Journal of Back and Musculoskeletal Rehabilitation - Volume Preprint, issue Preprint
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: INTRODUCTION: Scoliosis is one of the common spinal deformities and considered as lateral curvature of the spine. Scoliosis lead to changes in the synergy between body segments, spinal anatomy, left-right trunk symmetry and cause pathological gait pattern [1,4-7]. Scoliosis is a structural deformity, so it can alter center of mass (COM) position and weight distribution on lower limbs. This suggests that scoliotic patients show the poorer stability rather aged match normal group. It was controversial that scoliosis influences the balance and gait performances, and also the effects of brace on these parameters. Therefore, it was aimed to evaluate…the available literatures on balance and gait of scoliotic subjects. MATERIALS AND METHODS: We conducted a search via PubMed, Google scholar and ISI web of knowledge to identify studies on scoliosis field and the effect of this deformity on kinetic and kinematic parameters as well as the influence of bracing on mentioned parameters. Some key words such as kinetic, kinematic, gait, stability, and walking were used in combination with scoliosis. The publication dates of the full-length articles were between 1998 and 2014. Down and Black tool was used to evaluate the quality of the articles. RESULTS: Our multiple Medline searches led to the find out 54 papers that 26 of which were relevant based on title and abstract. Based on their references, we retrieved 6 more articles. We ultimately included 31 articles in this literature review. The number of studies regarding the influence of brace on kinetic and kinematic parameters in scoliotic subject was small. Based on the results of various studies, there is no correlation between gait pathology and scoliotic curve direction, no difference between stability of scoliotic and normal subjects and no difference between range of motions of lower limb joints in scoliotic subjects while walking with and without orthosis. CONCLUSION: There was a not sufficient robust evidence to judge about the influence of scoliosis deformity on kinetic and kinematic parameters. However, it should be emphasized that use of orthosis may influence the symmetry of gait and improve standing stability in adult with idiopathic scoliosis.
Abstract: BACKGROUND: Anxiety and depression may cause temporomandibular joint (TMJ) complaints or TMJ disorders may trigger some of psychiatric problems. OBJECTIVE: The aim of this study was to determine the risk factors and the interactive role of anxiety and depression in patients with TMJ dysfunction. METHOD: A total of 273 patients who presented to the multidisciplinary outpatient clinic of TMJ diseases that were followed up for temporomandibular dysfunction (TMD), were included in this trial. Patients were classified in three sub-groups: patients with myofacial pain alone (group-1), patients with TMJ disorder alone (group-2), and patients with…TMJ disorder and also myofacial pain (group-3). All patients were examined using the standard TMJ examination and were evaluated with the Hospital Anxiety Depression (HAD) scale in order to determine anxiety and depression. RESULTS: According to the univariate analysis, risk factors for patients with confirmed anxiety and/or depression were being female (p= 0.005), existence of myofacial pain (p= 0.01), effects of stress on complaints (p= 0.005) and insufficient social support (p< 0.001). According to regression analysis, presence of psychopathology was increased 3.7 times in those being female, 3.5 times with insufficient social support, and 1.2 times with myofacial pain. CONCLUSIONS: Among the patients with TMD, the groups who were considered to have anxiety and depression were female patients, patients with deficient social support system, and patients with myofacial pain alone or patients with myofacial pain accompanying an existing TMJ disorder. The existence of anxiety and depression should be considered in addition to musculoskeletal pathologies during the treatment plan of patients with TMJ who have these risk factors.
Abstract: OBJECTIVE: Compare the efficacy of orthoses and patient education with and without the addition to Low-Level Laser Therapy (LLLT - 660 nm, 30 mW, a continuous regime and bean area of 0.06 cm2 ). The laser irradiation was delivered with the fluency of 10J/cm2 in patients with mild and moderate Carpal Tunnel Syndrome (CTS). METHODS: 48 patients were randomized and 30 finished the protocol (a sample loss of 37.5%), 90% female and 10% males. Randomization was applied to allocate the patients in each one of the groups, with association or not to LLLT (group orthoses…or LLLT and orthoses). All of them were submitted to ergonomic home orientations. The short-term symptoms and function outcome were assessed through: Boston Carpal Tunnel Questionnaire (BCTQ) - Severity of Symptoms (SS) Functional Score (FS). Pain (VAS), Semmes-Weinstein monofilaments, 2PD and pinch strength was used for characterization of the sample. Most of the participants were women, over 4th decade enrolled on heavy hand duties occupations, right-handed, 66.7% affected on dominant hand, without alterations in sensory median nerve thresholds or pinch strength. RESULTS: Both groups showed a reduction of total BCTQ score and its subdomains after six weeks, with significant difference (p< 0.05), comparing to baseline. No significant difference was found between groups. A Minimal clinical change was observed after the intervention in 92.3% of participants for BCTQ subdomain severity of symptoms at individual comparison for LLLT and orthoses group and 76.5% for the orthoses group, demonstrating clinical relevance. Effect size Cohen's index was moderate for the severity of symptoms. CONCLUSION: LLLT in association to orthoses and ergonomic orientation seems to be effective in short-term symptoms relieve for patients with mild and moderate CTS.
Abstract: BACKGROUND: Regular exercise training is one of the core components of multifactorial fall-prevention programs. OBJECTIVE: To compare the effect of Tai Chi and combined exercise prescription that consists of three main components of an exercise prescription on static balance, dynamic balance, fear of falling and mood. METHODS: Sixty older adults aged 55-76 were randomly assigned to Group 1 (Tai Chi exercise) or Group 2 (combined exercise prescription). Exercise was performed three times a week over a period of 12 weeks. Single Leg-Stance-Eyes Open (SLS-EO), Single Leg-Stance Eyes Closed (SLS-EC), computerized balance measurements, the Timed…Up and Go (TUG) test, Berg Balance Scale (BBS), the Survey of Activities and Fear of Falling in the elderly (SAFFE), the Geriatric Depression Scale (GDS), and the Beck Depression Scale (BDS) were assessed before and after the final training session. RESULTS: Both exercise groups yielded better results in dynamic balance assessments (TUG and BBS) at the 12th week (p< 0.05). Group 1 also showed significant improvements in the measurements of SLS-EO, SLS-EC, SAFFE, GDS, and BDS during the post-intervention period (all p< 0.05). When the groups were compared, a significant difference was found between groups in favor of Group 1 in terms of the SLS-EO and SAFFE (p< 0.05). CONCLUSIONS: It can be concluded that Tai Chi may be a more successful exercise intervention for factors-related to falls in older people.
Keywords: Tai Ji, Tai Chi, balance, frail elderly, falls
Abstract: BACKGROUND: Exercise is considered the first line of treatment for people with non-specific chronic low back pain (NSCLBP) but the ideal exercise type is currently unclear. Given the unique anatomical structure of the lower lumbar spine and the lumbosacral junction transverse-plane rotation exercises may be helpful for people suffering from pain in this region. OBJECTIVE: We aimed to examine the effect of spinal rotation exercises delivered in a group format on range of motion, pain level and function parameters in women with NSCLBP. METHODS: This was a randomized controlled single-blinded study. Thirty-five women with…NSCLBP, participated in either a bi-weekly rotation exercise classes (n= 20) or a `wait-list' control group (n = 15). The exercises aimed at improving lumbar mobility in the transverse plane. Pain rated on a Visual Analog Scale, back specific disability (Rolland Morris questionnaire), and lumbar range of motion (flexion, extension and left and right rotation) were taken prior to intervention, immediately following 4 weeks of intervention and 8 weeks later. RESULTS: There were no significant differences for either group (p> 0.05) on all dependent variables at all times of measurements. CONCLUSIONS: A specific group program of rotation exercises had no effect on the functional status, pain level and lumbar range of motion in women with NSCLBP.
Keywords: Low back pain, rotation exercises, group exercise, Rolland Morris, visual analog scale, lumbar rotation
Abstract: BACKGROUND/OBJECTIVE: The aim of this study is to investigate the effect of mud compress (MC) therapy compared to hot pack (HP) therapy on cartilage destruction and subchondral bone alterations detected by urine levels of C telopeptide fragment of collagen type-II (uCTX-II) in patients with knee osteoarthritis (OA). METHODS: Fifty-nine patients between 49-74 years of age with bilateral knee OA divided into 2 groups. Twenty-five patients (16 females, 9 males) and 34 patients (22 females, 13 males) were given HP and local natural organic and mineral-rich MC therapy respectively for 2 weeks as a total of 12…sessions. uCTX-II, Visual Analog Scale (VAS), 15 m walking time, Western Ontario and McMaster Universities multifunctional (WOMAC) index were measured at baseline, after-treatment and 3 months after treatment. RESULTS: uCTX-II level did not show any difference between the two groups, however it decreased significantly in MC and HP groups 3 months after treatment (p< 0.017). WOMAC stiffness sore was significantly lower in MC group 3 months after treatment (p< 0.05). Both MC and HP therapies lowered VAS, WOMAC total and subscores significantly up to 3 months (p< 0.017). CONCLUSIONS: HP and MC therapies for OA of knee are not superior to one another with respect to the level of uCTX-II. MC may probably decrease the ongoing cartilage destruction and related subchonral bone interactions earlier compared to HP treatment in patients with knee OA as evidenced by decreased uCTX-II levels after-treatment.
Abstract: BACKGROUND: Static radiographic techniques are unable to capture the wealth of kinematic information available from lumbar spine sagittal plane motion. OBJECTIVE: Demonstration of a viable non-invasive technique for acquiring and quantifying intervertebral motion of the lumbar spine in the sagittal plane. METHODS: Videofluoroscopic footage of sagittal plane lumbar spine flexion-extension in seven symptomatic volunteers (mean age = 48 yrs) and one asymptomatic volunteer (age = 54 yrs) was recorded. Vertebral bodies were digitised using customised software employing a novel vertebral digitisation scheme that was minimally affected by out-of-plane motion. RESULTS: Measurement errors…in intervertebral rotation (± 1°) and intervertebral displacement (± 0.5 mm) compare favourably with the work of others. Some subjects presenting with an identical condition (disc prolapse) exhibited a similar column vertebral flexion-extension relative to S1 (L3: max. 5.9°, min. 5.6°), while in others (degenerative disc disease) there was paradoxically a significant variation in this measurement (L3: max. 28.1°, min. 0.7°). CONCLUSIONS: By means of a novel vertebral digitisation scheme and customised digitisation/analysis software, sagittal plane intervertebral motion data of the lumbar spine data has been successfully extracted from videofluoroscopic image sequences. Whilst the intervertebral motion signatures of subjects in this study differed significantly, the available sample size precluded the inference of any clinical trends.
Abstract: BACKGROUND: Automatic and voluntary body position control is essential for postural stability; however, little is known about individual factors that impair the sensorimotor system associated with low back pain (LBP). OBJECTIVE: To evaluate automatic and voluntary motor control impairments causing postural instability in patients with LBP. METHODS: Motor control impairments associated with poor movement and balance control were analyzed prospectively in 32 patients with LBP. Numeric Rating Scale (NRS) for pain assessment, Oswestry Disability Index (ODI) for disability measurement, and computerized dynamic posturography (CDP) for analysis of postural responses were used to measure outcomes…of all patients. Computerized dynamic posturography tests including Sensory organization test (SOT), limits of stability test (movement velocity, directional control, endpoint, and maximum excursion), rhythmic weight shift (rhythmic movement speed and directional control), and adaptation test (toes-up and toes-down tests) were performed and the results compared with NeuroCom normative data. RESULTS: The mean age of the patients was 40.50 ± 12.28 years. Lower equilibrium scores were observed in SOT (p < 0.05). There was a significant increase in reaction time and decrease in movement velocity, directional control, and endpoint excursion (p < 0.05). Speed of rhythmic movement along the anteroposterior direction decreased, while speed increased along the lateral direction (p < 0.05). Poor directional control was recorded in the anteroposterior direction (p < 0.05). Toes-down test showed an increased COG sway in patients compared with that in the controls (p < 0.05). CONCLUSIONS: LBP causes poor voluntary control of body positioning, a reduction in movement control, delays in movement initiation, and a difficulty to adapt to sudden surface changes.
Keywords: Low back pain, postural stability, balance control, posturography
Abstract: BACKGROUND/PURPOSE: The purpose of this study was to evaluate the neuropathic symptoms after local steroid injection in CTS. Since 2001, neuropathic pain scales have been used in the assessment and follow-up of neuropathic pain. DN4 and LANSS pain questionnaires have been applied to groups, mostly consisted of radiculopathy and polyneuropathy cases, before and after various treatments and the results have been compared with the electrophysiologic findings. However to our knowledge there is yet no such study focusing on neuropathic complaints and the relationship between neuropathic pain and electrophysiological findings before and after local corticosteroid injection. METHODS:…Forty-one patients aged 22-65 years and diagnosed with carpal tunnel syndrome by nerve conduction studies who were also found to have a neuropathic symptoms were included in the study. All patients received local steroid injection into the carpal tunnel while the questionnaires and nerve conduction studies were performed before and 2 months after the injection. RESULTS: Local steroid injection was found effective on clinical and electrophysiologic parameters as well as on DN4 and LANSS scores in CTS patients (p< 0.05). Electrophysiologic severity exhibited no statistically significant relationship with DN4 and LANSS scores, before and after treatment (p> 0.05). CONCLUSION: These findings suggests that the treatment of neuropathic complaints should be planned independently from the electrophysiologic findings and minimally invasive local steroid injection appears to be effective with regard to clinical and electrophysiologic aspects in CTS patients with neuropathic complaints.