Journal of Back and Musculoskeletal Rehabilitation - Volume 21, 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: Degenerative spondylolisthesis (DS) is a major cause of spinal stenosis and is often related to low back and leg pain. We reviewed the anatomical and biomechanical predisposition of lumbar DS and discuss possible predictors and risk factors for this condition. Spinal segment L4–L5 is most vulnerable because of the great forces in this region and the increased mobility of this segment due to the specific anatomy of quadratus lumborum muscle and iliolumbar ligament. A high pelvic incidence and lumbar lordosis increase the forces on the low spinal segments and probably raise the risk for DS. Individuals with relatively…more sagittal orientation of the lumbar facets have a higher probability of developing DS because such joints have less ability to resist the shearing forces. Disc degeneration is not an important predisposing factor for DS. Reduced disc space caused by disc degeneration increases the facet joint articulation overlap and together with osteophyte formation and ossification of spinal ligaments, can be seen as a part of the restabilization process. Deep abdominal and paraspinal muscles, most likely, play an important role in dynamic lumbar stability. Factors found to be associated with lumbar DS include age > 50, female gender, pregnancy, African American race, and generalized joint laxity.
Abstract: Objective: To compare levels of pain, disability, fatigue, kinesiophobia, physical performance, and physical activity of the patients who underwent two different operations on he cervical region. Patients: A total of 27 patients were studied; eleven were included in group I undergoing cervical nucleoplasty; 16 in group II, undergoing anterior cervical microdiscectomy and fusion procedure. Material and Methods: Pain and disability levels (the Neck Pain and Disability Scale), fatigue (the Fatigue Scale), fear of activity (Tampa Scale), physical activity (the Compendium of Physical Activity Scale) and performance (total rolling time, lie/sit test, sit/stand test, loaded reach, and…fifty-foot walking test and putting on-off t-shirts) were measured preoperatively, on the day of discharge and in the postoperative 2nd month. Results: Compared to the Group I, the recovery of the Pain and disability level was significantly better in the group II on the postoperative discharge day and in the postoperative 2nd month. Although fatigue results improved in both groups (p<0.05), there was no significant difference between the scores of preoperative, discharge day and postoperative 2nd month. The lowest scores of kinesiophobia were obtained during the 2nd postoperative month found significantly different in both groups (p<0.05), and the postoperative 2nd month scores were better than those of the postoperative discharge day. The scores of physical activity level showed difference in both groups (p<0.05), with the least lowest activity level appearing on the discharge day. Conclusion: It seems necessary to maintain the physiotherapy program for longer periods in patients undergoing nucleoplasty.
Abstract: Objective: Anterior cruciate ligament (ACL) deficiency is frequently associated with muscle weakness. It is not clear whether this potential reduction in muscle strength is progressive and related to the duration from the injury to ACL reconstruction. The aim of this study was to evaluate a possible effect of the period from the injury to surgery on pre and postoperative outcomes of isokinetic muscle performance and laxity of knee in patients with anterior ACL deficiency. Patients and methods: Clinical and isokinetic assessments of 98 patients with ACL injury were evaluated preoperatively. Patients had appropriate surgical intervention with allograft achilles…tendon, autograft quadriceps tendon and auto or allograft bone patellar tendon bone reconstructions. After surgery a standard rehabilitation program, accelerated rehabilitation protocol of Shelbourne, was programmed for patients. The time from the initial injury to surgery was determined and the patients were divided into groups according to the period from the injury to surgical intervention; group 1: surgery within 12 months and group 2: surgery more than 12 months. Group 2 was also subdivided into two groups group 2A: surgery within 12–36 months and group 2B: surgery more than 36 months from the injury. Also the postoperative outcomes of patients were assessed prospectively in the main groups as group 1 and 2. Isokinetic performance and KT- 1000 assessments were evaluated 1 week before and 2, 4, 6, 12 months after ACL reconstruction. All measurements were evaluated both in injured and uninjured legs and healthy legs were considered as controls. These differences between preoperative three groups were analyzed by performing one-way ANOVA and independent samples t test was used to compare the data between postoperative two groups. Results: 98 patients were included in our study. In arthrometer measurements, no significant difference was determined between groups except in KT 1000 tests between group 1 and group 2B preoperatively (p< 0.05). Also there was no significant difference between groups in flexion isokinetic performance. Preoperatively, in group 1, the difference between healthy and injured leg in extension measurements of peak torque, total work and endurance ratio was significantly lower than both group 2A and group B (p< 0.05). However preoperative analysis of group 2A and group 2B showed that these parameters did not differ significantly when surgery was performed within 12–36 months or more than 36 months from the injury. In the comparisons of groups postoperatively, lower values in these parameters on 2nd month and in endurance on 4th month remained significant after reconstruction in group 1 (p< 0.05). After 6 and 12 months, statistical significance did not remained between groups in spite of some higher deficits in lately operated patients. Conclusion: Reconstruction of ACL carried out within 12 months from the injury can minimize the strength deficit in isokinetic evaluations. Satisfactory results in isokinetic muscle performance can be achieved even with late reconstruction with appropriate rehabilitation involving especially quadriceps strengthening exercises.
Abstract: Body composition undergoes changes with aging and menopause. This study was planned to investigate the body composition in postmenopausal women. Total lean, fat mass and total body BMD were measured by dual-energy X-ray absorptiometry (DXA). All subjects with a T-score less than −1.5 were called the patient group. Total lean, fat mass and other components of body composition were also assessed by bioelectrical impedance (BIA). Demographical and physical characteristics were recorded for each subject. Total lean mass was significantly lower and fat mass was higher in the patient group than in healthy controls (p<0.05). BMD values were…positively correlated with lean mass (r=0.336, p< 0.05). There were no significant differences between patients and healthy controls with regard to body composition measured by DXA and BIA (p<0.05). These findings suggest that there is a difference between postmenopausal women with osteopenia/osteoporosis and healthy controls with regard to fat and lean mass. Total lean mass may be an important determinant of BMD in postmenopausal women. BIA might be an alternative method to DXA for the measurement of total body fat and lean mass.
Keywords: Bone mineral density, body composition, bioelectrical impedance analyses, osteoporosis
Abstract: Objectives: To determine the correlations among pain, disability, lumbar muscle endurance and fear-avoidance behaviour in patients with chronic low back pain and to investigate the predictive power of fear-avoidance behaviour on improvement in treatment outcomes. Design: Longitudinal retrospective correlation study. Participants: 178 patients with chronic low back pain. Intervention: Back reconditioning exercises using standardized protocol. Outcome measures: Pain, disability and lumbar muscle endurance were measured at week 0, 6 and 12. Fear-avoidance behaviour was measured at week 0. Changes in pain and disability were measured at week 6 and 12.…Results: Fair to moderate correlation was found between pain and disability (r=0.35–0.62, p< 0.01). Fear Avoidance Behaviour Questionaire (FABQ) correlated with pain at a weak degree (r=0.23, p< 0.01). FABQ correlated with disability at a fair degree (r=0.30–0.42, p< 0.05). FABQ correlated inversely with long-term improvement in disability at a fair degree (r=–0.35, p< 0.05). FABQ significantly predicted long-term reduction in disability, accounting for 12% of the variance in outcome. Conclusions: No strong correlations were found among pain, disability, lumbar muscle endurance and fear-avoidance behaviour in patients with chronic low back pain. Treatment, therefore, should aim to address as many related aspects including physical, psychosocial and behavioural aspects, as possible, in order to enhance treatment success. Fear avoidance behaviour significantly predicted long-term reduction in disability, accounting for 12% of the variance in outcome.
Keywords: Correlation, back pain, disability, muscle endurance, fear-avoidance behaviour
Abstract: Background: The objective measurement of free-living physical activity may facilitate the rehabilitation of people with chronic low back pain (CLBP). Objective: This study was designed to investigate the validity of a novel monitor which purports to measure physical activity. Methods: Ten participants with CLBP (9 female, 1 male; age 51 ± 10 years; BMI 27 ± 5 kg.m-2 ) wearing an activPAL™ activity monitor, were videoed performing a range of everyday tasks in a semi-constrained environment. From the video recordings the activity involved in the tasks was visually classified (criterion method) into four postures: lying/sitting; upright (standing and…walking); standing; and walking. This provided a second-by-second recording of movement and posture. Observational data were compared to the activity monitor output for the same four postures. The accuracy of the monitor in measuring step count and cadence was also compared to visual observation. Results: Overall agreement between the monitor and observation was 97%, with overall sensitivity and positive predictive values ranging from 92% to 99%. The 95% limits of agreement for step count and cadence was <1%. Conclusion: The activPAL™ activity monitor is a valid device for measuring postural physical activity, step count and cadence in people with CLBP in a semi-constrained environment.
Abstract: Work Related Musculo-Skeletal Disorders (WRMSDs) are a common health problem and one of the major causes of disability. Exposure to risk factors of musculoskeletal disorders and the change in exposure can be measured by observational assessment techniques. One of the techniques is QEC (Quick Exposure Check), which was developed by Li and Buckle in 1998. We designed this study to translate QEC to Turkish and investigation of QEC's reliability among cleaners. The study was conducted among 20 cleaners who were randomly chosen from 200 subjects working at Istanbul University, Istanbul Medical Faculty Hospital. Test-retest reliability of QEC was investigated…by intraclass correlation coefficient (ICC) and Bland Altman method. The reliability coefficients of QEC items were found between 0.589 and 1. Among those QEC items, wrist hand position, back position, using vehicle, work period, were found statistically the most reliable between measurements. The items' reliability of QEC was generally fair to good. For this reason, we suggest that, QEC would be helpful for evaluation of WRMSD risk assessment to those who work in the field of work health and safety in the industry of Turkey.
Abstract: Objectives: The Shoulder Pain And Disability Index (SPADI) is a self-report questionnaire developed to evaluate patients with shoulder problems. No validated Turkish version exists. This study sought to translate and culturally adapt a Turkish version of the SPADI and validate its use for assessing shoulder pain and disability in Turkish patients with shoulder pathology. Methods: One hundred forty patients (mean age, 60.31 ± 13.02 years) with shoulder problems participated. Patients completed the Turkish SPADI, the Short Form 36 (SF-36), and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaires. Results: Internal consistency of the SPADI…was good (Cronbach alpha: 0.83 for pain and 0.83 for disability subscales). There was a significant relation between SPADI pain and SF-36 bodily pain (r: –0.594; P < 0.01), SPADI disability and SF-36 physical function (r: –0.339, P < 0.01), and SPADI disability and SF-36 physical role limitation (r: –0.317, P < 0.05). There was a significant relation between SPADI pain and DASH 1 (r: 0.354, P < 0.01) and SPADI disability and DASH 1 (r: 0.591, P < 0.01). Conclusions: The Turkish version of the SPADI is a reliable and valid instrument to assess pain and disability in patients with shoulder pathology.
Abstract: Meningioma mostly present with localised pain associated with signs of spinal cord compression. We present a case of a 72 year old woman with a thoracal meningioma with an atypical manifestation: radicular thoracal pain with signs of mechanical hyperalgesia and allodynia without any signs of spinal cord compression. Diagnosis was made by MRI-scan of the dorsal spine. After neurosurgical resection there was a complete recovery. We like to stress the importance of providing detailed information on clinical cases, especially with an atypical manifestation. We review the literature published on meningioma and discuss the most important symptoms and signs.
Abstract: Reflex sympathetic dystrophy (RSD) is characterized by severe pain, swelling, autonomic dysfunction and usually affects extremities following trauma. In this case we report a 16-year-old female patient who had undergone several operations on the distal of the right lower extremity over a period of 1.5 years. During the follow-up she was determined to have adolescent osteomalacia (primary vitamin D deficiency) and RSD findings at the right lower extremity. We also examined reports in the literature concerning the probable initiator role of vitamin D deficiency among the mechanisms of RSD occurrence. This is the first report of primary vitamin D deficiency…accompanied by RSD in an adolescent with multiple fractures.