Journal of Back and Musculoskeletal Rehabilitation - Volume 31, 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: Flying related transient Low Back Pain (LBP) among helicopter pilots is considered an occupational distress. OBJECTIVE: To examine if exercise programs can alleviate transient LBP. METHODS: Sixty-five helicopter pilots (92% males), all reporting flying related LBP, responded to an epidemiological survey and a long-term follow-up, 44.8 months later, comprising questions regarding transient LBP and number of sick leaves. Data from 37 pilots participating in two exercise programs, A; general for LBP, B; focused for lumbar trunk (LT), included information from clinical examinations and muscular endurance tests of the LT before and after…intervention. Twenty-eight pilots did not participate in any intervention. RESULTS: At long-term follow-up 42% of the pilots still reported flying related transient LBP. Among participants in program B 26% had persistent pain, 70% in program A and 46% among pilots without intervention. Sick-leave reduction was only observed among participants in program B (30% to 4%). Upon re-occurrence of LBP symptoms, half of the pilots in program B again performed exercises to improve their pain. CONCLUSION: This study indicates that exercise programs focused towards lumbar trunk muscular endurance reduces flying related transient LBP and sick-leave among helicopter pilots. These findings may have implications for the pilots’ working conditions.
Abstract: OBJECTIVES: To study the incidence, diagnostics, treatment, anatomical region and return to play of non-acute groin injuries among professional footballers in the Netherlands. DESIGN: Prospective cohort study. METHODS: Medical staff members of all Dutch professional football clubs, recording prospectively injury occurrence of all professional footballers in their clubs, were asked to fill in an injury form about time-loss (⩾ 8 days) non-acute groin injury over the 2012–2013 season. RESULTS: A cohort of 410 players from 12 professional football clubs were included (response rate = 44%). The season incidence…of non-acute groin injuries was nearly 7% (29 non-acute groin injuries). In 82% of all cases, the player suffered from non-acute groin injury in the first half of the season. The average time to return to play was 35 days, ranging from 8 to 84 days. The adductors were the most affected anatomical regions (82%), with the most frequent diagnosis being overuse of the adductors (36%), followed by adductor tendinopathy (18%). In addition to medical history and physical examination, ultrasound (50%) and MRI (32%) were the diagnostic methods most frequently mentioned. As well as physical therapy, treatment consisted mostly of manual therapy (96%) and dry needling (61%). CONCLUSIONS: A professional club with a squad of 25 players can expect on average two non-acute groin injuries per season with an average time-loss of 35 days. Players are more at risk in the first half of the season. In Dutch professional football, ultrasound is commonly used to diagnose non-acute groin injury, while manual therapy is the most commonly applied treatment.
Keywords: Professional athletes, injury, adductor, groin, soccer, return to play
Abstract: OBJECTIVE: This study compared the dietary habits of patients with ankylosing spondylitis (AS) and rheumatoid arthritis (RA). METHODS: The nutritional status of 56 patients, seen at the Rheumatology Outpatient Clinic and diagnosed with RA based on the ACR-2010 criteria, was compared with that of 28 patients diagnosed with AS using the modified New York criteria. Nutritional status was determined using a form that was filled out during face-to-face interviews with all patients. Patient demographics, disease activity, smoking and alcohol use, concomitant diseases, disease duration and nutritional status were determined using a questionnaire. RESULTS:…RA patients consumed butter on 2 days a week, and AS patients on 1 day per month. Yoghurt was consumed by RA patients daily and by AS patients 3 days a week. CONCLUSIONS: Compared to the diet of AS patients, the diet of RA patients was richer in protein and lipids. The impact of diet on these two diseases remains to be determined in large-scale studies.
Abstract: BACKGROUND: Spinal surgeries have strongly increased in number over the past decade. The question of when it is safe to resume driving is thereby one the most frequently asked questions that patients ask of their treating physician. OBJECTIVE: The aim of this study was to assess braking performance before and after spine surgery. METHODS: Reaction time, foot transfer time (together brake response time [BRT]), and brake force (BF) were evaluated in a drive simulator. A longitudinal patient cohort (n = 27) was tested preoperatively and at the first…follow-up. A cross-sectional cohort (n = 27) was tested at > 1 year postoperatively. The values from these groups were compared with a healthy age-matched control group of 24 volunteers. RESULTS: No significant improvement in BRT was seen in lumbar fusion three months postoperatively (p = 0.597); BF was even weaker than it was preoperatively (p = 0.044). In comparison to the control group (median BRT 479 ms), preoperative BRT was already impaired in lumbar fusion patients (median 560 ms), representing an increased braking distance of 2.25 m at 100 km/h. CONCLUSION: Although most patients performed adequately, about one third presented critical braking performance. Risk factors for impaired braking may include scheduled multisegmental fusion surgery, female sex, and pain.
Keywords: Total brake response time, driver reaction time, driving reaction time, lumbar fusion, nucleotomy, lumbar decompression
Abstract: BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA), insulin-dependent diabetes mellitus (IDDM), inflammatory bowel disease, systemic lupus erythematosus (SLE) and multiple sclerosis (MS) are some of the autoimmune diseases related to the decreases in Vitamin D levels. The same immunological properties as psoriasis, such as Th1/Th2 dysregulation, are seen in all of them. This study aims to compare 25-hidroksi Vitamin D (25-OHD) serum concentrations in patients with psoriasis and psoriatic arthritis. METHODS: This study includes 91 outpatients; 48 of these patients were chosen randomly among the psoriasis (PS) patients from the dermatology department of the researchers’ hospital. Forty-three of…them were chosen among the psoriatic arthritis (PsA) patients matching the age and gender criteria from the rheumatology department of the researchers’ hospital. In this study, 25-OHD serum concentrations among the psoriasis and psoriatic arthritis patients were compared. RESULT: There are more patients in the PsA group with 25-OHD levels lower than 20 ng/ml; however, this finding is insufficient to obtain statistical significance (p = 0.09). PsA and psoriasis groups had similar numbers of patients with 25-OHD levels ranging from 20 to 30 mg/mL and those higher than 30 mg/mL (p > 0.05). CONCLUSION: The literature does not show significant differences between the PS and PsA groups in terms of serum 25-OHD levels and a prevalence of Vitamin D deficiency. Besides, PASI scores were higher in the PS group. CRP values in the PsA group were higher than in the PS group. There was a poor negative correlation between CRP and serum 25-OHD levels in the PsA group. This correlation was not found in the PS group.
Keywords: Psoriasis, psoriatic arthritis, Vitamin D
Abstract: OBJECTIVE/BACKGROUND: Treatment options for spinal cord injuries are currently limited, but multiple clinical trials are underway for a variety of interventions, drugs, and devices. The Food and Drug Administration website www.ClinicalTrials.gov catalogues these trials and includes information on the status of the trial, date of initiation and completion, source of funding, and region. This investigation assesses the factors associated with publication and the publication rate of spinal cord injury trials. DESIGN: Retrospective analysis of publically available data on www.ClinicalTrials.gov. METHODS: The www.ClinicalTrials.gov was queried for all trials on patients with spinal…cord injury, and these trials were assessed for status, type of intervention, source of funding, and region. Multiple literature searches were performed on all completed trials to determine publication status. RESULTS: There were 626 studies identified concerning the treatment of patients with spinal cord injury, of which 250 (39.9%) were completed. Of these, only 119 (47.6%) were published. There was no significant difference in the rate of publication between regions (p > 0.16) or by study type (p > 0.29). However, trials that were funded by the NIH were more likely to be published than trials funded by industry (p = 0.01). CONCLUSION: The current publication rate of spinal cord injury trials is only 47.6%, though this rate is similar to the publication rate for trials in other fields. NIH-funded trials are significantly more likely to become published than industry-funded trials, which could indicate that some trials remain unpublished due to undesirable results. However, it is also likely that many trials on spinal cord injury yield negative results, as treatments are often ineffective.
Keywords: Clinical trials, publication bias, research funding, spinal cord injury
Abstract: BACKGROUND: Neurodevelopmental treatment (NDT), neuromuscular electrical stimulation (NMES), and Kinesio Taping (KT) applications are separately used to improve postural control and sitting balance in children with cerebral palsy (CP). OBJECTIVE: The aim of this study is to examine the combined effect of NDT, NMES and KT applications on postural control and sitting balance in children with CP. METHODS: Forty five children, in 3 groups, between the ages 5–12 years were included in the study. Group 1 received NDT; group 2 received NDT + NMES; and the group 3 received NDT +…NMES + KT for 6 weeks. Sitting function evaluated by the sitting section of the gross motor function measure (GMFM), and postural control assessed with the seated postural control measurement (SPCM). RESULTS: Seating section of GMFM was improved significantly in all the groups; however, increases in the group 3 were higher than groups 1 and 2 (p = 0.001). While significant differences were observed in all groups in the SPCM posture (p < 0.001), function (p < 0.001), and the total scores (p < 0.001); the change in the third group was higher according to the comparison of the three groups within each other. CONCLUSIONS: Implementation of the NMES, and KT additionally to NDT improve the sitting posture, postural control, seating function, and gross motor function in children with CP.
Keywords: Motor control, physiotherapy, kinesio taping, electrical stimulation, cerebral palsy
Abstract: BACKGROUND: The prevalence of chronic back pain poses major challenges for all health care systems and patients worldwide. Myofascial trigger therapy (MT), although a very popular standard non-pharmaceutical form of treatment, only shows small to medium effectiveness. OBJECTIVE: To test a new vibrotreatment (Cellconnect Impulse) transmitting low-frequency, vertical shock waves in a routine clinical practice. METHODS: Eligible patients were adults seeking physiotherapeutic treatment. They were randomly allocated to either six treatments of MT or to six treatments of combined MT and vibrotreatment. Outcome parameters were pain intensity, pain days, pain duration, and quality…of life. RESULTS: The pain relieving effects of the combined treatment were very large (d = 1.6). It clearly outperformed MT and considerably improved patients’ health related quality of life. CONCLUSIONS: Combining MT with Cellconnect Impulse enhances the physiotherapeutic effectiveness of treating chronic back pain.
Keywords: Cellconnect Impulse, chronic back pain, myofascial trigger point therapy, quality of life, vibrotherapy
Abstract: BACKGROUND: Many studies have shown asymmetric behavior of the surface and deep layers of spine muscles in scoliosis patients, compared to normal individuals. However, there is a lack of research on the transversus abdominal (TA) muscle, which plays an important role in trunk stabilization. OBJECTIVE: To assess symmetry in subjects with adolescent idiopathic scoliosis (AIS) by measuring the thickness of abdominal muscles, and to investigate characteristic features through a comparative analysis of the data with healthy aged-matched group. METHODS: Subjects consisted of 33 AIS and 32 healthy subjects of similar ages between 11–28 years…old. We measured TA, internal abdominal oblique (IO), and external abdominal oblique (EO) muscles were measured using ultrasonography imaging. Three repeat measurements of the thickness of each muscle were performed during rest and contraction. RESULTS: For the healthy subjects, the intra-class correlation coefficients (ICCs) for the muscle thickness measures ranged from 0.70 to 0.99, standard error of measurement (SEM) was 0.38 cm, and minimal detectable change (MDC) was 1.07 cm. The ICCs for the muscle thickness measures in the AIS group ranged from 0.90 to 0.98, SEM was 0.45 cm, and MDC was 1.24 cm. The symmetry of the two groups was compared, and showed significant difference only in TA in AIS patient group (P < 0.01). CONCLUSIONS: In conclusion, treatment should be focused on exercises that emphasize symmetry, to induce normal action of the TA and structural changes in the spine because AIS induces asymmetry in TA, which plays an important role in trunk stability.
Abstract: STUDY DESIGN: A prospective observational comparative study. BACKGROUND: Because epidural corticosteroids are more effective for pain relief when delivered close to the site of pathology, lumbar spinal stenosis with multilevel stenotic areas can be treated more effectively when medications cover all of the stenotic areas. Distribution of medications to the pathologic sites is considered an important factor in the effectiveness of inter-laminar epidural injection. OBJECTIVE: To determine whether spread of a lidocaine and triamcinolone mixture over the stenotic areas improves clinical symptom of spinal stenosis more effectively. METHODS: Twenty-four patients…with lumbar spinal stenosis were enrolled in this study. A lumbar inter-laminar epidural injection under fluoroscopic guidance was administered to each patient. A numeric rating scale (NRS), claudication distance, the Romberg test, and the Oswestry Disability Index (ODI) were checked pre-injection and at 2, 6, and 12 weeks after the epidural injection. Vertebrae that showed more than moderate stenosis were considered stenosis levels. Inter-laminar epidural injection was performed with radiopaque contrast and lidocaine mixed with triamcinolone acetate. When the contrast covered all of the stenosis levels, this was considered a sufficient distribution (SD) and when the contrast did not cover all stenosis levels, this was considered an insufficient distribution (ID). RESULTS: At 2 weeks, percentages of NRS improvement were 71.4 (IQR, 20.2) in SD group and 50.0 (IQR, 31.4) in ID group (P = 0.02), changes in Romberg test time were 0.0 (IQR, 35.0) in SD group and - 3.0 (IQR, 12.0) in ID group (P = 0.02), decreases in ODI were 9.6 (IQR, 11.2) in SD group and 0.0 (IQR, 7.8) in ID group (P = 0.02). However, these parameters were not significantly different at 6 weeks and 12 weeks. Claudication distance showed no significant group difference. CONCLUSION: Coverage of the stenotic area by the lidocaine, triamcinolone, and contrast dye mixture during inter-laminar epidural injection was an important predictor of acute pain reduction.