Journal of Back and Musculoskeletal Rehabilitation - Volume 31, 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: The purpose of this study was to investigate the effects of combination therapy with global postural reeducation exercise (GPR) and anti-TNF treatments on clinical parameters in patients with active Ankylosing spondylitis (AS). MATERIALS AND METHOD: Sixty patients with active AS were distributed into three groups. Group 1 was given anti-TNF therapy plus GPR program. Group 2 was given anti-TNF and conventional exercise therapy. Group 3 was accepted as the control group. Patients were assessed according to pain, disease activity (Bath Ankylosing Spondylitis Disease Activity Index), functionality (Bath Ankylosing Spondylitis Functional Index and walking performance), mobility…(lumbar Schöber, chest expansion, hand-finger to floor distance), fatigue (Multidimensional Assessment Questionnaire), sleep quality (Pittsburgh sleep quality index), and depression. RESULTS : The parameters were significantly improved in both groups receiving exercise and anti-TNF therapy compared to the control group after treatment. The anti-TNF plus GPR exercise therapy resulted in greater improvements than the anti-TNF plus conventional exercise therapy in pain, walking performance, and mobility. CONCLUSIONS: Anti-TNF therapy and exercise were efficient in both groups on improving all clinic parameters. However, the improvements in pain, function, and mobility were greater in the active AS patients with GPR exercise method. Therefore, motivated patients should be encouraged to perform this method.
Keywords: Ankylosing spondylitis, exercise, global postural reeducation, anti-TNF therapy
Abstract: BACKGROUND: Lumbar mobilizations are used to clinically treat the lumbar and hamstring region. However, evidence is limited regarding the effectiveness of specific mobilization methods. OBJECTIVE: To compare central and unilateral posterior-anterior mobilizations (CPA, UPA) of the lumbar spine on lumbar and hamstring range of motion (ROM), and muscle activity (sEMG). METHODS: Twenty participants received CPA, UPA, or no mobilization (CON) on separate occasions (crossover design). Post-treatment outcome measures were ROM during active lumbar flexion (ALF) and active knee extension (AKE), as well as sEMG of the Erector Spinae (ES) and Biceps Femoris…(BF) during these movements. RESULTS: sEMG was possibly to very likely lower following CPA (mean difference range = - 5% to - 21%) and UPA (- 7% to - 36%), while ROM was most likely greater (- 12% to 25% and - 17% to 24%, respectively). Most sEMG measures were possibly to likely lower following UPA versus CPA (- 18% to - 11%), while AKE ROM was possibly greater (- 5.5%). Differences in ES sEMG (- 2.5%) and ROM (- 1.4%) during ALF were unclear and most likely trivial, respectively. CONCLUSIONS: CPA and UPA mobilizations increase lumbar and hamstring ROM whilst reducing local muscle activity. These effects appear to be greater for UPA mobilizations when compared with CPA.
Abstract: BACKGROUND: Cervical spinal instability often leads to neck pain and forward head posture (FHP). To improve neck pain and FHP, both the suboccipital muscle inhibition (SMI) technique and cranio-cervical flexion exercise (CCFE) have been used. However, little is known regarding the validity of hamstring flexibility in neck pain subjects after CCFE as a treatment index, and comparison between the SMI technique and CCFE for neck pain treatment. OBJECTIVE: This study aimed to determine the short-term effects of SMI technique and CCFE, which represent passive and active exercise programs, respectively, and whether these improve the straight leg raise…(SLR) test results, popliteal angle (PA), cranio-vertebral angle (CVA), and cervical range of motion (CROM) and are equally effective in immediate enhancement of such measures in neck pain subjects. METHODS: Twenty subjects with neck pain were randomly allocated to the SMI and CCFE groups (n = 10 each). The outcomes were evaluated via clinical evaluation and SLR, PA, CVA, and CROM measurement before and after intervention. RESULTS: SLR test results, PA, CVA (sitting and standing), and CROM (flexion, extension, lateral flexion, and right and left rotations) after both interventions were significantly higher than those before the interventions (P < 0.05). The SLR test results (left), PA, and CVA (standing) after the SMI technique improved to levels similar to those observed after CCFE. CONCLUSIONS: Both the SMI technique and CCFE improve SLR test results, PA, CVA, and CROM and are equally effective in immediate enhancement of the hamstring flexibility, CVA, and CROM in subjects with neck pain.
Keywords: Cervical range of motion, cranio-cervical flexion exercise, cranio-vertebral angle, hamstring flexibility, suboccipital muscle inhibition technique
Abstract: OBJECTIVE: The aim of this study was to compare platelet distribution width (PDW) and neutrophil to lymphocyte ratio (NLR) values in mild-to-moderate and severe knee osteoarthritis (OA). METHODS: This was a retrospective study of patients with knee OA according to the Kellgren-Lawrence (KL) grading system. Of 465 patients, 231 were excluded (62 due to not meeting the inclusion criteria and 169 due to the lack of simultaneous haemogram and radiographic evaluations). Demographic characteristics and PDW and NLR values were recorded. The patients were then divided into two groups: KL grade 1–3 (mild-to-moderate OA) and KL grade 4…(severe OA). RESULTS: In severe knee OA patients, blood PDW (13.44 ± 2.58, p = 0.01) and NLR values (2.16 ± 0.84, p = 0.04) were elevated as compared with those in mild-to-moderate knee OA patients. Blood PDW and NLR values of ⩾ 12.5 and ⩾ 2.1, respectively, were taken as cut-offs based on a receiver operating characteristics (ROC) curve analysis. In the ROC curve analysis, blood NLR ⩾ 2.1 had 60% sensitivity and 64.8% specificity, and PDW ⩾ 12.5 had 61% sensitivity and 58% specificity in predicting severe knee OA. In a univariate analysis, age (p < 0.001), PDW ⩾ 12.5 (p = 0.029) and blood NLR ⩾ 2.1 (p = 0.030) emerged as significant predictors of the severe knee OA. CONCLUSION: The results suggested that the blood PDW and NLR are novel inflammatory markers that can predict the radiographic severity of knee OA in clinical practice.
Keywords: Knee osteoarthritis, platelet distribution width, neutrophil to lymphocyte ratio, inflammatory marker
Abstract: BACKGROUND: Low frequency sound wave stimulation therapy has become increasingly popular in the rehabilitation fields, due to its ease, less fatiguing and time efficient application. OBJECTIVE: This 12-week pilot study examines the efficacy of applying low frequency sound wave stimulation (between 16–160 Hz) through both hands and feet on relieving pain and improving functional ability in patients with chronic back pain. METHODS: Twenty-three participants with chronic shoulder (eleven participants) or low back pain (twelve participants) underwent a 12-week vibration therapy program of three sessions per week. A low frequency sound wave device comprising…four piezoelectric vibration-type tactile tranducers enclosed in separate 5-cm diameter circular plates, which generate sinusoidal vibratory stimuli at a frequency of 16–160 Hz, was used in this study. Primary outcome measure was pain sensation measured using the Visual Analogue Scale (P-VAS). The secondary outcome measures were pain-related disability measured using the pain disability index (PDI) and quality of life measured using the SF-12. RESULTS: At week 12, significant reductions in pain sensation and pain-related disability were observed, with mean reductions of 3.5 points in P-VAS and 13.5 points in the PDI scores. Sixty-five percent of the participants had a reduction of at least 3 points on the P-VAS score, while 52% participants showed a decrease of at least 10 points in the PDI score. Significant improvement was observed in the SF-12 physical composite score but not the mental composite score. CONCLUSIONS: The preliminary findings showed that passive application of low frequency sound wave stimulation therapy through both hands and feet was effective in alleviating pain and improving functional ability in patients with chronic back pain.
Abstract: BACKGROUND: Shoulder imbalance is a problem for scoliosis patients. Rasterstereography uses radiation-free surface topography to follow up these patients. Its use for assessing shoulder level has not been investigated earlier. OBJECTIVE: This study aimed to determine the accuracy of shoulder assessment using rasterstereography (versus radiography) and to analyze its relationship with patients’ self-image. METHODS: In a cross-sectional setting, the reliability and validity of five rasterstereographic shoulder variables were measured in comparison with six radiographic shoulder parameters, using correlation analysis. The patients’ self-perception was documented using the Scoliosis Research Society-22 (SRS-22) questionnaire and Trunk…Appearance Perception Scale (TAPS). RESULTS: Forty patients were included in the study. The test-retest reliability of all rasterstereographic shoulder parameters was excellent (ICC > 0.95). The validity was moderate in comparison with six radiographic parameters (highest coefficient: 0.582). The radiographic and rasterstereographic shoulder levels correlated with the results in the SRS-22 questionnaire (highest coefficient: - 0.463) and TAPS (highest coefficient: 0.413). CONCLUSIONS: Rasterstereography is a reliable and valid method for assessing shoulder level in idiopathic scoliosis. The parameters can be recommended as a complement to radiography and clinical evaluation for follow-up purposes. Radiographic and rasterstereographic shoulder parameters are significantly related to patients’ self-perception. Shoulder variables thus need to be considered in scoliosis patients.
Abstract: OBJECTIVE: To evaluate the effects of robotic rehabilitation on upper extremity functions, cognitive development, and activities of daily living in patients with subacute stroke. METHODS: This study was set as prospective and controlled. Subjects with subacute stroke were allocated into two groups as the robotic and control groups. All subjects received a conventional rehabilitation program five times a week for 3 weeks. In addition, robotic group received robotic rehabilitation five times a week for 3 weeks (30 minutes per session). RESULTS: There were 20 patients in the robotic group (mean age of 63.27 ±…3.88 years) and 15 patients in the control group (mean age of 59.25 ± 8.10 years). Compared with baseline, the Functional independence measure (both motor and cognitive subscale), Fugl-Meyer Assessment Scale, and Motricity Index values did increase in both groups. Change levels of Fugl-Meyer Assessment FMA shoulder/elbow/forearm, and Motricity Index shoulder scores were significantly higher in the robotic group than the control group (p < 0.05). Compared with the baseline, physical component summary scores improved only in the robotic group, yet motor component summary scores improved only in the control group. Although Brunnstrom levels increased in both groups compared with baseline, change levels were similar. CONCLUSION: In the light of our results, robotic rehabilitation in addition to the conventional rehabilitation program seems to be effective on improving motor recovery and the quality of life in subacute stroke patients.
Keywords: Cerebrovascular accident, robotic rehabilitation, motor recovery, activities of daily living, the quality of life
Abstract: OBJECTIVE: Magnetic field therapy involves the application of low-intensity magnetic fields (1–3.5 mT) to a patient’s whole body. The purpose of this study was to assess the effectiveness of whole-body magnetic field (WBMF) therapy in the early rehabilitation of patients after lumbar discectomy. METHODS: A convenience sample of 73 patients who underwent lumbar discectomy within 1 month previously participated in the study. All patients were randomly assigned to one of two groups and received either a course of conventional rehabilitation (control group) or conventional rehabilitation together with 10 sessions of WBMF therapy (WBMF group). Participants were…evaluated before and after the rehabilitation course by using the Visual Analog Scale for Pain (VAS) and thermal infrared imaging. The latter was used to detect pathological changes in temperature (hyperthermia and thermal asymmetry) of the surface of the skin overlying the lumbar spine and lower extremities. RESULTS: The VAS score of the WBMF group decreased from 6.2 ± 0.3 cm before to 3.2 ± 0.2 cm after rehabilitation (p < 0.01), compared to 6.1 ± 0.4 cm before to 4.3 ± 0.2 cm after rehabilitation for the control group (p < 0.05). Reduction of the area of lumbar hyperthermia was observed in 88% of WBMF and 35% of control group patients. CONCLUSIONS: When combined with conventional rehabilitation, WBMF therapy was effective in reducing lumbar pain, temperature, and, possibly, inflammation. Results of this study will be used for designing a large-scale clinical trial.
Keywords: Pulsed magnetic field therapy, physical therapy, infrared thermography, spine, pain, spine cord injury
Abstract: BACKGROUND AND OBJECTIVE: Sleep disorders should be routinely evaluated and treated in low back pain (LBP) patients because they represent an important contributor to pain. However, no study thus far has investigated the potential benefit to LBP management of a device improving the sleep quality. Therefore, aim of this study was to assess the effectiveness of an innovative mattress overlay as add-on treatment to LBP rehabilitation. METHODS: Thirty eight LBP patients were randomized to standard rehabilitation plus mattress overlay use (cases) or standard rehabilitation only (controls). The intervention duration was 2 months and the following assessments…were performed before and after: pain intensity; level of perceived back disability and sleep health; spine mobility; thickness and echo intensity of the lumbar multifidus. RESULTS: Significant pre-post-intervention improvements were observed in cases for resting and movement pain, perceived back disability, sleep, fingertip-to-floor distance, multifidus thickness (∼ 6% increase) and echo intensity (∼ 13% decrease). On the contrary, all these variables remained constant between the two experimental phases in controls. CONCLUSIONS: A combination of rehabilitation and mattress overlay use seems an effective approach for improvement of pain, perceived back disability, sleep, spine mobility, and lumbar multifidus size and structure of LBP patients.
Abstract: BACKGROUND: Altered lower limb movement patterns (LLMP) during the forward step down (FSD) test have been studied in people suffering from knee instability. However, ankle dorsiflexion range of motion (ADROM) seems to be related to LLMP but no causal inference has been defined between those variables. OBJECTIVE: Our goals were to evaluate (1) psychometric quality of the FSD test in healthy people and (2) the influence of experimental restricted ADROM on LLMP. METHODS: Kinematics were measured by a motion capture system. Angular displacement and speed were calculated as well as center of mass…(COM) and knee linear displacement. Forty-two healthy participants; firstly, performed the test three times to assess reliability, and secondly the same test in an experimental condition limiting the ADROM. RESULTS: Reliability was excellent for all parameters (ICC: 0.75–0.99, SEM%: 2.0–34.0%). ADROM limitation significantly decreased Knee flexion range of motion (ROM) (- 3.8 ∘ ), increased Hip flexion ROM (6 ∘ ), Hip adduction ROM (6.1 ∘ ), Pelvis drop ROM (3.5 ∘ ), Pelvic rotation ROM (3.1 ∘ ). No significant effect was found for Hip rotation ROM. CONCLUSIONS: LLMP was affected by this experimental ADROM limitation in healthy people. As this limitation is often encountered in post-traumatic ankle sprain patients, clinicians should consider this point during FSD assessment test.
Keywords: Lower limb, movement pattern, functional tests, kinematics, biomechanics