Journal of Back and Musculoskeletal Rehabilitation - Volume 17, 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: Forty-eight patients with type II diabetes mellitus were recruited for the study. Fifty-one shoulder joints with adhesive capsulitis were treated in this population. A physical therapy protocol including Transcutaneous Electrical Nerve Stimulation, pulsed ultrasound and exercises was applied to each patient. The patients were assessed on entry and termination of treatment and at 3 months post-treatment by Visual Analogue Scale for rest and activity pain intensity, active and passive range of motion of shoulder and Constant scores. The scores were compared between 18 patients with good glycemic control and no neuropathy and 30 patients with insufficient glycemic control and neuropathy.…The results indicate that glycemia levels and neuropathy have no effect on response to physical therapy.
Keywords: type II diabetes mellitus, glycemic regulation, adhesive capsulitis, physical therapy, exercise
Abstract: Various musculoskeletal system disorders occur as a result of the use of computers, which have become an integral part of modern life. The most important among such disorders is known as cumulative trauma disorder (CTD). In this study, we attempt to investigate CTD's effects on daily life and the effectiveness of training and exercise programs in the management of this disorder at a state department where computers are widely used. Fifty patients with CTD between the ages 25 and 50 were recruited for the study and were randomized into two groups. The complaints of patients with CTD had appeared…after they had started working in this job and they reported that their complaints were related to their occupation. The patients complained of head, neck, shoulder, back and wrist pains and most of them were diagnosed as Myofascial Pain Syndrome (MPS) and Carpal Tunnel Syndrome (CTS). The first group was given mobilization, stretching, strengthening and relaxation exercises five days a week for a period of two months following a training course. The second group was given a training course only. Both groups were assessed in terms of the following outcome criteria before and after the treatment: Numeric Rating Scale (NRS) and Pain Disability Index for pain; Tiredness Scale for tiredness; and Beck Depression Scale for depression. At 2 months, the treatment group was observed to have experienced statistically significant improvements in NRS (p < 0.001), pain disability index (p < 0.05) and Beck depression scale (p < 0.05) values as compared to the control group. Mobilization, stretching, strengthening and relaxation exercises reduce pain and depression levels of CTD patients in the short term. We propose that studies with long-term follow-up are needed to confirm the above results.
Abstract: Objective: This investigation aims to determine whether optimal muscle length was estimated with joint toque generated by maximal voluntary isometric muscle contraction (MVIC), which differed from that was estimated with joint torques generated through electrical stimulation superimposed on MVIC (MVIC ES ). Design: An experimental investigation was conducted to measure joint torques of the elbow joint in the conditions with MVIC and with MVICES. The measured joint torques were used to examine the level of neuromuscular activation under MVIC condition as well as to estimate the optimal muscle length of elbow flexors by…using in a theoretical muscle model with various conditions of muscle contraction. Background: Usually muscle model parameters such as maximum muscle force, optimal length are estimated by the joint torques measured during MVIC, assuming maximum level of neuromuscular activation. However, several experimental studies have shown that MVIC are in fact submaximal contraction and cannot represent as complete neuromuscular activation. As a result, the use of MVIC for the estimation of muscle model parameters may not be appropriately able to produce satisfactory results. Methods: Eight subjects first performed MVIC of their elbow flexors. Electrical stimulation was superimposed to MVIC to induce true maximal contraction of the muscles. The resulting joint torques were measured in each test condition and used to calculated the optimal muscle lengths by a muscle model combined with an optimization procedure. Comparisons of the results for the two conditions were made with paired T test. Results: The joint torques produced by electrically stimulated the elbow flexors at the elbow joint were statistically higher than those produced by maximal voluntary contraction. Optimal muscle lengths estimated through the joint torques generated by MVIC with electrical stimulation were statistically different from those estimated without electrical stimulation. The optimal lengths of the elbow flexors were calculated with adjusting the neuromuscular activation to be submaximal level and showed no statistically difference from that estimated with superimposed electric stimulation. Conclusion: Joint torques used for estimating optimal muscle lengths are better derived from electrical stimulation superimposed on MVIC of the relevant muscles or MVIC accompanied with adjusting the level of neuromuscular activation in the range of 0.62 to 0.93.
Abstract: In 1980, Waddell et al. proposed that the presence of psychological factors in chronic low back pain patients could be efficiently assessed by the use of five “non-organic” physical symptoms . However, subsequent research on this relationship has been equivocal . In this study, 99 patients completed measures of depression and anxiety and were divided into two groups based on the traditional cut-off score of three or more Waddell signs. Group comparisons indicated that patients with three or more Waddell signs endorsed more depressive and anxious symptoms, even when controlling for pain severity and duration. Examination of mean scores showed…a more pronounced difference between patients with two or more Waddell signs and those with one or none. Results suggest that Waddell signs can be an efficient means of identifying chronic low back pain patients who may be depressed or anxious, although the traditional cut-off score may be too conservative in some populations.
Abstract: The aim of this randomized, controlled study was to evalaute effects of 12 months alendronate therapy on bone mineral density (BMD) and markers of bone formation and resorption in women with postmenopausal osteoporosis. Study enrolled women with BMD at least 2 SD below adult, premenopausal BMD mean. Patients to be treated were randomized into two groups. Patients in the control group received 500 mg elemental calcium tablet daily and treatment group received 10 mg/day alendronate and 500 mg elemental calcium tablet for twelve months. Pretreatment characteristics of patients in both groups were similar. A significant increase in BMD of the…treatment group patients compared to control group was observed at 12 months (p < 0.001). Markers of bone formation and resorption in the treatment group reduced significantly at 6 and 12 months of therapy compared to control group (p < 0.001). In conclusion, we found that 12 months alendronate therapy (10 mg/day) significantly increased BMD in all sites of measurement compared to control group and also significantly reduced markers of bone formation and resorption at all time points (at 6 and 12 months) in postmenopausal women with osteoporosis compared to control group. It is fact that bone density clearly improved by alendronate therapy and the biochemical markers were shown as valid tools for monitoring and prediction of treatment effect of alendronate therapy.
Keywords: postmenopausal osteoporosis, alendronate, bone mineral density, markers of bone formation and resorption
Abstract: The purpose of this study was to establish the interrater reliability of the flexicurve when used by novice testers to measure thoracic kyphosis and lumbar lordosis in a community-based population. Three graduate students independently measured 51 healthy women (aged 21 to 88 years). The flexicurve was molded to the contour of the spine and traced onto a plain piece of paper to calculate the Index of Kyphosis (IK) and Index of Lordosis (IL). Subjects were measured while standing in their usual relaxed posture and again in their maximally erect posture. Intraclass correlation coefficients (ICCs) were calculated to determine the reliability…among the three testers. IK measures were more reliable than IL measures with ICCs of 0.94 and 0.93 for the relaxed and erect postures, respectively. ICCs for the IL were 0.60 when relaxed and 0.73 when maximally erect. Greater variability in the lumbar measures may be attributed to difficulty in conforming the flexicurve to the smaller, concave curvature of the lumbar spine and interference from some subject's clothing. Nevertheless, these findings indicate good reliability for flexicurve measures of thoracic kyphosis and support the use of this measurement when documenting clinical changes in posture or identifying postural abnormalities in community-based screenings.