_doi":"10.3399/bjgp26x746037","tag_type":"warning","value":"This is an authored opinion piece, not a primary research study — no original data are presented; the evidence cited (e.g., mortality risk figures) derives from referenced external studies not fully detailed in this text.","value_numeric":null}],"summaries":{"what_studied":"This opinion piece examines whether GPs should continue to certify long-term sickness in the UK, outlining six arguments against the current system and reviewing alternative models such as Swedish capacity notes, vocational advisors, and work coaches.","key_result":"The author argues GPs should not certify long-term sickness, citing that prolonged or frequent sickness absences are linked to up to **5× higher all-cause mortality** vs. those without absences; vocational advisors in general practice reduced sickness absence and could generate millions of pounds in societal savings.","limitations":"This is an opinion/commentary piece with no primary data collection; claims about mortality risk and cost savings are cited from external studies without full detail. The referenced BBC survey (n=752 GPs) is not peer-reviewed.","practice_takeaway":"GPs should be aware that long-term sickness certification carries real health risks for patients and may conflict with their clinical role — pending UK pilots (launching July 2026) will test models where GPs do or do not issue initial fit notes, with referral to multidisciplinary work-support services."}},{"doi":"10.1136/emermed-2025-215411","pmid":"42264914","title":"Same day emergency care for low back pain: quality improvement to support emergency flow and reduce unnecessary acute admissions","journal_title":"Emergency Medicine Journal","journal_issn":"1472-0205","published_at":"2026-06-09T00:00:00.000Z","url":"https://doi.org/10.1136/emermed-2025-215411","source_score":6,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-14T13:34:53.882Z","updated_at":"2026-06-14T13:34:53.882Z","tags":[{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"condition","value":"Low Back Pain","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"modality","value":"Same Day Emergency Care Pathway","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"sample_size","value":"n=3921","value_numeric":3921},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"study_design","value":"Quality Improvement Study","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"warning","value":"No control group or comparator site; admission rate reductions may partly reflect system learning or case-mix changes over time rather than the pathway alone.","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"warning","value":"Patient safety outcomes such as missed serious pathology, readmissions, or 30-day mortality are not reported, limiting conclusions about safety of the reduced admission rate.","value_numeric":null},{"paper_doi":"10.1136/emermed-2025-215411","tag_type":"warning","value":"Study spans 2018–2021, including the COVID-19 pandemic period, which may have affected referral volumes and admission thresholds in ways not fully accounted for.","value_numeric":null}],"summaries":{"what_studied":"A quality improvement (QI) project evaluated a same day emergency care (SDEC) pathway for low back pain (LBP) in an ED setting over four PDSA cycles from November 2018 to December 2021, aiming to reduce avoidable hospital admissions.","key_result":"Across 3,921 total referrals, hospital admission rates fell from 31% in early cycles to 8% by cycle 4 (n=172/2,042), while same-day MRI utilisation stabilised at 11% — without an apparent increase in overall MRI demand.","limitations":"Single-centre QI project without a control group; no formal ethical review or randomisation; long-term follow-up outcomes (e.g., readmissions, patient safety) are not reported.","practice_takeaway":"An ED-based spinal SDEC pathway staffed by specialist nurses and advanced physiotherapists can cut LBP admission rates from ~31% to ~8% over time. Embedding iterative feedback cycles and stakeholder co-design appears key to sustaining these gains."}},{"doi":"10.1002/acr.25653","pmid":"40963458","title":"Impact of Positive Lifestyle Behaviors on Direct Health Care Cost Savings for Low Back Pain","journal_title":"Arthritis Care & Research","journal_issn":"2151-464X","published_at":"2025-09-18T00:00:00.000Z","url":"https://doi.org/10.1002/acr.25653","source_score":26,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2025-12-19","doi":"10.1002/acr.25653","days":"30","issn":"2151-464X","rank":"3","field":"Clinical Medicine","score":"26","category":"Rheumatology","categories":["Rheumatology"],"_categories":["Rheumatology"]},"pubmed":{"doi":"10.1002/acr.25653","title":"Impact of Positive Lifestyle Behaviors on Direct Health Care Cost Savings for Low Back Pain.","journal":"Arthritis care & research","methods":"","results":"Individuals with lower lifestyle behavior scores, women, and those with a baseline episode of LBP were more likely to incur health care use costs (n = 307). A total of 2.6% of participants accounted for over 56% of the total expenditures. A one-point improvement in the lifestyle behavior scale was significantly associated with 23% decrease in overall health care costs for LBP (95% confidence interval [CI] 7%-36%; P = 0.006), 25% decrease in medication costs for LBP (95% CI 13%-35%; P < 0.001), and 27% decrease in health care visit costs for LBP (95% CI 14%-39%; P < 0.001). The predicted difference in yearly health care use costs between individuals with the lowest and highest lifestyle scores was AU$873.","abstract":"$30","keywords":[],"pubmed_id":"40963458","conclusions":"This study demonstrated the association between greater adherence to positive lifestyle behaviors and reduced health care costs related to LBP. Interventions aimed at improving lifestyle behaviors could yield substantial cost savings for individuals and the health care system, mitigating the burden of LBP.","publication_date":"2025-09-18T00:00:00"},"crossref":{"DOI":"10.1002/acr.25653","URL":"https://doi.org/10.1002/acr.25653","ISSN":["2151-464X","2151-4658"],"link":[{"URL":"https://acrjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/acr.25653","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Impact of Positive Lifestyle Behaviors on Direct Health Care Cost Savings for Low Back Pain"],"author":[{"given":"Ye","family":"Tian","sequence":"first","affiliation":[{"name":"School of Health Science, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia"}]},{"given":"Katharine E.","family":"Roberts","sequence":"additional","affiliation":[{"name":"School of Health Science, Faculty of 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The predicted annual cost difference between the lowest and highest lifestyle scores was AU$873, and 2.6% of participants accounted for over 56% of total expenditures.","limitations":"Single Australian twin cohort (AUTBACK) with n=307. Costs were highly concentrated, with 2.6% of participants driving over 56% of expenditures, which may skew estimates.","practice_takeaway":"In this cohort, healthier baseline lifestyle profiles (better BMI, more activity, non-smoking, better sleep) were linked to markedly lower LBP-related health care costs over one year; assess and support these behaviors when managing LBP."}}],"initialOffset":6,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Low Back Pain"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Low Back Pain"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Low Back Pain"}}}]]

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