Journal of Back and Musculoskeletal Rehabilitation - Volume 35, 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: BACKGROUND: Adherence to treatment is one of the most common problems in patients suffering from chronic disease such as osteoporosis, and special commitment is required to patients, especially regarding rehabilitation. There is increasing evidence that physical interventions aimed at relieving pain and reducing physical impairments could play a crucial role in improving the quality of life and reducing the risk of fractures in patients with severe osteoporosis. OBJECTIVE: The aim of this study was to assess the compliance and determine the acceptability of a home-self-managed exercises program in patients with vertebral fractures, one of the most…frequent and serious consequences of osteoporosis. METHODS: We conducted a retrospective observational study of patients undergoing a home exercise program, monitoring them with clinical scales, questionnaires, and routine visits. RESULTS: 62.86% of the patients were compliant with the treatment; the absence of supervision by health personnel was the primary cause of non-compliance, followed by the lack of time and the lack of motivation. Compliant patients showed a significant reduction in lumbar pain (p 0.011), an improvement in posture with a reduction of dorsal kyphosis (occipital-wall distance T0-T1, p -value = 0.02) and an improvement in QoL (p -value = 0.001) and physical performance at the 20 m walking test (p -value = 0.003). CONCLUSIONS: A home exercise program is feasible and could improve signs and symptoms in patients with vertebral fractures due to OP.
Abstract: BACKGROUND: The function of trunk muscles in chronic nonspecific low back pain (CNLBP) is controversially discussed, and trunk muscle function in sedentary occupation workers is poorly understood. OBJECTIVE: To investigate whether muscle function differs between sedentary occupation workers with and without CNLBP and to determine the association between functional limitations and muscle function. METHODS: This study included 32 sedentary occupation workers (16 workers with CNLBP and 16 age- and sex-matched workers without CNLBP). Group differences in isokinetic trunk flexion-extension strength, muscle cocontraction, endurance time (Biering-Sorensen test) and electromyographic muscle fatigue were assessed. The…association of these parameters and Oswestry Disability Index (ODI) score were examined in the CNLBP group. RESULTS: Participants with CNLBP had lower trunk extensor (- 20%) and flexor (- 18%) strength and less cocontraction (- 22%) than participants without CNLBP, but due to large variability in both groups these differences were not statistically significant. Trunk muscle endurance and fatigue were comparable between groups. Variance in endurance time explained 28% of variance in the ODI-score in the CNLBP group (R 2 = 0.277). CONCLUSIONS: In patients with CNLBP, greater functional disability was associated with lower endurance. Further evidence is necessary to elucidate whether specifically training endurance performance may be beneficial for sedentary occupation workers.
Abstract: BACKGROUND: Because regular visits to distant hospitals may be a burden to patients, both in terms of time and cost, some patients with chronic musculoskeletal pain may discontinue multidisciplinary pain treatment, unable to maintain motivation to attend. OBJECTIVE: To evaluate and compare the pre-program characteristics of patients who dropped out and patients who continued treatment, thereby clarifying the characteristics of patients at risk of dropping out. METHODS: A multidisciplinary pain management treatment program was implemented for patients at the Pain Management Center, Hoshi General Hospital. From April 2015 to March 2018, 23 patients…participated in the program. Twelve of the 23 patients lived outside the prefecture where the hospital is located. Of these 12 patients, five completed the program, while seven did not. We compared the dropout and continuation groups in terms of patient characteristics, pain severity, pain-related psychosocial factors, and quality of life. RESULTS: We found significant differences (p < 0.05) in median age, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire walking ability dysfunction score, and Roland-Morris Disability Questionnaire score. CONCLUSIONS: The characteristics of patients who dropped out were older age, walking ability dysfunction, and low quality of life associated with low back pain.
Keywords: Chronic musculoskeletal pain, multidisciplinary treatment, inpatient pain management program, drop out
Abstract: BACKGROUND: The first-line contact for patients seeking care for low back pain (LBP) can potentially change the disease course. The beliefs and attitudes of healthcare providers (HCPs) can influence LBP management. Although referring patients with LBP to physical therapy is common, the first-line contact for patients with LBP in Saudi Arabia is the primary care physician (PCP). Physical therapy will soon be integrated into primary care; therefore, it is rational to compare physical therapists’ (PTs) beliefs and attitudes regarding LBP with those of PCPs. OBJECTIVE: We compared PCPs’ and PTs’ attitudes and beliefs regarding LBP management.…METHODS: We employed a cross-sectional, voluntary response sample research design using the Pain Attitudes and Beliefs Scale (PABS). Participants were PTs and PCPs practicing in Saudi Arabia. RESULTS: In total, 153 participants completed the PABS (111 PTs and 52 PCPs). PCPs demonstrated significantly higher PABS biomedical subscale scores than did the PTs. CONCLUSIONS: HCPs in Saudi Arabia should receive additional training to adopt a biopsychosocial approach to managing LBP. In this study, the HCPs’ treatment recommendations may not correspond with contemporary clinical guidelines. Research to facilitate the implementation of optimal professional education and training to adopt a biopsychosocial approach is an urgent priority.
Keywords: Primary care physicians, physical therapists, low back pain, pain attitudes and beliefs scale, cross-sectional study
Abstract: BACKGROUND: Early full weight-bearing mobilization is controversial in osteoporotic patients who have undergone uncemented hemiarthroplasty (UCH). OBJECTIVES: The aim of the study was to compare the results of early full weight-bearing mobilization in CH and uncemented hemiarthroplasty (UCH). The effect of subsidence on the results was also evaluated. METHODS: Fifty-nine patients who underwent CH and UCH were evaluated. The mean age was 79.8 years (10 females, 15 males) for CH and 75.5 years (10 females, 24 males) for UCH. All patients started immediate full weight-bearing mobilization and weight-bearing exercises. RESULTS: There was no…difference between the groups according to the Harris Hip Score. Both groups were evaluated in subgroups according to whether there is varus in the femoral stem. There was no difference between subgroups according to the Harris Hip Score. The femoral subsidence was not determined in CH group. In the UCH group, the subsidence was 1.13 ± 1.03 mm in varus femoral stem subgroup and 0.81 ± 0.85 mm in without femoral stem varus subgroup. There was no difference in subsidence between femoral stem with varus and without varus. The subsidence did not affect the Harris Hip Score. CONCLUSION: Full weight-bearing mobilization could be safely preferred in UCH, as in CH. Femoral stem varus below 5 degrees does not affect the results and subsidence.
Abstract: BACKGROUND: Functional stability of the shoulder requires a balance of active forces, passive forces, and control subsystems of the joint complex. Although whole-body vibration enhances shoulder muscle function and proprioception, the impact of vibration on the sensorimotor control of the shoulder joint remains unclear. OBJECTIVE: To investigate the acute effect of vibratory stimuli on the sensorimotor control of the shoulder joint. METHODS: Fifteen male participants (age, 22.7 ± 2.3 years) were included and performed the exercise in a modified push-up position with partial weight-bearing on a vibration platform with and without…vibratory stimuli. The vibration protocol included six sets lasting for 30 s each with a 30-s rest between sets. The main outcome measures included the upper limb static stability test, Upper Quarter Y Balance Test (UQYBT), and electromyography data of the upper limb. RESULTS: Vibratory stimuli resulted in an increased UQYBT score (all directions; P < 0.01) and infraspinatus, serratus anterior, and lower trapezius muscle activity (P < 0.05) between pre- and post-exercise versus the control condition. Stabilometric parameters showed no significant interaction between condition and time. CONCLUSIONS: Vibratory stimuli could maximize training benefits while limiting injury risk for athletes. Our findings could guide the development of rehabilitation programs for patients with shoulder instability.
Abstract: BACKGROUND: Upper limb lymphedema is one of the complications following breast cancer-related surgery. It is a fact that there are alterations in posture of the trunk following surgery, however, there is not much data on whether upper limb lymphedema has any effect on body posture. OBJECTIVES: The main purpose of the study was to investigate the effect of upper limb lymphedema in the trunk posture and spine mobility of patients following breast cancer surgery. METHODS: Twenty-seven women with lymphedema and 29 women without lymphedema with mastectomy or breast-conserving surgery participated in the study.…Posture was evaluated by the New York Posture Rating Chart and spinal stability and thoracic mobility were evaluated by the Spinal Mouse device. RESULTS: Posture and spine posture scores were significantly higher in the without lymphedema group (p = 0.004; 0.041; respectively). There was a significant difference between the groups in terms of lateral (p < 0.001) and posterior (p < 0.001) view of shoulders, spine (p = 0.027), upper (p < 0.001) and lower back (p = 0.009), and trunk postures (p = 0.001). CONCLUSIONS: Body posture and spine are more affected due to upper limb lymphedema following breast cancer surgery. Alterations of posture mainly occur on shoulders, spine, upper and lower back, and trunk, but not on head and neck postures.
Keywords: Lymphedema, posture, spine, mastectomy, breast
Abstract: BACKGROUND: To restore core stability, abdominal drawing-in maneuver (ADIM), abdominal bracing (AB), and dynamic neuromuscular stabilization (DNS) have been employed but outcome measures varied and one intervention was not superior over another. OBJECTIVE: The purpose of this study was to compare the differential effects of ADIM, AB, and DNS on diaphragm movement, abdominal muscle thickness difference, and external abdominal oblique (EO) electromyography (EMG) amplitude. METHODS: Forty-one participants with core instability participated in this study. The subjects performed ADIM, AB, and DNS in random order. A Simi Aktisys and Pressure Biofeedback Unit (PBU) were…utilized to measure core stability, an ultrasound was utilized to measure diaphragm movement and measure abdominal muscles thickness and EMG was utilized to measure EO amplitude. Analysis of variance (ANOVA) was conducted at P < 0.05. RESULTS: Diaphragm descending movement and transverse abdominis (TrA) and internal abdominal oblique (IO) thickness differences were significantly increased in DNS compared to ADIM and AB (P < 0.05). EO amplitude was significantly increased in AB compared to ADIM, and DNS. CONCLUSIONS: DNS was the best technique to provide balanced co-activation of the diaphragm and TrA with relatively less contraction of EO and subsequently producing motor control for efficient core stabilization.
Abstract: BACKGROUND: The effectiveness of side-sling plank (SSP) exercises on trunk and hip muscle activation in subjects with gluteus medius (Gmed) weakness is unclear. OBJECTIVE: To quantify muscle activation of the rectus abdominis (RA), external oblique (EO), erector spinae (ES), lumbar multifidus (LM), Gmed, gluteus maximus (Gmax), and tensor fasciae latae (TFL) during SSP with three different hip rotations compared to side-lying hip abduction (SHA) exercise in subjects with Gmed weakness. METHODS: Twenty-two subjects with Gmed weakness were recruited. SHA and three types of SSP exercises were performed: SSP with neutral hip (SSP-N), hip…lateral rotation (SSP-L), and hip medial rotation (SSP-M). Surface electromyography was used to measure the activation of the trunk and hip muscles. RESULTS: The trunk and hip muscles activations were generally significantly higher level during three SSP than SHA. SSP-M showed significantly lower EO activation while significantly higher ES and LM activation than SSP-L. Gmed activation was significantly higher during SSP-M than during SSP-L. TFL activation was significantly lower during SSP-M than during SSP-N and SSP-L. CONCLUSIONS: SSP could be prescribed for patients who have reduced Gmed strength after injuries. Especially, SSP-M could be applied for patients who have Gmed weakness with dominant TFL.
Abstract: BACKGROUND: Persistent symptoms in patients with systemic joint laxity (SJL) are often equivalent with complications. Screening for SJL is an important part of the assessment of musculoskeletal phenotype. The common measuring tool, the Beighton score (BS), still has unclear evidence. OBJECTIVE: To assess the Beighton score in a clinical context for (1) ability to classify SJL as absent or present (criterion validity), and (2) interrater reliability (physician-physiotherapist), for a dichotomous cut-off (yes/no), as well as for interpretation in categories (no, some, clear SJL). METHODS: This real-world observational study included 149 consecutive patients seeking…secondary care for investigation of possible myalgic encephalomyelitis/chronic fatigue syndrome. Assessment was done during a routine examination. Data were evaluated with Cohen’s kappa and Spearman’s rho. RESULTS: BS criterion validity showed poor agreement with the assessment of SJL: percentage agreement was 74 % and kappa 0.39 (3-cut level), 73 % and kappa 0.39/0.45 (4-/5-cut level). The best interrater reliability was moderate (rho 0.66) for interpretation in categories. CONCLUSIONS: The BS alone was not a reliable proxy for SJL and should be supplemented with a targeted history. Nevertheless, its interrater reliability was acceptable, and the categorised score appears to have greater clinical relevance than the dichotomous score.
Keywords: Beighton score, hypermobility, joint laxity, somatosensory disorders, physical examination, connective tissue, primary health care