Journal of Back and Musculoskeletal Rehabilitation - Volume 29, 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: Neuromuscular scoliosis (NMS) is the second most prevalent spinal deformity (after idiopathic scoliosis) and is usually first identified during early childhood. Cerebral palsy (CP) is the most common cause of NMS, followed by Duchenne muscular dystrophy (DMD). Progressive spinal deformity causes difficulty with daily care, walking and sitting, and can lead to back and rib pain, cardiac and pulmonary complications, altered seizure thresholds, and skin compromise. Early referral to specialist spinal services and early diagnosis of NMS is essential to ensure appropriate multidisciplinary patient management. The most important goals for patients are preservation of function, facilitation of daily care, and…alleviation of pain. Non-operative management includes observation or bracing for less severe and flexible deformity in young patients as a temporising measure to provide postural support. Surgical correction and stabilisation of NMS is considered for patients with a deformity >40-50°, but may be performed for less severe deformity in patients with DMD. Post-operative intensive care, early mobilisation and nutritional supplementation aim to minimise the rate of post-surgical complications, which are relatively common in this patient group. However, surgical management of NMS is associated with good long-term outcomes and high satisfaction rates for patients, their relatives and carers.
Abstract: Low back pain is one of the four most common disorders in all regions, and the greatest contributor to disability worldwide, adding 10.7% of total years lost due to this health state. The etiology of chronic low back pain is, in most of the cases (up to 85%), unknown or nonspecific, while the specific causes (specific spinal pathology and neuropathic/radicular disorders) are uncommon. Central sensitization has been recently recognized as a potential pathophysiological mechanism underlying a group of chronic pain conditions, and may be a contributory factor for a sub-group of patients with chronic low back pain. The purposes of…this narrative review are twofold. First, to describe central sensitization and its symptoms and signs in patients with chronic pain disorders in order to allow its recognition in patients with nonspecific low back pain. Second, to provide general treatment principles of chronic low back pain with particular emphasis on pharmacotherapy targeting central sensitization.
Keywords: Chronic low back pain, chronic disorders, central sensitization
Abstract: OBJECTIVE: The objective of this meta-analysis was to systematically assess the association between aortic calcification (AC) and fractures. METHOD: Relevant studies were identified through searching PubMed, EMBASE and Cochrane databases before August 2014. Two investigators extracted data independently from the included studies. A random-effects model was derived to composite the pooled HRs or ORs for association of aortic calcification with fractures. RESULTS: A total of 15 articles (21927 subjects) were included in the final meta-analyses. Comparing with non-calcification subjects, patients with aortic calcification were associated with increased risk of fractures (OR = 2.97,…95% CI: 1.98-4.42). Stratified analysis indicated that patients with aortic calcification showed a higher risk of fractures in hemodialysis patients (OR = 1.89, 95% CI: 1.33-2.67; I2 = 0.0%, p= 0.781) and general population (OR = 2.90, 95% CI: 1.80-4.80; I2 = 33.0%, p= 0.225), respectively. Similar significant association between severe aortic calcification and fractures were also observed. CONCLUSIONS: Patients with aortic calcification or severe aortic calcification were associated with higher risk of fractures.
Abstract: OBJECTIVE: The purpose of this study was to investigate the relationship between flexion-rotation test and ultrasound (US) thickness measurement of the antero-lateral abdominal muscles. DESIGN: Following ethical approval, a convenience sample of 55 subjects between the ages of 20 and 30 years participated in this study. Endurance of the abdominal muscles was measured using the flexion-rotation test in all subjects. US thickness measurement for the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles was performed on the right side at rest in a supine position. RESULTS: Pearson correlation coefficient between…the variables of the study showed no significant relationship between the flexion-rotation test and US thickness measurements of the TrA (r = -0.03, P = 0.80), IO (r = -0.13, P = 0.32), and EO (r = -0.14, P = 0.31) muscles. The significance level of 0.05 was chosen. CONCLUSION: It seems that there is no significant relationship between the flexion-rotation test and US measurement of abdominal muscles thickness.
Keywords: Ultrasound, thickness, endurance, abdominal muscles, clinical test
Abstract: BACKGROUND: Pilates programs are widely used as a form of regular exercise in a broad range of populations investigating their effectiveness for chronic low back pain (CLBP) treatment. OBJECTIVE: The aim of this study was to compare the effects of a Pilates program and a trunk strengthening exercise program on functional disability and health-related quality of life (HRQOL) in women with nonspecific CLBP. METHODS: A total of 101 volunteer women with CLBP provided data with a 3-month follow-up. They were randomized to either a Pilates (n= 37), trunk strengthening exercise (n= 36) or…a control group (n= 28), exercising for a period of 8 weeks, three times a week. Data were collected on HRQOL using the Short-Form 36 Health Survey (SF-36v2), and functional disability using the Roland Morris Disability Questionnaire prior to program initiation, mid-intervention, immediately after program termination, and three months post-intervention. RESULTS: The Pilates participants reported greater improvements on self-reported functional disability and HRQOL compared with participants in the trunk strengthening exercise and control groups (p < 0.05). The effects were retained for a period of three months after program termination for the Pilates group and to a lesser extent for the trunk strengthening exercise group. CONCLUSIONS: An 8-week Pilates program improved HRQOL and reduced functional disability more than either a trunk strengthening exercise program or controls among women with CLBP.
Abstract: OBJECTIVE: To investigate the effect of transcutaneous electrical nerve stimulation (TENS) on clinical recovery in the management of patients with complex regional pain syndrome Type I (CRPS Type I). MATERIAL AND METHOD: The study included 30 patients with stage 1 and 2 CRPS Type I in the upper extremities. The patients were randomly assigned into 2 groups, group 1 (n= 15) received conventional TENS therapy for 20 minutes, and group 2 (n= 15) received sham TENS therapy. The standard physical therapy program, which included contrast bath for 20 minutes; whirlpool bath for 15 minutes; assisted active…and passive range of motion, and static stretching exercises up to the pain threshold, was also conducted in both groups. Therapy was scheduled for 15 sessions. A visual analogue scale (VAS) was used to assess spontaneous pain. The Leeds Assessment of Neuropathic Signs and Symptoms (LANSS) scale and the Douleur Neuropathique en 4 Questions (DN-4) were used to assess neuropathic pain. In addition, range of motion (ROM) was measured using a goniometer and volumetric measurements were taken to assess edema. Functional capacity was assessed using a hand dynamometer and the Duruöz Hand Index (DHI). All measurements were performed at baseline and after therapy. RESULTS: Significant improvements were achieved in spontaneous and neuropathic pain scores, edema, ROM, and functional capacity in both groups (p< 0.05). However, improvement was found to be significantly greater in group 1 regarding pain intensity, neuropathic pain assessed using LANNS, edema, and in the 2nd -3rd finger ROM measurements (p< 0.05). No significant difference was detected between groups regarding improvements in 4th -5th finger and wrist ROM measurements, grip strength, and DN4 and DHI scores (p> 0.05). CONCLUSION: The addition of TENS to the physical therapy program was seen to make a significant contribution to clinical recovery in CRPS Type 1.
Abstract: BACKGROUND: Approaches in the treatment of general chronic low back pain (CLBP) are multifaceted relative to specific interventions. In the past, passive interventions have commonly been employed with little evidence to support their effectiveness. Recent reviews suggest a focus on active exercises programs that includes pain education and cognitive behavioral therapy. OBJECTIVE: To investigate the outcomes of CLBP patients and describe the approach in persons undergoing a group spinal rehabilitation program using graded exercise, and operant conditioning. METHODS: Adult patients with CLBP participated in a twice weekly 90 minute exercise sessions for 8-weeks…(n= 201). The program consisted of behavioral education, stretching, aerobic exercises, graded progressive resistance exercise, MedX isotonic strengthening, and functional bending lifting task exercises. RESULTS: A total of 201 patient records were evaluated where the overall ODI improvement was 13.2% (± 14.0) (p< 0.001). There were significant and clinically meaningful improvements in flexibility, VAS, functional lifting tasks (p< 0.001), and lumbar extension strength (p= 0.01) at 8-week follow-up. Questionnaires were delivered via mail with a 21% return rate revealed sustained improvements. CONCLUSION: CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although further investigation is warranted due to limited survey return rate and study design.
Keywords: Kinesiophobia, graded exercise, group therapy, Oswestry, operant conditioning, rehabilitation, chronic low back pain
Abstract: In the past two decades, the cost associated with managing low back pain has increased significantly. Improved consciousness of how clinicians utilize resources when managing low back pain is necessary in the current economic climate. The goal of this review is to examine the component costs associated with managing low back pain and provide practical solutions for reducing healthcare costs. This is accomplished by utilizing examples from a major metropolitan area with several major academic institutions and private health care centers. It is clear that there is considerable local and national variation in the component costs of managing low back…pain, including physician visits, imaging studies, medications, and therapy services. By being well informed about these variations in one's environment, clinicians and patients alike can make strides towards reducing the financial impact of low back pain. Investigation of the cost discrepancies for services within one's community of practice is important. Improved public access to both cost and outcomes data is needed.
Keywords: Health expenditure, low back pain, delivery of health care
Abstract: BACKGROUND: Transforaminal epidural steroid injection (TESI) is a frequently used intervention for lumbar radicular pain. OBJECTIVE: To evaluate the value of MRI findings, neurologic assessment and the Slump test (neurodynamic test) as predictors of treatment response to TESI. METHOD: One hundred subjects (mean age 58 [SD13], 54% females) were included in this trial. The sample was stratified by location of disc herniaton, grade of nerve root compression, clinically assessed neurologic deficit and positive Slump test. Treatment response was primarily evaluated by Visual Analogue Scale for leg pain after three weeks. Predictive value for…each stratum was analyzed using logistic regression after the sample was dichotomized into definite treatment response (≥ 50% reduction of pain) and negative response (≤ 0% reduction) to TESI (the 1-49% reduction group was excluded). RESULTS: The overall definite treatment response rate was 27%. The Slump test was the only predictor of the response to TESI (p= 0.031). The definite treatment response rates for subjects with positive and negative Slump test were 33% and 15%, respectively. CONCLUSION: In patients with chronic low back related leg pain, MRI findings and neurologic assessment results failed to predict treatment response, whereas a positive Slump test predicted the best 3-week response to TESI.
Keywords: Lumbar radicular pain, transforaminal epidural steroid injection, predictive value of tests
Abstract: BACKGROUND: Psoriatic arthritis (PsA) is a common form of arthritis that may vary from asymmetric oligoarthritis to symmetric polyarthritis and spondyloarthritis. OBJECTIVES: To evaluate femoral cartilage thickness using ultrasonography in patients with PsA. METHODS: Thirty-three patients (24 female, 9 male) with a diagnosis of PsA and 31 age-, sex- and body mass index-similar healthy subjects were enrolled in this study. Demographic and clinical characteristics of the patients were recorded, including disease duration, morning stiffness and medications. The femoral cartilage thicknesses of both knees (while held in maximum flexion) were measured with a 7-12…MHz linear probe. Three mid-point measurements were taken from both knees (at the lateral condyle, intercondylar area and medial condyle). RESULTS: Cartilage thicknesses were similar between PsA patients and healthy control subjects. However, there were significant correlations between cartilage thickness and the Maastricht Ankylosing Spondylitis Enthesitis Score, Bath AS functional index and Bath AS disease activity index scores. CONCLUSION: Femoral cartilage thickness is similar between PsA patients and healthy controls. The femoral cartilage thickness in PsA patients is associated with disease activity, functional inadequacy, and enthesopathy scores.