Journal of Back and Musculoskeletal Rehabilitation - Volume 30, issue 6
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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: OBJECTIVE: To review and update the evidence for different forms of manual therapy (MT) and exercise for patients with different stages of non-specific neck pain (NP). Data sources: MEDLINE, Cochrane-Register-of-Controlled-Trials, PEDro, EMBASE. METHOD: A qualitative systematic review covering a period from January 2000 to December 2015 was conducted according to updated-guidelines. Specific inclusion criteria only on RCTs were used; including differentiation according to stages of NP (acute – subacute [ASNP] or chronic [CNP]), as well as sub-classification based on type of MT interventions: MT1 (HVLA manipulation); MT2 (mobilization and/or soft-tissue-techniques); MT3 (MT1 +…MT2); and MT4 (Mobilization-with-Movement). In each sub-category, MT could be combined or not with exercise and/or usual medical care. RESULTS: Initially 121 studies were identified for potential inclusion. Based on qualitative and quantitative evaluation criteria, 23 RCTs were identified for review. Evidence for ASNP: MODERATE-evidence: In favour of (i) MT1 to the cervical spine (Cx) combined with exercises when compared to MT1 to the thoracic spine (Tx) combined with exercises; (ii) MT3 to the Cx and Tx combined with exercise compared to MT2 to the Cx with exercise or compared to usual medical care for pain and satisfaction with care from short to long-term. Evidence for CNP: STRONG-evidence: Of no difference of efficacy between MT2 at the symptomatic Cx level(s) in comparison to MT2 on asymptomatic Cx level(s) for pain and function. MODERATE to STRONG-evidence: In favour of MT1 and MT3 on Cx and Tx with exercise in comparison to exercise or MT alone for pain, function, satisfaction with care and general-health from short to moderate-terms. MODERATE-evidence: In favour (i) of MT1 as compared to MT2 and MT4, all applied to the Cx, for neck mobility, and pain in the very short term; (ii) of MT2 using sof-tissue-techniques to the Cx and Tx or MT3 to the Cx and Tx in comparison to no-treatment in the short-term for pain and disability. CONCLUSION: This systematic review updates the evidence for MT combined or not with exercise and/or usual medical care for different stages of NP and provides recommendations for future studies. Two majors points could be highlighted, the first one is that combining different forms of MT with exercise is better than MT or exercise alone, and the second one is that mobilization need not be applied at the symptomatic level(s) for improvements of NP patients. These both points may have clinical implications for reducing the risk involved with some MT techniques applied to the cervical spine.
Abstract: BACKROUND: The mechanical behavior of the peripheral nervous system under elongation and tension has not been adequately established in vivo . OBJECTIVE: The purpose of this review is to investigate the mechanical behavior of the peripheral nervous system in vivo . METHODS : In vivo studies which evaluated the effects of limb movement and neurodynamic tests on peripheral nerve biomechanics were systematically searched in PubMed (Medline), the Cochrane Database, CINAHL, PEDro, Embase and Web of Science. Studies fulfilling the search criteria were assessed for methodological quality with a modified version of the Down…& Blacks scale by two reviewers. RESULTS: This review includes the results of 22 studies, of which 15 examined limb movement influencing the median nerve, four the sciatic nerve, two the tibial nerve; and one each the ulnar and peroneal nerves respectively. Substantial nerve longitudinal and transverse excursion and changes in diameter were reported. Despite this, increased nerve strain was not a major finding. CONCLUSION: The heterogeneity of included studies, including wide variety of nerves tested, measurement location and joint position prevented comparisons between studies and also amalgamation of data. Limb movement induces complex biomechanical effects of which nerve elongation plays only a minor role.
Keywords: Neurodynamic, stretch, strain, in vivo, peripheral nerve, excursion
Abstract: BACKGROUND: LBP is one of the most common symptoms with high prevalence throughout the world. Conflicting conclusions exist in RCTs on cupping for LBP. OBJECTIVE: To assess the effects and safety of cupping for the patients with LBP. METHODS: Pubmed, Cochrane Library databases, and Embase database were electronically researched. RCTs reporting the cupping for the patients with LBP were included. The meta-analysis was conducted using Review Manager software (version 5.3, Nordic Cochrane Centre). The primary outcome was VAS scores. The secondary outcomes included ODI scores, MPPI scores and complications. RESULTS:…Six RCTs were included in this synthesized analysis. The results showed that cupping therapy was superior to the control management with respect to VAS scores (SMD: - 0.73, [95% CI: - 1.42 to - 0.04]; P = 0.04), and ODI scores (SMD: - 3.64, [95% CI: - 5.85 to - 1.42]; P = 0.001). There was no statistical significant difference as regard to MPPI scores. No serious adverse event was reported in the included studies. CONCLUSIONS: Cupping therapy can significantly decrease the VAS scores and ODI scores for patients with LBP compared to the control management. High heterogeneity and risk of bias existing in studies limit the authenticity of the findings.
Keywords: Low back pain, cupping therapy, meta-analysis
Abstract: OBJECTIVE : The aim of this study was to investigate the effects of normalized muscle tension via tensegrity-based massage on postural stability in a sample of female young adults. METHODS : Nineteen females aged 21.8 ± 1.9 years were recruited presenting abnormal tension at muscles adhering to any of the following structural sites: superior iliac spine, lateral sacropelvic surface, linea aspera at 1/2 of femur length, and superior nuchal line of the occiput. Balance and postural control were assessed during bipedal stance using a force platform in multiple conditions: hard surface or soft foam surface with…the head in either a neutral posture or tilted backward. Baseline and 3-min and 15-min post-treatment measures were collected while barefoot and eyes closed. Main outcomes measures included center of pressure variability, range, radius, and velocity in the anteroposterior (AP) mediolateral (ML) dimensions. RESULTS : In the solid surface with neutral head posture condition only AP COP measures decreased significantly (p < 0.05). In the soft surface condition, significant differences were observed in the AP and ML dimensions among most measures (p < 0.05). CONCLUSIONS: A single application of tensegrity-based massage positively influenced postural control in young adult females, particularly in the AP direction.
Keywords: Postural control, tensegrity, stability, COP, force platform, muscle chains
Abstract: OBJECTIVE: To evaluate the reliability and validity of an adapted Korean version of the Spinal Appearance Questionnaire (SAQ). METHODS: Translation/retranslation of the English version of the SAQ was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the SAQ (K-SAQ) and the previously validated appearance domain of the Korean version of the Scoliosis Research Society-22 Outcomes questionnaire (K-SRS-22) were mailed to 160 patients with adolescent idiopathic scoliosis (AIS). Reliability assessments were conducted using kappa statistics to assess item agreements, and intraclass correlation coefficients (ICC) and Cronbach’s α…values were calculated. Convergent validity was evaluated by comparing K-SAQ and K-SRS-22 appearance domain scores and discriminant validity by analyzing relationships between K-SAQ scores and patient characteristics. RESULTS: All items of the K-SAQ had kappa values of agreement of > 0.6. The K-SAQ showed excellent test/re-test reliability with an intraclass correlation coefficient of 0.922. Internal consistency of the K-SAQ was found to be very good (α = 0.883). Convergent validity testing demonstrated a moderate correlation between the K-SAQ and K-SRS-22 (r = - 451). The correlation between the K-SAQ and major curve magnitude was significant (r = 0.812). Discriminant validity was confirmed by significant differences in K-SAQ scores and individual K-SAQ domain scores among patients requiring observation, bracing, or surgery. CONCLUSIONS: The adapted Korean version of the SAQ showed satisfactory reliability and validity, and thus, is considered suitable for the evaluation of spinal deformity appearance in Korean speaking patients with adolescent idiopathic scoliosis.
Keywords: Adolescent idiopathic scoliosis, Spinal Appearance Questionnaire, Korean version
Abstract: BACKGROUND: A few studies have pointed that trunk extensors may affect the spinopelvic alignment; however, little is known about the exact association between degeneration of lower lumbar paraspinal muscles and spinopelvic parameters. OBJECTIVE: The study aimed to analyze the relationship between degeneration of lower lumbar paraspinal muscles and spinopelvic alignment in patients with osteoporotic vertebral compression fracture (OVCF). METHODS: Thirty-nine OVCF patients were involved in this study. All patients underwent a standing lateral radiographs of the entire spine and pelvis 6 months after kyphoplasty. Pelvic incidence, pelvic tilt, lower lumbar lordosis (LLL) were measured.…On the MRI images, the cross-sectional areas of the erector spinae (ES), multifidus (MF), vertebral body and the signal intensity of ES, MF, subcutaneous fat were measured. Pearson’s correlation coefficients was applied to analyze the correlation between the muscular degeneration degree (muscular atrophy and fatty infiltration) and spinopelvic parameters. RESULTS: The fatty change degree of ES at L4 inferior endplate level was positively correlated with pelvis retroversion (r = 0.480, p < 0.05). The grade of fat infiltration of ES plus MF at L5 level was negatively related to LLL (r = - 0.446, p < 0.05). The fatty change of ES at L5 level, atrophy of ES at L4 and L5 level did not correlate with pelvis back tilt. The fat infiltration of ES plus MF at L4 level, the atrophy degree of ES plus MF at L4 and L5 level had no correlation with LLL. CONCLUSIONS: With the increase of fatty infiltration of the erector spinae, the degree of pelvis retroversion increases; the lower lumbar lordosis decreases with the increase of intramuscular adipose tissue of the erector spinae plus multifidus. The atrophy degree of the erector spinae and multifidus is not correlated with pelvis back tilt and lower lumbar lordosis.
Abstract: BACKGROUND: Ankle sprain are one of the most common injuries in sports and public health in general. Cross-slope may creat a risk for ankle sprain and are commonly found in both urban and rural environment. OBJECTIVE: The purpose of study was to clarify the environmental risk factor that can be easily occurred ankle sprain during walking (stance phase) and one leg standing at various ramp environment. METHODS: Participants was measured muscle activation on peroneus longus during both conditions (walk across the ramp and one leg stand in the transverse direction) of seven different…angle (0 ∘ , 2 ∘ , 5 ∘ , 10 ∘ , 15 ∘ , 20 ∘ , 25 ∘ ). The measured data were analyzed using one-way ANOVA to investigate the effect of muscle activation on the each condition. RESULTS: Ankle sprain can be easily occurred when cross walk and one-leg stand on a ramp from higher than 10 ∘ , and highest risk was angle of 25 ∘ or more. As a people with peroneus longus weakness walks a ramp, the ramp angle has a cross relationship with the sprain on the ankle. CONCLUSIONS: If people with peroneus longus weakness walk on the more than 10 ∘ of ramp angle, they will need a lot of attention for prevent ankle sprain.
Abstract: BACKGROUND: Depression, a common comorbidity encountered in physical therapy (PT) practice, negatively impacts outcomes. There is limited knowledge of PT practice patterns relative to screening for depression. OBJECTIVE: Objectives were to describe beliefs regarding depression, and identify practice patterns and perceived barriers regarding screening for depression among APTA Board Certified Orthopedic Clinical Specialist (OCS) PTs. METHODS: Surveys were distributed to all PT OCSs in the US; 416 responses were analyzed. Descriptive, univariate and multiple regression analyses were performed. RESULTS: Ninety-five percent of respondents believed that depression has a moderate to…high influence on PT outcomes, whereas 68% believed a pre-existing diagnosis of depression influences the plan of care. Most believed that 20% or more of their current patients presented with symptoms of depression. Nevertheless, only 18% formally screen for depression during the initial evaluation. Those with formal depression screening education were 2.3 times more likely to screen at initial examination. Common barriers to screening included lack of department policy, limited knowledge and lack of follow-up resources. CONCLUSIONS: Formal screening did not occur as frequently as expected, given the belief regarding depression’s impact on plan of care and outcomes. Addressing barriers may assist in greater compliance with recommended screening guidelines.
Abstract: BACKGROUND: Upper-limb function is important in patients with hip fracture so they can perform activities of daily living and participate in leisure activities. Upper-limb function of these patients, however, has not been thoroughly investigated. OBJECTIVE: The aim of this study was to evaluate the upper-limb motor and sensory functions in patients with hip fracture by comparing these functions with those of community-dwelling older adults (control group). METHODS: We compared the results of motor and sensory function tests of upper-limb function – range of motion, strength, sensibility, finger dexterity, comprehensive hand function – between…patients with hip fracture (n = 32) and the control group (n = 32). RESULTS: Patients with hip fracture had significantly reduced grip strength, pinch strength, finger dexterity, and comprehensive hand function compared with the control group. CONCLUSIONS: Most upper-limb functions are impaired in the patients with hip fracture. Thus, upper-limb function of patients with hip fracture should be considered during treatment.
Keywords: Hip fracture, upper limb, hand, community-dwelling, comparative study
Abstract: BACKGROUND: Knee proprioception is an integral component of neuromuscular control system that stabilizes the joints, reducing incidence of injury. Knee injuries’ incidences differ between genders. Knee rotation is a component of different knee injury mechanisms. Gender differences in knee proprioception in internal (IR) and external (ER) rotations are not sufficiently studied. OBJECTIVE: To check whether proprioceptive acuity in IR and ER directions of knee rotation is inherently lower in women compared to men. Moreover, to assess gender difference in ranges of knee rotation. METHODS: Thirty volunteers (15 women and 15 men) participated. Knee…proprioception acuity and ranges of knee rotation were assessed using the knee rotatory kinesthetic device (KRKD). Proprioception was tested using absolute judgment task, subject’s ability to discriminate different rotation movements (stimuli) randomly presented, then just notable difference (JND) was calculated; least difference accurately discriminated in 75% of trials. RESULTS: Women had lower proprioception acuity in IR than men (1.70 ∘ ± 0.79 ∘ and 1.12 ∘ ± 0.32 ∘ , p = 0.011) respectively. Active IR (women: 41.29 ∘ ± 7.46 ∘ , men 32.80 ∘ ± 3.64 ∘ , p = 0.000), and passive IR (women: 53.43 ∘ ± 11.67 ∘ , men: 37.94 ∘ ± 5.22 ∘ , p = 0.000) were higher in women compared to men. Active ER (women: 49.71 ∘ ± 11.37 ∘ , men: 39.16 ∘ ± 5.46 ∘ , p = 0.003), and passive ER (women: 62.29 ∘ ± 13.74 ∘ , men: 48.89 ∘ ± 7.09 ∘ , p = 0.002) were, also, higher in women. CONCLUSION: Gender difference in knee proprioception acuity was found in IR, which is the direction of rotation that anterior cruciate ligament (ACL) stabilize. Women’s ranges of knee rotation are greater than men in both IR and ER.
Keywords: Proprioception, knee rotation, JND, joint position sense