Journal of Back and Musculoskeletal Rehabilitation - Volume 18, issue 3-4
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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: Lumbar stabilizing exercises (LSE) have been recommended to improve lumbar function in patients with low back injury so that these patients may improve their activities of daily living (ADL). This study has been designed to investigate the effect of LSE in patients with herniated lumbar disc (HLD). Sixty patients (aged 22–55 years old) with HLD at L4-L5 or L5-S1 were randomly arranged into two groups (A and B) of thirty. Group A performed a LSE protocol for four weeks upon recruitment into the study, followed by a four week no-exercise period, whilst group B performed the opposite. Measurements were taken…before and after the LSE protocol and no-exercise period and included; pain (measured on a visual analogue scale); trunk flexion; straight leg raising (SLR) angle without pain and time to complete ADL tasks such as climbing 5 steps, 10 meter walking, laying prone from standing position and standing up from prone position. Significant pain relief (p<0.0001), left and right SLR angle improvement (p<0.005), increased trunk flexion (p<0.001) and improved ADL performance (p<0.05) were found after first four week LSE period in group A. The same results were found in group B following their exercise period. These findings indicate that a LSE protocol may improve ADL performance in patients with HLD.
Abstract: The present study was performed to evaluate the effects of erector spinae muscle fatigue on trunk repositioning accuracy. Trunk repositioning accuracy in forward and lateral flexion was measured in 25 healthy men using a 3-Space Fastrak (Polhemus Inc., Colchester, VT, USA) with a transmitter on the sacrum and a sensor on Th9. The subjects reproduced 1/3, 1/2, and 2/3 maximum forward and lateral flexion angle of the trunk before and immediately after fatiguing of the erector spinae muscle by repetitive maximum isokinetic trunk exertion. Average trunk repositioning errors in all the positions were measured. The results indicated that, in both…forward and lateral flexion, the trunk repositioning error was significantly (p<0.05) greater after the fatiguing procedure than under normal conditions (paired t-test). In conclusion, fatigue of the erector spinae muscles significantly decreases the trunk repositioning accuracy in both forward and lateral flexion.
Keywords: Spinal position sense, proprioception, rehabilitation, trunk performance, fatigue, back muscle
Abstract: Objective: To investigate the feasibility of a randomised controlled trial in a usual clinical setting and the effect of work rehabilitation on improvement to the ability to work in chronic pain patients. Design: 33 patients with chronic musculoskeletal pain, valid job contracts and absence from work, random allocation. The interdisciplinary work rehabilitation contained work-specific exercises and education and lasted 8 weeks, 3.5 hours each working day. The control treatment took place with the allocating physician, who received recommendations concerning physical therapy and the uptake of work. Assessments took place at 0, 8 and 32 weeks. Measurements: ability to…work, actual work status in % of a full time job, functional capacity tasks measured in kilograms. Results: Feasibility: the recruitment was of a long duration due to the rather restrictive inclusion criteria. Actual work status: the improvement between the groups was not significantly different, but the ability to work improved significantly from an overall median of 0% to 50% at 8 weeks (p=0.004 for the intervention group, p=0.026 for the control group). Conclusions: The evaluation of a running work rehabilitation programme in a clinical outpatient setting in clinical science is feasible, but a more effective recruitment strategy for a main study is favoured by application of a multi-centric or company based setting.
Keywords: Rehabilitation, vocational, musculoskeletal diseases, pain, evidence-based practice
Abstract: Context: Neuropathic pain arises from ectopic firing of nociceptors. Since pulsed electromagnetic fields (PEMF) generate extremely low frequency (ELF) quasi-rectangular currents which influence biological activity, it was hypothesized that directing this energy into the carpal tunnel region could influence neuronal firing patterns and lower VAS scores of neuropathic pain. Objective: To determine if nine consecutive one-hour treatments (excluding weekends) of a pulsed signal therapy can reduce neuropathic pain scores in refractory hands with carpal tunnel syndrome. Design/setting/patients: 35 consecutive hands were enrolled in this non-placebo pilot study between July and November 2002. All subjects had to…be constantly symptomatic and a failure to therapy. Primary endpoints were comparison of visual analog scores (VAS 0–10) at end of 9 days of treatment and end of 30 days follow-up compared to baseline pain scores. Additionally, at end of study, patients responded to a questionnaire (PGIC) describing their response to treatment. Secondary endpoints were comparison of sensory and motor distal latencies of median nerve after treatment with baseline. Additionally, clinical examination changes were tabulated with baseline. Five hands were surgical failures. Intervention/device: Non-invasive pulsed signal therapy generated a patented unidirectional quasi-rectangular waveform with strength less than 20 gauss and frequency less than 30 Hz into the carpal tunnel region for nine consecutive one-hour treatments (excluding weekends). The specific amount of energy directed at the target site was unknown. Results: Statistical reduction (ANOVA) of pain scores at end of treatment (23%) and also end of follow-up (37%) were noted in the 33 hands that completed the study. The PGIC questionnaire revealed 67% improvement. Clinical and electrodiagnostic examination data did not change from baseline to end of study. There were no adverse events or safety issues. Conclusion: Our pilot data suggests that directing PEMF to the carpal tunnel region can provide modest, short-term relief for a majority of individuals. The precise mechanism is unclear in the absence of electrophysiological changes. This provocative data requires confirmation with randomized, placebo-controlled, double-blind trials and additional electrophysiological markers.
Keywords: Carpal tunnel syndrome, pulsed magnetic field stimulation, neuropathic pain
Abstract: The objective of the study was to compare the effects of alendronate, risedronate and calcitonin on biochemical markers of bone turnover and bone mineral density (BMD) in postmenopausal osteoporosis. The patients (n=200) were equally divided to one of four treatment groups: alendronate 10 mg/daily, risedronate 5 mg/daily, calcitonin 200 IU/daily and control group for 12 months. All groups also received 1000 mg of calcium/daily. The control group received only 1000 mg calcium/daily. Serum osteocalcin (OC), bone specific alkaline phosphatase (BSAP) and urinary deoxypyridinoline (uDPD) levels were determined. There are increases in BMD at two regions, at the end of 12…months in four groups. The mean increases in BMD at 12 months, at the lumbar spine and hip respectively, were: alendronate (p<0.05, p<0.001), risedronate (p<0.001, p<0.01), calcitonin (p<0.05, p<0.01) and control group (p>0.05 for both site). In comparison with control group, the mean changes in BMD at the spine and hip were greater in the other groups (p<0.05 for both region). uDPD levels were gradually reduced at the end of study in all groups (p<0.01 for three groups), while no significant change was found in calcium group. The treatment with alendronate produced significantly greater increases in total hip BMD than did risedronate and calcitonin and tretment with risedronate produced significantly greater increases in lumbar spine BMD than did alendronate and calcitonin over 12 months. This study demonstrated the efficacy of alendronate, risedronate and calcitonin in preventing the bone loss related to postmenopausal osteoporosis.
Keywords: Osteoporosis, bone metabolism, BMD, alendronate, risedronate, calcitonin, calcium