Journal of Back and Musculoskeletal Rehabilitation - Volume 26, 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: Objectives: To compare responsiveness for the two region specific questionnaires Shoulder Disability Questionnaire (SDQ) and Shoulder Pain Disability Index (SPADI) and the disease specific Western Ontario Rotator Cuff (WORC) index in subacromial impingement syndrome (SIS) receiving physical therapy or subacromial corticosteroid injection. Material and Methods: Sixty-four patients with SIS diagnosed participated in this study. All the patients were provided either physical therapy or subacromial corticosteroid injection treatment. The SDQ, the SPADI and WORC index were assessed both at the beginning and after the 3rd month of treatment. The responsiveness of the three questionnaires was compared by using the…effect size (ES), the standardized responsiveness mean (SRM) and Guyatt’s method. Results: For both treatment groups there was no statistical difference observed between the pre- and post treatment measurement results versus improvement differences (p > 0.05 ). SDQ (ES=0.94; SRM=1.14; Guyatt value=0.95), SPADI (ES=1.55; SRM=2.14; Guyatt value=1.08), WORC index (ES=1.37; SRM=1.70; Guyatt value=1.15) were highly responsive for SIS. Conclusions: The SDQ, the SPADI and the WORC index are suitable for measuring changes in patients with SIS. Of these three indices, the SDQ and the SPADI are more suitable for a rapid assessment whereas the WORC index is better in cases where a more detailed assessment including the psychological impact created by the functional status needs to be assessed.
Keywords: Responsiveness, subacromial impingement syndrome, Shoulder Disability Questionnaire, Shoulder Pain Disability Index, Western Ontario Rotator Cuff Index
Abstract: Objective: The purpose of this study was to determine the prevalence of and risk factors for neck pain in dentists of Tehran province and to analyze the association of neck pain with individual and occupational characteristics. Design: Following ethical approval, a cross sectional study was conducted on 300 randomly selected dentists at Tehran city. Different questionnaires were used to collect personal and occupational characteristics as well as the prevalence and risk factors of neck pain. The Iranian validated version of visual analogue scale and neck disability questionnaires were also used to assess the pain intensity and functional disability…of neck, respectively. Results: Point, last month, last year and lifetime prevalence of neck pain were 19.3%, 27.3%, 29.9% and 34.7%, respectively. The prevalence of neck pain was significantly correlated with regular exercise, general health condition and having an assistant (P < 0.05 in all instances) and was not significantly correlated with body mass index, age and gender. Prolonged sitting, awkward postures and repeated movements were the most significant aggravating factors. Conclusions: Results indicated that the prevalence of neck pain in dentists appears to be high. Therefore, further studies on different preventive strategies in dentists’ population seem necessary.
Abstract: Background and Objective: Cervicogenic headache (CGH) is a common problem associated with neck pain. In this study the effect of cervical mobilizations was compared with that of massage therapy in the management of CGH. Design: Thirty-six subjects with CGH, randomly assigned into two groups, participated in the study. The first group was treated with spinal mobilization techniques of the upper cervical spine, while the second group was treated with massage therapy of the neck region. All subjects underwent active neck range of motion, isometric and dynamic strengthening and endurance exercises in two sessions/week for 6 weeks. Pre- and…post-treatment outcomes were assessed with means and standard error of the means of measured headache pain intensity, frequency and duration of headache attacks as well as via the functional Neck Disability Index (NDI) and active neck range of motion. Results: The results of the study showed significant improvement in all measured variables in each treatment group. Comparison between the two groups showed significant differences in all measured variables after intervention in favor of mobilization techniques with the exception of the functional NDI. Conclusion: Upper cervical spine mobilization demonstrated more clinical benefits than massage therapy with regard to headache pain parameters and neck mobility for CGH subjects.
Abstract: Objective: The aim of this study was to investigate the effect of scapular muscle endurance on chronic shoulder pain in textile workers. Methods: In total, 91 textile workers were divided into two groups based on the presence (n = 43 ) or absence (n = 48 ) of chronic shoulder pain, as assessed using the Nordic Musculoskeletal Questionnaire (NMQ). The endurance of the serratus anterior and trapezius muscles was assessed using the Scapular Muscle Endurance (SME) test. Results: In the group with chronic shoulder pain, mean scapular muscle endurance was significantly lower…than that in the pain-free group (t -test, p < 0.05 ). There was a significant negative correlation between rest – activity pain intensity and SME (Pearson correlation analysis, p < 0.01 ). Conclusions: Scapular muscle endurance has an effect on the development of shoulder pain in textile workers.
Abstract: Objectives: To study the effect of a protocol involving joint manipulation and specific exercises for pelvic stability to influence proprioceptive input to the spinal tissues and to observe the effects on sensorimotor function. Methods: Seven patients with pelvic anteversion and low back pain participated in an eight-week protocol (three sessions per week/nonconsecutive days). At each session, a high-velocity, low-amplitude manipulative thrust was applied to the sacroiliac joint, followed by quadriceps eccentric and hamstring concentric contractions. The perceived pain symptoms, pelvic anteversion as determined by photogrammetry analysis, and the electromyographic activity of the rectus femoris and lateral and medial…hamstrings during flexion and extension exercises were assessed before and after treatment. Non-parametric tests were used to compare the groups before and after treatment with α = 0.05 . Results: Perceived pain symptoms decreased after treatment (p = 0.0007 ). The differences in the pelvis angles (p = 0.0130 ) suggested significant differences between the assessments, and the electromyographic activities of all the muscles during isometric voluntary contraction increased. Conclusion: The eight-week manipulation/exercise protocol was effective for these subjects’ needs. Further research should include a greater sample size to confirm the results and to determine the lead factors of pelvic stability.
Keywords: Physiotherapy, manipulation, electromyography, low back pain
Abstract: Background and Objectives: Low Back Pain (LBP) results in significant level of disability, producing significant restriction on usual activity such as an inability to work. Nearly two third of the adults are affected by non-specific low back pain at some point in their lives. The purpose of the study was to determine the effect of core stabilization exercises in comparison with conventional exercises on pain, functional status in patients with non-specific LBP. Material and Methods: Thirty patients diagnosed with non-specific LBP participated with age group between 20âĂŞ50 years and divided in to 2 groups, one with core stabilization…exercises and other conventional exercises, 15 subjects each. Three months study, pre and post treatment outcome measures used were VAS for pain intensity and Modified Oswestry Low Back Pain Disability Index for functional status (disability). Results: Data were analyzed using student ‘t’ test (paired and unpaired). Whereas both groups improved significantly from the initiation of treatment, a between-group comparison revealed significantly greater (p < 0.001 ) improvements regarding pain and functional status for experimental group compared to control group. Conclusion: Core stabilization exercises were found to be more effective in reducing pain and improving functional status by decreasing disability of patients with non-specific low back pain in comparison with conventional exercises.
Keywords: Low back pain, core stabilization exercises, modified oswestry low back pain disability index, activities of daily living
Abstract: Objective: To develop a valid and reliable functional disability scale for chronic low back pain (CLBP). Methods: Inpatients and outpatients suffering from low back pain (LBP) for at least 3 months were selected randomly. Patients with inflammatory LBP were not recruited. Interrater reliability and Cronbach’s α were examined. Face, content, convergent and divergent validities were investigated. Factor Analysis and pearson’s correlation coefficients (r) were performed. Results: 112 patients (71 females) with a mean age of 39.93 (SD: 12.92) answered the 66 questions on the provisional scale. Elimination left 18 daily activity questions. The interrater reliability…of the scale was 0.79 and Cronbach’s α was 0.90. Face and content validities were determined. It showed good convergence with the Quebec Back Pain Disability Scale (r: 0.82), the Oswestry Disability Index (r: 0.76), Waddell’s Functional Index (r: 0.68), and the Visual Analog Scale of Handicap (VAS-handicap) (r: 0.49) The scale showed no significant or fair relationship (divergence) with VAS-lumbar, VAS-radicular, Beck Depression Inventory, morning stiffness, night pain, finger tip-ground distance, radicular pain duration, or modified Schöber’s index. The scale had two main factors. First represents activities implicating forward bending and second represents standing activities. Conclusion: A practical functional disability scale for CLBP was developed and validated.
Keywords: Chronic low back pain, functional disability, outcome assessment
Abstract: Accompanying leg pain is commonly observed in patients with chronic low back pain (CLBP) and is assumed to be an indicator for the disorder severity. However, it is still unknown whether it is possible to estimate a patient's functional status by the extent of leg pain present. In a post rehabilitation cohort of 132 patients with CLBP (mean age 44.3 years) the relationship between pain extent and functional status was determined using pain drawings scored for pain extent by a simplified scoring system (Lower Extremity Region: LER) and several function related questionnaires. Primary outcomes were pain extent, pain intensity ratings…(Visual Analog Scale: VAS), disability status (Oswestry Disability Index: ODI) and physical and mental health (Short Format 12: SF-12). Statistically significant differences between patients with low (1–2) and high (⩾ 3) LER scores were found in VAS, ODI and SF-12 physical health scores, however, the LER score has a poor diagnostic accuracy in predicting desirable versus undesirable VAS, ODI and SF-12 scores. Pain intensity (VAS), back disability (ODI) and physical health are worse in CLBP patients with high LER scores. However LER scores cannot be used to predict elevated VAS, ODI and SF-12 scores in an individual patient.
Keywords: Pain drawing, pain extent, low back pain, leg pain
Abstract: Objectives: The HLA-DRB1 gene plays an important role in the genetic predisposition to rheumatoid arthritis. The anti-citrullinated protein antibody (ACPA) is known to be associated with the susceptibility to rheumatoid arthritis (RA), as well as the severity of the disease. The aim of this study is to determine the HLA genes that are associated with the severity of the RA measured by seropositivity, functional status, radiological damage and the anti-modified citrullinated vimentin (MCV) levels. Material and Method: Ninety-six patients diagnosed with rheumatoid arthritis and a control group consisting of 84 healthy individuals were enrolled in the study. The…HLA-DRB1 type and subtypes were specified using the polymerase chain reaction with sequence-specific primers (PCR-SSP). The association of the HLA-DRB1 type and subtypes with seropositivity, anti-MCV levels, functional status and anatomical joint damage were explored using the modified Larsen scoring method. Results: The DRB1*01, DRB1*04, DRB1*07, DRB1*10, DRB1*11 and DRB1*15 alleles were found to be related with higher anti-MCV levels (p < 0.05 ). The DRB1*11 type and the DRB1*1001 subtype were observed to be associated with poor functional status (Stages 3–4). The DRB1*0801 subtype was associated with lower anti MCV levels (OR=8.35, p = 0.02 ). DRB1*04 type and DRB1*0405 subtypes were related with radiological damage (OR=0.52 and 0.25; p = 0.04 and 0.03, respectively). No significant relationship was observed between the RF seropositivity and the HLA-DRB1 alleles. Conclusion: This study revealed the association between the HLA alleles and seropositivity, functional status, anti-MCV levels and radiological damage in patients in the Southeast Anatolian region of Turkey.
Abstract: Background and Objectives: To investigate the relations between alexithymia, temperament features, depression and anxiety levels and level of benefit from physical therapy. Material and Method: Fifty-eight patients in a physical therapy program were included in this study. Toronto Alexithymia Scale (TAS), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A), Beck Depression Scale (BDS) and State-Trait Anxiety Inventory (STAI) were used before the treatment. Response to treatment parameters were as follows: pre-treatment, 10th session and 3rd month resting and activity pain was evaluated using the Visual Analogue Scale (VAS-R, VAS-A), patients’ self global evaluation (PSGE),…doctors’ global patient evaluation (DGPE) and Nottingham Health Profile (NHP). Results: At the end of treatment, significant recovery was obtained in VAS-R, VAS-A, PSGE, DGPE, NHP-pain, NHP-physical mobility and NHP-energy scores. No changes were found in NHP-sleep, NHP-social isolation and NHP-emotional reaction scores (p > 0.05 ). Except for the recovery percentage of TAS and NSP-energy, no relations between TAS and other parameters were detected (p < 0.05 ). Only the recovery percentage of the PSGE parameter revealed significant negative correlation with depressive, cyclothymic and anxious temperament means of TEMPS-A (p < 0.05 ). Other temperament features of TEMPS-A (hyperthymic, irritable) revealed no correlations. Significant negative correlations were found between BDS and PSGE, and VAS-A (p < 0.05 ). No correlations were found between BDS and other parameters, or between STAI scores and response parameters (p > 0.05 ). Conclusion: Although pain, life quality and doctor evaluation of the patients in the physical treatment program improved greatly after the treatment, no favorable results were obtained for patients who had high depressive, cyclothymic, anxious temperament and depression scores. It was detected that alexithymia and anxiety scores revealed no effect in this evaluation.
Abstract: Objectives: The aim of this retrospective study was to investigate the effectiveness of the nerve block of articular branches of obturator and femoral nerves in patients with intractable pain due to hip osteoarthritis. Material and Method: Twenty patients (8 female and 12 male; with a mean age 53.5 years) were retrospectively identified who had received nerve block of articular branches of obturator and femoral nerves for chronic hip joint pain due to hip osteoarthritis. The outcome measures (visual analogue pain scale, the level of patient satisfaction with nerve block, reduction rate of NSAID using) were assessed before the…treatment and at the 1st and 3rd months after injection. Results: Mean reduction in hip joint pain while walking and at night between the baseline and 1st month, and between the baseline and 3rd month were statistically significant (p < 0.05 ). At the 1st and 3rd months after treatment, the reduction rates of NSAID using were almost 67% and 71%; respectively. At the 1st and 3rd months after treatment, the level of patient satisfaction with nerve block were 73.00 ± 21.23 mm and 73.50 ± 18.14 mm; respectively. Conclusion: We found that nerve blocks of articular branches of obturator and femoral nerves were effective in short- and mid-term for reducing chronic hip joint pain.
Keywords: Hip joint pain, articular branches, obturator and femoral nerves, pain reduction
Abstract: Objective: The objective of this retrospective study was to examine the efficacy of fluoroscopically guided cervical interlaminar epidural steroid injections (CILESI). Materials and Methods: Sixty-five patients who received their first fluoroscopically guided CILESI over a 12 months interval were retrospectively identified. Patients who had failed conservative non-surgical management and patients who were otherwise candidates of surgery were included in this trial of CILESI. The verbal numerical rating scales (VNRS) before the treatment, within one hour after the treatment, and upon follow-up, were analyzed. Results: The most preferred intervention level of CILESI was C5-C6. There was a…statistically significant improvement in the VNRS scores from before the injection to immediately after the injection, and upon follow-up. Fifty-one patients (80%) had perfect/good scores. No major complications were encountered after CILESI, but one patient (1.54%) had a vasovagal reaction and another patient (1.54%) had a transient increase of pain after injection. Conclusion: Fluoroscopy guided CILESI is a safe and an effective the treated of patients with cervical pain syndromes. The success rates show that a large percentage of the patients may obtain relief from radicular symptoms and avoid surgery for the follow-up period up to 12 months.
Abstract: Background and Objectives: Nuclear magnetic resonance (NMR) has been shown to stimulate repair processes and cartilage and to influence pain signalling. It represents an alternative therapy for patients suffering from osteoarthritis (OA). To prove the clinical success of this new therapeutical method, validated measuring parameters are important that are convincing for pain and function in a one-year-follow-up. Methods: During the course of its application over the last 10 years, over 4,500 protocols of a one-year-follow-up have been collected to record the outcome of NMR therapy. This report reflects the outcome of NMR therapy on patients with the following…degenerative rheumatic diseases: OA of the knee (n = 2.770 ), OA of the hip (n = 673 ), OA of the ankle joint (n = 420 ) and chronic low back pain (n = 655 ). Data were collected at baseline, 6–8 weeks and 6 and 12 months following NMR treatment. Results: Pain was reduced significantly 6 weeks after NMR treatment in the cases of all four examined indications and stayed measurably reduced up to 6 and 12 months. The improvements in all three forms of pain (pain on load, pain on motion, pain at rest) following NMR treatment were around 21–50% on average. Conclusions: Following therapy with NMR, patients with OA of all four types experienced a distinct improvement in their ability in functional parameters. Overall, the 10 years of a one-year-survey with multicenter data gathered on the effect of NMR therapy on patients verifiably proved its efficacy amongst patients with degenerative rheumatic diseases.
Keywords: Nuclear magnetic resonance, osteoarthritis, outcome measurement