Journal of Back and Musculoskeletal Rehabilitation - Volume 16, 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: Purpose: To assess the efficacy of botulinum toxin type A in spasticity in upper-motor neuron syndromes. Methods: Twenty-three patients with spasticity resulted from stroke-related hemiplegia, transverse myelitis and multiple sclerosis took part in the study. Following the history and physical examinations of the patients, injections of botulinum toxin-A were applied. The dose ranged from 80 to 400 mouse unit (MU) depending on the size of the muscle injected. In all patients, spasticity, spasms and pain were measured using the Ashworth Scale, Spasm Frequency Score, and Visual Analogue Scale prior to the therapy, at the 1st week, 1st month…and 3rd month of the therapy. Results: In all patients, botulinum toxin type A led to a significant decrease in spasticity, spasms and pain after the 1st week, 1st and 3 rd months of the treatment when compared to the baseline values (p < 0.001 ). No significant side effects or complications were observed. Conclusion: Our results have demonstrated that botulinum toxin type A is effective in the management of patients with spasticity due to stroke-related hemiplegia, transverse myelitis and multiple sclerosis, without major adverse effects.
Abstract: Alterations in body composition in chronic rhematologic disorders have been associated with decreased strength, altered energy metabolism and immunologic compromise and may provide a useful indicator of the severity of the disease. However, results of anthropometric parameter studies have been equivocal. The purpose of this study, was to compare body composition parameters of patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS) with those of healthy controls. Mean age, height, weight and body mass index (BMI) of patients with RA were not found to be different from those of the controls. BMI, body fat percent (BFP) were found to be…high in patients with AS, but the differences between this two parameters of AS patients and controls were not statistically significant. Mean BFP of patients with RA was higher than the control subjects, but only the difference between female patients with RA and controls was statistically significant. Mean lean body mass (LBM) was slightly lower in male and female patients with RA compaired to the healthy controls. LBM of AS patients was found to be similar with that of the controls. Upper/lower body fat ratio (U/L BFR) and central/peripheral body fat ratio (C/P BFR) were higher in male patients with RA, but there were no differences between patients and controls. U/L BFR and C/P BFR body fat ratios were higher in AS patients. But, only the differences between C/P body fat distribution of AS patients and control subjects was statistically significant. The results obtained from this preliminary report show some anthropometric parameters of RA and AS patients can differ from those of the healthy controls. Future investigations are needed to determine the metabolic alterations causing the changes in body composition.
Keywords: rheumatoid arthritis, ankylosing sponylitis, body fat
Abstract: Background: Accurately assessing patient-reported pain and functional ability is essential to measuring quality of care. Purpose: Evaluating the instruments used in assessing quality of care is often overlooked. The North American Spine Society Lumbar Spine Outcome Assessment (NASS-LS) instrument measures patient-reported pain and function in a combined scale. We evaluated the original instrument and assessed separate pain and function subscales based on a set of the items in the original instrument. Study Design/Setting: Data were collected from seven spine clinics in the United States participating in the Spinal Surgery Consortium for Outcomes Research Project. Consenting patients…were enrolled in the project and asked to complete the NASS instrument when arriving for a surgical consult. Patient Sample: Data from 811 lumbar spine patients were used. Methods: Analyses were conducted on the original instrument to determine its internal consistency and to determine the structural existence of any underlying scales. Internal consistency of the original and new scales were assessed with Cronbach’s coefficient alpha. Results: The original scale was found to be a useful measure of pain and functional ability. Important subscales of pain and functional ability were also identified allowing us to report more meaningful results. Conclusion: The original instrument is useful for assessing low-back pain and function as a combined concept. The separate pain and function scales may prove useful assessing varying outcome levels and/or different decisions about subsequent follow-up care.
Abstract: Context: In the evaluation of patients with upper limb symptoms, electrodiagnosis (EDX) provides valuable information regarding neurological disorders such as radiculopathies and entrapment neuropathies. What is less clear from the literature is whether or not EDX findings contribute to the prediction of outcomes. Objective: In order to examine the relationship between EDX findings and outcomes, this pilot study was conducted. Methods: Thirty-eight patients with neck and upper limb symptoms who underwent EDX testing and standardized data collection as part of a previously conducted prospective study were contacted by telephone a mean of 30 months after testing…to determine their outcomes. Patients were classified into three categories according to EDX findings: i) 15 had radiculopathies, ii) 13 had normal studies, and iii) 10 had other electrodiagnostic findings. Primary outcome variables of interest were the interval verbal pain rating scale and a subjective report of symptom improvement. Results: None of the patients with radiculopathies or normal studies worsened, whereas 30% of persons with other findings on EDX significantly worsened. Conclusions: The findings from this small pilot study raise many questions regarding electrodiagnosis and its relationship to outcome. A larger prospective study is necessary to fully examine this relatively unexplored but potential use for EDX testing.
Abstract: Hamstring shortening (HS) causes changes in the posture and walking ability in spastic children, however, there are no studies defining the abnormalities in patellar alignment in individuals with HS. Twenty-five patients with a primary complaint of anterior knee pain, having HS detected at physical examination, and 11 healthy individuals without any HS or knee discomfort as a control group are included in this study. Serial x-rays of the spine, pelvis and knee are taken and knee x-rays are evaluated for the position of the patella in both groups. In patients with Knee Extension Deficit (KED) ≥…60°, the Blackburne-Peel ratio is lower and the Insall-Salvati ratio is higher than the other groups, denoting a cephalic location of the patella p<0.05). There are no changes in the congruency and sulcus angles between the HS and control groups. Vertebral and pelvic changes correlate well with the literature, confirming that significant alterations occur after 60° of KED in adults. The extensor mechanism of the knee is affected and patella is located higher than normal in patients with severe HS, which may be a cause for knee discomfort. In the light of these findings, a routine knee extension deficit examination can be suggested in the initial evaluation of knee discomfort.
Abstract: The primary purpose of this study was to test the inter-rater reliability of assessments by physical therapists using the movement testing protocol from the Movement System Balance (MSB) approach developed by Sahrmann for classification of low back pain. A second purpose was to determine if attendance at a continuing education course improves reliability. A convenience sample of 37 patients with low back pain (mean age = 37.2 SD = 13.6, range = 20 - 63) participated. Each patient was examined by a pair of examiners. One examiner pair had both attended a three day continuing education course and one pair…had not. Within each pair of examiners, separate examinations of the same subject were done using 16 movement tests. The examiners made a decision whether the test provoked symptoms and which movement (flexion, extension, or rotation) was the cause. Kappa coefficients and proportionate agreement in positive and negative decisions were calculated. A paired t-test showed no difference between the agreement of the examiner pairs for each movement test based on type of examiner training so the results were combined for the rest of the analysis. The range of kappas statistics for the movement tests (0.02–0.62) indicated 6 of the 16 tests showed satisfactory reliability. The results suggest that that clinicians attending continuing education courses or learning these techniques from printed materials or videos should apply clinical decisions based on these movement tests judiciously.
Keywords: classification, inter-rater reliability, low back pain
Abstract: The purpose of this study was to determine the overall incidence and distribution of lumbosacral congenital abnormalities in healthy and active young male individuals. The study population consisted of 503 healthy young male candidates for sports training. Lumbosacral transitional vertebral (LSTV) abnormalities were found in 37 (7.4%) of subjects and were unilateral in 14 (2.8%) subjects (lumbarization/sacralization). Lumbar rotoscoliosis (LRS) was present in 14 (2.8%) subjects and facet asymmetry in one subject. LSTV and LRS together were present in 3 subjects. Spina Bifida Occulta (SBO) was present in 107 of 503 candidates (21.4%). The distribution of SBO throughout…vertebra levels was as follows: 86 only in S1, 11 in S1+S2, 9 in L5, 1 in L5+S1. SBO and LSTV were present together in 8 subjects. SBO and LRS were present together in three subjects. 356 (70.4%) subjects had normal lumbosacral radiographs. Our study results support the notion that SBO is a common lumbosacral abnormality especially in young male healthy individuals.
Keywords: young male, physical deformities, transitional vertebra, spina bifida occulta, low back pain, sport training
Abstract: The purpose of this study was to quantify the loading characteristics of the upper body during variable angle Roman chair (VARC) exercise and to compare back extension strength outputs obtained from a VARC to a criterion measure (lumbar dynamometer). For twenty-four healthy volunteers (age, 22.7 ± 3.2 years), the load attributed to the upper body and isometric back extension strength were measured twice at six positions over a full range of lumbar flexion on a VARC. In addition, isometric back extension strength was measured at seven positions over a full range of lumbar flexion on a lumbar dynamometer. Test-retest reliability…was high for measures of the load attributed to the upper body (r = 0.99) and isometric strength (r = 0.96 to 0.97) on the VARC. The load attributed to the upper body increased from the most flexed to most extended position, while isometric strength increased from the most extended to the most flexed position on the VARC. Average VARC and dynamometer strength values were highly correlated (r = 0.90), but were lower on the VARC than on the dynamometer (888.4 ± 249.8 N vs. 1050.0 ± 438.5 N, respectively; p < 0.05).
Abstract: Study design: A systematic review of clinical trials. Objective: To determine the effectiveness of therapeutic exercise in the treatment of instability-related lumbar spine pain. Background: Segmental instability of the lumbar spine contributes to the overwhelming incidence of back pain and disability. The extensive range of exercises proposed to treat segmental instability is indicative of the lack of agreement as to the most efficacious management approach. Methods: A search of MEDLINE (1966- April 2002), the Cumulative Index of Nursing and Allied Health Literature (CINAHL) (1982- April 2002) databases was performed. The searches were restricted to…articles that used human subjects and were published in English. Key words utilized for searches included, “lumbar stability”, “segmental instability of the lumbar spine”, “spinal stability”, “low back exercises”, and “treatment of lumbar instability”. The aforementioned key words were combined with “clinical trial” in an attempt to locate studies that were primary sources and included original data. Results: The clinical trials analyzed varied considerably in the type of therapeutic exercise evaluated. However, it has been demonstrated that therapeutic exercise can be beneficial in reducing pain and improving function in patients presenting with instability-related lumbar spine pain. Conclusion: Although the reviewed clinical trials have demonstrated the effectiveness of therapeutic exercise in ameliorating pain and disability, the variations in methodologies of the studies reviewed makes it difficult to speculate which specific exercises would be the most beneficial.