Journal of Back and Musculoskeletal Rehabilitation - Volume 28, 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: Physiotherapists and clinicians require methods that can be used in everyday practice for measuring proprioception of the trunk in individuals with non-specific low back pain (NSLBP). Objective: Our objective was to conduct a systematic literature review of methods used for assessment of proprioception of the trunk in individuals with non-specific low back pain. Method: Data were obtained from MEDLINE, CINAHL, Embase, PEDro and CENTRAL databases from their inception to December 2011. Reference lists of the selected reviews were hand searched for other potentially relevant studies. Randomized and nonrandomized controlled studies proprioception of the trunk in…individuals with low back pain were selected. Thirty-six studies satisfied the selection criteria and were included in this review. Results: Two reviewers independently selected the studies, conducted the quality assessment, and extracted data from each study. The Strobe scale was used to evaluate the scientific rigor of each selected study. Conclusions: This systematic review covered all the relevant literature, but none of the included studies offered a valid, reliable and feasible method to assess neuromotor capacity in everyday physiotherapy clinical practice.
Keywords: Non-specific low back pain, low back pain, proprioception, motor control, equilibrium, balance, kinesthesia, repositioning error, clinical applicability
Abstract: Background: The predictive validity of the Low Back Pain Perception Scale is determined in two studies in general practice and showed sufficient discriminative ability, although the psychometric properties of the scale have never been established until now. Objective: To determine the reliability and validity of the Low Back Pain Perception Scale in acute nonspecific low back pain patients. Methods: The Low Back Pain Perception Scale has been authorized translated into Dutch by two bilingual content experts. A sample of 84 acute low back pain patients in physiotherapy primary care, mean age (SD) age 42 (12) years…participated in this study. Internal reliability and a test-retest procedure within one-week interval were evaluated. Results: The internal consistency Cronbach α = 0.38 (95% CI 0.09 to 0.56) and test – retest reliability within one week Intra Class Correlation coefficient = 0.50 (95% CI 0.31 to 0.64). Minimal Detectable Change was measured 1.95. The concurrent validity demonstrates Pearson’s r = 0.35 (95% CI 0.14 to 0.53). CONCLUSIONS: The Low Back Pain Perception Scale demonstrates poor internal consistency and reliability and moderate concurrent validity. Extreme high or low scores may be clinical relevant therefore the scale can be used as a first screening instrument.
Keywords: Perception, reliability, validity, acute low back pain, prognosis
Abstract: Objective: We determined the effects of short-wave diathermy (SWD) treatment on mild and moderate idiopathic carpal tunnel syndrome (CTS). Methods: This was a prospective, randomized, controlled, double-blind clinical trial. The study involved 58 wrists in 31 patients diagnosed clinically and electrophysiologically with mild and moderate CTS. They were assigned randomly to one of two groups. Group 1 received a hot pack, SWD, and nerve and tendon gliding exercises and Group 2 received a hot pack, placebo SWD, and nerve and tendon gliding exercises. The treatment was applied five times weekly for a total of 15 sessions. Patients were…evaluated using the Tinel test, Phalen test, carpal compression test, reverse Phalen test, carpal tunnel compression test, Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), and a visual analog scale (VAS). Clinical tests and scales were evaluated at the beginning and end of therapy. Results: In the SWD group, in the Tinel test, Phalen test, reverse Phalen test, carpal compression test, VAS, BCTQ-FSS, and BCTQ-SSS, statistically significant improvements were detected (p < 0.001 ). In the placebo group, although improvements were seen in all parameters, the results were not statistically significantly different (p > 0.05 ) from baseline. All parameters improved significantly in the SWD group versus the controls (p < 0.05 ). Conclusion: SWD provided short-term improvements in pain, clinical symptoms, and hand function in patients with mild and moderate CTS.
Keywords: Carpal tunnel syndrome, short wave diathermy, tendon and nerve gliding exercise, hand function
Abstract: Background: The function of specific abdominal muscles can be assessed using both electromyography (EMG) and ultrasound imaging (USI) thickness measures. However, the relationship between these two measurements is not conclusive during sitting isometric trunk efforts. Objective: This study was conducted to assess the relationship between USI thickness and EMG amplitude measures of the right external oblique (EO) muscle during isometric efforts in the sitting position. Method: Eighteen subjects performed ramp isometric efforts progressing from 0 to 50% of their maximal voluntary contraction (MVC) in three trunk directions on a dynamometer: (1) forward flexion; (2) right lateral…flexion; and (3) left axial rotation. USI and surface EMG amplitude measures of the EO muscle were recorded concomitantly and both normalized against rest values and maximal EMG, respectively. Results: EO muscle was significantly more activated (p < 0.001 ) during forward flexion (42% on average) and axial rotation (35%) than during lateral flexion (24%). Non-significant (r = 0.01 ; P = 0.979 ) to highly significant (r = 0.98 ; P < 0.0001 ) and negative and positive Pearson correlations were observed between EMG and EO thickness measures for both flexion and rotation directions. Conclusion: The negative correlations between EMG and USI measures as well as the great variability of these correlations across individuals suggest that USI is not a valid measures of EO muscle activity. USI thickness measures should be interpreted with great caution in research and clinical settings.
Abstract: Background: Investigation and discrimination of neuromuscular variables related to the complex aetiology of low back pain could contribute to clarifying the factors associated with symptoms. Objective: Analysing the discriminative power of neuromuscular variables in low back pain. Methods: This study compared muscle endurance, proprioception and isometric trunk assessments between women with low back pain (LBP, n = 14 ) and a control group (CG, n = 14 ). Multivariate analysis of variance and discriminant analysis of the data were performed. Results: The muscle endurance time (s) was shorter in the…LBP group than in the CG (p = 0.004 ) with values of 85.81 (37.79) and 134.25 (43.88), respectively. The peak torque (Nm/kg) for trunk extension was 2.48 (0.69) in the LBP group and 3.56 (0.88) in the GG (p = 0.001 ); for trunk flexion, the mean torque was 1.49 (0.40) in the LBP group and 1.85 (0.39) in the CG (p = 0.023 ). The repositioning error (degrees) before the endurance test was 2.66 (1.36) in the LBP group and 2.41 (1.46) in the CG (p = 0.664 ), and after the endurance test, it was 2.95 (1.94) in the LBP group and 2.00 (1.16) in the CG (p = 0.06 ). Furthermore, the variables showed discrimination between the groups (p = 0.007 ), with 78.6% of the individuals with low back pain correctly classified in the LBP group. In turn, variables related to muscle activation showed no difference in discrimination between the groups (p = 0.369 ). Conclusion: Based on these findings, the clinical management of low back pain should consist of both resistance and strength training, particularly in the extensor muscles.
Abstract: Background and Objective: Chronic low back pain (LBP) is a major public health problem in industrialized countries and is one of the most common reasons for seeking healthcare. Although the McKenzie therapy is widely used for the treatment of low back pain, there is evidence for no improvement with exercise in short-, intermediate-, or long-term outcomes of pain relief or function. The aim of this study was to compare the effect of the McKenzie therapy with electrophysical agents (EPAs) in patients with chronic LBP. Material and Method: A randomized controlled comparative trial with a 3-month follow-up period was…conducted between January 2009 and June 2012. 271 patients with chronic LBP, (more than three months duration of symptoms) were randomized into two groups: the McKenzie therapy group (n = 134 ), and electrophysical agents group, (n = 137 ). The treatment period of both groups was 4 weeks at an outpatient clinic. Clinical outcomes (pain intensity, trunk flexion range of motion, and disability) were obtained at follow-up appointments at the end of the treatment period, 2 and 3 months. Results: Significant improvement of spinal motion, reduction of pain and disability were demonstrated in both groups but the results show the greater improvement in the McKenzie group (p < 0.05 ). Conclusion: McKenzie therapy reduces pain, and disability, among subjects with chronic LBP. This study revealed that the McKenzie therapy is more effective than EPAs group.
Abstract: Background: The muscle activity of the deep cervical flexors is emphasized more than that of the superficial cervical flexors, and it has been reported that functional disorders of the longuscolli are found in patients who experience neck pain. Objective: The objective of this study was to analyze the recruitment patterns and muscle activities of the cervical flexors during Cranio-Cervical Flexion Tests (CCFTs) through real-time ultrasonography and surface electromyography with a view to presenting appropriate pressure levels for deep cervical flexor exercise protocols based on the results of the analysis. Methods: The twenty subjects without neck pain…were trained until they became accustomed to CCFTs, and the pressure level was increased gradually from 20 mmHg to 40 mmHg by increasing the pressure level 5 mmHg at a time. Real-time ultrasonography images of the longuscolli and the sternocleidomastoid were taken to measure the amounts of changes in the thicknesses of these muscles, and surface electromyography was implemented to observe the muscle activity of the sternocleidomastoid. The measured value is RMS. Results: According to the results of the ultrasonography, the muscle thicknesses of both the longuscolli and the sternocleidomastoid showed significant increases, as the pressure increased up to 40 mmHg (p < 0.05 ). The differences in the muscle thicknesses at all individual pressure levels showed significant increases (p < 0.05 ). According to the results of the electromyography, the muscle activity of the sternocleidomastoid gradually increased as the pressure increased up to 40 mmHg, the increases were significant between 20 mmHg and 25 mmHg, between 30 mmHg and 35 mmHg (p < 0.05 ). Conclusions: The pressure levels of exercise methods at which the muscle activity of the deep cervical flexors is maximally increased and the muscle activity of the superficial cervical flexors is minimally increased are 25 mmHg–30 mmHg.
Abstract: Background and Objective: Cervical spondylotic amyotrophy (CSA) is a relatively rare disorder. This study was conducted to elucidate the prognosis of proximal-type CSA after anterior decompressive surgery by evaluating clinical factors and imaging findings. Methods: Anterior decompressive surgery was performed in 40 patients with proximal-type CSA between March 2000 and December 2011. Patients were classified into 2 categories based on axial T2-weighted magnetic resonance imaging (MRI) findings: “nerve root compression (NRC)”, with nerve root compressed at the intervertebral foramen, and “spinal cord compression (SCC)” with spinal cord compressed at the medial or paramedial site of spinal canal. Manual…muscle testing (MMT) was used to evaluate the surgical effect. Scapular, deltoid, and biceps brachii muscles of the affected side were tested and the sum scores were calculated. Clinical factors and imaging findings, such as age, duration of disease, preoperative MMT grade, number of affected levels and signal intensity changes of spinal cord, were collected to analyze prognostic factors. Results: After anterior decompressive surgery, 30 patients (75%) showed an improvement. NRC was observed in 6 patients and SCC in the rest 34 patients based on MRI findings. All patients (100%) with NRC had an improvement, while only 24 patients (70.6%) with SCC improved. In patients with SCC, there was a significant difference in duration of disease between patients who had an improvement and those who had not (P < 0.01 ). Conclusions: Anterior decompressive surgery is effective in the treatment of most patients with CSA. NRC on MRI may indicate a good surgical outcome. In patients with SCC, a long duration of disease is a risk factor for poor prognosis.
Abstract: Background: Early identification of patients at risk of developing persistent low back pain (LBP) is crucial. Objective: Aim of this study was to identify in patients with a new episode of LBP the time point at which those at risk of developing persistent LBP can be best identified. Methods: Prospective cohort study of 315 patients presenting to a health practitioner with a first episode of acute LBP. Primary outcome measure was functional limitation. Patients were assessed at baseline, three, six, twelve weeks and six months looking at factors of maladaptive cognition as potential predictors. Multivariate logistic…regression analysis was performed for all time points. Results: The best time point to predict the development of persistent LBP at six months was the twelve-week follow-up (sensitivity 78%; overall predictive value 90%). Cognitions assessed at first visit to a health practitioner were not predictive. Conclusions: Maladaptive cognitions at twelve weeks appear to be suitable predictors for a transition from acute to persistent LBP. Already three weeks after patients present to a health practitioner with acute LBP cognitions might influence the development of persistent LBP. Therefore, cognitive-behavioral interventions should be considered as early adjuvant LBP treatment in patients at risk of developing persistent LBP.
Abstract: Background and Objective: The intervertebral disc degeneration changes and paraspinal muscles changes are believed to be risk factors for lumbar degenerative spondylolisthesis (LDS). But there is limited quantitative information about this progression. This study is to reveal their changes the in the progression of LDS. Methods: Data were gathered from 149 middle-aged degenerative spondylolisthesis patients and same amount of age- and sex-matched control group with both lumber spine MRI and X-ray. Narrowed disc space were measured in percent as anterior inferior disc height (DHIA)/anterior superior disc height (DHSA), inferior disc height (DHI)/superior disc height (DHS), and posterior inferior…disc height (DHIP)/posterior superior disc height (DHSP). Signal intensity ratio of multifidus muscle (RM) and erector spinae (RES) to psoas muscle, muscle atrophy ratio of lean CSA (LCSA) to gross CSA (GCSA) of paraspinal muscles were calculated. Results: In the case group the most common slipped vertebra was L4 (75.84%). Disc height (DHIA/DHSA, DHI/DHS) and multifidus muscle atrophy ratio (M-LCSA/M-GCSA) tended to be lower than those in the control group, whereas the disc degeneration degree and T2 signal intensity ratio (RM,RES) of the paraspinal muscles and erector spinae muscle atrophy ratio were higher than control group. The difference between the two groups was statistically significant (P < 0.05 ). Using multivariate logistic regression analysis, it was confirmed that ES-LCSA/ES-GCSA, especially RM are independent predisposing factors to lumbar spondylolisthesis (OR > 1 , P < 0.05 ) while DHIA/DHSA, M-LCSA/M-GCSA are independent protective factors (OR < 1 , P < 0.05 ). Conclusions: Decreased anterior disc height and multifidus muscle atrophy are found in the LDS patients and thy could be the cause of LDS. The presence of erector spinae hypertrophy could be a compensatory mechanism to compensate for the instability.