Journal of Back and Musculoskeletal Rehabilitation - Volume 26, issue 4
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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 Objective: The association between facet orientation, tropism (asymmetry of the facet angles) and facet joint osteoarthritis (OA) has been previously reported, however, it is necessary to confirm the association in other samples. Our aim was to evaluate the association between facet orientation, tropism, and facet joint OA in an Israeli sample. Methods: One hundred and fifty low back and abdominal CTs of 82 males (mean age 61.74 ± 12.99) and 68 females (mean age 59.51 ± 11.74,) were evaluated in a cross-sectional study. Facet joint OA was evaluated at the L4–L5 spinal level using a 4-graded scale.…The association between facet joint OA, facet orientation and tropism was examined using multiple logistic regressions adjusted for age and sex. Results: Facet orientation showed a statistically significant association with facet joint OA on the right side (p = 0.009 ) and in a model where both sides were combined (p = 0.003 ). Facet joints with OA were more sagittally oriented. Tropism was not associated with facet joint OA on either side (p = 0.251 for right and 0.609 for the left side), or in a combination of both sides (p = 0.482 ). Conclusions: We confirm a significant association between sagittal orientation and OA of the lumbar facet joints at level L4–L5. Facet tropism was not associated with facet joint OA. Additional longitudinal studies are needed to understand the causal relationship between facet joint orientation and OA.
Abstract: Background and Objective: The aim of this prospective, randomized controlled 6-month interventional trial was to investigate the effects of strengthening and high-impact exercise training on bone mineral density (BMD), bone turnover markers and health-related quality of life (HRQoL) in postmenopausal women. Material and Methods: Forty-two eligible postmenopausal women with osteopenia who referred to our outpatient clinics were included in the study and allocated equally to three groups receiving strengthening exercise, high-impact exercise or no exercise (control). The supervised training program consisted of a one-hour exercise session three times a week for six months. BMD at the L1–L4 and…femoral neck, serum bone turnover markers (osteocalcin, OC; N-telopeptides of type I collagen, NTx) and HRQoL were measured at the beginning and sixth months. Results: There was a significant increase in the BMD at the lumbar spine (p = 0.017 ) and femoral neck (p = 0.013 ) in the high-impact group compared to the strengthening and control groups. Serum OC (p = 0.033 ) increased, and NTx (p = 0.034 ) decreased significantly only in the high-impact group. HRQoL improved significantly in both training groups (p < 0.001 ). Conclusions: Our data suggest that 6-month supervised high-impact exercise training can be effective in prevention of bone loss at lumbar spine and femoral neck. These data also indicate that both supervised training programs improve HRQoL in postmenopausal women.
Keywords: Postmenopausal women, exercise, bone metabolism, quality of life
Abstract: Background and Objectives: It has been known that tender points detected by ACR 1990 criteria alone might not describe the essence of fibromyalgia, so preliminary diagnostic ACR 2010 criteria was developed. Since there has been no clear evidence exist examining the concordance rates and sensitivity to treatment of these two criteria comparatively, we aimed to shed light on this ambiguity. Matherial and Methods: One hundred patients with widespread pain were studied. Fulfillment of both criteria was determined at baseline, at 3th and 12th months. Sensitivity and specificity values were identified. The relationship between Fibromyalgia Impact Questionnaire and components…of two criteria was detected by pearson correlation. And the concordance rate was evaluated by kappa coefficient. Results: At the 1st visit (baseline), two criteria were concordant in 48.5% (n = 49 ) of cases (κ = 0.43 [ 95 % CI .0.22 , 0.58 ] ). However, the concordance was present in only 25(25%) of the subjects (κ = 0.29 [ 95 % CI : 0.12 , 0.36 ] ) at the end of the study. After 1 year of follow-up, the sensitivity of ACR 2010 was higher than that of ACR 1990 (0.88; 0.56 respectively) (p < 0.05 ). Conclusion: ACR 2010 criteria is more sensitive than ACR 1990 both at first diagnosis and after 1 year of follow-up. So; it enables to diagnose and may give oppurtunity to treat more underdiagnosed FM patients.
Abstract: Background and Objectives: Incidence of Low Back Pain (LBP) in athletes is as high as 30%. Patients with LBP show altered postural and neuromuscular responses to various functional tasks. The objective of the study was to compare long latency reflex response (occurring between 40 to ∼ 100 ms duration) in athletes with chronic LBP with asymptomatic athletes. Methods: Surface electromyography (EMG) of superficial trunk muscles âĂŞ Rectus Abdominis (RA) and Erector Spinae (ES) were studied in athletes with chronic LBP (n = 24 ) and asymptomatic athletes (n = 25 ). Perturbations were introduced…in standing both expectedly and unexpectedly. The latency of onset and the Root Mean Square (RMS) amplitudes within the reaction duration were compared between the two groups. Results: The latency of onset was delayed in Unexpected perturbations but no change was observed in Expected tasks. The mean RMS amplitudes were significantly lower in both tasks for RA and in the Expected task for ES (p < 0.05 ). Conclusion: Chronic LBP athletes exhibit a delay in onset latency to Unexpected perturbations and reduced long latency response amplitudes to perturbation tasks compared to asymptomatic athletes. These changes could predispose athletes to recurrent low back pain and further injury.
Keywords: Long latency reflex, low back pain, athletes, EMG, perturbation
Abstract: Background and Objectives: In clinical examinations of a patient with non-specific low back pain (LBP), there is a need to dispose over a valid and quick to perform rating system. The “Backache Disability Index” for LBP or BADIX includes rating of 5 trunk movements in erect position and a “Morning Back Stiffness” score, whereof the sum gives the BADIX (max. 20 points). The objective of this study was to explore the reliability, responsiveness and concurrent validity of the BADIX. Patients with LBP (n = 100 ) were randomly assigned into a “control” group (n = 40…) in function of validity studies, and a “treatment” group (n = 60 ) in function of responsiveness studies. The treatment group underwent two weekly sessions of in total 30 minutes of deep cross-friction on the thoraco-lumbar Erector spinae and gluteals. All patients completed the Oswestry Disability Questionnaire validated Dutch version (ODQ), the McGill Pain Questionnaire (MPQ). The impairment examination consists, besides current orthopaedic and neurologic examinations, of the new BADIX scoring system. Results: In our study the retest reliability after 3 days of the BADIX was perfect (n = 039 , r = 0.95 ). A good correlation (p < 0.001 ) was found between BADIX at baseline, and Oswestry Disability Index (ODI) (n = 93 , r = 0.76 ), and McGill-Quality of Life Index (r = 0.74 ). Similar discriminative ability and effect size of measures was found for BADIX and ODI (n = 54 ). It is proposed that the minimal detectable change should be equal or more than 2 points. Conclusions: The “Backache Disability Index” appears to be a reliable and a valid assessment tool of morning stiffness and restricted spinal movements, and discriminates between successful and unsuccessful treatment outcome. The BADIX will allow patients to take snapshots of their daily treatment evolution, save them on their computer or tablets (apps) and share the results with their doctors and/or therapists.
Keywords: Low back pain, validity, reliability, disability index, impairment
Abstract: Background: The Knee injury and Osteoarthritis Outcome Score-Physical function Short-form (KOOS-PS) is a disease-specific questionnaire that can be used to evaluate physical function in patients with knee problems and it has not been adapted to Turkish language. Objective: The purpose of the present study was to adapt the KOOS-PS to the Turkish language and to evaluate the psychometric properties of the Turkish version of the KOOS-PS in patients with primary knee osteoarthritis. Methods: The translation from the source language to the target language, synthesis, back-translation, revision and pre-test stages were performed. A total of eighty patients…participated in the study. Internal consistency was tested by Cronbach’s alpha, test-retest reliability was tested by the intra-class correlation coefficient (ICC). Construct validity was investigated with Spearmann’s rank correlation coefficient and correlations of the KOOS-PS with the WOMAC and Lequesne osteoarthritis indexes and with the duration of complaints, radiological grade and range of flexion were assessed for this purpose. Results: Internal consistency was good, with a Cronbach’s alpha of 0.904 and an ICC value of 0.839 certifying that the Turkish KOOS-PS is a reliable tool. Spearman’s rank correlation coefficients between the KOOS-PS and the overall WOMAC (r = 0.764 ), WOMAC-physical function (r = 0.754 ), WOMAC-pain (r = 0.706 ), overall Lequesne (r = 0.775 ), Lequesne-daily living activities (r = 0.737 ) and Lequesne-pain (r = 0.716 ) were high. Moderate correlations were found between the WOMAC-stiffness, Lequesne-walking distance and KOOS-PS (r = 0.599 and 0.528, respectively). Conclusions: The Turkish KOOS-PS was found to be reliable and valid for patients with primary knee osteoarthritis.
Abstract: Background and Objectives: The aim of this study was to investigate the clinical relevance of Michigan Hand Outcomes Questionnaire (MHQ) in patients with rheumatoid arthritis (RA) and to evaluate the relationship between MHQ and disease activity, quality of life (QL), and handgrip strength separately. Material and Method: Eighty RA were included in the study. Disease activity is evaluated with Disease Activity Score 28 (DAS28), pain is evaluated with Visual Analog Scale (VAS). The Disabilities of Arm, Shoulder and Hand (DASH), MHQ, Short-Form 36 (SF-36), and Health Assessment Questionnaire (HAQ), Arthritis Impact Measurement Scales-hand and finger function scale-2 (AIMS-2)…were completed by all patients. Hand muscle strength (HMS) was measured with a hand-held dynamometer. Results: The MHQ moderately correlated with DAS28. When the patients were grouped according to three disease activity measurements, DASH scores were significantly higher with higher disease activity and MHQ scores were significantly lower with higher disease activity. A high correlation was found between MHQ total and HAQ, AIMS-2. The SF-36 scores were correlated with MHQ scores. Conclusions: The MHQ scores correlate with disease activity indices, functional disability, QL and DASH. The clinical relevance of MHQ, like DASH, is high and both questionnaires can be used effectively.
Abstract: Low-back pain is a common complaint during pregnancy and the post-partum period, and it may be due to a variety of conditions. Among these, a frequently overlooked cause is a sacral fracture. We report the case of a 37 year old woman, suffering from post-partum low-back pain which had not responded to treatment. Though rare, a sacral stress fracture must be considered in cases of prolonged low-back or sacral pain in pregnant or post-partum women. Plain radiographs are frequently inconclusive and MRI is the imaging technique of choice. Capacitive coupling electric fields (CCEF) seemed to be effective in treating pain…and in reducing the patient's recovery time.
Keywords: Low-back pain, stress fractures, sacrum, pregnancy, capacitive coupling electric field
Abstract: Background and Objective: In this article, we describe a patient unusual presenting with both arachnoiditis ossificans and syringomyelia. We have reviewed the patient’s evaluation, surgery, and treatment. Case Description: This patient developed paraparesis following thoracolumbar spinal surgery to treat kyphosis secondary to ankylosing spondylitis. Results: We performed a T9-T11 total laminectomy, drained the cyst, dissected and removed the calcified plaques posterior to the cord, and decompressed the neural structures. Conclusion: Symptomatic arachnoiditis ossificans (AO) a rare clinical manifestation is characterized by the calcification or ossification of the spinal arachnoid. The occurrence of AO with…syringomyelia is rare. To date, a few cases with both AO and ankylosing spondylitis have been reported.