Journal of Back and Musculoskeletal Rehabilitation - Volume 34, 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: Hip fractures are serious fractures for the elderly. The rehabilitation of patients with hip fractures has been greatly affected by the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: We have piloted a new model for tracking patients and providing rehabilitation guidance that uses WeChat. The purpose of this study is to explore the role of chat software in rehabilitation guidance for hip fracture patients during COVID-19. METHODS: Patients treated for hip fractures from February 1 to April 30, 2020 were randomly divided into a control group and an observation group. The control group…was given conventional discharge guidance, while the observation group also followed up the patients using WeChat to guide the exercise. Satisfaction, the Harris Hip Score, complications and the mortality of the two groups after discharge were compared. RESULTS: The incidence of complications and mortality in the observation group were significantly lower than in the control group: p = 0.022 and p = 0.048, respectively. The Harris Hip Score and satisfaction were significantly better than the control group’s: p = 0.000 and p = 0.007, respectively. CONCLUSION: During the COVID-19 pandemic, it is very helpful to use WeChat software or other social software with similar functions (such as WhatsApp and Facebook) to guide the rehabilitation of hip fractures.
Keywords: COVID-19, hip fracture, rehabilitation, mortality
Abstract: BACKGROUND: Numerous studies have investigated factors for non-specific chronic low back pain (NSCLBP) in nurses, and have reached different conclusions. Evidence-based recommendations are required for the prevention and treatment of NSCLBP in nurses. OBJECTIVE: This meta-analysis aimed to systematically review and quantify the factors of NSCLBP in nurses. METHODS: Eleven databases were searched. The odds ratios (OR) with 95% confidence intervals (CIs) were pooled using meta-analysis, and either a fixed-effect or random-effect model was used based on heterogeneity across included studies. RESULTS: Eighteen publications including 11,752 nursing staff were included.…Being female (pooled estimate [95% CI], 1.56 [1.24–1.96]; P < 0.001), married (1.89 [1.38–2.60]; P < 0.001), overweight (0.63 [0.43–0.93]; P = 0.02), working at least 10 years (0.65 [0.48–0.89]; P = 0.007), and working night shifts (2.19 [1.16–4.21]; P = 0.02) were positively related to NSCLBP. Junior college education (0.60 [0.47–0.77]; P < 0.001) and job satisfaction (0.58 [0.47–0.73]; P < 0.001) were negatively related. Age (0.80 [0.50–1.27]; P = 0.34) and physical exercise (0.99 [0.39–2.49]; P = 0.98) were not related. CONCLUSIONS: This is the first meta-analysis to quantify the risk factors for NSCLBP in nurses. Being female, married, working night shifts, overweight, working at least 10 years and dissatisfied with work are risk factors. High-quality prospective studies are required to validate the findings of this study.
Keywords: Nurse, factors, non-specific chronic low back pain, meta-analysis, review
Abstract: BACKGROUND: Accurate clinical decision support tools may help clinicians select appropriate interventions for patients with spinal conditions. The Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) is a screening questionnaire extensively studied as a predictive tool. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed to help select interventions for injured workers. OBJECTIVE: To compare the classification accuracy of the ÖMPQ and WATT to clinician recommendations for selecting interventions leading to a successful return to work in patients with spinal conditions. METHODS: A secondary analysis was undertaken of data from injured workers…with spinal conditions assessed between 2013 and 2016. We considered it a success if the workers did not receive wage replacement benefits 30 days after assessment. Analysis included positive likelihood ratio (LR+ ) as an indicator of predictive accuracy. RESULTS: Within the database, 2,872 patients had complete data on the ÖMPQ, WATT, and clinician recommendations. At 30 days, the ÖMPQ was most accurate for identifying treatments that lead to successful outcomes with a LR+ = 1.51 (95% Confidence Interval 1.26–1.82) compared to 1.05 (95% Confidence Interval 1.02–1.09) for clinicians, and 0.85 (95% Confidence Interval 0.79–0.91) for the WATT. CONCLUSIONS: All tool recommendations had poor accuracy, however the ÖMPQ demonstrated significantly better results.
Keywords: Spine, decision making, return to work, occupational health, rehabilitation
Abstract: BACKGROUND: Pressure pain threshold (PPT) is decreased in several musculoskeletal disorders, giving indirect evidence regarding pain status. Despite the fact that PPT has been already proven to be reliable in patients with acute conditions, there is great variability of methods and results observed within studies, and only a few evidences confirming its reliability in chronic conditions. OBJECTIVE: The objective of this study was to determine the test-retest reliability of PPT in the neck and low back regions to discriminate individuals with neck or low back pain from healthy individuals. Additionally, one secondary aim was to establish the minimum…detectable change (MDC) and the standard error of measurement for future clinical studies and interventions. METHODS: In this reliability study, 74 individuals (15 individuals from the neck pain and 17 from the neck control group; 21 individuals from the low back pain and 21 from the low back control group). PPT was measured in the neck region (suboccipital, trapezius and supraspinal muscles) and in the lower back region (paraspinal muscles in the levels of L1, L3 and L5). Intrarater reliability was assessed using intraclass correlation coeficient and Bland-Altman. RESULTS: Excellent intra-rater reliability was observed for both (ICC of 0.874 for the neck pain versus ICC of 0.895 in neck control group; ICC of 0.932 for the low back pain group versus ICC of 0.839 for the control group). A small bias was observed for all groups (- 0.08 for the neck pain group versus 0.10 in the control group; and 0.32 in low back pain group versus 0.44 in the control group). Minimum detectable change of 0.63 kgf of neck pain and 1.21 kgf of low back pain was calculated. It was found difference in PPT between pain and control groups (p < 0.05). CONCLUSION: It may be suggested that the protocol with PPT is reliable and able to discriminate individuals with and without neck and low back pain with a minor measurement error. Therefore, this method may be used to detect possible progress after interventions in patients with neck or low back pain.
Keywords: Chronic pain, neck pain, low back pain, pressure pain threshold, test reproducibility, pain measurement
Abstract: BACKGROUND: Chest size is a known factor in the development of back pain for women. However, the neuromuscular mechanisms associated with chest size and back pain are poorly understood. OBJECTIVE: The purpose of this study was to investigate chest size and its association with back pain development and muscle activity patterns during prolonged standing. METHODS: Twenty university-aged women were divided into two groups: small chest size (n = 10, ∼ A/C cup) and large chest size (n = 10, ∼…D/E cup). Participants completed a 2-hr standing protocol, where eight channels of bilateral trunk electromyography were collected. Muscle activity, specifically co-contraction, was compared between chest size groups, pain developers, and time. RESULTS: The large chest size group reported higher amounts of pain at the upper, middle, and low back. Women in the large chest group sustained higher levels of co-contraction for muscles involving the thoracic and lumbar erector spinae compared to those in the small chest size group during prolonged standing. CONCLUSIONS: Thoracolumbar co-contraction determined in this study may be a potential mechanism contributing to increased back pain development for women with large chest sizes during prolonged standing. This pain mechanism could be targeted and addressed in future non-invasive musculoskeletal rehabilitation to improve back pain for women.
Keywords: Anthropometry, low back pain, occupational standing, muscle co-contraction
Abstract: BACKGROUND: The World Health Organization states that low back pain is the leading cause for disability worldwide. Patients with chronic low back pain (CLBP) show important decreases in lumbar strength and can now be assessed by using the new isokinetic dynamometer BioniX Sim3 Pro which offers very detailed measurements. OBJECTIVE: To compare lumbar flexion and extension strength values, as well as extension-flexion ratio (EFR) based on isokinetic velocity and gender, for patients with CLBP on the BioniX Sim3 Pro. METHODS: A retrospective analysis was performed on data from 20 men and 22 women…with CLBP. Maximum torque in flexion and extension was measured isometrically and isokinetically. Statistical analysis was performed on these parameters. RESULTS: EFR shows a downward trend with increasing speed of measurement (isometric to isokinetic 30 ∘ /s and isokinetic 30 ∘ /s to isokinetic 90 ∘ /s, respectively): in men from 1.21 to 1.04 (p < 0.001) and from 1.04 to 0.93 (p = 0.207). In women, EFR decreased from 1.41 to 1.13 (p < 0.001) and from 1.13 to 1.00 (p = 0.144). CONCLUSIONS: Patients with CLBP have a decreased strength in lumbar extension and flexion compared to the age-corrected normal values of Bionix Sim3 Pro. With increasing speed of testing protocol, a decrease in EFR is observed in this population.
Keywords: Isokinetic, low back pain, bionix, lumbar, torque values
Abstract: BACKGROUND: Previous studies have analysed the effect of wearing high-heeled shoes (HHS) on gait analysis, balance and its relation to health. However, further research is needed to study its effect on the difference of chain reactions in the transfer of body impacts from the lower to the upper limbs. OBJECTIVES: The aims of the present research were: (a) to compare the effects of wearing HHS on impacts across body joints during walking with sport shoes (SS) as a reference, and (b) to examine such effects at different speeds. METHODS: Seven well-trained women completed…this study. Incremental treadmill walking test were performed with two different footwear: SS and HHS. Inertial devices were used to quantify the chain reactions at selected anatomical lower limbs and trunk locations. Statistical analysis included the Wilcoxon test with ranges and Cohen’s d effect size with percentage of differences. RESULTS: The highest values were found at the heel in both footwear and in both legs (SS: right = 0.76 ± 0.27, left = 0.79 ± 0.27; HHS: right = 1.07 ± 0.38, left = 1.11 ± 0.41), while the lowest values were registered at lower and upper back. Furthermore, significant differences were found with the HHS load being higher at all locations (p < 0.05; %= 𝑑𝑖𝑓𝑓 12.20–36.36%), influenced by the walking speed. In addition, a strong influence of footwear in the change of the laterality profile was found (p < 0.05). CONCLUSIONS: These findings suggest that the use of HHS increase the load on the lower limb and the trunk. Until reaching 5 km/h during walking, no significant differences were found between wearing HHS or SS in accelerometer load, producing exponential differences from this speed. The great between-subject variability implies that within-subject analysis is recommended, as it is more related to real clinical practice.
Abstract: BACKGROUND: Illness perceptions predict chronic low back pain (CLBP) disability. This study cross-culturally adapted and validated the Igbo Brief Illness Perceptions Questionnaire (Igbo-BIPQ) in people with CLBP in rural/urban Nigeria. METHODS: A cross-cultural adaptation and validation of the Igbo-BIPQ was undertaken. The BIPQ was forward/back-translated by clinical/non-clinical translators. An expert review committee appraised the translations. The questionnaire was pre-tested on twelve rural Nigerian dwellers with CLBP. Internal consistency using Cronbach’s alpha; test-retest reliability using intra-class correlation coefficient and Bland-Altman plot; and minimal detectable change were investigated amongst 50 people with CLBP in rural and urban Nigeria.…Construct validity was determined by correlating the Igbo-BIPQ score with those of eleven-point box scale and Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ) using Pearson’s correlation analyses in 200 adults with CLBP in rural Nigeria. Ceiling and floor effects were investigated in both samples. RESULTS: Good face/content validity, internal consistency (α = 0.76) and intraclass correlation coefficient (ICC = 0.78); standard error of measurement and minimal detectable change of 5.44 and 15.08 respectively; moderate correlations with pain intensity and self-reported disability (r ⩾ 0.4); no ceiling/floor effects were observed for Igbo-BIPQ. CONCLUSION: This study provides evidence of some aspects of validity and reliability of the Igbo-BIPQ.
Keywords: Illness perceptions, Africa, cross-cultural, psychometric, low back pain
Abstract: OBJECTIVE: The aim of this study was to compare the potential post-activation performance enhancement (PAPE) effects of two different warm-up strategies, involving dynamic stretching (DS) or heavy load leg press (HL) on several key physical qualities in tennis players. METHODS: Twenty-six elite male tennis players (age: 19.22 ± 4.20 years; body mass: 67.37 ± 8.19 kg; height: 1.77 ± 0.07 m) performed both warm-ups, with 48-hours between protocols (DS and HL), performed in a randomized order. Pre- and post-tests included: countermovement jump, 5-m and 10-m sprint, 5-0-5…agility test, and hip extension and flexion range-of-motion which were performed before and after DS and HL warm-up protocols. RESULTS: The DS warm-up led to substantial improvements in 5-m and 10-m sprint, 5-0-5 agility test, countermovement jump, and also to higher hip flexion range-of-motion. The HL warm-up caused impairments in 5-m and 10-m sprints, but improvements in 5-0-5 agility test, countermovement jump and hip extension range-of-motion. Compared to HL, DS warm-up induced possibly to likely positive effects on 5-m and 10-m linear sprint performance, as well as in hip flexion range-of-motion. Nevertheless, no differences in performance improvements in 5-0-5 agility test, countermovement jump and hip extension range-of-motion were found when comparing DS and HL warm-up protocols. CONCLUSION: DS seems to be more effective than HL when performing a short warm-up protocol in elite tennis players.
Keywords: Racquet sport, vertical jump, sprint, range of motion