Journal of Back and Musculoskeletal Rehabilitation - Volume 10, issue 3
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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: This study investigated the influence of presenting low back pain symptoms on objective measures of spinal motion. A total of 115 low back pain patients presenting at the hospital's outpatient clinic underwent a detailed motion analysis of their lumbar spine movement. Subjects were then divided into one of three groups based on the distribution of their presenting symptoms using a modification of the Quebec Task Force Classification System. The motion characteristics of these three groups were then compared with an existing database of 203 normal subjects. Prior to analysis, all subjects were age- and sex-standardized to facilitate interpretation of the…results. The low back pain subjects were further sub-divided according to their underlying pathology which was ascertained from radiological investigations and clinical examination. Further analysis was performed to investigate if greater clarification in motion characteristics could be identified when patients were classified according to their symptom distribution and their underlying pathology. Analysis revealed that the severity of presenting symptoms did influence the motion characteristics of low back pain subjects. A trend of decreasing flexibility with increasing symptom severity was noted. However, there was considerable variability in the data. Accounting for the subject's underlying pathology as well as the severity of their presenting symptoms did not clarify this variability in motion characteristics any further. In conclusion, although motion is influenced by the severity of the presenting symptoms, the effects are not substantial enough to distinguish between these subjects clinically. Greater clarification is not gained by the inclusion of underlying pathology, suggesting that the Quebec Task Force Classification System using symptoms to categorize patients is adequate.
Keywords: Low back pain, Spinal motion, Symptom severity, Classification, Diagnosis, Range of motion, Velocity
Abstract: This study investigated the concurrent validity of a method developed to evaluate the presence of symptom magnification syndrome in a sample of patients receiving workers' compensation benefits due to reported chronic low back pain. A validation study involving maximum voluntary effort (MVE) testing of 165 subjects who also received a functional capacity evaluation is described. Various applications of the MVE data were utilized. This study demonstrates that most methods were not significant predictors of the symptom magnification syndrome and that even the best of these methods frequently led to misclassification.
Keywords: Symptom magnification syndrome, Functional capacity evaluation, Low back pain, Performance test, Maximum voluntary effort, Workers' compensation
Abstract: The purpose of this study was to examine the relationship between hand size and grip strength at various handle positions using the Jamar handheld dynamometer in females. Eighty-eight female physical therapy students between the ages of 20 and 40 were recruited. Subjects were weighed and their height measured. Right hand size was determined by measuring from the distal tip of the third digit to the radiocarpal joint with a tape measure. Subjects were divided into two groups by hand size (< 7.0 and ≥ 7.0 inches). The order of handle positions was randomly selected.…Subjects were seated according to the American Society of Hand Therapists’ recommended testing position with shoulder adducted and neutrally rotated, elbow flexed to 90° and forearm and wrist in neutral. Subjects maximally squeezed the handle of the dynamometer with the right hand for 3 s. This process was repeated three times at each handle position. A repeated measures ANOVA was performed comparing the change in average grip strength between position 2, 3 and 4 for small and large hands. The mean age of the two groups were similar (25.96 vs. 25.89, p = 0.95 ). Subjects with smaller hands were shorter (61.7 vs. 65.5 inches, p = 0.0001 ) and produced lower grip strengths than those with large hands at all positions (p = 0.0084 ). Height and hand size were strongly correlated (r = 0.74 , p = 0.0001 ) as were height and weight (r = 0.66 , p = 0.0001 ) and weight and hand size (r = 59 , p = 0.0001 ). Height was the most strongly correlated with grip strength at all positions followed by hand size then weight. Age was shown not to be significantly correlated with grip strength in this study. These findings suggest that handle position 2 and 3 produce similar grip strength measurements even in women with smaller hands. Position 4 is significantly worse than positions 2 and 3.
Keywords: Grip, Jamar dynamometer, Grip strength, Hand size
Abstract: Theologians are not the only ones concerned with spiritual matters. To enhance their effectiveness as healers, doctors are now studying spirituality at American medical colleges. They are learning that suffering springs from causes physical, nervous and moral, and how stubbornly these intertwine. So how do doctors go about healing their patients? To begin with, they must seek to understand each one empathetically, with an aim toward fellowship. This means to listen with attention and provide an atmosphere of spontaneity. Until the patient is understood empathetically, there can be no reciprocity of feeling. And without reciprocity of feeling, there can…be no trust in which the patient can seek, unjudged, peace with his or her situation. Responding verbally is also recommended. Doctors can offer pithy statements that guide the healing course. To empower themselves, an honest study must be made of their own lives: ‘How have life events and conditions influenced my beliefs and decisions? How ought I respond to pain, disappointment, and the needs of others?’ Having considered these questions, they are better equipped to mediate the interior struggle of the hurting. And physicians must read. Without examples to learn from, it's difficult to formulate the right words. This pastoral approach to medicine, while helping patients to see the significance of their illness in holistic terms, benefits the doctor also. Often victims of routine, cut off from their relational/intuitive side, doctors may be offering only a fragment of their ability. When they provide the mediation necessary for the patient to break down resistances that block a more meaningful life, their vocation increases in value. The following essay contains encouragement for succoring those who feel trapped in their illness, that they may find a measure of relief and escape.