Journal of Back and Musculoskeletal Rehabilitation - Volume 35, issue 1
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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: Fibromyalgia is a chronic condition characterized by generalized pain. Several studies have been conducted to assess the effects of non-pharmacological conservative therapies in fibromyalgia. OBJECTIVE: To systematically review the effects of non-pharmacological conservative therapies in fibromyalgia patients. METHODS: We searched MEDLINE, Cochrane library, Scopus and PEDro databases for randomized clinical trials related to non-pharmacological conservative therapies in adults with fibromyalgia. The PEDro scale was used for the methodological quality assessment. High-quality trials with a minimum score of 7 out of 10 were included. Outcome measures were pain intensity, pressure pain threshold, physical…function, disability, sleep, fatigue and psychological distress. RESULTS: Forty-six studies met the inclusion criteria. There was strong evidence about the next aspects. Combined exercise, aquatic exercise and other active therapies improved pain intensity, disability and physical function in the short term. Multimodal therapies reduced pain intensity in the short term, as well as disability in the short, medium and long term. Manual therapy, needling therapies and patient education provided benefits in the short term. CONCLUSIONS: Strong evidence showed positive effects of non-pharmacological conservative therapies in the short term in fibromyalgia patients. Multimodal conservative therapies also could provide benefits in the medium and long term.
Abstract: BACKGROUND: Proprioceptive neuromuscular facilitation (PNF) has been widely used in the clinical treatment of chronic low back pain (LBP) in recent years. However, its role remains controversial and it is unclear whether PNF offers more advantages for patients with chronic LBP. OBJECTIVE: The purpose of this systematic review is to evaluate the evidence on the effect of PNF on pain, waist function, pulmonary function and dynamic balance in patients with chronic LBP. METHODS: Seven English and Chinese electronic databases were searched to identify articles published from 1970 to February 2020. Relevant randomized controlled…trials (RCTs) were selected by two independent reviewers to investigate PNF in treatment of chronic LBP. Data extraction was performed by the same reviewers. RESULTS: Twelve eligible trials involving 410 participants were included in this meta-analysis. Compared with the control group, the aggregated results suggested that PNF showed beneficial effects in relieving pain (SMD = - 1.17; 95% CI: - 1.50 to - 0.84; p < 0.00001) and improving waist functional disability (MD = - 1.63; 95% CI: - 1.89 to - 1.37; p < 0.00001). In addition, PNF was shown to have a significant effect on pulmonary function (MD = 0.65; 95% CI: 0.26 to 1.03; p = 0.001). However, the results of the study show that PNF could not significantly improve dynamic balance in patients with chronic LBP compared with the control group (MD = - 0.04; 95% CI: - 2.16 to 2.08; p = 0.97). A high risk of bias occurred in the areas of blinding (i.e., participants/personnel and outcome assessment). CONCLUSIONS: PNF showed more beneficial effects in pain relief and waist function improvement in patients with chronic LBP in the short term (4 to 8 weeks of intervention) or at 12-week follow-up and also played a positive role in pulmonary function. However, no significant effect of PNF on dynamic balance was found compared with the control group. However, these results have certain limitations, and these conclusions were supported by low-quality data. Therefore, articles that are methodologically reasonable and more authoritative are required to verify the effects. In addition, articles with long-term follow-up and other outcomes are needed to confirm additional findings.
Abstract: OBJECTIVE: The aim of this study was to examine the efficacy and safety of kinesiology tape in treating hemiplegic shoulder pain. METHODS: Web of Science, MEDLINE, Embase, Cochrane Library, six other English databases and three Chinese databases (CNKI, VIP, Wan Fang) were searched for randomized controlled trials published prior to December 13, 2020 in English or Chinese on the use of kinesiology tape for hemiplegic shoulder pain. RESULTS: Fourteen randomized controlled trials (679 patients) of good PEDro quality (6.43 ± 1.09) were included in this meta-analysis. The pooled results for…pain (SMD - 0.92, 95% CI - 1.10 to - 0.74, P < 0.001, 10 RCTs, 539 patients), range of motion (SMD 2.27, 95% CI 1.23 to 3.32, P < 0.001, 7 studies, 320 patients), the acromion humeral distance (SMD - 0.62, 95% CI - 0.88 to - 0.37, P < 0.001, 7 RCTs, 246 patients) and the FMA-UE score (SMD 0.66, 95% CI 0.41 to 0.91, P < 0.001, 5 RCTs, 263 patients) suggested that therapeutic kinesiology tape relieved pain, increased ROM, shortened the acromion humeral distance and improved upper extremity motor function to a greater extent than the sham or blank control conditions. The pooled results for individual activity (SMD 0.42, 95% CI - 0.22 to 1.07, P = 0.199, 5 RCTs, 199 patients) and quality of life (SMD 0.308, 95% CI - 0.288 to 0.903, P = 0.311, 1 RCT, 44 patients) showed that the kinesiology tape group was not significantly different from the sham or blank control group. Publication bias was not observed. No adverse events were reported in any of the included studies. CONCLUSION: KT relieved pain and improved the ROM, DAH and FMA-UE score in patients with HSP to a greater extent than did the sham KT or blank control conditions. The effects on independence in activities of daily living and quality of life and whether this method is superior to active treatment in patients with HSP were not verified. More rigorous, reasonably designed RCTs with large sample sizes are still needed in the future.
Abstract: BACKGROUND: Enhanced recovery after surgery (ERAS) has been demonstrated to improve early postoperative outcomes and is becoming a crucial component of any perioperative management paradigm. OBJECTIVE: To investigate the effect of an ERAS protocol on lumbar disk herniation (LDH) patients undergoing dynamic stabilization and discectomy. METHODS: A total of 119 lumbar disk herniation (LDH) patients undergoing Dynesys dynamic stabilization and discectomy were divided into the ERAS (n1 = 56) and control group (n2 = 63). ERAS group received an enhanced recovery after surgery (ERAS) protocol, and control…group received a traditional care protocol. RESULTS: Both the ERAS and control groups had significantly decreased visual analog scale (VAS) score and Oswestry Disability Index (ODI) and increased Japanese Orthopaedic Association (JOA) score at postoperative 1 week, 1 month and 3 months compared with preoperative scores. Moreover, the ERAS group had lower postoperative VAS score and ODI and higher postoperative JOA score and rate of improved JOA score compared with the control group. Intraoperative blood loss, operation time, ambulation time and length of stay were all lower in the ERAS group than in the control group. CONCLUSIONS: The ERAS protocol designed was feasible for LDH patients undergoing dynamic stabilization and discectomy with significantly improved perioperative outcomes.
Keywords: Enhanced recovery after surgery, lumbar disk herniation, dynamic stabilization, discectomy
Abstract: BACKGROUND: The General Health Questionnaire 12 (GHQ-12) is a short easy-to-use scale to assess psychological distress. The GHQ-12 has not been validated for assessing psychological distress in patients with chronic low back pain (LBP). OBJECTIVE: To investigate the psychometric properties of the GHQ-12 in patients with chronic LBP. METHODS: The study involved a population of patients undergoing functional restoration for chronic LBP. The intraclass coefficient correlation was used for test-retest reliability (good if > 0.7) and the standard error measurement for absolute reliability. Construct validity was assessed with the Spearman…correlation coefficient (moderate and high if r ⩾ 0.35 and 0.5, respectively) and internal consistency with Cronbach’s alpha (suitable if > 0.7). Responsiveness was assessed by the Wilcoxon test and effect size. RESULTS: Four hundred and five patients were included. The intraclass coefficient correlation was 0.73 and standard error measurement 2.49. The GHQ-12 showed high convergence with the Beck Depression Inventory and subscales of the Dallas Pain Questionnaire for anxiety and depression and for sociability. It showed moderate convergence with the Quebec Back Pain Disability Scale and subscales of the Dallas Pain Questionnaire for daily activities and for leisure and occupation. Cronbach’s alpha was 0.89. The GHQ-12 score changed after functional restoration. It was lower (better) with than without improvement. CONCLUSIONS: We provide validation of the GHQ-12 for assessing psychological distress in patients with chronic LBP.
Keywords: General Health Questionnaire, GHQ-12, psychological distress, chronic low back pain, validation
Abstract: BACKGROUND: Recent clinical studies have revealed the advantages of using suspension devices. Although the supine, lateral, and forward leaning bridge exercises are low-intensity exercises with suspension devices, there is a lack of studies directly comparing exercise progression by measuring muscular activity and subjective difficulty. OBJECTIVE: To identify how the variations in the bridge exercise affects trunk muscle activity, the present study investigated changes in neuromuscular activation during low-intensity bridge exercises. We furthermore explored whether the height of the suspension point affects muscle activation and subjective difficulty. METHODS: Nineteen asymptomatic male participants were included.…Three bridge exercise positions, supine bridge (SB), lateral bridge (LB), forward leaning (FL), and two exercise angles (15 and 30 degrees) were administered, thereby comparing six bridge exercise conditions with suspension devices. Surface electromyography and subjective difficulty data were collected. RESULTS: The rectus abdominis activity was significantly higher with the LB and FL exercises compared with the SB exercise (p < 0.05). The erector spinae muscle activity was significantly higher with the SB and LB exercises, compared with the FL exercise (p < 0.05). The LB exercise significantly increased the internal oblique muscle activity, compared with other exercise variations (p < 0.05). The inclination angle of the exercise only affected the internal oblique muscle and subjective difficulty, which were significantly higher at 30 degrees compared with 15 degrees (p < 0.05). CONCLUSIONS: Relatively higher inclination angle was not effective in overall activation of the trunk muscles; however, different bridge-type exercises could selectively activate the trunk muscles. The LB and SB exercises could be good options for stimulating the internal oblique abdominis, and the erector spinae muscle, while the FL exercise could minimize the erector spinae activity and activate the abdominal muscles.
Keywords: Electromyography, exercise, sling, ratio
Abstract: BACKGROUND: Alexisomia is characterized by difficulties in the awareness and expression of somatic feelings. Trigger points are classified into two types, active and latent, according to the presence or absence of identifying spontaneous pain. OBJECTIVE: We aimed to examine the association between alexisomia and the presence of latent trigger points (LTrPs) in the upper trapezius of healthy volunteers. METHODS: This study was designed as a cross-sectional survey. A correlation analysis between the Shitsu-Taikan-Sho Scale (STSS) and LTrPs was performed on 154 healthy volunteers. The LTrP odds ratio for healthy volunteers with alexisomia was…selected as the primary endpoint. RESULTS: LTrPs were seen in the upper trapezius of 82 healthy volunteers (53.2%). There was no significant difference between the LTrP and non-LTrP groups in STSS total score (p = 0.11). However, there was a significant difference between them in STSS difficulty of identifying bodily feelings (DIB) score (p = 0.03). In the alexisomic versus non-alexisomic groups, the LTrP odds ratio for STSS total score was 2.30 (95% confidence interval [CI] 1.03–5.10) and for STSS DIB score, 2.08 (95% CI 1.05–4.11). CONCLUSIONS: In STSS DIB in particular, alexisomia was associated with the presence of LTrP in the upper trapezius of healthy volunteers.
Keywords: Latent trigger point, upper trapezius, alexisomia, difficulty in identifying bodily feelings, over-adaptation
Abstract: BACKGROUND: The role of the serratus anterior is to maintain scapular stability. To strengthen this muscle, scapular protraction exercises are typically performed. Although the angle of arm rotation leads to changes in shoulder muscle activation, the arm rotation position is not normally determined. OBJECTIVE: To investigate if scapular muscle activations were changed by combining arm external rotation during scapular protraction exercises. METHODS: Thirty-four healthy men were enrolled in this study. Participants were instructed to perform scapular protraction exercises at 90 ∘ and 120 ∘ of…shoulder flexion while in the standing and supine positions. Two different arm rotation angles were used: the thumb-up position (neutral position) and the maximum arm external rotation (ER) position. The percentages of maximum voluntary contractions (%MVCs) were measured, and %MVCs in the neutral and arm ER positions were compared. RESULTS: Muscle activities of the middle serratus anterior (MSA) and lower serratus anterior (LSA) in the arm ER position were significantly higher than those in the neutral position during all tasks. The highest MSA and LSA positions were observed with the arm ER position of 120 ∘ while standing. CONCLUSIONS: Scapular protraction exercises with arm ER resulted in a higher serratus anterior activity.
Keywords: Arm rotation, electromyography, serratus anterior, scapular protraction exercise
Abstract: BACKGROUND: Diaphragmatic release technique and thoracolumbar manipulation have been found effective in restoring normal diaphragmatic movement in healthy and diseased populations. Smoking has deleterious effects on human systems, including the musculoskeletal system. OBJECTIVE: The current study aimed to investigate the immediate effects of diaphragmatic release technique and thoracolumbar manipulation on diaphragm muscle strength in healthy smokers. METHODS: A double-blinded randomized clinical trial was conducted on 30 asymptomatic healthy smokers randomly assigned into two groups [intervention group (IG) and sham group (SG)] with 15 participants each. The IG received thoracolumbar manipulation and diaphragmatic release…techniques, while the SG received no active treatment. The outcome measure was sniff nasal inspiratory pressure (SNIP). RESULTS: The IG showed a significant increase in the SNIP with a mean difference of 20.13 cmH 2 O (95% CI: 13.62–26.64; P < 0.001), while the SG had a reduction in the SNIP value - 3.27 cmH 2 O (95% CI: - 0.65 to - 5.89; P = 0.02). Diaphragmatic release technique and thoracolumbar manipulation significantly improved SNIP values immediately after the intervention, with a between-group difference of 31.07 cmH 2 O (95% CI: 15.26–46.87; P < 0.001). CONCLUSIONS: Diaphragmatic release technique and thoracolumbar manipulation increased the diaphragm strength in healthy adult smokers, suggesting its potential utility in the management of participants with reduced respiratory muscle strength.