Journal of Back and Musculoskeletal Rehabilitation - Volume 33, 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: OBJECTIVES: High-intensity laser therapy (HILT) has recently been used to control pain and symptom improvement in knee osteoarthritis. We performed a systematic review and meta-analysis of randomized controlled trials to assess the effectiveness of HILT in patients with knee osteoarthritis. METHODS: We conducted a search of articles in the MEDLINE, EMBASE, Cochrane CENTRAL, and Web of Science databases up to March 2020 for randomized controlled trials investigating HILT intervention, placebo, or active intervention as comparator groups for alleviating pain in knee osteoarthritis. Two independent reviewers evaluated the methodological quality and extracted pain and functional outcomes using…a pre-specified form. A meta-analysis was performed using an inverse-variance random effect model. Heterogeneity was assessed using Higgins I 2 with p -values. RESULTS: Six randomized controlled trials (RCTs) were included in this meta-analysis. For VAS pain, 334 patients from four studies showed that HILT significantly decreased pain compared to the control (MD, - 1.18; 95% CI, - 1.68 to - 0.69). HILT significantly improved WOMAC stiffness (SMD - 1.00; 95% CI - 1.32, - 0.68) and function (SMD, - 5.36; 95% CI - 7.39 to - 3.34) compared to the control. CONCLUSION: The effectiveness of HILT on pain, stiffness, and function in patients with knee osteoarthritis is promising. However, due to the limited number of studies, further randomized controlled trials with large, well-designed samples are needed.
Abstract: BACKGROUND: Work-related musculoskeletal disorders (WMSDs) represent a significant problem for nurses. It is thus important to investigate nurses’ WMSDs prevalence and comprehensive predictors including motor, mental, and lifestyle factors. OBJECTIVES: To investigate the prevalence and predictors of lower quadrant WMSDs among Jordanian nurses. METHODS: A cross-sectional design, using self-administered questionnaires, was utilized. Outcome measures included Nordic Musculoskeletal Questionnaire (NMQ), Depression Anxiety Stress Scale (DASS21), Pittsburgh Sleep Quality Index (PSQI), sociodemographic data, and self-reported work ergonomics. Descriptive analyses were used to determine lower quadrant WMSDs prevalence and regression analyses were used to assess their…predictors. RESULTS: A total of 597 nurses participated in the study. Twelve-month prevalence of lower quadrant WMSDs were 77.4% in lower back, 22.3% in hips, 37.5% in knees, and 28.5% in ankles and feet. Older age, longer years of experience, high workload, poor work habits and ergonomics, high physical activity level, availability of patient handling equipment, handling policies, stress, and anxiety were significant predictors (p < 0.05) of lower quadrant WMSDs. CONCLUSIONS: Jordanian nurses have a high prevalence of lower quadrant WMSDs. Many modifiable risk factors of WMSDs were identified. Future studies need to design effective treatment and preventive strategies for nurses’ WMSDs to improve their work efficiency and wellbeing.
Abstract: BACKGROUND: Exercise programs in the treatment of chronic lumbar pain are quite diverse, but it has been proven that stabilization exercises are the most effective. OBJECTIVE: We compared the lumbar stabilization exercise program in a closed and open kinetic chain (LSCO) and lumbar stabilization exercises and thoracic mobilization program in a closed kinetic chain (LSTMC), and evaluated the clinical effectiveness of each program. METHODS: Prospective, randomized, controlled trial in 80 chronic low back pain (CLBP) patients with lumbar radiculopathy of both sexes (35 male, 45 female), average age (48.45 ±…10.22 years), divided in two groups that performed different sets of exercises. Participants were given laser therapy, transcutaneous electro-nerve stimulation and an eight-week kinesiotherapy that included exercises to strengthen the deep lumbar spine stabilizers. Retesting was done after four and eight weeks. RESULTS: Statistically significant (p < 0.05) superior recovery of the LSTMC group subjects compared to the LSCO group was achieved at all measurement intervals in the pain intensity and functional disability parameters. CONCLUSION: Patients who performed the lumbar stabilization and thoracic mobilization exercise program in a closed kinetic chain had the most effective reduction of pain intensity and functional disability.
Abstract: OBJECTIVE: The present study aimed to estimate the reliability, standard error of measurement (SEM), and minimum detectable change (MDC) of the star excursion balance test (SEBT) in children with cerebral palsy (CP). METHODS: Eight children with CP (five boys and three girls, sixteen legs) participated in this study. Each child carried out the SEBT and was assessed by two examiners. To determine intra-rater reliability, the intra-class correlation coefficient (ICC) model (3, 3) was calculated. To determine the inter-rater reliability, the ICC model (2, 3) was computed. RESULTS: In terms of the intra-rater reliability…of the SEBT, the ICC varied from 0.98 to 0.99 and the total ICC score was 0.99 (p < 0.001). For the inter-rater reliability, the ICC varied from 0.98 to 1.00 and the total ICC score was 0.99 (p < 0.001). The SEBT had an SEM of 2.63 and an MDC of 7.31. CONCLUSION: The SEBT is not only reliable with a small SEM, but is also a simple and cheap assessment of dynamic balance in children with CP.
Keywords: Cerebral palsy, reliability, star excursion balance test
Abstract: BACKGROUND: Lumbar vertebrae carry the greatest load from the spinal column, often leading to several pathologies, including degenerative disc disease (DDD), potentially disturbing spinal movement patterns. Mobilisation increases hypomobile segment mobility, however there is little evidence on mobilisation in patients suffering from different types of DDD. OBJECTIVE: To assess the efficacy of mobilisation in young patients with DDD, as diagnosed by MRI. METHODS: Thirty patients (24–35 years) participated in this study, and were divided into two groups, based on progression levels of DDD diagnosed by MRI (protrusion-PRO/extrusion-EXT). Twenty sessions of sustained stretch mobilisation…(grade III) were applied to both groups over four weeks. Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), straight leg raise (SLR), passive lumbar extension (PLE) and lumbar range of motion (ROM) assessed outcome variables. Three trial stages were investigated: pre-therapy (1), post-therapy (2) and follow-up (3). RESULTS: Age (p = 0.007) and NRS (p = 0.002) were significantly different before therapy. Patient outcomes were significantly improved for all parameters in both groups, except SLR which improved in the EXT group only (p = 0.043). CONCLUSIONS: Applied treatments improved patient outcomes and were statistically significant in both groups, however, better outcomes were observed in the EXT group during follow-up. Mobilisation was a safe and effective procedure for the treatment of DDD.
Keywords: Mobilisation, herniated disc, low back pain, spine, lumbosacral region
Abstract: BACKGROUND: Differences in pain processing, muscle structure and function have been reported in patients with low back pain (LBP) with different grades of pain chronicity. OBJECTIVE: The present study aims to examine differences in psychological factors, disability and subjective fatigue between subgroups of LBP based on their chronification grade. METHODS: Twenty-one healthy controls (HC) and 54 LBP patients (categorized based on the grades of chronicity into recurrent LBP (RLBP), non-continuous chronic LBP (CLBP), or continuous (CLBP)) filled out a set of self-reporting questionnaires. RESULTS: The Hospital Anxiety and Depression Scale…(HADS) and Multidimensional Pain Inventory (MPI) scores indicated that anxiety, pain severity, pain interference and affective distress were lower in HC and RLBP compared to non-continuous CLBP. Anxiety scores were higher in non-continuous CLBP compared to RLBP, continuous CLBP and HC. The Pain Catastrophizing Scale for Helplessness (PSCH) was higher in non-continuous CLBP compared to HC. The Survey of Pain Attitudes (SOPA) showed no differences in adaptive and maladaptive behaviors across the groups. The Pain Disability Index (PDI) measured a higher disability in both CLBP groups compared to HC. Moreover, the Rolland Morris Disability Questionnaire (RMDQ) showed higher levels of disability in continuous CLBP compared to non-continuous CLBP, RLBP and HC. The Checklist Individual Strength (CIS) revealed that patients with non-continuous CLBP were affected to a higher extent by severe fatigue compared to continuous CLBP, RLBP and HC (subjective fatigue, concentration and physical activity). For all tests, a significance level of 0.05 was used. CONCLUSIONS: RLBP patients are more disabled than HC, but have a tendency towards a general positive psychological state of mind. Non-continuous CLBP patients would most likely present a negative psychological mindset, become more disabled and have prolonged fatigue complaints. Finally, the continuous CLBP patients are characterized by more negative attitudes and believes on pain, enhanced disability and interference of pain in their daily lives.
Abstract: BACKGROUND: In people with chronic low back pain (cLBP) and active discopathy, glucocorticoid intradiscal injection (GC IDI) reduces LBP in the short-term. Lumbosacral immobilization may be useful to obtain long-term results. OBJECTIVE: To assess the feasibility of a lumbosacral immobilization using a pantaloon cast following GC IDI in people with cLBP sand active discopathy. METHODS: We conducted a retrospective feasibility study. Participants were allocated to experimental or control groups by preferences. The experimental group received lumbosacral immobilization using a custom-made pantaloon cast worn continuously for one week following a GC IDI of 25 mg…of prednisolone acetate. The control group received GC IDI alone. The primary endpoint was the feasibility of lumbosacral immobilization assessed by the rate of refusal and early withdrawal of the cast. RESULTS: Twelve patients were offered lumbosacral immobilization following GC IDI: the rate of refusal was 3/12 (25.0%) and was 3/9 (33.3%) of early withdrawal. Mean (95% CI) acceptability of the procedure was 55.0 (26.9–83.1)/100 in the experimental group (N = 6) and 61.6 (25.1–98.2)/100 in the control group (N = 6). CONCLUSIONS: We found high rates of refusal and early withdrawal of the lumbosacral immobilization using a pantaloon cast following GC IDI in people with nonspecific cLBP and active discopathy.
Keywords: Chronic low back pain, Modic 1, active discopathy, intradiscal therapy, glucocorticoid, lumbar brace
Abstract: BACKGROUND: Alterations in plantar loading patterns are risk factors for stress injuries of the lower limb, particularly of the foot and ankle. Epidemiological studies have revealed a higher incidence of soccer-related stress fractures of the fifth metatarsal (MT V) in younger athletes than in their adult counterparts. OBJECTIVE: The aim of the present study was to assess the plantar pressure distributions of members of four high-level soccer teams of different age groups to identify age-related differences in loading patterns. METHODS: A total of 65 elite soccer players were included in the study. Data…were computed with sensor-loaded insoles (pedar ® X system, novel Inc., Munich, Germany) while the players ran in soccer shoes. Plantar pressures for nine defined regions on the preferred and nonpreferred foot were analyzed. RESULTS: The participants consisted of 17 elite male soccer professionals from the first national league (mean 23 years, height 184 cm, weight 81 kg), 14 players from the under-21 squad (U21, 20 years, 180 cm, 75 kg), 15 players from the U17 squad (16 years, 176 cm, 69 kg) and 19 players from the U16 squad (15 years, 179 cm, 70 kg). We detected statistically significantly elevated peak pressures on the lateral aspects of the nonpreferred foot compared with the preferred foot in the U16 and U17 players, corresponding to a relative increase by 29% (p = 0.044) in the lateral midfoot, a relative increase by 24% (p = 0.031) in MT heads 4–5 in the U16 players and a difference of 18% (p = 0.049) in the lateral midfoot in the U17 players. In contrast, the U21 and adult professional players displayed symmetric plantar pressure distributions in all foot regions. CONCLUSIONS: In contrast to adult elite soccer players, adolescents demonstrate asymmetric foot loading patterns with increased peak loads in the lateral aspects of the nonpreferred foot. Our results may provide some explanation for MT V stress fractures that occur in elite adolescents.
Abstract: BACKGROUND AND OBJECTIVE: This case report describes the long-term effect of the high-intensity laser therapy (HILT) in a patient with chronic shoulder pain refractory in comparison to other treatments. CASE DESCRIPTION: Ten sessions of HILT were applied in a thirty-one-year-old woman diagnosed with subacromial syndrome. Assessment was carried out through different tests: Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Scale (NPRS) and pressure pain threshold (PPT). All measurements were taken at four different points: at the end of the 10 sessions, after one month, three months after the intervention and nine months after the…initial intervention. RESULTS: There was a clinically significant improvement in NPRS (decrease of 5 points), PPT (increase of 1.5 kg/cm 2 ) and SPADI (decrease of 24 points) one month after the intervention. After three months, the increase of NPRS and SPADI required a 5-session intervention to support the clinical improvement. Six months after these booster sessions an increase in PPT and a decrease in NPRS and SPADI were observed. CONCLUSION: Results indicate the suitability of developing new research lines which will optimize the use of HILT.
Keywords: Shoulder pain, shoulder impingement syndrome, high intensity laser therapy, high power laser therapy
Abstract: BACKGROUND: Pain relief is important both for the movement of patients suffering from low back pain and the quality of life. Dry needling is effective on myofascial trigger points but its effect on the area of pain and the functional balance is not fully known. OBJECTIVE: To examine the immediate effect of dry needling on pain and functional balance of patients suffering from low back pain. METHODS: Twenty five patients with sub-chronic low back pain were randomly divided into two groups: the intervention or control group. Needles were used for the participants of the…intervention group, bilaterally at the spinus level, one and a half finger breath from the midline in levels L2–L5 of the lumbar spine. A third line of needles was inserted in the interspinosus spaces, except L5-S1 level. Bipedal stance, lateral loading and mediolateral body sway were assessed using a pair of force plates. Pain tolerance was assessed using an algometer. RESULTS: The pain tolerance significantly increased in the intervention group from (M = 4.87, SE 0.663) to (M = 6.52, SE 0.547) (F( 1 , 23 ) = 7.8, p < 0.05) after intervention. During mediolateral body sway the force signal in the dominant frequency significantly increased in the intervention group from (M = 43.2, SE 4.6) to (M = 54,9, SE 3.6) (F( 1 , 23 ) = 4.63, p < 0.05) after intervention, exhibiting more controlled rhythmic behavior. CONCLUSIONS: Dry needling in painful areas and penetrating all the muscle groups seems to improve pain and functional balance, yet its effect on specific muscles needs to be studied further.
Keywords: Low back pain, dry needling, force platforms, body sway