Journal of Back and Musculoskeletal Rehabilitation - Volume 30, 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: The significance of fluoroscopy-guided transforaminal epidural steroid injections (TFESI) in the treatment of lumbar disc herniation (LDH) is well known. The aim of our study is to investigate the effectiveness of TFESI on radicular pain, functionality, psychological status, and sleep quality in patients with LDH. METHODS: Seventy-five LDH patients (36 males, 39 females) were enrolled in the study. All patients received a fluoroscopically guided TFESI (betamethasone 40 mg, lidocaine 2%). Also all patients were evaluated according to (with the visual analogue scale) radicular pain, Oswestry disability index (ODI), hospital axiety and depression scale, and Pittsburgh…sleep quality index (PSQI) at baseline, at two weeks, and 12 months post injections. RESULTS: Mean age was 46.4 ± 12.5. When compared to baseline measurements there were significant improvements in radicular pain, ODI, modified schober, Laseque angle, finger to floor distance, depressive symptoms and PSQI scores at two weeks and 12 months after injection. Improvement of at least 50% in radicular pain relief, ODI score and sleep quality index was detected at two weeks 83%, 71%, 69% respectively. This rate showed regression at 12 months of 73%, 65% and 62% respectively. Duration of symptoms was significantly negatively correlated with changes in scores of radicular pain, ODI, depressive symptoms, and PSQI. There were no significant correlations with symptom duration and anxious symptoms. CONCLUSION: Fluoroscopy guided TFESI had positive effects on radicular pain, functionality, depressive symptoms and sleep quality in management of LDH.
Abstract: BACKGROUND: Complementary and alternative medicine (CAM) use has been increasing. OBJECTIVE: To identify the factors associated with perceived benefit from CAM methods in back problems. METHODS: The study was conducted on patients who practiced any CAM methods due to complaints of back pain. Social-demographic properties, details of CAM methods employed were questioned. Severity of pain was measured by visual analog scale (VAS); benefits were evaluated by the Likert scale. Hierarchical cluster analysis was used to discover relationships among variables. RESULTS: In total, 500 patients (265 female, 235 male)…were included in the study. Mostly used methods were herbal therapy (32%), balneotherapy (31%), cupping (19.4%) and massage-manipulation (19.2%). Of patients, 355 (71%) were satisfied. The variables associated with benefit finding were female gender, age, chronicity and severity of pain, high educational level, upper middle income status, use as a result of recommendation, dissatisfaction with conventional methods, residence in an urban area, non-herbal method use, being married, and social insurance (p < 0.005). CONCLUSION: The majority of patients using CAM perceived benefits; in particular, women living in urban areas, highly educated, aged more than 40, who suffer from severe chronic back pain, may be more inclined to go to CAM therapists.
Keywords: Complementary medicine, alternative medicine, back pain, benefit, cluster analysis
Abstract: BACKGROUND: Although low back pain (LBP) is a debilitating problem internationally, there is not a lot of research on its impact on physical, psychosocial and lifestyle factors. Especially in mediterranean countries, such as Greece, it is not sufficiently explored whether physical (pain location, activity limitation etc.), sociodemographic (education, smoking etc.) or lifestyle factors (i.e. quality of life or anxiety) are influenced by LBP. OBJECTIVE: To estimate LBP prevalence in the Greek general population and explore its association with particular sociodemographic, physical and lifestyle factors. METHOD: A sample of 3125 people of the Greek…adult population was randomly selected by stratified sampling encompassing rural and urban representation within the Greek mainland. An extended survey form was developed entailing three sections; personal (sociodemographic) information, questions on symptomatology and physical factors (i.e. pain characteristics, recurrence, physical disability etc.) and 3 self-administered questionnaires (including mostly lifestyle factors); Hospital Anxiety and Depression (HAD) scale for anxiety and depression, SF-12 for quality of life (QoL) and Roland-Morris for disability. RESULTS: A total of 471 (15%) people reported LBP (210 males, mean age: 47.04 ± 15.03). Amongst them 60% reported sciatica, 76% suffered recurrent LBP and 70% received specialist care. Low disability levels, moderate to high pain intensity, gender differences and good self-reported QoL and psychosocial status were reported. Sociodemographic characteristics (income, smoking, marital status etc.) were not associated with LBP physical factors, apart from age which correlated with physical disability and wellness (r being 0.446 and 0.405, respectively, p< 0.001). Physical factors (particularly pain intensity and location) correlated with lifestyle factors (QoL) and disability (r ranging between 0.396 and 0.543, p< 0.001). Mental wellness, anxiety and depression (as lifestyle factors) were not associated with sociodemographic or physical factors. CONCLUSIONS: Physical parameters were amongst the most prevalent characteristics of the Greek sample, thus offering a direction towards a more targeted treatment and rehabilitation planning. Unlike previous literature, most sociodemographic characteristics were not correlated with any LBP physical or lifestyle factors, thus possibly indicating a different socioeconomic background and aetiology domain to that of the usual non-specific LBP spectrum.
Keywords: Low back pain, prevalence, physical, sociodemographic, lifestyle, Greece
Abstract: BACKGROUND: Although there are several studies of Transcutaneous Electrical Nerve Stimulation (TENS) and exercise in myofascial pain syndrome, there are no studies comparing the effectiveness of Kinesio Taping (KT) and TENS in myofascial pain syndrome patients. OBJECTIVE: To compare the early and late effects of TENS and KT on pain, disability and range of motion in myofascial pain syndrome patients. METHODS: Sixty-nine patients were divided into three groups randomly as TENS+Exercise, KT+Exercise and exercise groups. Visual Analogue Scale (VAS), pain threshold, Neck Disability Index and cervical contralateral lateral flexion were employed in the…evaluation of the patients performed before treatment, after treatment and 3rd month after treatment. RESULTS: The VAS, pain threshold, Neck Disability Index and contralateral lateral flexion values were improved in all groups both in after treatment and 3rd month after treatment (p< 0.01). In the comparison of after treatment vs. before treatment evaluations, VAS score was decreased in KT group compared to the TENS and control group (p= 0.001), in the TENS group compared to control group (p= 0.011). In the comparison of 3rd month and before treatment evaluations, VAS score was decreased in the TENS group compared to control group (p= 0.001) and in the KT group compared to the control group (p= 0.001). There was no significant difference between TENS and KT groups. All other parameters did not differ between the groups. CONCLUSIONS: TENS and KT added exercises can decrease pain severity and increase pain threshold, function and cervical range of motion in myofascial pain syndrome patients. Addition of TENS or KT to the exercise therapy resulted in more significant improvement compared to exercise therapy alone with a more pronounced improvement in KT group compared to the TENS group in the early period. Because KT was found to be more effective in decreasing the pain and had the advantage of being used in every 3 days, it seems to be beneficial in acute painful periods in myofascial pain syndrome patients.
Abstract: BACKGROUND: Previous studies have reported strength deficit in hip abduction, extension and external rotation in females with patellofemoral pain (PFP) when compared with healthy control; however, there is conflicting evidence for a decrease in hip muscle endurance. Therefore, it seems important to evaluate hip muscle endurance in females with PFP. Moreover, trunk extensor and ankle plantar flexor endurance have not yet been evaluate in females with PFP. OBJECTIVE: To compare hip abductor, trunk extensor and ankle plantar flexor endurance between females with and without PFP. METHODS: Twenty females with PFP (mean age, 21.1…years) and 76 healthy females (mean age, 20.5 years) were recruited. Subject performed three endurance clinical tests: (1) The hip abductor isometric endurance test, (2) The Sorensen test and (3) The heel rise test. Group differences were assessed using an independent t tests, or Mann-Whitney U tests for non-normally distributed data. RESULTS: Subjects with PFP exhibited significantly lower hip abductor, trunk extensor and ankle plantar flexor endurance than healthy controls. On average, subjects with PFP had deficits of 16% in hip abduction, 14% in trunk extension and 26% in ankle plantar flexion. CONCLUSION: Females with PFP exhibited diminished hip abductor, trunk extensor and ankle plantar flexor endurance compared to healthy controls.
Abstract: BACKGROUND: The symptoms of hip osteoarthritis (OA) influence instrumental activities of daily living (IADL). Evidence form previous studies suggest that body functions and walking speed are important etiological factors for IADL. However, no studies have investigated which factors that have the greatest influence on IADL. OBJECTIVE: The aims of this study were (1) to analyze factors related to IADL in patients with hip OA, including 10 m walking speed (10 mWS), and (2) to establish cut-off values for factors that predict maintenance of IADL. METHODS: Forty-eight patients participated in this study. IADL was…treated as dependent variable. Range of motion (ROM), muscle strength of the hips and knees, and 10 mWS were measured as independent variables. Other potential confounding factors were also measured. Data were analyzed using hierarchical multiple regression and Receiver Operating Characteristic curve analysis. RESULTS: The hip flexion ROM on the affected side and 10 mWS were selected as significant variables in this study. The cut-off values obtained were 92.5 degrees for the hip flexion ROM on the affected side and 42.3 m/min for 10 mWS. CONCLUSIONS: The suggested target associated with maintaining IADL in patients with hip OA is the cut-off value of 42.3 m/min for 10 mWS found in this study.
Keywords: Instrumental activities of daily living, osteoarthritis of the hip, walking speed
Abstract: INTRODUCTION: The effect of the application of kinesiotape on muscle strength is still uncertain. This trial represents the first randomized-controlled trial to investigate the immediate and delayed effects of kinesiotape application on triceps muscle strength in healthy subjects. METHOD: The trial was randomized and placebo-controlled. Young adult (18-35 years of age), healthy men were randomly assigned in a 1:1 ratio to either a kinesiotape group or a sham tape for the control group. ``Y''-shaped kinesiotape was applied to the triceps muscle in the sitting position. ``I''-shaped tape was used for the control group, and the sham…tape was placed horizontally on the triceps muscle. A hand-held digital dynamometer was used to evaluate the peak force of elbow extension and flexion. Assessments were carried out before taping, an hour after taping, and after the first week. RESULTS: The mean ages of the participants in the kinesiotape and control groups were 26.2 ± 4.8 and 26.7 ± 4.8, respectively. The mean values of the peak force before taping, after the first hour, and after first week were statistically analyzed using one-way repeated measures. No statistical significance was found for in-group analysis of either the kinesiotape group or the control group (p> 0.05). In addition, there was no statistical significance in the between-group assessments (p> 0.05). CONCLUSION: The triceps muscle is appropriate for studying the effects of kinesiotape on muscle strength because elbow extension is provided by only one fusiform-shaped muscle. The results of this study did not show any significant changes in immediate or delayed muscle strength according to the initial measurements and between-group assessments.
Abstract: BACKGROUND: Gold standard for spine deformities assessment is X rays, but the procedure bears a risk of exposure. OBJECTIVE: To investigate intra-rater and inter-rater reliability of a pocket compass needle goniometer (IncliMed® , University of Padua) to non-invasively evaluate spine curves in children and adolescents. METHODS: Prospective reliability study in a paediatric population (mean age 12.5 years ± 2.5). Children with spine deformities (Scheuermann's or postural kyphosis, idiopathic scoliosis) and healthy controls were included. Two physician measured spinal curves with the surface goniometer IncliMed® within a temporal range of 10 minutes.…Participants were re-tested after a mean of 28 days for the intra-rater study. Agreement limit and coefficient of repeatability were calculated according to the linear regression analysis; the Bland and Altman method was applied to obtain average of differences and standard error of the mean of the differences. RESULTS: One hundred and thirty-nine subjects participated to the inter-rater reliability assessment; 30 to the intra-rater reliability assessment. Inter-observer variability for IncliMed® measurements was ± 11° both for kyphosis and for lordosis. The intra-observer variability for kyphosis and lordosis measurements was ± 11° and ± 12°. CONCLUSIONS: IncliMed® is a reliable, non-invasive tool to screen and monitor spinal curves in paediatric populations.
Abstract: BACKGROUND: Electro-diagnostic studies are the most reliable methods in diagnosis of carpal tunnel syndrome (CTS). Although there are many risk factors associated with CTS, there are a limited number of studies in the literature indicating that manual milking, which is frequently seen in Turkey, is a risk factor for CTS. OBJECTIVE: The purpose of this study was to evaluate demographic findings of cases referred due to initial diagnosis of CTS as well as aetiological data especially manual milking and to investigate the sensitivity of initial diagnosis of CTS. METHODS: Six hundred patients, who…were referred to our electromyography laboratory due to initial diagnosis of CTS, were included. Demographic findings, duration of complaints, existence of diabetes mellitus, and manual milking histories of all patients were recorded. Sensitivity of initial diagnosis was investigated based on electro-diagnostic test results. RESULTS: According to electro-diagnostic test results, 289 of the patients were diagnosed with CTS (48.17%). 110 (18.3%) of 600 patients had a history of manual milking. In 94 of this group (85.4%), CTS was detected. Statistically significant correlation was found between CTS and age, female gender, duration of complaints, obesity and manual milking. CONCLUSIONS: This study confirms that manual milking is an important risk factor for CTS in addition to female gender, age, symptom duration and obesity. The fact that sensitivity of initial diagnosis of CTS was found to be low according to electro-diagnostic test results indicates importance of detailed clinical evaluation.
Abstract: BACKGROUND: Quality of life measurements evaluate surgical results from patients' reported outcomes. OBJECTIVE: To assess the impact of spinal deformity treatment using the Scoliosis Research Society-22 questionnaire. METHODS: SRS-22 data was collected in 545 consecutive patients (425 females-120 males) pre-operatively, 6-, 12- and 24-months post-operatively. Variables included type and age of surgery (mean: 15.14 ± 2.07 years), gender, diagnosis and year of surgery. Age at surgery was divided in: 10-12, 13-15, and 15-19 years. RESULTS: Mean pre-operative SRS-22 scores for the whole group were: function 3.77 ± 0.75;…pain 3.7 ± 0.97; self-image 3.14 ± 0.66; mental health 3.86 ± 0.77; total 3.62 ± 0.66. Mean 2-year post-operative scores were: function 4.39 ± 0.42; pain 4.59 ± 0.56; self-image 4.39 ± 0.51; mental health 4.43 ± 0.56; satisfaction 4.81 ± 0.40; total 4.52 ± 0.37 (p< 0.0001). Males performed better at 2-years post-surgery (4.62 ± 0.25) compared to females (4.49 ± 0.39), (p= 0.004). Patients with spondylolisthesis performed worse pre-operatively (2.93 ± 0.26) compared to other diagnoses (p< 0.0001). This did not impact 2-year post-operative outcomes. There were no significant changes regarding age or year of surgery, type of operation or between the 3 age groups. CONCLUSIONS: All individual domains and total SRS-22 scores improved significantly with incremental change during post-operative follow-up. Patient satisfaction was very high for all individual diagnosis. 2-year post-operative outcomes compared favorably to reported SRS-22 scores in healthy adolescents.
Keywords: Spinal deformity, scoliosis, spinal fusion, quality of life assessment, patient satisfaction, Scoliosis Research Society-22 questionnaire