Journal of Back and Musculoskeletal Rehabilitation - Volume 33, issue 4
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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 systematic review with meta-analysis was to compare the effects of low load resistance combined with blood flow restriction (BFR) versus conventional quadriceps strengthening on knee symptoms and function as well as knee extensor strength and muscle thickness in adults with knee conditions. LITERATURE SURVEY: Guidelines based on the latest evidence highlight the importance of quadriceps strengthening to reduce pain and improve function in patients with knee conditions. Blood flow restriction is based on brief periods of vascular occlusion which cause muscle hypertrophy and increased strength. Before it can be recommended for individuals…with knee conditions, quadriceps strengthening with low load resistance combined with BFR (LL-BFR) must show beneficial effects on clinical outcomes in addition to quadriceps strength and mass. METHODS: A systematic review with meta-analysis was conducted to identify relevant studies through PubMed, PEDro, and ScienceDirect up to January 2019. The protocol was registered on PROSPERO (CRD42019121306). Differences in pre- and post-intervention means and standard deviations were extracted to calculate the standardized mean difference for each intervention in each included study. SYNTHESIS: Eight studies were included. Limited evidence suggests that LL-BFR is more beneficial on quadriceps strength and thickness in patients with knee conditions than LL training alone or in addition to a rehabilitation program. Limited evidence indicates that LL-BFR training is equally effective in improving function and muscle thickness compared with a HL quadriceps strengthening program but elicits less knee pain, corresponding to additional benefits of 22 (95% confidence interval 1 to 43) mm on a 0–100 mm visual analogue scale. CONCLUSIONS: BFR could be a useful option for patients with knee conditions where conventional quadriceps strengthening program exacerbate knee symptoms. Future investigations should compare different BFR protocols to help establish better guidelines for clinicians.
Abstract: BACKGROUND: Rehabilitation is currently the preferred first-line treatment for thoracic outlet syndrome (TOS). When physiotherapy fails, the next treatment option is usually surgery – a complex procedure with potential complications. OBJECTIVE: We sought to establish whether an intensive, multidisciplinary, day-hospital-based rehabilitation programme could reduce the symptoms of TOS after the failure of private-practice physiotherapy and before surgery was considered. METHODS: We performed a retrospective, single-centre study of 63 TOS patients admitted to our day hospital for 3 weeks (15 therapy sessions) between 2003 and 2014. The data were extracted from hospital records or…gathered in a phone interview. RESULTS: Immediately after discharge, the observed improvements in hand function were related to lifting a load, reaching a high shelf, sweeping the floor, cleaning windows, and combing hair. Three months after the end of the intensive rehabilitation program, 80% of the patients reported a reduction in their symptoms. Forty-one of the 63 patients were subsequently contacted by phone. The mean time interval between the end of the rehabilitation programme and the phone interview was 4.5 years (median: 3.5 years; range: 1–12 years). Twenty-seven patients (66%) reported a worsening in hand function, and 25% had undergone surgery. Twenty-three patients had kept the same job, 7 had changed jobs after retraining, 4 had stopped working before the programme but were able to return to work afterwards (including one patient in a part-time job), 4 had not returned to work, and 3 received disability benefits. CONCLUSION: An intensive, multidisciplinary, hospital-based rehabilitation programme was associated with improvements in the great majority of patients with TOS – even after private-practice physiotherapy had failed.
Keywords: Thoracic outlet syndrome, rehabilitation, physical and rehabilitation medici
Abstract: BACKGROUND: Previous studies have examined when activities of daily living (ADL) recovery more than six months after surgery can be predicted, and how much accuracy the predictors have. OBJECTIVE: The purpose of this study was to determine the predictors of ADL decline and evaluate their accuracies one year post-operation for hip-fracture patients. METHODS: We studied patients who underwent hip fracture surgery and were able to walk independently pre-operatively. The predictors of ADL declined one year post-operation, as analyzed using data of the basic medical attributes of the patients, including pain, 30-s chair-stand test,…dementia [using the Revised Hasegawa Dementia Scale (HDS-R)], and walking/mobility style [using Barthel Index (BI)]. Using a receiver operating curve (ROC) curve, the cut-off value for each significant predictor was determined in the logistic regression analysis. To calculate the cut-off values and diagnostic performances of each of the extraction factors. RESULTS: The data of 36 patients were collected over a period of one year. The prior probability of ADL decline at one year post-operation was 44.4%. The results of logistic regression analyses showed that the score of HDS-R at admission and the walking/mobility BI score at three weeks post-operation were significant predictors of the one year post-operative decline in ADL. The results of the ROC analyses showed that the cut-off value of the HDS-R score at admission was < 23 points. The posterior probability increased to 62.0%. In contrast, the cut-off value of the walking/mobility BI score was 0 points. The posterior probability increased to 91.0%. CONCLUSION: The ADL decline of the patients who underwent hip fracture surgery at one year after surgery can be predicted at three weeks post-operation.
Keywords: Hip fracture, one year post-operation, ADL, surgery
Abstract: BACKGROUND: Among new technological rehabilitation systems, there are proprioceptive platforms. These could be useful to improve static and dynamic balance. OBJECTIVE: To evaluate technological proprioceptive rehabilitation compared to conventional rehabilitation in patients after total hip arthroplasty (THA). METHODS: Sixty-four patients after THA were divided in two groups: a conventional group (CG) and a technological group (TG) treated with proprioceptive platforms. Before (T0) and after 20 sessions (T1), we recorded static and dynamic balance. Clinical and disability scales (Modified Harris Hip Score, Barthel Index, Deambulation Index), pain scales (ID-PAIN, DN4, VAS) and QoL scale…(SF-36) were administered to patients during T0 and T1. Mann-Whitney U test was used for stabilometric and dynamic assessments to detect differences between groups of patients and healthy subjects. The Wilcoxon signed-rank test was used for the within-group analysis and the ANCOVA test for the analysis between groups of patients. RESULTS: All scales improved significantly in both groups after treatment (p < 0.05). Static balance improved in both groups, but there were greater improvements in the TG than in the CG. All dynamic balance indexes showed significant improvements only in the TG after treatment. CONCLUSIONS: Both treatments improved the clinical, disability, pain, and QoL scales, as well as static balance, but only proprioceptive technological rehabilitation improved dynamic balance. Rehabilitation through proprioceptive platforms can indeed improve static and dynamic balance, which are both crucial for the patient’s safety and autonomy.
Keywords: Total hip arthroplasty (THA), technological rehabilitation, proprioceptive conventional rehabilitation, static balance, dynamic balance
Abstract: BACKGROUND: During the rehabilitation phase, physical exercise is a key element that requires an assessment of the best alternatives for application since the pre-prosthetic phase (PPF) for an accurate prescription. Therefore, the assessment of fitness for health (FFH) shall be included in the initial rehabilitation process. OBJECTIVE: To develop a FFH evaluation battery (Evam1) for pre-prosthetic unilateral lower-limb amputees (PPULLA). METHOD: A descriptive study of the theoretical construction and validation of a FFH evaluation battery based on a review of international literature for tests that measure amputee physical capability. RESULTS:…During the scientific literature review, no batteries designed with this goal were found. We therefore designed a battery that was assembled of five tests for anthropometry, aerobic capacity, strength and flexibility. Combined leg and arm cycloergometrics, isokinetic dynamometry, and flexi test are the most reliable tests for the corresponding assessment of each component. CONCLUSIONS: PPF is of great importance, since the basic physical capabilities are altered due to long immobilization and hospitalization periods, inadequate postures, alteration of basic daily activities, and decrease in participation in sports, recreational, and work activities. This is a fundamental proposal, given that the procedures for FFH assessment of PPULLA have been rarely addressed, thus limiting the information on assessment methods, processes and/or tests established for these procedures.
Abstract: BACKGROUND: The STarT Back Screening Tool (SBT) is a multidimensional questionnaire consisting of physical and psychological factors which categorizes the patients in the low, medium or high risk subgroups. OBJECTIVE: To investigate the relationship between SBT-based subgrouping and clustering of patients with LBP using uni-dimensional psychological, clinical and physical examination measures. METHODS: One hundred and fifty-seven patients with chronic LBP completed the SBT and uni-dimensional psychological, disability and pain questionnaires. Physical impairments were evaluated through the Physical Impairment Index (PII). Hierarchical and K-means methods were used for cluster analysis. Between-clusters differences and the…association between the clusters and SBT-based subgrouping were investigated. RESULTS: Three clusters were identified. The derived clusters were labeled severe, moderate and mild physical-psychological-distress clusters, because pain intensity, disability, psychological and physical factors were relatively high, moderate or low, respectively. Most of the patients in moderate and mild physical-psychological distress clusters were categorized as medium risk based on SBT. The mean difference for the PII was higher than that of psychological factors between moderate and mild physical-psychological-distress clusters. CONCLUSIONS: Patients in low and high risk subgroups of SBT were sufficiently differentiated, but patients in a medium risk subgroup had a different profile based on PII. Including additional physical factors in the SBT may be required to better differentiate among patients.
Keywords: Physical factors, psychological factors, low back pain, clustering, STarT Back Screening Tool
Abstract: BACKGROUND: Lumbar disc herniation (LDH) can affect lower limb muscle function resulting in an abnormal gait. This study aims to use surface electromyography (SEMG) to evaluate patients with L 4 /L 5 and L 5 /S 1 LDH throughout muscle movement. METHODS: Twenty L 4 /L 5 LDH patients (L5 Group), twenty L 5 /S 1 LDH patients (S1 Group), and twenty healthy controls (Healthy) were recruited for…the study. SEMG of bilateral tibialis anterior (TA) and lateral gastrocnemius (LG) muscles of patients were recorded using the DELSYS Wireless EMG System (Trigno TM Wireless Systems, Delsys Inc., USA). Root-mean-square (RMS), mean power frequency (MPF), and median frequency (MF) were compared between bilateral limbs in each participant. RESULTS: Reduced MPF and MF was found in TA measurements of the L5 Group and LG measurements of the S1 Group. The MPF and MF of the TA of symptomatic limbs of the L5 Group were reduced when compared to asymptomatic limbs (p = 0.006, p = 0.012, p < 0.05), and there were no significant differences in LG measurements (p > 0.05). The LG MPF and MF of the S1 Group in symptomatic limbs were reduced when compared to asymptomatic limbs (p = 0.006, p = 0.017, p < 0.05), and there were no significant differences in TA measurements (p > 0.05). Although there were no significant differences in RMS between bilateral limbs of the L5 and S1 Groups, we found some changes in RMS curves. First, compared to asymptomatic limbs of L 4 /L 5 LDH patients, β -peaks in the TA of symptomatic limbs appeared earlier. Second, two peaks in the LG of symptomatic limbs were found in L 5 /S 1 LDH patients. CONCLUSION: TA is affected in patients with LDH of L 4 /L 5 , and LG is affected in patients with LDH of L 5 /S 1 . As demonstrated, SEMG can identify LDH-related muscle dysfunction.
Keywords: Lumbar disc herniation, gait, surface electromyography, root mean square, median frequency
Abstract: BACKGROUND: The interest in biological treatments that have the potential to modify cartilage biology has gradually increased in recent years. OBJECTIVE: The aim of our study was to investigate the effects of intra-articular platelet-rich plasma (IA-PRP) injections on the femoral cartilage thickness, pain, functional status, and quality of life of patients with knee osteoarthritis. METHODS : A total of 71 patients (109 knees) with knee osteoarthritis who were administered IA-PRP injections twice with two-week intervals were included in this study. The resting and activity pain values measured using a Visual Analogue Scale (VAS), the Western Ontario…and McMaster Universities Osteoarthritis Index (WOMAC) scores, the Lequesne index scores, and the quality of life scores measured using Short Form-36 (SF-36) were recorded before treatment and at 1 month, 3 months, and 6 months after treatment. The femoral cartilage thickness was measured via ultrasonography before treatment, and at 3-month and 6-month follow ups. Obtained results were analyzed by the Wilcoxon signed rank test. RESULTS: The mean age of the patients was 47.4 ± 10.4 years old. The resting and activity pain scores were significantly decreased at 1-month, 3-month and 6-month follow ups when compared to the pre-injection values (p < 0.05). Significant reductions were found in the Lequesne index and WOMAC pain, stiffness, and function scores at 1, 3, and 6 months (p < 0.05), while a significant increase was detected in the third month scores when compared to the first month. Significant improvements were determined in the physical functioning, physical role, pain, general health, and emotional role sub-scores during the 6-month period (p < 0.05). However, there was no significant difference with regard to the cartilage thickness at the follow ups (p > 0.05). CONCLUSIONS: The results of our study indicated that the IA-PRP injections improved the pain, stiffness, physical functioning, and quality of life of knee osteoarthritis patients; however, they did not seem to affect the cartilage thickness during the 6-month follow up period.
Abstract: BACKGROUND: Chronic demyelinisation in multiple sclerosis (MS) involves changes in the muscle structure and development of motor disorders. OBJECTIVE: The aim of this research is to assess the muscle balance of thigh muscle in MS using a noninvasive method, to have information about the muscle status prior to the rehabilitation and to prevent muscle damage. METHODS: The studied group consisted of 20 patients: 9 men and 11 women, with a mean age of 42 years. The patients were diagnosed with MS in different stages. The clinical evaluation included clinical examination, neurological examination, functional…evaluation by using the Hamilton score, the activity daily living (ADL) scale and the Kurtze (EDSS) scale. For the muscle assessment we used tensiomyography (TMG), an evaluation method for the functional potential of the muscle, depending on the muscle composition. The TMG parameters are displacement (Dm), contraction time (Tc) and sustain time (Ts) for biceps femoris (mBF) and rectus femoris (mRF). RESULTS: The value of Dm shows low values for both studied muscle groups, but closer to the normal value for mBF. The average normal Tc values for mBF are 30.25 ± 3.5 ms and 32.83 ± 4.5 for mRF. The values are low values for mRF and high for mBF. The normal values of Ts are not standard values and can be compared healthy individuals’ values. These parameters could monitor the evolution and in our research have lower values for mRF. In the thigh, there was a significant difference in the Dm values, with higher values in mBF and also with higher values in the right lower limb. Analyzing the Ts results, we noticed a difference between the two muscle groups with a significant reduction in mRF, showing the inability to achieve anterior-posterior symmetry and the tendency to develop type I fibers at mBF level. CONCLUSIONS: Our study showed the presence of a structural and functional asymmetry explained by the tendency of increasing the tonus at mRF level in order to compensate the knee stability. We noticed a decrease in Tc value at the mRF level, but close to the value of the two lower limbs. TMG analysis revealed the asymmetry of the muscle composition at the level of the antagonist muscle groups of the thigh, with an increase in the percentage of type II fibers in the previous group, which became hyperton, and a decrease in the percentage of type I fibers in the posterior group.
Abstract: BACKGROUND: Numerous classification systems have been proposed to interpret lumbar MRI scans. The clinical impact of the measured parameters remains unclear. To evaluate the clinical significance of imaging results in patients with multisegmental degenerative pathologies, treating specialists can perform image-guided local injections to target defined areas such as the epidural space. OBJECTIVE: The aim of this retrospective study was to evaluate the correlation between lumbar spinal stenosis measurements obtained by MRI and improvement obtained through local epidural injection. METHODS: In this retrospective study various measurement and classification systems for lumbar spinal stenosis were…applied to MRI scans of 100 patients with this pathological condition. The reported effect of epidural bupivacaine/triamcinolone injections at the site was recorded in these patients and a comparative analysis performed. RESULTS: MRI features assessed in this study did not show any relevant correlation with reported pain relief after epidural injection in patients with chronic lumbar stenosis, with the exception of posterior disc height with a weak Kendall’s tau of - 0.187 (p = 0.009). CONCLUSIONS: Although MRI is crucial for evaluating lumbar spinal stenosis, it cannot replace but is rather complementary to a good patient history and clinical examination or the results of local diagnostic injections.