Journal of Back and Musculoskeletal Rehabilitation - Volume 21, issue 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: Objective: The aims of this work are to evaluate the validity and reliability of manual assessment and treatment, and the effectiveness of manual therapy for non-specific adult thoracic pain. Data sources: Review of the literature. Databases consulted: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library. Study selection: Articles were selected if they concerned the thoracic spine and rib cage, and outcome measures were within the scope of manual therapy practice. Data extraction: Studies about diagnostic tests were excluded if the study population was less than 10 subjects, and Cohen’s Kappa scores or Pearson’s Correlation…Coefficients or Intraclass Correlation Coefficients were not calculated. Studies about treatment were excluded if the PEDro score was less than 4/10. Data synthesis: Studies concerning physical examination procedures have shown a good intrarater, but poor interrater reliability. Studies of the mechanical effects of manipulation have given discordant results, while those on the clinical effects of manipulation have given positive results. Conclusions: Procedures of physical examination did not show sufficient interexaminer reliability. Manipulative treatment seems to be clinically effective, but whether manual treatment is more effective than non-treatment, other treatments or placebo, cannot be established.
Keywords: Back pain, spinal manipulation, manual therapy, physical examination
Abstract: Purpose: To compare range of motion (ROM) outcomes of repeated extension versus static stretching of the lumbar spine in healthy adults. Methods: 101 subjects volunteered and were randomly assigned to 1of 3 groups: repeated extension (Group A, n = 33), static stretching (Group B, n = 36), or control (Group C, n = 32). Double inclinometers were used to measure lumbar extension ROM (prone). Measurements were taken at baseline, 4 weeks, and 8 weeks. MANOVA assessed equivalence of the 3 groups for age and initial ROM; chi-square testing assessed gender differences. ROM data were assessed using General Linear…Mixed Model Analysis. Alpha was set at 0.05. Results: Both methods of stretching increased lumbar extension ROM at 4 and 8 weeks. The repeated stretching group increased ROM more than the static group. Group A differences were significant comparing 8 to 4 weeks and to baseline. Group B differences were also significant comparing 8 to 4 weeks and to baseline. At 8 weeks, only group A was significantly different than the control group. Conclusion: Repeated and static stretching improved lumbar extension ROM when compared to no stretching. However, repeated extension when compared to static stretching showed greater gains in lumbar extension ROM after 8 weeks of stretching.
Abstract: Objective: To investigate the effects of a preoperative or postoperative rehabilitation program on health related quality of life, for patients affected by final-stage idiopathic knee osteoarthritis, before and after primary total knee arthroplasty. Design: 53 successive patients (aged 68.76 ± 5.64 years) were randomly assigned to receive a general strengthening exercise program for 3 weeks preoperatively (PROP, n = 18) or a specific strengthening rehabilitation program for 8 weeks postoperatively (POP, n = 15). The control group followed standard preoperative and postoperative care (CON, n = 20). Measurements: Health status (Short Form-36), functional ability (Iowa Level of Assistance…Scale), active range of motion (AROM). Results: PROP group showed improvement in their mental health dimensions preoperatively and better functional readiness at hospital discharge. POP group achieved higher level of functional ability (p < 0.05) after the exercise intervention and realized a substantial increment of AROM (p < 0.05). Conclusions: A preoperative general strengthening exercise program is feasible, seems to be beneficial to patients’ mental health affected by final-stage idiopathic knee osteoarthritis and assists in the early return of basic functional abilities during the in-patient rehabilitation period. A postoperative specific strengthening exercise intervention is effective in increasing the active range of motion and restoring rapidly the functional autonomy throughout the out-patient intermediate rehabilitation phase.
Keywords: Rehabilitation, preoperative, postoperative, total knee arthroplasty, knee osteoarthritis
Abstract: Background: Depression is associated with risk of poor outcome in patients with musculoskeletal disorders, and is under-diagnosed in healthcare professional practice. The purpose of this study was to estimate the point prevalence of depression in a cohort of patients with musculoskeletal disorders attending an outpatient physical therapy clinic, and assess the efficiency and compliance with use of two versions of a patient-rated screening questionnaire. Methods: A cohort of all patients participating in an episode of physical therapy care during a four week time-frame completed the modified Zung Self-rated Depression Scale (mZSDS) questionnaire. Scores were calculated for both the…original Zung Self-rated Depression Scale and the mZSDS. Results: The prevalence of depression was estimated to be 19.6% (95%CI 10.7, 33.3) in this population of patients attending an outpatient physical therapy clinic. Mean score on the mZSDS was out 23.6 out of 80 (sd 11.5). Compliance with completion of the mZSDS was 96%. Conclusions: The high prevalence of depression in patients with musculoskeletal disorders suggests that consideration should be given to screening in physical therapy practice. This pilot study indicates that use of the mZSDS as a screening tool is efficient and does not present major barriers to use. As depression is associated with increased risk of poor outcome, we recommend screening for depression in musculoskeletal outpatient physical therapy clinics.
Abstract: The purpose of this randomized study was to evaluate EMG spectral, subjective and cardiovascular recovery parameters after isometric lumbar extension contractions. Ten healthy women performed isometric lumbar extensions until exhaustion with 5%, 10%, 15% and 20% of maximal voluntary isometric contraction on 4 different days (random order). One baseline five second contraction was performed before the fatiguing task which was followed by eight submaximal five second extension contractions (until 20 minutes after the end of the fatiguing task) at the same intensity as the trial to evaluate muscle recovery. EMG (Median Frequency, Peak Power, Peak Power Frequency, Total Power and…Zero-crossing Rate) and cardiovascular variables did not demonstrate any statistical difference between the 5-second contractions (p > 0.05) performed before and after the fatiguing task, showing a quick EMG recovery. However, the data analysis showed that the perceived effort variable had not recovered even 10 minutes after the fatigue contraction (p < 0.05). Our results represent a data basis for future comparisons and since subjective felling can affect performance, this study shows the importance of its analysis, since the subjective effort rate was not fully recovered after 10 minutes the end of the exhaustion contraction.
Abstract: The objective of our nonrandomised controlled study was to evaluate the effect of a 4-week aerobic exercise program on muscle performance in patients with fibromyalgia. Thirty-two women were consecutively divided into two groups, either study or control group. Study group attended at aerobic exercise program on treadmill lasting 30 minutes, five times a week for four weeks. Electrotherapy and thermotherapy also were applied to back region of patients in study group for two weeks. Control group were treated only the same electrotherapy and thermotherapy interventions lasted 30 minutes, five times a week for two weeks. All patients were assessed before…and after treatment protocols with respect to pain, fatigue, fibromyalgia-related symptoms, tender point count/score, psychological status and muscle strengths of knee extensors and flexors. There were statistically significant improvements in the intensity of pain, fatigue, percentage of morning stiffness, paresthesia, irritable bowel syndrome, tender point count/score, psychological status and muscle strengths after aerobic exercise program. However, there were significant improvements only in the intensity of pain, percentage of paresthesia, tender point count/score in the control group. Submaximal aerobic walking program increased muscle performance in addition to positive effects on pain, fatigue, fibromyalgia-related symptoms and psychological status in patients with fibromyalgia.
Abstract: Purpose: The purpose of this first evaluation was to directly compare myoelectrical patterns of gluteus maximus activity during different walking tasks (level and 10° incline) and a stair climb task in healthy men and men with chronic low back pain (CLBP). Methods: Neuromuscular activity of the gluteus maximus of twelve male CLBP (age = 53.4 ± 7.7 yr) patients and twenty sex-matched control subjects (age = 32.6 ± 5.1 yr) was compared during level walking (1.25 m/s), graded treadmill ambulation (10%; 1.25 m/s) and stair climbing. EMG-recordings were carried out on one randomly selected body side in each…group. Results: Compared to level ambulation, incline walking and stair ascent induced a significant (p < 0.01) increase of about 25% respectively 50% of gluteus maximus activity in the healthy cohort. CLBP patients in contrast demonstrated an average increase of about 35% in incline walking and stair climbing along with an extended stance phase activity during stair ascent. Discussion: The findings suggest that low back disorders are associated with changes of the level and duration of gluteus maximus activity under different gait conditions. The alterations may point toward a compensatory recruitment pattern to accomplish a certain degree of lumbo-pelvic stabilization. More study is needed on the behaviour of CLBP patients in different provocative tests and functional rehabilitation programs.
Abstract: We have presented a patient with brucellar spondylodiscitis who developed paraparezi secondary to spinal cord compression, and responded well to the medical treatment A 55 year-old male farmer presented with a 7-day history headache, urinary retention, weakness in his lower extremities and a 3-month history of back pain. Blood brucella Wright antibody titer was 1/160 and Rose Bengal test was positive. Our case did not need a surgical intervention and gave a good response to medical treatment and rehabilitation. Thus, we suggest that in cases with brucella spondylitis, medical treatment should be considered at first, even…in cases with spinal cord compression due to prevertebral abscess.
Keywords: Brucellar spondylodiscitis, medical treatment, medullar compression, rehabilitation
Abstract: Objective: This study was carried out to investigate the effect of stomatognathic alignment exercise (SAE) program on pain, mouth opening range, and perceived level of functional impairments from temporomandibular joint dysfunction (TMD) associated with ankylosing spondylitis (AS). Methods: A sample of 10 patients with TMD associated with AS was recruited in this study. A 60-minute SAE program focusing on postural alignment and mobility of the temporomandibular joint, head, neck, and trunk was provided 3 times per week for 4 weeks. Outcome measurements included pain, maximum range of active mouth opening (MRAMO), radiographic test for anterior translation distance (ATD)…of a mandibular condyle, and the mandibular function impairment questionnaire (MFIQ) at pre-treatment, post-treatment, and 6-week follow-up after successful completion of treatment. Results: Statistically significant improvement was observed in pain, MRAMO, ATD, and MFIQ after the intervention (p < 0.05). The observed improvements in pain and MFIQ were well maintained throughout the follow-up period, whereas the improvement in ATD on the affected side was significantly decreased (p < 0.05). Conclusion: The SAE program seems to be beneficial for the management of pain, range of motion, and mandibular function in AS patients with TMD.