Journal of Back and Musculoskeletal Rehabilitation - Volume 16, issue 4
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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: Chronic low back pain (CLBP) is an increasingly common, persistent and costly problem. There is evidence to suggest that some sufferers benefit more from methods still considered `complimentary' in the UK, than from the conventional management methods, which continue to be offered as standard care under the British National Health System (NHS). Despite this evidence, relatively few CLBP sufferers in the UK utilize these `complimentary' therapies. This investigation set out to evaluate what factors affect utilization and asks why people do not use complimentary therapies (CTs) for CLBP, as this has not been asked before. One hundred and…fifty subjects completed self-reporting questionnaires, which asked about knowledge, health care beliefs and other possible influencing factors. The three groups comprised 50 CLBP sufferers using both private and National Health Service (NHS) funded outpatient conventional management methods, 50 CLBP sufferers using private CT management methods, and 50 `healthy' non-user subjects. Sixty-four per cent of conventional patients had not used CTs. The most significant barriers to the utilization of CTs appeared to be lack of knowledge and lower socio-economic group (SEG). Gender may affect selection.
Keywords: low back pain, alternative medicine, complimentary medicine, clinical trials
Abstract: Objective: To determine if physical examination can identify avascular necrosis of the hip (AVN) in asymptomatic HIV-infected patients. Design: Prospective, blinded population study Results: Ten of the 176 patients were positive for AVN by MRI. Four subjects had unilateral disease and six had bilateral disease. Five hips (1.4%) in four patients were indeterminate. We evaluated physical examination maneuvers both singly and in combination. Tests done singly generally provided a higher degree of specificity (67–92%) but sensitivities were lower (0–50%) with all p-values ≥ 0.08 . Positive predictive values based on physical exam, were <…17 % and negative predictive values were > 90 % for any single test. Combining all tests gave a high sensitivity (88%) and negative predictive value (98%), but low specificity (34%) and positive predictive value (6%) with p = 0.10. Only two of 16 hips with positive MRI findings showed no abnormalities when all tests were combined Conclusions: This study establishes the limited usefulness of a detailed physical examination of the hip early in the course of AVN. Patients who test negative on physical exam are unlikely to have AVN positive by MRI. Positive findings on physical examination of the hip may help identify patients who need further evaluation by MRI based on overall clinical suspicion.
Abstract: Objective: To increase the awareness of topiramate as a phantom limb pain treatment. Setting: Outpatient rehabilitation office in an urban academic center. Patient: 34-year-old white female who suffered a traumatic right upper limb amputation. Intervention: Oral topiramate at an initial dosage of 100 milligrams per day increased to 200 milligrams per day. Results and conclusion: After failure of multiple medications traditionally used to control phantom pain, the patient described significant relief with the use of oral topiramate. The authors suggest topiramate as an alternative approach to phantom limb pain treatment.
Abstract: Objectives: The purpose of this study was to record the incidence of Sport Injuries (acute and overuse syndromes) in Greek artistic gymnasts in relation to sex, age, event and exercise phase. Methods: 187 Greek elite artistic gymnastic athletes (100 male and 87 female athletes) participating in Greek artistic gymnastic championship involving all age-related categories, were observed on a weekly basis for a year. The athletes consisted of the pre-national team that was chosen to prepare for the next Olympic games. Results: 147 (61.5%)acute injuries and 93 (38.5%) overuse syndromes were recorded. The most common anatomical location…of injury was the ankle (110 cases, 46%), followed by the knee (63 cases, 26.2%). According to the results, the rate which involved mild injuries was 26.8% (64 cases, 34 males, 30 females) moderate injuries was 44% (106 cases, 59 males, 48 females), major injuries was 29% (70 cases, 38 males, 31 females). For the total sport injuries recorded, the injury incidence on the “floor” and especially during “landing phase”, were statistically significant. Conclusions: Artistic gymnastics predisposes to acute injuries, by its nature, but up to 70% are mild and moderate. Special attention needs to be given during “floor exercises”, especially on landing phase.
Keywords: artistic gymnastics, muscular and skeletal injuries
Abstract: Objective: To determine the relationship of previous lower extremity injury and the measured ratio of hip abduction to extension strength in collegiate athletes. Design: Cohort study of college athletes at time of pre-participation screening physical. Setting: An NCAA Division I college. Participants: Two hundred and thirty-six college athletes from a NCAA Division I school (162) males and (74) females. Main outcome measures: The ratio of maximal hip abduction to extension strength was calculated, following raw data collection with a specially designed dynamometer anchoring station. Injury to the lower extremities, in the past…year, was recorded via personal interview at the time of screening and verified by review of previous injury records. Results: A significant difference in the ratio of hip abduction to extension strength was noted on the left lower extremity of athletes with reported lower extremity (LE) injury compared to those without injury. Upon further review of data, hip extension weakness appears to be the likely cause of this difference. Conclusion: Athletes with reported lower extremity injury demonstrated a significant residual difference in the ratio of hip abduction to extension strength. This may be the result of injury related muscle weakness, altered muscle firing patterns, central inhibition or unknown compensatory strategies which all may be risk factors for recurrent injury. Further research is underway to identify the cause/effect relationship of this finding. Clinical relevance: This study may advance our understanding of potential compensatory strategies about the hip which theoretically may result from previous lower extremity injury or injuries which are incompletely rehabilitated. Additionally, this study provides some reasoning to support the screening of hip strength during the pre-participation physical, as it may be an important factor to prevent recurrent injury.
Abstract: Purpose: The purpose was to estimate the criterion validity of the Back Range of Motion (BROM II) and Electronic Digital Inclinometer (EDI-320) devices. METHODS. This study compared the range of motion measurements of low back pain (LBP) patients taken with the BROM II and EDI-320 with measurements using the double inclinometer (DI) method as the gold standard. Forty subjects with LBP volunteered for the study. The subjects were asked to do three forward flexion movements. A measurement was taken with each of the three different devices for each movement. Results: The BROM II demonstrated good linear relationship (Pearson…r = 0.78; 95% CI: 0.78–0.94) and the EDI-320 very good linear relationship (Pearson r = 0.88; 95% CI: 0.62–0.89) with the gold standard, the DI. Conclusions: The Pearson correlation value indicates good validity of the EDI-320 in our sample of LBP patients. Although a good correlation was established for the BROM II, the significant difference of the mean ROM reported for this instrument compared to the gold standard data suggests that the BROM II actually measures ROM differently. Our results suggest that the EDI 320 is clinically useful in providing objective and valid data for outcome measures in a population with LBP. More research is needed on the BROM II before we can make final conclusion on its use in clinical settings as an outcome measure.
Keywords: low back pain, range of motion, measurement, validity, outcome measure
Abstract: Functional capacity evaluations (FCE) are utilized to evaluate the physical abilities of workers to perform the specific demands of a job. FCEs are being used increasingly by insurers, employers, health care providers and attorneys as the basis to make decisions regarding workplace supports, vocational rehabilitation, disability determination, and litigation. These factors require that FCEs must have objectivity, reliability, validity and defensibility. One of the key elements in the usefulness of an FCE is a measure of the level of effort given by the individual being tested. This study investigated determinants of an FCE that identified corresponding level of effort. Thirty-five…healthy adults participated in a study to investigate whether computerized video movement analysis was an effective tool to determine consistency of effort during lifting (floor to waist and waist to overhead) and squatting activities of an FCE. Video data were examined using computerized analysis of each movement. The association between six factors identified from the video analysis and the distinction between real and intentionally sub-maximal efforts was analyzed. Terminal acceleration, mean velocity, and peak velocity were consistently, significantly correlated with consistency of effort in all three FCE activities. Computerized analyses of video taped FCE activities can identify factors associated with consistency of effort.