Journal of Back and Musculoskeletal Rehabilitation - Volume 30, 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: BACKGROUND: Measurement of lumbar spine movement and neuro-dynamic flexibility is fundamental to clinical examination and forms part of most systems or protocols used to classify patients with low back pain. However, the increased age and body mass index reported in the chronic low back pain subgroup, may compromise the reliability of these measurements. Specifically, this relates to greater soft tissue excursion relative to the underlying bony landmarks used for these clinical tests. OBJECTIVE: The objective of this research was to determine the intra-examiner reliability for six lumbar spine and two neuro-dynamic examination tests in older and…overweight individuals selected to represent a similar age and body mass index of a chronic low back pain population. METHODS: Nineteen volunteers (56.00 ± 7.62 years) performed sets of eight lumbar spine examination tests. Five repetitions of each set of tests were conducted with rest periods between sets. One examiner measured lumbar flexion, extension, right and left lateral flexion and rotation using a tape measure. A goniometer was used to measure Slump and Passive Straight Leg Raise (PSLR) test. RESULTS: Intra-class correlation coefficients (ICC intra ) were calculated to evaluate the reliability of measurement for each test. The eight tests showed ICC ranges between `Large' and `Nearly Perfect' (0.68-0.99). Measurement of lateral flexion and rotation had the highest reliability and extension the lowest. CONCLUSIONS: This study was conducted on an asymptomatic older, overweight population and the ICC results support the suitability of these methods and tools for measurement in a clinical setting for this population demographic. Measurement reliability in the study population was comparable with previous research in populations of contrasting demographics. Accordingly, further investigation specifically in a chronic low back pain population is indicated as the paucity of previous literature for some of the movement tests disallowed comparisons, and the reliability reported in this study may not be directly transferable to a chronic low back pain population.
Abstract: BACKGROUND: Passive Intervertebral Movements (PIVMs) are commonly used to assess and treat patients with non-specific neck pain. Only very few studies have investigated 3D movements until now. OBJECTIVE: This study assessed intra- and inter-rater reliability of three-dimensional (3D) cervical PIVMs performed by physical therapy students in patients with non-specific neck pain. METHODS: Thirty-one patients, mean age 47.2 ± 7.2 years, were independently evaluated by 2 physical therapy students. The raters (A and B) assessed mobility, end-feel and pain provocation performing bilaterally the 3D cervical segmental side-bending test (3D CSSB) from levels C2-C3…to C6-C7. Percentage agreement (raw, positive and negative), Cohen's kappa (95% CI), prevalence index and bias index were calculated to estimate intra- and inter-reliability. RESULTS: Intra-rater reliability showed kappa values ranging between fair and substantial (k 0.29-0.80) for pain provocation, mobility and end-feel, with percentage agreements between 61%-90%. Inter-rater reliability presented kappa values ranging between fair and substantial (k 0.22-0.62) for pain provocation, mobility and end-feel, with percentage agreements between 61% and 80%. CONCLUSIONS: Intra-rater reliability of 3D PIVMs was superior to inter-rater reliability in patients with non-specific neck pain. The most repeatable evaluation parameter was pain. However overall poor reliability suggests avoiding the use of these techniques alone to examine patients and measure their outcome. Further studies are needed to investigate PIVMs reliability in combination with other assessment procedure in symptomatic patients.
Abstract: BACKGROUND: Although there are studies evaluating pain in Parkinson's disease (PD), to our knowledge, there is no study evaluating the following topics in a cohort of PD patients; (1) frequency of chronic pain, (2) characteristics of chronic pain, (3) severity of chronic pain, (4) types of chronic pain, (5) independent predictors of chronic pain, (6) impact of chronic pain on health-related quality of life (HRQoL), and (7) the role of chronic pain among the independent predictors of HRQoL. OBJECTIVE: The purpose of this study was to evaluate the frequency, characteristics, severity, types, and independent factors of…chronic pain, as well as the relationship of chronic pain with HRQoL in a cohort of PD patients. METHODS: One-hundred and thirteen individuals with a confirmed diagnosis of PD who were consecutively referred to the Ministry of Health Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Movement Disorders Outpatient Clinic were included in the study. Demographic variables, disease characteristics, disease-related motor symptoms and motor complications, comorbid conditions, and health-related quality of life were evaluated and recorded. Pain lasting longer than three months was defined as `chronic pain' and participants were questioned relating to the characteristics of the chronic pain. The Visual Analogue Scale was used for assessment of pain. RESULTS: Seventy-three patients (64.6%) suffered from chronic pain. Of these, 12 (16.4%) had previous pain at the time of diagnosis of PD. The sources of pain experienced by patients were 89.0% musculoskeletal, 31.5% radicular/peripheral neuropathic, 15.1% dystonic, and 4.1% central parkinsonian, respectively. Twenty-six patients (35.6%) had different types of pain simultaneously. The pain type with the highest severity was a central parkinsonian pain. The independent predictors of chronic pain included gender (female), Unified Parkinson's Disease Rating Scale (UPDRS) part II (activities of daily living), UPDRS part III (motor symptoms) rigidity subscore, and depression. When compared with individuals not having chronic pain, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Physical Component Summary and Mental Component Summary scores were lower in patients with chronic pain. Also, it was shown that the most significant factor on SF-36 was chronic pain. CONCLUSIONS: This study demonstrated that chronic pain is a common problem in patients with PD, that different pain types may co-exist, and that they may negatively affect the HRQoL of patients. Chronic pain was correlated with both disease-related factors such as rigidity and daily living activities and also general factors such as gender and depression. We found that chronic pain is the most significant predictor of quality of life in PD patients. We believe, that in addition to treating motor symptoms and complications associated with them, treatment of comorbid conditions such as pain and depression bear significance for improving the quality of life in PD patients. The study indicates that PD patients who are optimally treated, may require additional rehabilitation treatment for non-motor associated pain and thus improve their HRQoL.
Keywords: Parkinson's disease, chronic pain, pain characteristics, health-related quality of life
Abstract: BACKGROUND: Failed back surgery syndrome (FBSS) is a condition characterized by persistent pain following back surgeries. OBJECTIVE: To determine the effects of different exercises programs in FBSS. METHODS: A single-blind, randomized, controlled trial designed. One hundred participants with failed back surgery syndrome were randomly assigned to three different exercises groups (Isokinetic, Dynamic lumbar stabilization (DLS), and home exercises (HE) groups) and a control group. Patients were evaluated before and after 8-week exercise program and follow-ups at the 3rd and 6th months after the exercise program. Finger-floor distance and lumbar Schober for…lumbar mobility, visual analog scale (VAS) for pain, Modified Oswestry Disability Index, Beck Depression Inventory, fear-avoidance attitudes survey, and progressive-isoinertial weight lifting test were used as follow-up parameters. Lumbar muscle strength was assessed with the isokinetic dynamometer. RESULTS: VAS levels were decreased from 67.7 to 22.8 in isokinetic and from 68.7 to 25.0 in DLS and from 64.6 to 47.1 in HE groups at the end of the program (p< 0.05). Also, all of other follow-up parameters of the isokinetic and DLS exercise groups viewed significant improvements compared to the control group. CONCLUSIONS: According to our results either isokinetic or DLS exercises are more effective in FBSS patients.
Keywords: Dynamic lumbar stabilization, exercise, failed back surgery syndrome, treatment, isokinetic
Abstract: BACKGROUND: Transcutaneous neuromuscular electrical stimulation (NMES) is known to stimulate contraction of deep lumbar stabilizing muscles. OBJECTIVE: The purpose of this study was to investigate changes in deep lumbar stabilizing muscle thickness during transcutaneous NMES on specific abdominal wall and paraspinal regions. METHODS: Thirty patients with low back pain (LBP) were recruited. Three sessions were preformed: Session 1: NMES on abdominal wall, Session 2: NMES on lumbar paraspinal area, and Session 3: concurrent NMES on abdominal wall and lumbar paraspinal area. Real time ultrasound imaging (RUSI) of three abdominal stabilizing muscles; transverse abdominis…(TrA), obliquus internus (OI), obliquus externus (OE) muscles and one posterior stabilizer, the lumbar multifidus muscles (LM) was captured. RESULTS: All studied muscles of TrA, OI, OE, and LM were found to have significant thickness increases during all three sessions compared to resting state (p < 0.05). Thicknesses changes of TrA, OI, and LM were significant during simultaneous NMES of both abdominal wall and lumbar paraspinal regions (Session 3) (p < 0.05). CONCLUSIONS: Our results indicate that concurrent NMES on abdominal wall and lumbar paraspinal area is most effective to maximally activate deep lumbar stabilizers. Rehabilitative efforts for patients with LBP may benefit from simultaneous transcutaneous NMES of abdominal and lumbar regions.
Keywords: Neuromuscular electrical stimulation, lumbar stabilizing muscle, real time ultrasound imaging, low back pain
Abstract: OBJECTIVES: Lumbar disc herniation leads to disability by restricting of patients' lives and reducing their quality of life. This situation causes a decrease in motivation of patients by triggering depressive mood. Therefore, the aim of the study was investigation of correlation between fear avoidance beliefs and burnout syndrome in patients with lumbar disc herniation. METHODS: Totally forty-seven patients (24 male and 23 female patients) diagnosed lumbar disc herniation was included in this study. Maslach II Burnout Inventory (MBI) and Fear Avoidance Beliefs Questionnaire (FABQ) for determining of levels of burnout and fear avoidance level were used,…respectively. RESULTS: It was observed that MBI and FABQ scores of the patients were 50.78 ± 10.07 and 36.61 ± 13.91, respectively. Moderate level correlation was found between FABQ and MBI total scores (r= 0.49, p= 0.00). CONCLUSIONS: Fear avoidance beliefs of patients with chronic back pain can affect level of burnout syndrome. Therefore, symptoms of burnout syndrome and fear avoidance beliefs of patients should be considered in evaluation and treatment process.
Abstract: BACKGROUND: Low back pain (LBP) is one of the most common health complaints, with lifetime prevalence rates as high as 84%. The Oswestry Disability Index (ODI) is often the measure of choice for LBP in both research and clinical settings and, as such, has been translated into 29 languages and dialects. Currently, however, there is no validated version of Hebrew-translated ODI (ODI-H). OBJECTIVE: To examine the psychometric properties of the ODI-H. METHODS: Cross-culturally appropriate translation into Hebrew was conducted. A convenience sample of 115 participants (Case Group) with LBP and 68 without LBP…(Control Group) completed the ODI-H, SF-36 Health Survey, and two Visual Analog Scales (VAS). RESULTS: Internal consistency was α = 0.94 and test-retest reliability for 18 participants repeating the ODI-H was 0.97. No floor or ceiling effects were noted for Cases, although there was a floor effect for the Control Group. Scores were significantly different for the two groups, indicating discriminant validity. Concurrent validity was reflected by significant correlations with SF-36 scores, particularly the Physical Functioning and Bodily Pain subscales (-0.83 and -0.79, respectively) and with the VAS (0.84 and 0.79). CONCLUSIONS: The ODI-H is a valid and reliable measure of low back pain-related disability for the Hebrew-speaking public.
Keywords: Oswestry Disability Index, ODI, Hebrew, low back pain, validation, SF-36 Health Survey, Visual Analog Scale, translation, reliability, psychometric, assessment
Abstract: PURPOSE: The purpose this study was perform a biomechanical evaluation to compare the influence of commercial models of different non-articular proximal forearm orthoses widths (2.5 cm, 5.5 cm, 7.5 cm and 12.0 cm) in the extensor muscle activation, range of motion and grip strength in healthy subjects. METHODS: Was analyzed data from extensor carpi radialis, extensor carpi ulnares and extensor digitorum comunis using surface electromyography, simultaneous with a wrist electrogoniometer MiotecTM and a hydraulic dynamometer JamarTM . The sequence of tests with all the commercial orthoses models was randomized. Statistics analyses were performed by linear…model with mixed effects. RESULTS: According to our findings the non-articular proximal forearm orthoses (2.5 cm - narrowest) positioned close to lateral epicondyle provided lesser muscle activation on extensor carpi radialis brevis/longus and extensor digitorum comunis, decreased wrist extension and grip strength during submaximal grip task (p< 0.01). CONCLUSIONS: A narrow non-articular proximal forearm orthosis positioned close to the lateral epicondyle might decrease the extensor muscle activation and therefore could reduce mechanical stress on its insertion, based on this sample. Clinical studies must be conducted to confirm these findings.
Abstract: BACKGROUND: Fascial dehiscence after spinal instrumentation is usually located at the mechanically stressed interscapular thoracic spine and often causes cosmetic impairment and pain. However, therapy options remain barely discussed. Synthetic meshes have been successfully used in the treatment of abdominal hernias. OBJECTIVE: It was hypothesized that synthetic meshes are a successful treatment option for spinal fascial dehiscence. METHODS: This retrospective study of a prospective database investigated all consecutive patients who received a synthetic mesh for a fascial dehiscence of the spine between 2010 and 2014 after prior spinal instrumentation. Primary outcomes were healing…of the fascial dehiscence, recurrence, infection, revision, subjective satisfaction on a visual analog scale (VAS), and the Oswestry Disability Index (ODI). Among others, secondary outcomes consisted of seroma formation and return to work. The evaluated risk factors consisted of the body mass index (BMI), outer abdominal fat (OAF), back tissue, smoking, immunomodulatory therapy, preoperative radiation dose, and instrumented levels. RESULTS: Sixteen patients with a mean follow up of 24 (SD 15) months were included. Every fascial dehiscence successfully healed with the synthetic mesh and there were no recurrences, infections or revisions. The mean subjective satisfaction level was VAS 7.3 and the mean ODI was 26%. Five (31%) patients had a seroma postoperatively, but did not show any differences in the outcome (e.g. ODI of 28%). In the patient group < 65 years (n = 12), all but two patients, who had work restrictions due to other diseases, regained at least some capacity to work. Worse ODI scores were found for patients with increased BMI, OAF, back tissue, cortisone therapy, instrumented levels, preoperative radiation dose, and smokers. CONCLUSION: Synthetic meshes are a successful treatment option for spinal fascial dehiscence, even seemingly in patients with a higher risk profile such as obese and immunocompromised patients as well as in revision procedures. They are associated with respectable cosmetic results, pain relief and clinical outcome. Postoperatively, it is recommended to leave drains for more than five to seven days in order to avoid seroma formation and to avoid weight training for six weeks. Further prospective, comparative studies are recommended.
Keywords: Synthetic mesh, spinal fascial dehiscence, instrumentation of the spine, Oswestry Disability Index (ODI), patient satisfaction
Abstract: BACKGROUND: Postural control allows performance of daily and sports activities. The previous studies show that postural sway inceases in orthopaedic injuries such as osteoarthritis and total knee arthroplasty. OBJECTIVE: To compare postural sway, risk of falling and function between individuals with and without patellofemoral pain syndrome (PFS). METHODS: This study included 22 subjects with patellofemoral pain syndrome, age-matched pain-free 22 females serving as a control group. Visual anolog scale and Kujala were used to evaluate the pain. Posturographic assesment was performed by Tetrax posturographic device. Biering Modified Sorenson test for extensor endurance and…sit-up test for flexor endurance were used for the evaluation of trunk endurance. Timed get-up and go test was used for lower extremity function. The Student's t Test was used to compare variables between the groups. The Pearson correlation coefficients were calculated to examine correlation between the quantitative variables. RESULTS: Postural sway included eyes open without pillow, eyes open on pillow, eyes closed on pillow, risk of falling, function and postural stabilization included flexor endurance, extansor endurance are impared in patient with patellofemoral pain syndrome when compare to controls. In subjects with PFPS increased postural sway significantly associated with body mass index (r= 0.52), pain duration (r= 0.43), postural control (extansor endurance) (r= -0.50) and risk of falling (r= 0.62) on pillow with open eyes. In addition we found function significantly related with postural control (extansor endurance and flexor endurance) (r= -0.59 and r= -0.59) and risk of falling (r= 0.77) CONCLUSIONS: Decreased neuromuscular control of the trunk core and increased postural sway and falling risk were found in patients with PFPS. Patients may be evaluated for deficits in postural control and falling risk before treatment.
Keywords: Patellofemoral pain syndrome, postural sway, postural control, falling, function