Lower back pain is the most burdensome symptom causing disability in the world. Around 80% of people have back pain in their lifetime. The biggest disability is experienced by those in the age group of 40–49 years. In most cases, the back pain is only temporary, but around 20-25% of back pain is prolonged over 3 months. Around 90% of back pain is benign, and no specific disease or structural reason can be pointed out. Several different risk factors are associated with such benign, so-called non-specific lower back pain. Nieminen gathered these factors in a literature review.
“According to the systematic literature review, 45 different factors are recognised as meaningful and linked to chronic lower back pain. These risk factors include obesity, smoking, heavy physical work, depression, anxiety, and maladaptive behaviour strategies, such as catastrophising and avoidance behaviour. Physical activity, on the other hand, works as a protective factor,” says Linda Nieminen.
Experts on back pain encourage people to develop ways to recognise factors that are related to prolonged pain so that rehabilitation could be tailored individually in a timely fashion. In the dissertation study, a technology based on artificial intelligence was used to recognise such factors. The company behind the technology used in this study is Finnish Headai. Their technology is used broadly, e.g., in education and the manufacturing industry. AI technology was trained to recognise pain and disability factors related to lower back pain. These factors were linked to World Health Organization’s ICF classification, which helps to understand disability not only through body structures and functions but also the psychological and social operational environment.
“AI performed well in electronic health records to recognise factors causing disability. It must be noted, however, that when performing an analysis in a new area, a medical professional was needed to label the relevant information, and, after the analysis, to assess whether the retrieved information is essential. Overall, the developed method can speed up the process of browsing through the health records and helps professionals to understand disability in a wider perspective,” says Nieminen.
When bringing new technologies to health care, a rigorous assessment must be made concerning safety, clinical impact, cost-effectiveness, and their fit to current computing architectures as well as to the daily routines of health care.
The dissertation study also included new treatment pathways to primary and occupational healthcare, where individual factors related to pain prolongation should be noted. Multidisciplinary and multisectoral collaboration was seen as crucial. A team of professionals from different sectors and professions were involved in the development.
Linda Nieminen is a specialising doctor in physical and rehabilitation medicine and works as a consultant for primary health care and medical rehabilitation coordinators in the wellbeing services county of Pirkanmaa, Finland.
Public defence on 6 June
The doctoral dissertation of MD Linda Nieminen in the field of medicine, Decision support for tailored biopsychosocial rehabilitation in non-specific low back pain, will be publicly examined (in Finnish) at the Faculty of Medicine and Health Technology of Tampere University at 12 o’clock on Friday 6 June, 2023 in the auditorium A1, main building, Kalevantie 4, Tampere. Research director of the Finnish Association of People with Physical Disabilities, Adjunct Professor Sinikka Hiekkala from the University of Jyväskylä will act as the opponent, while Adjunct Professor Markku Kankaanpää from Tampere University will act as the custos.
Photograph: Simo Nieminen