Journal of Back and Musculoskeletal Rehabilitation - Volume 13, issue 2-3
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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: The current article provides evidence-based revisions to the practice guidelines for treating chronic non-malignant pain syndrome patients published in 1995 and adopted by the American Academy of Physical Medicine and Rehabilitation in 1996. Like the 1995 guidelines, the current ones are applicable to chronic pain syndrome patients, except cancer pain, regardless of general etiology of pain. They recommend that treatment continue to be goal directed across eight clinical and economic goals, with evaluation and treatment provided in an interdisciplinary, integrated fashion. Improvement in patient function continues to be emphasized, as does outpatient intervention; delivered with a blend of medical, psychological/behavioral,…physical/occupational therapy, and vocational interventions in an individualized treatment plan. Updates and/or new recommendations are provided with regard to the use of opioids and sedative-hypnotic medications, trigger point injections, nerve blocks, surgery, implantable spinal infusion and stimulation devices, and acupuncture based upon the most recent empirical research. The current guidelines continue to recommend upper limits regarding the number of treatment days and specific recommendations about patient selection. There is a new section discussing areas in need of additional evidence and a possible conceptual model allowing integration of the current guidelines with the ever-increasing number of others appearing in the clinical and research literature.
Keywords: chronic pain, practice guidelines, pain rehabilitation, evidence based
Abstract: The purpose of this article is to present a descriptive paper concerning a therapeutic approach to cervical dysfunction. This active rehabilitation process for patients with cervical dysfunction is an application of a five-step rehabilitation process that includes functional progressions. The major thrust of this approach is the return of patients to maximal level of activity or pre-dysfunctional level. The five steps of rehabilitation presented emphasize education, posture, flexibility, strength, and aerobic fitness. Functional progressions are implemented throughout the rehabilitation process, increasing the demands from simple to complex activities, to attain the goal of returning to maximal function. Case studies are…incorporated to assist clinicians in developing treatment plans.
Abstract: Introduction: This prospective clinical observation analyses the effects of postoperative standard in-hospital physiotherapy after surgery of a symptomatic (paralysis) lumbar discal hernia. Material and methods: From 1994 to 1996, 40 patients were investigated using a 3-D-motion-analaysis of the spine as well as a surface electromyography (EMG) of the paralumbar muscle 4 weeks after microsurgery of a hernia of L4/L5 or L5/S1. As a control, 40 healthy individuals were investigated. Results: There was only a tendency toward reduced segment mobility in the patient group. During dynamic excercises (walking) the differences in the muscle activity were low while…isometric excercises showed obvious muscle activity deficiency in patients. Conclusion: There might be a benefit from dynamic exercises such as walking or even jogging for patients after surgery of a symptomatic lumbar hernia.
Abstract: Given the multidimensional nature of chronic pain, some variability in pain reports is expected; however, a subset of chronic pain patients report persistently high levels of pain with little variability. Such reports may be influenced by psychological factors and may be relevant in the assessment and treatment of chronic pain. The authors assessed the relationship between pain variability and a variety of clinical variables using the archival records of an interdisciplinary chronic pain rehabilitation program. It was found that patients who report high levels of pain with little or no variability are more likely (a) to drop out of a…rehabilitation program, (b) to catastrophize in response to pain, (c) to report more pain-related conflict with spouses, and (d) to rate their pain as severe. These results suggest that assessment of pain variability has some predictive utility and that such variability warrants further study using multidimensional measures of pain.
Abstract: Clinical experience and research show that patients with chronic pain who have a more accepting attitude about their pain experience less distress and function better as compared to those with chronic pain who do not have this attitude. Because this idea has only recently received some empirical scrutiny, the meaning of acceptance and methods for assessing it in relation to chronic pain have not been firmly established. The purpose of this study was to investigate the behavioral components underlying acceptance of chronic pain. Responses to the Chronic Pain Acceptance Questionnaire from 230 persons seeking treatment for chronic pain were submitted…for principal components analysis with oblique rotation. Based on percent variance, interpretability, and the scree test, four factors were extracted, accounting for 53% included (1) engaging in normal life activities, (2) believing that controlling thoughts controls pain, (3) recognizing that pain may not change, and (4) needing to avoid or control pain. Based on analysis of item summary scores, Factor 2, the “cognitive control” factor, showed the smallest corrected factor-total correlation, suggesting that it may not be an important facet of acceptance. Studies of acceptance of pain have shown that it has potentially high utility for understanding the process of adjustment to chronic pain, however, continued study of this complex attitude is needed.
Abstract: The focus of this study was to investigate the electromyographic (EMG) activity level of two back muscles and two lower limb muscles during a leg holding exercise in strapped (supported) and unstrapped positions. The strapped position is usually used in clinical situations while the unstrapped position is commonly adopted by the patient in the home environment. Muscle activity of the longissimus thoracis, multifidus, gluteus maximus and biceps femoris muscles of 15 healthy young males was recorded by surface electrodes. During the leg holding exercise in the strapped position, normalized EMG activity of longissimus thoracis (64%) and multifidus (71%) (39%) thoracis…(66%) biceps femoris (46%) differences were demonstrated in the activity of the back and lower limb muscles between strapped and unstrapped positions. The present study may suggest that more training effect will be expected for back muscles than for lower limb muscles when using leg holding as a training exercise. The leg holding exercise using hands for stabilization (common in home environment) may be regarded as effective as the exercise stabilized with straps (common in clinical situations).