Journal of Back and Musculoskeletal Rehabilitation - Volume 24, issue 2
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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: Background: There have been a number of recent studies showing the effectiveness of lumbosacral transforaminal steroid epidural injections used in the treatment of radicular pain. The studies include retrospective, prospective and randomized controlled studies. Thus, the data is valuable with regard to identifying evidence based recommendations that can be used for clinical practitioners. Purpose: To review and critically evaluate literature focusing on the efficacy of lumbosacral transforaminal steroid injections. The goal of this review is to identify pertinent journal information that aids in the improvement of clinical care and guides future research by increasing the awareness of the…efficacy of this procedure. Study design: A comprehensive literature review of the efficacy of lumbar sacral transforaminal epidural steroid injections. Methods: Medical databases were searched for key words of transforaminal lumbar sacral, anatomy, and efficacy of steroid injection using Pub Med, Medline, Cochrane databases and U.S. National Library of Medicine. Works cited lists were then searched and cross-referenced as well. Articles focusing solely on interlaminar and caudal steroid injections were excluded as were transforaminal studies focusing on the cervical spine. Also, articles were excluded that did not differentiate the type of technique with type of relief it produced. Papers focusing on the efficacy of lumbosacral transforaminal steroid injections were included in the data that followed the patient for three months or greater. Results: In all there were 10 randomized trials, 4 retrospective studies and 8 prospective studies found. Among the 10 randomized control studies only 8 met inclusion criteria. All 8 of the randomized control studies included show a positive outcome in both the short term and long term results. There were a total of 9 prospective trials showing a positive short term and long term outcome and that used both CT guided injections as well as fluoroscopic injections. Conclusion: This systemic review included prospective, retrospective and randomized clinical trials showing that there was strong evidence for transforaminal injections in the treatment of lumbosacral radicular pain for both short term and long term relief.
Abstract: Background and objective: We studied the long-term efficacy of pulsed radiofrequency treatment (PRF) on the saphenous nerve in 115 patients with chronic knee pain. Materials and methods: 115 patients with chronic knee pain were investigated in a period of 22 months retrospectively. All patients had pulsed radiofrequency to the saphenous nerve. The mean age was 59 (range, 51–67). All patients were accessed with the visual analog scale (VAS) and WOMAC score pain at rest, pain on movement, and pain in flexion at 10th day, 3rd and 6th months post procedure. Results: All patients showed improvement in…their VAS scores as well as in their WOMAC scores after ten day, three month, and 6 months (p=0.001). No side effects were reported. Conclusion: PRF application to the saphenous nerve for eight minutes showed remarkable amount of patient satisfaction. Application of PRF for the second time could be recommended if it shows some benefit after the sixth month. But none of our patients needed a second application of PRF after six months period.
Abstract: Objective: The Roland-Morris Disability Questionnaire (RMDQ) is a reliable tool for evaluating disability in patients with back pain, but no Korean version has been published and validated. We developed a cross-culturally adapted Korean version of the RMDQ (RMDQ-K) and validated its use for assessing disability in Korean patients with low back pain. Methods: Two hundred thirty-one patients with low back pain were assessed using the RMDQ-K, visual analog scale (VAS) during rest and activity, and the Oswestry Disability Index (ODI). The results of 40 patients were used to evaluate the test-retest reliability. The correlations of the RMDQ-K with…the VAS and ODI were used to assess validity. Results: The reliability of the RMDQ-K estimated using the internal consistency reached a Cronbach’s alpha of 0.893. Test-retest trials showed a high intraclass correlation coefficient of 0.837 (95% CI 0.833–0.953). The RMDQ-K was significantly correlated with the ODI (r=0.738) and VAS during rest (r=0.450) and activity (r=0.412). Conclusion: This study demonstrates that the RMDQ-K is a reliable, valid instrument for measuring of disability in Korean patients with low back pain.
Keywords: Low back pain, disability evaluation, roland-morris questionnaire, reliability, validity
Abstract: Aim: The purpose of this article is to present the clinical results of percutaneous nucleotomy treatment on patients with cervical disk herniation. Methods: Patients with long-term chronic pain due to either cervical prolapse or protrusion were recruited for cervical nucleotomy. The surgical procedures were performed between mid-2008 and the beginning of 2009. The purpose of the surgeries was to relieve radicular irritation and reduce the chronic, high level of pain by micro-technically withdrawing herniated nucleus pulposus tissue. Results: After the percutaneous nucleotomy, the patients were hospitalized for an average of 3 to 4 days. In all…complete documented cases (57.5%) the pain was substantially reduced. Conclusion: Cervical percutaneous nucleotomy is a promising alternative to traditional open disk surgery or to chemonucleolysis for herniated disks of the cervical spine.
Keywords: Percutaneous nucleotomy, herniated cervical disk, radicular irritation, VAS score
Abstract: Objective: Rheumatoid arthritis (RA) is a chronic and disabling disease frequently effects physical and psychological well being. The aim of the present study was to determine the impact of psychological status on health related quality of life in patients with RA and also to assess which quality of life (QoL) instrument – disease specific and generic – is more prone to this effect. Methods: A total of 421 patients with RA recruited from joint database of five tertiary centers. Depression and anxiety risks were assessed by the Hospital Anxiety and Depression Scale (HADS); and quality of life assessed…by Rheumatoid Arthritis Quality of Life (RAQoL), Nottingham Health Profile (NHP) and The Short Form 36 (SF 36) questionnaire. Results: Patients with higher risk for depression or anxiety had poorer quality of life compared to the patients without risk for depression or anxiety. Depression and anxiety scores significantly correlated with quality of life questionnaires. There was significant association between anxiety and depression with worsening in both disease specific and generic health related quality of life. However, RAQoL showed more association with depression and anxiety levels. Conclusion: Higher depression and anxiety risks showed increased deterioration in quality of life. Compared to generic QoL scales, RAQoL scale, a disease specific QoL instrument, is much more influenced by depression and anxiety.
Keywords: Rheumatoid arthritis, depression, anxiety, quality of life
Abstract: Background and objective: Lack of baseline values is a limitation in the quantification of physical performance testing of the low back muscles. The purpose of this study is to present an age and gender normative values for static back extensor muscles’ endurance in adults. Subjects and methods: Five hundred and sixty one healthy adults aged between 19 to 67 years volunteered for this study. Endurance of the low back musculature was assessed using modified Biering-Sørensen test of Static Muscular Endurance. The mean, standard deviation, and percentile scores for endurance time were determined for five gender / age groups…classified on a range of 10 years. Results: The mean endurance time of all the participants was 113 ± 46 seconds. Men had higher mean endurance than women (t=3.309; p=0.001). Significant difference (F=32.702; p=0.001) was found in the endurance time across the age groups. There was an age and gender variation in the percentile values. The normative values demonstrate that a decrease in endurance time is expected with increasing age. The significant age and anthropometric differences across the age groups could contribute to the endurance differences. Conclusion: These values could be used to compare a patient’s score at intake and also serve as clinical target for which subsequent testing after treatment, at discharge and/or follow up can be compared, providing an indication of change in endurance capacity over time.
Abstract: Objective: To determine whether obesity or blood pressure relate to the level of pain experienced by persons with chronic back pain. Design: Retrospective Study. Setting: University spine program. Patients (or Participants): Adults seeking care for back pain of more than 3 months duration. Methods or Interventions (or Assessment of Risk Factors): Measurement of weight, blood pressure, and pain on a numeric scale. Main Outcome Measurements: Relationships between body mass index (BMI) and pain, blood pressure and pain. Results: 198 subjects had a mean BMI of 29.50 ± 7.12,…with 33.3% obese. The relationship between pain as a continuous variable and BMI approached significance (r= 0.125, n= 175, p= 0.098). The BMI of persons with lower pain scores of 0–3 was significantly different from those with high pain scores of 7–10. No significant relationship was found between pain and systolic (r=0.126, p=0.078) or diastolic (r= 0.099, p=0.165) blood pressure. Conclusions: Contrary to assumptions about acute pain, increased chronic pain does not appear to relate to increased blood pressure. The relationship of obesity with increased pain level among persons who have chronic pain raises the possibility that psychological or physiological mechanisms may be important above and beyond the biomechanical impact of obesity.
Keywords: Pain, back pain, obesity, blood pressure, hypertension, rehabilitation
Abstract: Objective: This report is to present the results of treatment of women suffering from postpartum osteoporosis and eight-level thoracolumbar compression fractures, and how they improved through clinical manifestation and bone mineral density (BMD). Methods: Radiological evaluation revealed eight-level compression fractures over the thoracolumbar vertebrae of the 31-year-old women that were suffering with back pains and radiating pains for 4 months after child-birth. Bone mineral densitometry showed significantly decreased lumbar T score, while other laboratory findings related to calcium metabolism were within normal range. The treatments administered on the women include risedronate and calcium with vitamin D, transforaminal epidural…injection and rehabilitation treatment such as physical therapy and exercise. Results: BMD improved and the back and radiating pains were significantly reduced after one year of treatment. Conclusions: Conservative management including medication, epidural injection, and a rehabilitation program was effective in treating patients with post partum osteoporosis and associated multiple compression fractures.
Keywords: Post partum osteoporosis, multiple compression fractures, rehabilitation, bone mineral density