Journal of Back and Musculoskeletal Rehabilitation - Volume 11, issue 1
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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: Aging is accompanied by a decline in the incidence of most primary headache disorders and an increase in the incidence of organic causes of headache. Headaches that begin after age 55 are more often due to serious conditions, or are exacerbated by comorbid disorders. When evaluating the older patient with new onset headache or a change in headache pattern, one must rule out serious secondary causes of headache, such as tumor, subdural hematoma, stroke, transient ischemic attack, and temporal arteritis. When older patients present with headache, a lowered threshold for ordering tests is justified, particularly if the headaches are of…recent onset, are atypical, or are associated with neurologic findings. This article discusses the secondary causes of headache in the elderly and the symptoms and appropriate testing and treatment of these headaches. The epidemiology and treatment of the primary headache disorders in the elderly are reviewed.
Abstract: Both heads of the gastrocnemius muscle contribute to ankle plantar flexion. This study utilized integrated electromyography to investigate whether the percent electrical activity contributed by each head remained constant or changed during isometric contractions at five different resistance levels. Fifty healthy volunteers ranging in age from 19 to 34 years, with no history of musculoskeletal or neuromuscular disorders involving the right lower extremity, were studied. All tasks were performed in the prone position, knee in extension, with the leg and foot in neutral with respect to rotation. Motor points of the medial head and lateral head were identified and surface…electrodes were placed just distal to them. The subjects maintained 20° of plantar flexion under five conditions: a maximal isometric plantar flexion contraction (one trial only), and with a 5-, 10-, 15- and 20-lb cuff weight attached to the right foot (three trials each). EMG recordings, 8 s in length, were taken during the isometric contractions. Integrated EMGs were averaged for each cuff weight and the resulting values used in the analysis. A repeated measures ANOVA was performed and a significance level of p≤0.05 was used to determine statistical significance. As weight increased, the absolute value of the integrated EMG recorded over both muscles increased, but the percent contributed by each head remained essentially equal (50%) within the four submaximal loads tested. However, for the maximal isometric contraction, the medial head contributed a significantly higher percentage of the total integrated EMG (58%). Therefore, in the open-chain activity described, the two heads of the gastrocnemius demonstrate similar neural drive at submaximal levels of contraction, but this changes as maximum isometric levels are reached.
Abstract: Approximately two-thirds of cancer patients suffer from significant pain. Until recently, less expensive and less costly conservative treatments have been utilized to treat these patients' pain, but the outcomes have been poor, with many experiencing inadequate pain relief. Although intraspinal opioid therapy is relatively new and more invasive than traditional treatments, it can provide most cancer patients better pain relief with less side effects. Intraspinal opioids can be used successfully to treat intractable malignant pain states.
Keywords: Intraspinal opioid therapy, Cancer pain, Intrathecal opioids, Epidural opioids
Abstract: Summary: Low-back injuries are among the most common and costly work-related injuries. Many studies show a wide variation in the diagnostic and therapeutic approaches to treat these injuries. To help standardize medical practice patterns and reduce the use of procedures with little or no proven benefit, the Agency for Health Care Administration (AHCA) developed and endorsed a scientifically sound medical practice guideline for the treatment of low-back injuries. This study investigates the potential of the guideline to reduce workers’ compensation costs by reducing unnecessary diagnostic and therapeutic treatments to workers with low-back injuries. The study considers the universe of new…low-back injuries reported to the Department of Labor and Employment Security (DLES) during the period October 1993 through September 1994. As many as two-thirds of the procedures provided to these workers were outside the guideline recommendations. In seven out of 11 procedure categories tested, 50% or more of the procedures were outside the guideline. In five of these areas, as many as 90% of the procedures were outside the guideline. The use of procedures outside the guideline was widespread across all major diagnosis groups, carrier types, geographic regions and practitioner types. Policy Implications: These results suggest that a large percentage of the procedures in use during the study period were unnecessary. Unnecessary procedures represent inessential spending and, in some cases, needless patient risk. The Florida low-back guideline has great potential to reduce practice variation and standardize treatment patterns according to the best scientific evidence. Relevant Florida Statutes: Section 408.02, Florida Statutes, authorizes AHCA to develop and endorse medical practice guidelines. Section 440.13, Florida Statutes, requires workers’ compensation insurance carriers and DLES to use guidelines in evaluating the appropriateness and overutilization of medical services provided to injured employees. For information Contact: Russell E. Mardon, Ph.D or Glenn E. Mitchell, Ph.D., Co-Principal Investigators, State Center for Health Statistics Agency for Health Care Administration. + 1 850 9225866, + 1 850 9225569.