Journal of Back and Musculoskeletal Rehabilitation - Volume 28, 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: Patients with fibromyalgia present a reduced capacity of upper and lower limb physical performance and affect their independence in performing everyday activities. OBJECTIVE: The purpose of the present systematic review was to summarize evidence for the effectiveness and structure of exercise programs on functional aerobic capacity in patients with fibromyalgia syndrome. METHODS: Keyword searches were made of seven databases. The systematic review was limited to English language studies of people with FM that evaluated the effects of exercise programs on functional aerobic capacity (6-minute walk test). RESULTS: The criteria for inclusion…were satisfied by 12 randomized controlled trial (RCT) studies. The main cumulative evidence indicates that the programs based on aerobic exercise alone and on aquatic exercises have large (effect size = 0.85) and moderate (effect size = 0.44) effects. CONCLUSIONS: Aerobic and aquatic exercises at the proper intensity favour the increased functional aerobic capacity of fibromyalgia patients; however, most works do not adequately detail the intensity of the exercises. Moderate intensity exercise (aerobic and aquatic exercise) performed at least two times per week and 30-60 minutes a day is effective for increasing functional aerobic capacity, favouring the daily activities of daily living in this population.
Abstract: BACKGROUND: Chronic low back pain causes socioeconomic burdens. Whether lumbar fusion is more effective than nonsurgical treatment of discogenic low back pain (DLBP) is controversial. Several randomized controlled trials that compared conservative treatment and fusion surgery had conflicting conclusions. OBJECTIVE: To compare between the effectiveness of lumbar fusion and nonsurgical intervention in patients with chronic low back pain caused by disc degeneration. METHODS: PubMed, the Cochrane Library, EMBASE, the Science Citation Index, Chinese Biomedical Literature Database, and references of relevant papers published from 1990 to 2013 were searched. Related data matching standards established for…this research were extracted and statistically analyzed by using the RevMan (5.2) software. RESULTS: Meta-analysis of 6 randomized controlled trials with a total of 889 patients revealed no difference in Oswestry Disability Index (ODI) score for DLBP between the fusion surgery and nonsurgical groups (mean difference, 1.94; 95% confidence interval [CI], -6.02 to 2.14). Postsurgical complication rate significantly differed between the 2 groups (risk ratio, 22.11; 95% CI, 55.99-81.60). CONCLUSIONS: Fusion surgery was not superior to nonsurgical treatment in terms of changes in ODI scores for DLBP. Fusion surgery resulted in surgical complications. Longer follow-up observation is necessary regarding condition-specific disability, pain, and life satisfaction.
Keywords: Discogenic chronic back pain, lumbar fusion, nonsurgical treatment, meta-analysis
Abstract: OBJECTIVE: The purpose of this study is to compare the plantar foot pressure and the center of pressure (COP) pathway of normal and flat feet while crossing an obstacle at different heights. METHODS: Nineteen subjects (10 normal feet, 9 flat feet) participated in this study. The plantar foot surface was divided into the following seven regions for pressure measurement: two toe regions, three forefoot regions, one midfoot region, and one heel region. A one-way ANOVA with repeated measurements was used to compare the plantar foot pressure of normal and flat feet according to the obstacle height.…RESULTS: The trend analysis showed a quadratic trend during level walking for the normal foot group, but a linear trend appeared as the obstacle height increased. In the flat foot group, the trend analysis showed a linear trend regardless of the obstacle height. In the 2nd-3rd metatarsal head region, the plantar pressure of the flat foot group increased more than the normal foot group as the obstacle height increased; however, in the 4th-5th metatarsal head region, the plantar pressure in flat feet was lower than in normal feet. In the heel region, the plantar pressure in both groups generally increased as the obstacle height increased, but the plantar pressure in the flat foot group was lower than in the normal foot group. CONCLUSION: We believe that, due to a loss of longitudinal arch, the COP path and plantar pressure of flat feet may be different from normal feet when crossing obstacles of different heights.
Keywords: Plantar pressure, obstacle, flat foot, pathway of COP
Abstract: OBJECTIVES: To compare the thickness of lateral abdominal muscles and Cross Sectional Area (CSA) of lumbar Multifidus Spinae (LM) muscles of competitive off-road cyclists with and without Low Back Pain (LBP). We also aimed to compare the maximum isometric back strength and endurance, as well as flexibility of lower back in cyclists with LBP and in the controls. METHODS: The thickness of Transversus Abdominis (TrA), Internal Oblique (IO) and External Oblique (EO) along with the CSA of LM muscles of 14 professional competitive off-road cyclists with LBP and 24 controls were measured by ultrasound (US) in…hook-lying position on the examination table, and mounted on the bicycle. In addition, the back strength and endurance of the subjects and the flexibility of the participants were measured. RESULTS: Data showed a significantly lower thickness of Transversus Abdominis (TrA) and CSA of LM muscles in cyclists with LBP comparing to controls in all positions. No significant result regarding the flexibility of the subjects in case group comparing with the controls was found (p= 0.674). In addition, it was found that there is no significant difference in isometric back strength of the subjects between the groups (p= 0.105). However, we found that subjects with LBP have a lower endurance in back dynamometry with 50% of their maximum isometric back strength (p= 0.016). CONCLUSION: In this study, useful information regarding possible factors associated with low back pain in off- road cyclists was found (lower thickness of TrA and LM muscles and decreased back endurance).
Abstract: In the present study, we aimed to examine the changes in the thickness of the transversus abdominis (TrA) and internal oblique (Io) muscles using ultrasonography in adults who performed bridge exercises with the abdominal drawing-in maneuver and a sling and received micro vibrations. In total, 32 subjects were divided into a therapy (n= 16) and control (n= 16) groups. The therapy group completed nine sets, with four repetitions, of bridge exercises with the sling and received vibrations. The control group completed nine sets, with four repetitions, of bridge exercises with the sling and did not receive vibrations. The thicknesses of…the TrA and Io muscles were measured in both groups using ultrasonography before and after therapy. According to the pressure applied to the biofeedback unit, both groups showed significant changes in the thicknesses of the TrA and Io muscles after therapy (P< 0.05). The change in the thickness of the TrA muscle after therapy was significantly different between the 2 groups when the pressures applied at 38, 42, and 46 mmHg (P< 0.05). Moreover, the change in the thickness of the Io muscle did not significantly different between the 2 groups at any of the pressures applied (P> 0.05). These findings indicate that approximately 15 minutes of vibrations during bridge exercises on unstable surfaces with a sling facilitates the activation of the deep trunk muscles and further enhances the activation of the TrA.
Abstract: BACKGROUND: Chronic low back pain (CLBP) is a serious health problem in industrialised countries and the efficacy of current treatment options is unsatisfying. OBJECTIVE: The present study examines the effects of a combined intervention that utilizes visual feedback, motion and sensory discrimination training in CLBP patients. METHODS: Thirty patients of an outpatient orthopaedic rehabilitation unit were randomly assigned to either feedback or control group. In addition to standard treatment, patients of the feedback group received 6 feedback sessions where they watched the image of their back during a brief 2-point discrimination training and,…after that, while they were tilting their pelvis up and down on the left and right side using their lumbar musculus multifidus solely. The control group received 6 sessions consisting of 2 units of physiotherapy, relaxation training and movement training (walking) each. RESULTS: A significant effect on self-reported pain and sensory discrimination threshold could be found for the feedback intervention, while, as expected, other pain related variables, like pain anxiety, pain vigilance, depression and cognitive appraisal of pain remained unchanged. CONCLUSIONS: These findings imply that very simple feedback interventions without major technical requirements could be a valuable supplement to standard treatment in CLBP.
Abstract: OBJECTIVE: The aim of this study was to investigate the psychometric properties of the Italian version of the Pain Catastrophizing Scale (PCS-I) in patients with chronic low back pain. METHODS: In a cross sectional study a total of 150 subjects with chronic low back pain were included. The Italian translation of the PCS was administered to all subjects. The properties of the Italian version of the PCS were explored by a Rasch analysis. RESULTS: The PCS-I, by means of few modifications, fitted the Rasch model and passed the independent t-test for a unidimensional scale.…The response categories for item 2 ``I fell I can't go on'' needed to be collapsed from 4 to 3 levels. Only the item 7 ``I keep thinking to of other painful events'' showed fit residual that exceeded the chosen thresholds of ± 2.5. No Differential functioning (DIF) was observed for age, sex, marital status, BMI and smoking. CONCLUSION: The Italian version of PCS, with the purposed modifications, seems to reflect a unidimensional construct of Pain Catastrophizing. The scale seemed to be quite robust across age, sex, marital status, BMI and smoking. Targeting of the scale was moderate. A raw score to metric conversion was proposed.
Abstract: PURPOSE: Lumbar Segmental Instability (LSI) is a subgroup of nonspecific Low Back Pain (NSLBP) without any accepted diagnostic tool as a gold standard. Some authors emphasize on quality measure such as centre of rotation (COR) but construct validity of this measure had not been approved. Therefore the purpose of the present study was to evaluate Concurrent and Convergent validity of COR in differentiating LSI. METHODS: A total of 66 volunteered males participated in three groups named control, NSLBP and LSI groups based on clinical examination. Patients were diagnosed as LSI according to screening criteria adopted by…Hicks et al. Study variables included CORs of lumbar segments in sagittal plane. Three x-rays were taken in neutral, flexion and extension positions. The variables were calculated using CARA software. The ANOVA and Tukey test were utilized in statistic analysis. RESULTS: ANOVA results demonstrated mean differences between three groups for COR of L4 motion segment in y axis (p= 0/008) and L5 motion segment in y axis (p= 0/005) were significant. Tukey test showed significant difference for COR of L4 motion segment in y axis between LSI and healthy groups (p= 0/038) and between LSI and NSLBP groups (p= 0/009). For COR of L5 motion segment in y axis, tukey test demonstrated mean difference between LSI and healthy groups (p= 0/028) and between LSI and NSLBP groups (p= 0/007) were significant. Tukey test did't show any significant difference between NSLBP and healthy groups for COR of L4 (p= 0/852) and L5 (p= 0/871) motion segments in y-axis. CONCLUSIONS: The COR has ability to differentiate patients with signs and symptoms of LSI from other NSLBP and healthy subjects based on the present study results. However, more researches are needed to develop and support results of this study.
Abstract: BACKGROUND: In a recent genome wide association study, polymorphisms in the DSCAM and CNTNAP2 genes were reported to be related with susceptibility of AIS. Consequently, further replication studies are warranted in other populations due to ethnic difference in genetic background. OBJECTIVE: To explore whether single nucleotide polymorphisms (SNPs) of DSCAM (rs2222973) and CNTNAP2 (rs11770843) genes are associated with the susceptibility and curve severity of AIS in a Chinese Han population. METHODS: A total of 648 AIS patients and 573 age- and sex-matched healthy adolescents…in rs2222973 were recruited, and in rs11770843 there were 100 AIS patients and 100 age- and sex-matched healthy adolescents included in present study. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was repeatedly carried out to verify the linkage of AIS with SNPs rs2222973 in the DSCAM gene and rs11770843 in the CNTNAP2 gene. Case-control and case-only studies were respectively performed to define the contribution of the DSCAM gene polymorphisms to predisposition and disease severity of AIS. RESULTS: Association analysis of the DSCAM SNP rs2222973 with AIS revealed no significant differences both in genotype frequency (p= 0.280) and allelic frequency (p= 0.643). The CNTNAP2 SNP rs11770843 (C/T) was not found in either the AIS or control group; all 100 AIS patients and 100 normal controls had the T/T genotype. Among skeletally matured AIS patients, the average maximal Cobb angles were also comparable within different DSCAM genotypes. CONCLUSION: Our study did not repeatedly confirm the association of the rs2222973 or the rs11770843 with AIS in a Chinese Han population. We concluded that the associations of rs2222973 with AIS predisposition and curve severity are negative in a Chinese Han population.
Keywords: Adolescent idiopathic scoliosis, DSCAM and CNTNAP2 genes, single nucleotide polymorphism
Abstract: BACKGROUND: The use of bandages improves quasi-static posture control in individuals with knee osteoarthritis, but it is unknown whether this increased sensory input influences postural control in dynamic tasks. OBJECTIVE: Assess the effect of bandage use on motor performance and reported pain in individuals with knee osteoarthritis during obstacle crossing. METHODS: Twenty-four individuals with knee osteoarthritis were enrolled. A force plate was used to measure the vertical and anterior-posterior components of the ground reaction force during obstacle crossing, for the trailing and leading legs, under conditions with and…without the use of a bandage. Pain was assessed using the visual analogue scale. RESULTS: With use of a bandage, the propulsive time, time to active peak, propulsive peak, passive peak, and active impulse were significantly reduced in the trailing leg, and the braking peak was significantly increased in the leading leg. The pain parameters did not exhibit any variation. CONCLUSIONS: These results suggest that the use of a bandage allowed for a more rapid movement, better estimates of the force applied against the ground in the propulsive stage, and a reduction in the overload on the locomotor system in the loading response stage.