Journal of Back and Musculoskeletal Rehabilitation - Volume 31, issue 3
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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: In patients with chronic low back pain (CLBP), postural control is a demanding task in terms of attention. Although the attentional demands of postural control have been investigated in these patients, the attentional demands of postural recovery during dual task performance have not been evaluated in patients with nonspecific CLBP. OBJECTIVE: To investigate the effect of dual tasking on anticipatory and compensatory postural adjustments in response to an external perturbation in patients with nonspecific CLBP. METHODS: Twenty-five patients with nonspecific CLBP of at least 3 months’ duration and 25 healthy persons were…exposed to predictable and unpredictable external perturbations. The attentional demands of postural adjustments were evaluated while participants simultaneously performed a cognitive task. Onset latency and integrated electromyographic activity of the trunk and leg muscles were compared between dual task (postural recovery and backward digit span memory) and single task conditions (postural recovery only). RESULTS: The results showed delayed activation of the tibialis anterior (agonist) and early activation of the gastrocnemius (antagonist) muscles during the dual task in patients with nonspecific CLBP compared to healthy participants. Integrated electromyographic activity was significantly greater in the dual task than the single task condition in the gastrocnemius (antagonist) muscle in patients with nonspecific CLBP compared to healthy persons during unpredictable perturbations. CONCLUSION: The impaired ankle muscle activities during a cognitive task suggest that postural control recovery following external perturbation requires attentional resources in patients with nonspecific CLBP. This may increase the risk of re-injury in people with nonspecific CLBP while they perform an attentionally demanding task in more difficult circumstances.
Keywords: Low back pain, attention, external perturbation, postural recovery
Abstract: OBJECTIVES: In this study, our objective was to determine the work productivity and work disability of the patients with ankylosing spondylitis (AS) and to investigate the relation of these parameters with disease activity, anxiety, depression and quality of life. PATIENTS AND METHODS: Fifty patients with the diagnosis of AS and 30 healthy control were included in the study. In patients with AS, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used to evaluate the disease activity; Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to evaluate the spinal mobility and Bath Ankylosing Spondylitis Functional Index (BASFI)…was used to determine the functional status. In addition, the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire and The Short Form (SF-36) Health Survey was used to evaluate the health status, Hospital Anxiety and Depression Scale (HADS) was used for the evaluation of depression and anxiety and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem v2.0 (WPAI:SHP) was used to evaluate the work productivity. RESULTS: In AS patients duration of disease at the diagnosis was 7.24 ± 6.23 years. The time lost at work due to the disease, decrease in the work productivity and impairment in the time off daily activities were worse in the patient group compared with the control group (p < 0.05). The impairment in the work productivity was correlated with BASDAI and depression; difficulty in time-off activities was correlated with BASFI and anxiety and depression was correlated with BASDAI (p < 0.05). While the impairment in work productivity was correlated with the subparameter vitality in SF-36, difficulty in time off activities was correlated with general health status, social functions, vitality and mental health (p < 0.05). CONCLUSION: In this study, we determined that AS had a significant influence on the working conditions and the factors related to the disease had a significant correlation with work productivity. Factors related to the psychology and the disease were also correlated with the working conditions.
Keywords: Ankylosing spondylitis, work disability, quality of life
Abstract: BACKGROUND: Ultrasound combined with transcutaneous electrical nerve stimulation (UltraTENS) and phonophoresis of piroxicam (PhP) are combined modality therapy that frequently used in musculoskeletal pain including knee osteoarthritis (OA). But it is lack of a good clinical trial to prove and compare their effects. OBJECTIVE: To compare the effects of UltraTENS with PhP on mild to moderate degree of symptomatic knee OA. METHODS: Sixty-one patients (55 women), mean age of 63.4 ± 8.1 y, 50–90 mm VAS of knee pain and Kellgren-Lawrence score of grade I–III were randomly allocated into UltraTENS…and PhP (N = 31 and 30, respectively). The UltraTENS group received a combined ultrasound with TENS program and a non-drug gel, whereas the PhP group got an ultrasound program with piroxicam gel and sham TENS. All patients were treated for a total of 10 sessions, consisting of five times per week and 10 min per session. Before and after treatment, patients were evaluated knee pain by using the 100-mm VAS and functional performance by Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. RESULTS: The UltraTENS and PhP groups experienced considerable improvement in both VAS and total WOMAC scores post-treatment (P < 0.001). The PhP had better VAS of pain and WOMAC scores but no statistical significance. CONCLUSIONS: Results show that UltraTENS and PhP were effective for relieving pain and improve functionality knee OA without significant differences between their effects.
Abstract: OBJECTIVE: Ankle rigidity is a common musculoskeletal disorder affecting the talocrural joint, which can impair weight-bearing ankle dorsiflexion (WBADF) and daily-life in people with or without history of ankle injuries. Our objective was to compare the immediate effects of efficacy of Mulligan Mobilization with Movement (MWM) and Osteopathic Mobilization (OM) for improving ankle dorsiflexion range of motion (ROM) and musculoarticular stiffness (MAS) in people with chronic ankle dorsiflexion rigidity. DESIGN: A randomized clinical trial with two arms. METHODS: Patients were recruited by word of mouth and via social network as well as posters,…and analyzed in the neuro musculoskeletal laboratory of the “Université Catholique de Louvain-la-Neuve”, Brussels, Belgium. PARTICIPANTS: 67 men (aged 18–40 years) presenting with potential chronic non-specific and unilateral ankle mobility deficit during WBDF were assessed for eligibility and finally 40 men were included and randomly allocated to single session of either MWM or OM. INTERVENTIONS: Two modalities of manual therapy indicated for hypothetic immediate effects in chronic ankle dorsiflexion stiffness, i.e. MWM and OM, were applied during a single session on included patients. MAIN OUTCOME MEASURES: Comprised blinding measures of MAS with a specific electromechanical device (namely: Lehmann’s device) producing passive oscillatory ankle joint dorsiflexion and with clinical measures of WBADF-ROM as well. RESULTS: A two-way ANOVA revealed a non-significant interaction between both techniques and time for all outcome measures. For measures of MAS: elastic-stiffness (p = 0.37), viscous-stiffness (p = 0.83), total-stiffness (p = 0.58). For WBADF-ROM: toe-wall distance (p = 0.58) and angular ROM (p = 0.68). Small effect sizes between groups were determined with Cohen’s d ranging from 0.05 to 0.29. One-way ANOVA demonstrated non-significant difference and small to moderate effects sizes (d = 0.003–0.58) on all outcome measures before and after interventions within both groups. A second two-way ANOVA analyzed the effect of each intervention on the sample categorized according to injury history status, and demonstrated a significant interaction between groups and time only for viscous stiffness (p = 0.04, d = - 0.55). CONCLUSION: A single session of MWM and OM targeting the talocrural joint failed to immediately improve all measures in
Abstract: BACKGROUND: In addition to conventional magnetic resonance imaging (cMRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and prognostic tool for patients with degenerative cervical myelopathy (DCM). OBJECTIVE: To assess the efficacy of cMRI and DTI parameters in prediction of surgical outcome in DCM patients. METHODS: One hundred and forty-two patients with DCM who underwent presurgical cMRI and DTI of the cervical spine were included. Quantitative parameters obtained by cMRI included compression ratio (CR), transverse area (TA), and signal intensity ratio (SIR). DTI was evaluated for apparent diffusion coefficient (ADC)…and fractional anisotropy (FA). The Japanese Orthopaedic Association (JOA) score and recovery rate were used to evaluate clinical outcomes. A JOA recovery rate < 50% was defined as a poor surgical outcome. The relationship of surgical outcome with various imaging parameters was examined. Receiver operating characteristic (ROC) curves were used to measure the predictive ability and determine the best cut-off values of the quantitative parameters. RESULTS: By ROC curve analyses of imaging parameters, the largest area under the ROC curve (AUC) was for FA (0.750), followed by ADC (0.719), TA (0.716), SIR (0.673), and CR (0.591). The cut-off values with the best compromise between sensitivity and specificity were set at 0.390 for FA, 1.344 × 10 - 3 mm 2 /s for ADC, 46.02 mm 2 for TA, 1.556 for SIR, and 26.56% for CR. Multivariate logistic regression model revealed that JOA score ⩽ 8 points, TA ⩽ 46.02 mm 2 , and FA ⩽ 0.390 were independently associated with poor surgical outcome. The AUC value for the three-predictor model was 0.871, indicating strong predictive discrimination, and was significantly higher than the AUC value for the model containing only the JOA score (0.763; P = 0.003). CONCLUSIONS: JOA score is a reasonable predictor of surgical outcome in DCM. However, a model inclusive of TA and FA provides superior predictive ability. Thus, quantitative analysis of cMRI and DTI is useful for predicting surgical outcome in DCM.
Abstract: BACKGROUND: Weight loss practice before competitions is a common method in weight sports. OBJECTIVE: The current study aimed to monitor Plasma Osmolarity (P Osm ), skeletal muscle damage and inflammation levels induced by pre-competition dehydration among elite wrestlers. METHODS: Twenty-four male elite wrestlers participated in the study. A survey information form that assessed pre-competition weight loss practices were administered to the wrestlers. Additionally, Total Creatine Kinase (CK), Lactate Dehydrogenase (LDH), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), C-reactive Protein (C-RP) and P Osm , analyses were evaluated by…a specialist at the biochemical laboratory. P Osm level for euhydration is ⩽ 290 mOsm/L. But if P Osm level is > 290, then dehydration occurs. The wrestlers were divided into two groups according to P Osm levels as weight loss and non-weight loss group. RESULTS: There were differences in the pre and post-test P Osm levels of weight loss group. Similarly; it was identified that there were also statistically significant differences in terms of ALT, LDH and CK levels of weight loss group between pre and post-test. CONCLUSIONS: It was seen that P Osm and levels of all indicators of skeletal muscle damage were higher than non-weight loss group. However, it was found that there were not any differences in terms of C-RP levels.
Keywords: Dehydration, inflammation, plasma osmolarity, skeletal muscle damage, weight loss
Abstract: BACKGROUND: It is unclear whether bone quality associates with severity and prognosis of back pain. OBJECTIVES: To investigate the association between bone quality and back pain severity at baseline, and whether low bone quality is a prognostic factor for persistent back pain in patients aged over 55 years at 1-year follow-up. METHODS: In this prospective cohort study persistent back pain was defined as a decrease in the back pain severity score of less than 30% at 1-year follow-up compared with baseline score or as a back pain severity score greater than 1 (0–10:…0 = no pain) Low bone quality was categorized as a T-score, calculated using a stiffness index by quantitative ultrasound of the heel, of 2.5 or below. Data were analyzed in multiple regression analyses. RESULTS: Of all 513 patients, 68 (13%) showed low bone quality at baseline. Back pain severity showed no differences between patients with normal and with low bone quality. At 1-year follow-up, low bone quality was not associated with persistent back pain (defined as < 30%: OR 1.0; 95% CI: 0.40–2.30, p -value = 0.93; and defined as score > 1: OR 0.4; 95% CI: 0.17–1.15), p -value = 0.09), adjusted for all covariates. CONCLUSIONS: In older adults with back pain presenting in general practice, low bone quality was not associated with severity of back pain at baseline nor with persistent back pain at 1-year follow-up.
Keywords: Older adults, bone quality, back pain, general practice
Abstract: BACKGROUND AND OBJECTIVES: Normal dorsiflexion (DF) required for normal gait is achieved through balance of the tibialis anterior (TA) and extensor hallucis longus (EHL). Imbalance may induce ankle and foot deformities and exacerbate pathology. EHL dominance is associated with progressive TA weakness, attributable to muscle non-use. When the EHL dominantly dorsiflexes the ankle, the big toe extends at the metatarsophalangeal joint (MTPJ) and pure ankle DF is absent. The effects of active MTPJ flexion on TA and EHL muscles, TA/EHL ratio, and the force applied during active DF in EHL-dominant (EHL-D) and EHL-non-dominant (EHL-ND) subjects were compared.…METHODS: The 38 subjects were divided into EHL-D and EHL-ND groups. All subjects performed active ankle DF with and without active MTPJ flexion. Surface electromyographic data, ankle active range of motion, and DF force were measured. Two-way mixed analysis of variance was used to evaluate differences in dependent variables. RESULTS: Compared to the EHL-ND group, the EHL-D group exhibited less TA activity, more EHL activity, and a reduced TA/EHL activity ratio. Active application of MTPJ flexion during DF significantly reduced muscle imbalance, whereas EHL activity decreased and the TA/EHL activity ratio increased. The DF force decreased significantly with MTPJ flexion in both groups. CONCLUSIONS: Active MTPJ flexion can reduce EHL and/or increase TA activity and increase the TA/EHL activity ratio during active ankle DF in both EHL-D and EHL-ND subjects.
Abstract: BACKGROUND: There is a lack of test-retest reliability studies of measurements of cervical muscle strength, taking into account gender and possible learning effects. OBJECTIVE: To investigate test-retest reliability of measurement of maximal isometric cervical muscle strength by handheld dynamometry. METHODS: Thirty women (age 20–58 years) and 28 men (age 20–60 years) participated in the study. Maximal isometric strength (neck flexion, neck extension, and right/left lateral flexion) was measured on three separate days at least five days apart by one evaluator. RESULTS: Intra-rater consistency tended to improve from day 1–2 measurements…to day 2–3 measurements in both women and men. In women, the intra-class correlation coefficients (ICC) for day 2 to day 3 measurements were 0.91 (95% confidence interval [CI], 0.82–0.95) for neck flexion, 0.88 (95% CI, 0.76–0.94) for neck extension, 0.84 (95% CI, 0.68–0.92) for right lateral flexion, and 0.89 (95% CI, 0.78–0.95) for left lateral flexion. The corresponding ICCs among men were 0.86 (95% CI, 0.72–0.93) for neck flexion, 0.93 (95% CI, 0.85–0.97) for neck extension, 0.82 (95% CI, 0.65–0.91) for right lateral flexion and 0.73 (95% CI, 0.50–0.87) for left lateral flexion. CONCLUSION: This study describes a reliable and easy-to-administer test for assessing maximal isometric cervical muscle strength.
Abstract: BACKGROUND: Algometry, as a highly sensitive method, provides an objective insight into the degree of pain, while the use of questionnaires can estimate the patient’s psychological status in a simple way. OBJECTIVE: This study was conducted in order to measure the pressure pain threshold in patients with cervical and lumbar radiculopathy and to find a possible association of pain with the anxiety and depression. METHODS: The study examined 60 hospitalized patients with cervical radiculopathy and 60 patients with lumbar radiculopathy before starting and after finishing kinesitherapy. The research was conducted using the digital…algometry device and Hospital Anxiety and Depression Scale. RESULTS: There was no statistically significant difference in algometric values between the patients with cervical radiculopathy and the patients with lumbar radiculopathy. The program of rehabilitation did not lead to significant improvement in the level of pain. Females have a lower pressure pain threshold than males. Psychological factors greatly affect the pain. CONCLUSIONS: The applied methods will provide the implementation of appropriate therapy and would achieve better verification of the results in a rehabilitation program. Radiculopathy in conservative therapy should be treated in cervical-thoracic and lumbar region together. Rehabilitation period for patients with radiculopathy have to be longer.