Journal of Back and Musculoskeletal Rehabilitation - Volume 22, 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: Objective: The aim of this study was to investigate the short-term effects of intra-articular injection of hyaluronan (Hylan G-F 20) on proprioception, isokinetic muscle force, self reported pain, and functional condition in patients with knee osteoarthritis (OA). Methods: 63 patients with stage II-III bilateral knee OA were included in this randomized, placebo controlled, and prospective study. Subjects were randomized with 42 of them into the treatment group and 21 of them into the placebo group. Hyaluronan was intraarticularly injected into both knees of the subjects which were in the treatment group, whereas physiological saline was intraarticularly injected to…the subjects which were in the placebo group. Proprioception and the isokinetic muscle force measurement were performed. Visual analogue scale (VAS) and WOMAC scale were used to evaluate pain and physical function. Results: Statistical analysis was performed on 120 knees of 60 patients completing the trial. The average absolute angular error (AAAE) value showing the proprioceptive error level in the treatment group was detected to be statistically significantly lower compared to placebo at the measurements performed after the 3rd injection (p = 0.02) and after one week (p = 0.01). While there was no inter-group difference in isokinetic measurements performed at 180 and 240°/sec, a significant difference was detected at the measurement performed at 60°/sec in favor of the treatment group (p = 0.02). Activity and resting VAS-pain values, WOMAC parameters (except the WOMAC stiffness) were detected to be significantly lower in the treatment group. Local adverse events were not reported in any patient. Conclusion: In this study, it was demonstrated that intraarticular injection of hyaluronan in patients with knee OA led to a short-term increase in proprioception and isokinetic muscle force, and also significant improvements in the functional conditions of patients. Long-term studies are needed.
Abstract: Objectives: The Amputee Body Image Scale (ABIS) is a self assessed questionnaire with 20 items created to measure body image perception of amputees. The questions assess how an individual perceives and feels about his or her body experience. But no Turkish version is available. The aim of this study was to cross-culturally adapt the ABIS for use with Turkish speaking lower limb amputees and to determine reliability. Methods: The sample consisted of 50 transtibial amputees. The mean age of the participants was 43.14, SD: 14.66. The ABIS has been filled by the patients for two times.…Results: Internal consistency of the ABIS was very high (Cronbach alpha 0.834 for test and 0.842 for retest). The test-retest reliability was excellent for the ABIS (ICC = 0.939, 95% CI 0.895-0.965). Conclusions: The Turkish version of the ABIS is a reliable instrument to assess body image in lower limb amputees.
Abstract: Objective: The purpose of this, open-label, non-comparative study, was to evaluate the efficacy on quality of life and the efficacy of gabapentin monotherapy in patients with chronic radiculopathy. Methods: Thirty-five patients with radicular pain and diagnosed as L4 , L5 or S1 radiculopathy were treated with oral gabapentin from a total of 300 mg per day once up to a total of 1800 mg per day divided in 3 doses for eight-week trial period. Quality of life, functional disability and psychological mood of the patients were assessed using the Nottingham Healthy Profile (NHP), Oswestry Low Back…Pain Disability Questionnaire (ODQ) and Beck Depression Inventory (BDI). Results: Of the patients (n = 35), 25 were females and 10 were males (mean age: 41.8 ± 10.4, range: 24–60 years); mean radiculopathy duration was 16.4 ± 14.2 months (range: 3–48 months). The pain intensity at rest, quality of life, functional disability and depression scores were determined significantly improved after treatment and 4 months compared to baseline scores (p < 0.001). 1.5 points compared to baseline for at pain rest and 15 points improvement on the ODQ were obtained. Conclusion: Gabapentin may provide benefits in terms of alleviation of pain and overall quality of life in patients with chronic radiculopathy.
Keywords: Gabapentin, radiculopathy, quality of life
Abstract: Objectives: The aim of this pilot study was to test the generally believed hypothesis that intervertebral disc degeneration is a prerequisite for degenerative spondylolisthesis (DS). Methods: This cross-sectional study was an ancillary project to the Framingham Study. A sample of 3529 participants aged 40–80 years had a CT scan performed to assess aortic calcification. 188 individuals were randomly enrolled in this study. The prevalence of intervertebral disc narrowing, facet joint osteoarthritis (FJOA) and DS were evaluated. We used the multiple logistic regressions to evaluate the association between DS as a dependent variable and FJOA, disc narrowing, age, sex…and BMI as independent variables. Results: There were 23 individuals (24 spinal segments) affected by DS (15 female, 8 male), mean age 62.0 ± 6.8 years. In segments with DS, FJOA was observed and rated “severe” at 20 (83.3%) segments, “moderate” at 3 (12.5%) levels, and “mild” at 1 (4.2%) level. Intervertebral disc height was normal in 6 (25.0%), slightly decreased in 6 (25.0%), moderately decreased in 5 (20.8%) and severely decreased in 7 (29.2%) of the segments. Three (12.5%) segments with DS had severe FJOA but no apparent disc degeneration. In 9 (37.5%) segments with DS we found no or mild disc degeneration and severe FJOA. In a multiple regression analysis age, sex and FJOA, but not disc narrowing, showed significant associations with DS. Conclusions: The results of our study did not support the theory that disc degeneration necessarily precedes vertebral subluxation in DS.
Abstract: Aim: Current guides recommend to evaluate the patients with low back pain complaints with initial clinical assessment and history, and to utilize radiological or other imaging technics, in case of possible diagnosis. The aim of this study was to compare the findings of radiological and clinical assessment, and validate the reliability of spondylolisthesis diagnosed with clinical assessment. This study is conducted on 100 patients with, and 30 patients without (control group) radiological diagnosis of spondylolisthesis, who had applied to Department of Physical Therapy and Rehabilitation, Haydarpasa Numune Hospital with low back pain complaints in one and a half year. Clinic…assessment was consisted of 20 parameters including examinations of motor system such as, sign of slipping observed on palpation and inspection, extension of trunk and increase in lumbar lordosis. Antero-posterior, lateral, oblique and lateral flexion/extension radiographies were used for radiological assessment. Slipping degree and lumbar lordosis angle were measured. Results: Women/men patients ratio was 91/9 in spondylolisthesis group and 22/8 in control group. Age of 69% of patients were 50 and over. In both groups, sciatalgia was observed in more than half of the patients, and no significant difference was detected in localization (p > 0.05). In clinical assessment, weak and drooping abdominal wall, paravertebral muscle hypertrophy, increase in lumbar lordosis, sign of slipping observed on palpation and inspection, hamstring muscle spasm, pain during lateral trunk flexion-extension tasks and during double leg raising task were found to be positively correlated with radiological assesment (p < 0.05). Conclusion: In our study, a systematic clinical assessment was proved to be useful in determination of possible spondylolisthesis cases. Radiological assessments are required in order to make the diagnosis clear and to determine the grade and prognosis of spondylolisthesis. Advanced imaging techniques like MRI and CT have to be used when neurological symptoms are present, and when surgical intervention is indicated.
Keywords: Low back pain, spondylolisthesis, clinical assessment, physical examination
Abstract: Background and objectives: Our latest work has demonstrated a strong correlation between the anti-streptolysin O (ASO) titer and the sacroiliac (SI) joint scintigraphy in subjects with undifferentiated arthritis [Journal of Rheumatology 34 (2007), 1746–1752]. Of a significant percentage in those subjects with sacroiliac disorder reported suffering from postural abnormality. The purpose of this study was to determine whether there was an abnormality of upright postural sway in those subjects. Methods: All subjects who have been examined for ASO titer levels and SI joint scintigraphy were divided into two groups according to the reference level of ASO titer in…our central laboratory, and were subjected to ten sway tests to assess static postural sway when they were standing upright. The comparisons of the sway parameters were analyzed by using two sample t-test for continuous variables and repeated-measures analysis of variance (ANOVA) for the degree effect and interaction effect (sloped degree × group) in varying stressful conditions (eyes open vs closed, plantar flexion or dorsiflexion of feet). Results: In a total of 84 subjects, mean age was 23 years (range 18.0–36.4). Compared with the low ASO (ASO titer ≤116 IU/mL) group, the two sample t-test showed that high ASO (ASO titer >116 IU/mL) group had 2.76-, 4.46- and 4.59-fold in sway area, 1.32-, 1.50- and 1.61-fold in sway velocity, and 2.02-, 1.97- and 1.70-fold in sway intensity, over the study period at 0°, 10°, and 20° in conditions of eyes open and plantar flexion. The values of sway velocity/intensity obtained with eyes open and plantarflexion/dorsiflexion had lower intensity values when compared with those obtained in closed eyes and plantar flexion/dorsiflexion in high ASO group, but not the same as in low ASO group. Repeated-measures ANOVA showed that the sloped degree only affected the sway area in condition of eyes closed and dorsiflexion (P = 0.016), and affected the velocity/intensity in all conditions tested (all P < 0.0001). In consideration of interaction effect, the sloped degree showed significant difference in sway area in conditions of eyes open and plantar flexion/dorsiflexion (P = 0.03 and P = 0.0113), in sway velocity in most conditions tested (P < 0.05), and in sway intensity in condition of eyes open and dorsiflexion only (P = 0.0004). Conclusion: Subjects with high level of streptococcal serology demonstrated increased sway on all postural control measures as compared to those with low serology. Proprioceptive deficits in the SI joint might contribute to the postural impairment measured in this study.
Keywords: Undifferentiated arthritis, anti-streptolysin O, sacroiliac joint, posture, sway
Abstract: The aim of this study is to assess the effect of a 12 week multicomponent exercise training program on the quality of life in females with knee osteoarthritis. Thirty four subjects, aged 50–69 years, completed a 12 week multicomponent exercise training program. The SF-36 and WOMAC were applied at baseline, at mid-training, and post-training, and the responses of the exercise group (EG) and the control group (CG) were compared. The multicomponent training program resulted in significant group differences in all domains of SF-36 (p < 0.004), while there were no group difference in WOMAC domains (p > 0.004). In the…EG between mid-training and baseline period vitality score increased; physical performance and general health scores increased between mid-training and post-training period; physical function, body pain, mental health, vitality, and general health scores increased between baseline and post-training period (p < 0.004). Between mid-training and baseline period of the WOMAC domains changed in the EG (p > 0.004), while all domains increased between mid-training and post-training and also between baseline and post-training (p < 0.004). Changes in quality of life after multicomponent training are affected by the different evaluation techniques.
Abstract: Phenylketonuria (PKU) is a disorder characterized by several biochemical mechanisms which may impair the brain functions in PKU, leading to neurological problems. Our case report concerns a 19 year-old man with phenylketonuria who was evaluated with the onset of stiffness following the abandonment of the phenylalanine-restricted diet. He was assessed with grade-4 spasticity according to Modified Aschworth scale. The deep tendon reflexes had increased and the plantar reflexes were positive. Knee extensions were limited due to the shortening of the hamstring muscles. Serum phenylalanine concentration was elevated and plasma vitamin B12 level was low. Cranial magnetic resonance imaging scan…revealed demyelinization area in periventricular deep white matter. We administered a phenylalanine-restricted diet and a rehabilitation program. Following the treatment, spasticity was reduced to grade-1 and patient could walk without aid. This case shows that, the combination of diet, medication and a rehabilitation program is an effective treatment model on adult PKU with upper motor neuron involvement.
Abstract: Background and objective: A less common but important cause of buttock and leg pain known as “Piriformis Syndrome”. Piriformis syndrome is all intrinsic pathology of the piriformis itself, such as myofascial pain, anatomical variations, hypertrophy, and myositis ossificans or it is caused by trauma to the pelvis or buttock. In this case report we are going to present a rare cause of piriformis syndrome. Case report: Our first case was a 32 year old woman. She was referred to our pain clinic for leg pain that radiates from buttock to backside of the knee for 5 years. She…did not have any problems in her history or laboratory findings. But in her lower extremity ortho roentgenogram, her leg was 2 cm short at the effected side. Second case was a 23 year old woman who had pain radiating from gluteal region to backside of the knee. In her history she had a car accident two years ago. In this accident, she had a fracture of collum femoris, and her leg was 1 cm short at the effected side. Conclusion: We conclude that “short leg” is one of the rare causes of piriformis syndrome and can be seen alone or with the other causes. The injection on piriformis muscle could be more effective for the patients who have PS after the “short leg” treated.
Keywords: Piriformis syndrome, short leg, injection