Journal of Back and Musculoskeletal Rehabilitation - Volume 25, 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: Background and objectives: Although several studies have considered obesity as a confounder for female osteoporosis, obesity’s role as risk factor or a protective factor is not clear. No conclusion has been made about the correlation between obesity and osteoporosis. In this study, we examined the association between obesity and osteoporosis in Chinese women. Material and methods: 4202 qualified women were enrolled between August 2003 and December 2005. Data on their age, height, weight, basic disease, frequency of exercise and smoking habits were obtained via a questionnaire. Body mass index (BMI) was assessed as a surrogate measurement of fat…mass and to describe obesity status in this study. The women were divided into an osteoporosis group or non-osteoporosis group according to the bone mineral density (BMD) of the lumbar spine (L1–L4), which was assessed by a peripheral dual-energy x-ray absorptiometry scanner. A T test was used to determine if the difference between the two groups had statistical significance. The rank sum test was used for ordinal numeration data analysis, and the Chi-squared test was used for unordered categorical data. Multiple logistic regressions were used to analyse the association between BMI and osteoporosis. Results: The logistic regression revealed five independent factors associated with osteoporosis, age, hypertension, smoking, exercise, and BMI, and three risk factors for osteoporosis: age, smoking and BMI. Conclusion: In Southwest China, obesity increases the risk of female osteoporosis. This finding provides a theoretical basis for its prevention in developing countries. Level of evidence: Level III (retrospective study).
Keywords: Obesity, osteoporosis, bone mineral density (BMD), body mass index (BMI)
Abstract: Background data: Lumbar segmental instability (LSI) is one of the subgroups of non-specific chronic low back pain. Pain, functional disability and reduced muscle endurance are common in such patients. Objective: The aim of this study was to determine the effects of stabilization exercise on pain, functional disability and muscle endurance in patients with LSI. Methods: A randomized clinical trial was carried out on 30 patients who had LSI aged between 18–45 years. They were divided into two groups; the control group underwent routine exercise only while the experimental group performed routine exercise plus stabilization training for…8 weeks. Both had 3 months follow-up. The variables included pain intensity, functional disability and flexion and extension range of motion and flexor, extensor and lateral flexor muscles endurance which were evaluated 3 times; before, post treatment and after three months. The data were analyzed using repeated measurement ANOVA. Results: The results revealed that after treatment, the trunk muscle endurance and flexion range of motion increased significantly and the pain intensity and functional disability decreased significantly in both groups; however the rate of improvement was significantly higher in the experimental group. The process of decreasing pain intensity and functional disability in addition to increasing muscle endurance time were significantly faster in the experimental group during the three months follow up. Conclusion: Regarding the positive effects of stabilizing exercises with routine exercises in reduction of pain intensity, increasing functional ability and muscle endurance, it is recommended to use this method in treatment of patients with lumbar segmental instability.
Abstract: Objective: Brucellosis is a zoonotic disease and still a major public health problem in many geographic areas including Mediterranean basin and Middle East. Brucellosis causes multisystemic involvement and although rare central nervous system involvement causes serious manifestations. Neurobrucellosis occurs less than 5% of patients and presents with meningitis, encephalitis, myelitis, myelopathy, stroke, paraplegia, radiculoneuritis, intracerebral abscess, epidural abscess, demyelination and cranial nerve involvement or any combination of these manifestations. Spastic paraparesis and the sensorineural involvement are rarely reported in the literature. Methods: Herein we present a 28 years-old man with spastic paraparesis and sensorineural hearing loss due to…neurobrucellosis. Results: The patient was treated with antibiotics combination for 6 months and underwent rehabilitation program. Conclusions: Neurobrucellosis should be ruled out in patients with unexplained neurological symptoms and/or sensorineural hearing loss particularly in those living in endemic areas.
Keywords: Neurobrucellosis, spastic paraparesis, sensorineural hearing loss
Abstract: Objectives: To determine the effect of a stretching program performed in the workplace on the hamstring muscle extensibility and sagittal spinal posture of adult women. Material and methods: Fifty-eight adult women volunteers (mean age of 44.23 ± 8.87 years) from a private fruit and vegetable company were randomly assigned to experimental (n=27) or control (n=31) groups. The experimental group performed three exercises of hamstrings stretching of 20 seconds per exercise, three sessions a week for a period of 12 weeks. The control group did not participate in any hamstring stretching program. Hamstring flexibility was evaluated through the passive…straight leg raise test and toe-touch test, performed both before and after the stretching program. Thoracic and lumbar curvatures and pelvic inclination were measured in relaxed standing and toe-touch test with a Spinal Mouse. Results: Significant increases (p < 0.01) in toe-touch score and straight leg raise angle (in both legs) were found in the experimental group during post-test, while the control group showed a non-significant decrease for both toe-touch score and straight leg raise test. A significant decrease in thoracic curve and significant increase in pelvic inclination were found in the toe-touch test for the experimental group (p <0.05). However, no significant changes were found in standing posture for any group. Conclusions: Hamstring stretching exercises performed in the working place are effective for increasing hamstring muscle extensibility. This increase generates a more aligned thoracic curve and more anterior pelvic inclination when maximal trunk flexion is performed.
Abstract: Objective: This study was designed to find out the relationship between the multiplied linear dimensions (MLD) measurement and the cross-sectional area (CSA) measurement of the lumbar multifidus muscle. Methods: Sixty healthy female subjects participated in this study. The CSA of the lumbar multifidus muscle from L2 to L5 was bilaterally measured by tracing around the muscle margins with an on- screen cursor. The linear dimensions including lateral dimension (LD), anteroposterior dimension (APD) and MLD of the muscles were also calculated at the same levels of lumbar vertebrae. Results: The linear regression between CSA and MLD for…each vertebral level was significant (r=0.89 to 0.97, p<0.0001). In addition, there was significant correlation between CSA and APD (r=0.69 to 0.87, p<0.05). Conclusions: MLD method can be used to predict the CSA of the lumbar multifidus muscle. The method described for assessing the multifidus muscle is a potentially valuable, quick and easy way to evaluate muscle size at different levels of the lumbar vertebrae in clinical practice.
Keywords: Lumbar multifidus muscle, cross-sectional area, multiplied linear dimension, ultrasonography
Abstract: The purpose of this review article is to introduce the concept of activity monitoring, and to discuss the application of accelerometry in rehabilitation research and clinical practice using lumbar spinal stenosis as a model. Function is a complex concept, and changes in function have historically been challenging to measure. The International Classification of Functioning (ICF) defines two distinct components of function: capacity and performance. Capacity, the ability to perform a given task in a controlled environment can be measured through any number of existing functional measures. Performance, defined as activities performed on a day to day basis in…the context of real life is challenging to measure, yet important in identifying the impact of pathology on real life. Recent advances in technology have allowed us to begin to measure performance, using activity monitors (accelerometers). Activity monitoring has the potential to change our concepts of outcomes, and as a result, expand our ideas about appropriateness of interventions in rehabilitation. Researchers and clinicians might benefit from using the new technology of activity monitors to measure the impact of intervention and to assess function. Therefore, this review will discuss the concept of activity monitoring and highlight potential uses for activity monitors in spine research and clinical care.
Abstract: Objective: This report describes the application of scapular elevation taping (SET) using kinesio tape to elevate the scapula and treat upper trapezius (UT) muscle tenderness in a patient with scapular depression syndrome. Methods: The patient was a 22-year-old man who had scapular depression and severe tenderness of the right UT. We performed SET for 2 months, 4 days a week, for an average of 9 h each day, to provide scapular elevation. Results: At the last assessment, the right superior angle of the scapula and the lateral border of the acromion were slightly elevated compared with…the spinous process of the second thoracic vertebra. A chest X-ray showed that the right coracoid process was higher compared to the initial level and that the level of the first ribs was similar on both sides. The pressure-pain threshold in the UT increased from 1 to 8 kg and the tenderness at 3 kg, assessed on a numeric rating scale, decreased from 6 to 0. No tenderness occurred when carrying a bag with the right hand or slinging a bag over the right shoulder. Conclusion: Continuous application of SET may be used as a supplementary method for scapular elevation and reduction in patients with UT tenderness.
Abstract: Objective: The objective of this study is to compare the efficacy of mature mud pack and hot pack therapies on patients with knee osteoarthritis. Design: This study was designed as a prospective, randomized-controlled, and single-blinded clinical trial. Twenty-seven patients with clinical and radiologic evidence of knee osteoarthritis were randomly assigned into two groups and were treated with mature mud packs (n 15) or hot packs (n=12). Patients were evaluated for pain [based on the visual analog scale (VAS)], function (WOMAC, 6 min walking distance), quality of life [Short Form–36 (SF-36)], and serum levels of tumor necrosis factor–alpha (TNF-α…), interleukin-6 (IL-6), and insulin-like growth factor–1 (IGF-1) at baseline, post-treatment, and 3 and 6 months after treatment. Results: The mud pack group shows a significant improvement in VAS, pain, stifness, and physical function domains of WOMAC. The difference between groups of pain and physical activity domains is significant at post-treatment in favor of mud pack. For a 6 min walking distance, mud pack shows significant improvement, and the difference is significant between groups in favor of mud pack at post-treatment and 3 and 6 months after treatment. Mud pack shows significant improvement in the pain subscale of SF-36 at the third month continuing until the sixth month after the treatment. Significant improvements are found for the social function, vitality/energy, physical role disability, and general health subscales of SF-36 in favor of the mud pack compared with the hot pack group at post-treatment. A significant increase is detected for IGF-1 in the mud pack group 3 months after treatment compared with the baseline, and the difference is significant between groups 3 months after the treatment. Conclusion: Mud pack is a favorable option compared with hotpack for pain relief and for the improvement of functional conditions in treating patients with knee osteoarthritis.
Keywords: Knee osteoarthritis, mud pack therapy, quality of life
Abstract: Objective: Determine the reliability and validity of the fear avoidance beliefs questionnaire (FABQ) translated into Arabic. Methods: The FABQ work and physical activity subscales (FABQ-W and FABQ-PA) were translated and culturally adapted into Arabic using the back-translation procedure. Forty-eight subjects with acute low back pain (LBP) and 63 subjects with chronic LBP, whose native language was Arabic, completed a demographic questionnaire, the FABQ, a pain intensity numerical scale, the Modified Oswestry Disability Index (MOSW), and the SF-36 questionnaire. Thirty patients completed the FABQ a second time 3–7 days later. Results: FABQ-W and FABQ-PA showed good internal…consistencies (α =0.90 and 0.81 respectively). Test-retest reliability was moderate to high (ICC (1,1) of 0.63 and 0.83 for the FABQ-W and FABQ-PA, respectively). Pain intensity correlated with FABQ-W only for subjects with acute pain (rho 0.41), and with the FABQ-PA only for subjects with chronic pain (rho 0.47). Significant differences between patients with acute and chronic pain were found. Correlations between the FABQ and the MOSW were moderate (rho between 0.40–0.42). Correlations between the FABQ subscales and the SF-36 questionnaire were stronger for subjects with chronic pain. A high ceiling effect was demonstrated for the FABQ-PA, in particular for patients with chronic LBP. Conclusions: The Arabic version of the FABQ has acceptable psychometric properties. However, the results of the physical activity subscale should be interpreted with caution due to a strong ceiling effect.
Keywords: Low back pain, reliability, validity, fear avoidance belief questionnaire, Arabic
Abstract: Background and objective: Tension tests or neurodynamic techniques assess the mobility of the peripheral nerves and provide a guide for planning and managing physiotherapy treatments of entrapment syndromes such as carpal tunnel syndrome (CTS). One of the upper limb tension tests (ULTT) is ULTT1 that evaluates the efficacy of physiotherapy treatment. It has been shown to be a valid test but its reliability has not been investigated for CTS. Therefore, it is not known if the ULTT1 helps in diagnosing CTS and assessing CTS treatments. The purpose of this study was to determine the reliability of the ULTT1 in CTS.…Material and methods: In order to determine the reliability of the ULTT1, we tested 23 healthy subjects and 12 subjects with CTS on two separate test days. Outcome measure for this study was elbow extension. Results: Inter subject elbow extensions were not significantly different between the two test days. Also, the coefficient of correlation ± SEM in healthy and CTS subjects were 0.89 ± 1.23 degrees and 0.84 ± 3.67 degrees, respectively. Conclusion: From the above results, we conclude that the ULTT1 is highly reliable and can be used in diagnosis as well as the management of CTS.
Keywords: Reliability, carpal tunnel syndrome, upper limb tension test