Journal of Back and Musculoskeletal Rehabilitation - Volume 36, issue 2

Authors: Scholten-Peeters, G.G.M. | Cagnie, B. | Castien, R.

Article Type: Editorial

DOI: 10.3233/BMR-235001

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 277-278, 2023

Authors: Ferrillo, Martina | Gallo, Vittorio | Lippi, Lorenzo | Bruni, Alessandro | Montrella, Roberta | Curci, Claudio | Calafiore, Dario | Invernizzi, Marco | Migliario, Mario | de Sire, Alessandro

Article Type: Review Article

Abstract: BACKGROUND: Temporomandibular disorders (TMD) are musculoskeletal conditions involving masticatory muscles and temporomandibular joints. Bibliometric analysis has been introduced as a new method for collecting and analyzing information on scientific articles. OBJECTIVE: The aim of this study was to identify the 50 most cited articles on TMD, performing a bibliometric analysis of the identified papers to favor research and clinical practice. METHODS: On December 17, 2021 a systematic research was performed to find all papers on TMD published in the literature. The Incites Journal Citation Reports dataset and Scopus database was used to obtain …bibliometric indexes of the authors and metrics data of the journals, including Impact Factor, Eigenfactor Score, and Normalized Eigenfactor. VOSviewer was used to visualize the keyword mapping networking, with the nodes standing for keywords and the edges for keyword relationships. RESULTS: Out of 24372 papers obtained by the search strategy, the 50 most cited articles on TMD were analyzed. The paper with the highest number of citations (n = 3020) was on TMD research diagnostic criteria. Rate of citations per year collected by the 50 most cited articles on TMD has been increasing over time (from 627 in 2006 to 1483 in 2021). Most of them were cross-sectional studies (n = 20; 40.0%) and narrative reviews (n = 14; 28.0%). CONCLUSION: This bibliometric study showed an increasing number of citations for articles on TMD, testifying a high interest in the last years. Starting from this analysis, future studies might provide high-quality evidence on TMD management. Show more

Keywords: Temporomandibular disorders, temporomandibular joint disorders, bibliometric analysis, rehabilitation, pain

DOI: 10.3233/BMR-220152

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 279-297, 2023

Authors: Gacto-Sánchez, Mariano | Lozano-Meca, José Antonio | Lozano-Guadalajara, Juan Vicente | Baño-Alcaraz, Aitor | Lillo-Navarro, Carmen | Montilla-Herrador, Joaquina

Article Type: Other

Abstract: BACKGROUND: Knee osteoarthritis often leads to chronic pain that frequently becomes disabling.Osteoarthritis has been linked to maladaptive plasticity in the brain, which can contribute to chronic pain. Therapies including neuromodulation and peripheral electrical stimulation are used to counteract the maladaptive plasticity of the brain. OBJECTIVE: To determine the efficacy of the addition of tDCS and TENS to an education and exercise program in reducing pain. METHODS: Over a 2-week study period, 60 participants will complete an exercise and educational intervention. Eligible participants accepting to participate will be subsequently randomized into one of the …three treatment groups: 1) Active Transcranial Direct Current Stimulation (tDCS) and active Transcutaneous Electrical Nerve Stimulation (TENS); 2) Active tDCS and sham TENS; 3) Sham tDCS and sham TENS. RESULTS: The primary outcome will be subjective pain intensity. Secondary outcomes: quality of life, physical function, central sensitization, and pain adjuvants (uncertainty, catastrophizing kinesiophobia, adverse events). CONCLUSION: This clinical trial will provide data on the effect that the addition of tDCS and/or TENS to an education and exercise program may have to counteract maladaptive plastic changes and improve the benefits of exercises, and whether the combination of both neuromodulator techniques may have a higher magnitude of effect. Show more

Keywords: Chronic pain, pain management, exercise therapy, physical therapy modalities

DOI: 10.3233/BMR-220015

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 299-307, 2023

Authors: Wang, Junfeng | Zhao, Changsheng | Yang, Bin

Article Type: Research Article

Abstract: BACKGROUND: Early complications after arthroplasty for geriatric femoral neck fractures are known to negatively affect postoperative recovery and increase postoperative mortality. Identifying risk factors associated with early complications after arthroplasty may offer an opportunity to address and prevent these complications in many patients. OBJECTIVE: To evaluate preoperative risk factors for early complications after arthroplasty in elderly patients with a femoral neck fracture. METHODS: 119 elderly patients with femoral neck fractures who had been treated with arthroplasty (hemiarthroplasty or total hip arthroplasty) between December 2015 and December 2018 were retrospectively analysed. Early complications were defined …as any complications that did not exist preoperatively, and occurred during hospital stay after arthroplasty Preoperative clinical, epidemiological and laboratory data were collected. Binary univariable and multivariable logistic regression analysis were applied to identify predictors of early complications after arthroplasty for geriatric femoral neck fractures. RESULTS: Median age of all patients was 80.0 (IQR 74.0–84.0) years. We identified 28 (23.5%) early complications after arthroplasty. Univariable logistic regression analysis found that preoperative body mass index (BMI p = 0.031), C-reactive protein (CRP p = 0.017) and serum Albumin (p = 0.006) were potential risk factors for early complications. Then preoperative BMI, CRP and serum Albumin were stratified and used for multivariable logistic regression analysis The multivariate logistic regression analysis showed that preoperative higher BMI (⩾ 28 kg/m 2 ; OR 10.440; 95% CI 2.674–41.170; p = 0.001) and lower serum Albumin (⩽ 35 g/L; OR 3.933; 95% CI 1.509–10.800; p = 0.006) were independent risk factors for early complications after arthroplasty in geriatric femoral neck fractures. However, preoperative higher CRP levels (> 10 mg/L; OR 1.139; 95% CI 1034–1428; p = 0.833) was found to be not an independent risk factor for early complications. CONCLUSION: Our results demonstrate that obesity and hypoalbuminemia are independent predictors for early complications during hospital stay after arthroplasty, which should be meticulously noted to minimize these risk factors in geriatric femoral neck fractures. Show more

Keywords: Femoral neck fracture, geriatric, early complication, risk factor, arthroplasty

DOI: 10.3233/BMR-220044

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 309-315, 2023

Authors: Mens, Jan M.A. | van Kalmthout, Ronald T.M.

Article Type: Research Article

Abstract: BACKGROUND: Accuracy of blind intra-articular injections for the shoulder is rather low. It is unclear whether accurate injections for capsulitis of the shoulder are more effective than inaccurate injections. OBJECTIVE: It has been hypothesized that a squishing sound following an intra-articular injection with a mixture of air and fluid means that the injection was accurately placed and that the efficacy of accurately placed injections is greater than that of inaccurate injections. The aim of the present study was to test the hypothesis that a squishing sound following an injection predicts a better clinical result. …METHODS: Files were selected of patients with capsulitis of the shoulder, who were treated with an intra-articular injection containing a mixture of triamcinolone, lidocaine, and air. After the injection, the shoulder was moved to determine whether a squishing sound could be produced. Efficacy was measured after two weeks according to the Patient Global Impression of Change scale. Differences in efficacy between injections with and without a squishing sound were expressed as an odds ratio. RESULTS: Sixty-one patients were selected. Squishing was heard after 47 injections (77%). Two weeks after the injection, a positive outcome was reported by 49 patients (80%). When squishing was heard, the effect was positive in 42 of the 47 patients (89%) and when no squishing was heard, the effect was positive in 7 of the 14 patients (50%). The odds ratio was 8.4 (95% CI 2.1–34.0; p = 0.003). CONCLUSION: Efficacy of injections with a mixture of triamcinolone, lidocaine, and air for capsulitis of the shoulder is significantly greater when a squishing sound was heard after the injection. We hypothesize that squishing is related to accuracy and accuracy to efficacy. A future study with X-ray arthrography is needed to verify both hypotheses. Show more

Keywords: Capsulitis shoulder, intra-articular injections, glucocorticoid, efficacy, accuracy

DOI: 10.3233/BMR-210360

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 317-322, 2023

Authors: Huang, Wei | Cai, Xian-Hua | Li, Yi-Rong | Xu, Feng | Jiang, Xin-Hao | Wang, Dan | Tu, Min

Article Type: Research Article

Abstract: BACKGROUND: According to reports in the literature, osteoporotic vertebral compression fracture (OVCF) is associated with paraspinal muscle degeneration; however, the association between the severity of OVCF and paraspinal muscle degeneration is not clear. OBJECTIVE: The purpose of this study was to investigate the association between paraspinal muscle degeneration and OVCF severity in postmenopausal women. METHODS: Three hundred and seventy-six MRI images from 47 patients were collected and analyzed. Sagittal and axial coronal T2-weighted images were used to measure the fractured vertebra sagittal cross-sectional area (FSCSA), the adjacent normal vertebral body sagittal cross-sectional area …(NSCSA), paraspinal muscle cross-sectional area (CSA), and the fat cross-sectional area (FCSA). The ratio of fractured vertebra compressed sagittal cross-sectional area (RCSA) and fatty infiltration ratio (FIR) was subsequently calculated. The formulas for RCSA and FIR calculations are as follows: RCSA = (NSCSA-FSCSA)/NSCSA; FIR = FCSA/CSA. RCSA and FIR represent the severity of OVCF and paraspinal muscle degeneration, respectively. RESULTS: The correlation between paraspinal muscle degeneration and OVCF severity was analyzed using the Pearson correlation, and multiple regression analysis was performed to explore related risk factors. OVCF severity was closely associated with paraspinal muscle degeneration (L3/4 FIR r = 0.704, P < 0.05; L4/5 FIR r = 0.578, P < 0.05; L5/S1 FIR r = 0.581, P < 0.05). Multiple regression analysis demonstrated that the risk factor for OVCF severity was L3/4 FIR (β = 0.421, P = 0.033). CONCLUSION: OVCF severity was associated with the FIR of paraspinal muscles, and L3/4 FIR was a predictive factor for OVCF severity in postmenopausal women. Show more

Keywords: Osteoporosis, vertebral fracture, paraspinal muscle, fatty infiltration, postmenopausal women

DOI: 10.3233/BMR-220059

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 323-329, 2023

Authors: Cagnie, Barbara | Castien, Rene | Scholten-Peeters, Gwendolyne G.M.

Article Type: Case Report

Abstract: BACKGROUND: In 2020, a revised version of the International IFOMPT Cervical Framework was published. This framework provides both physical therapists and educators the necessary information to guide the assessment of the cervical spine region for potential vascular pathologies of the neck in advance of planned Orthopaedic Manual Therapy (OMT) interventions. OBJECTIVE: The objective was to develop a framework flowchart which is useful in clinical practice and education to assist physical therapists to improve the safety of OMT, and apply this in a case report. METHODS: The framework was developed in co-creation with manual …therapy experts, researchers, educators in manual therapy, patients, medical specialists and the Manual Therapy Association in The Netherlands and Belgium. Manual therapists and patients tested the framework for intelligibility and usefulness. RESULTS: A framework flowchart is developed and presented, that is easy to use in both clinical practice and education. It is a visual representation of the sequence of steps and decisions needed during the process. A case description of a patient with neck pain and headache is added to illustrate the clinical usefulness of the framework flowchart. CONCLUSION: The framework flowchart helps physical therapists in their clinical reasoning to provide safe OMT interventions. Show more

Keywords: Clinical reasoning, algorithm, manipulative therapy, neck, adverse events

DOI: 10.3233/BMR-220155

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 331-336, 2023

Authors: Wang, Jun-Wu | Shi, Peng-Zhi | Zhu, Xu-Dong | Zhu, Lei | Feng, Xin-Min | Zhang, Wen-Jie | Zhang, Liang

Article Type: Research Article

Abstract: BACKGROUND: Posterior approach pedicle screw fixation without fusion is widely used in the treatment of neurologically intact type A3 thoracolumbar fractures. OBJECTIVE: To analyze the influence of the facet joint (FJ) angle on FJ degeneration following posterior approach pedicle screw fixation without fusion in neurologically intact type A3 thoracolumbar fractures. METHODS: Fifty-eight patients who underwent pedicle screw fixation via the traditional posterior approach (n = 28) or the Wiltse approach (n = 30) were enrolled. A CT scan was performed before fixation and …before fixation removal (Within 1.5 to 2 years after fixation) to evaluate the FJs parameters, including FJ inclination (FJI), FJ tropism (FJT), FJ violation, and FJ degeneration grade (FJDG), of three fixed segments and the adjacent segment below the fixed segments. RESULTS: There was no significant difference in FJ violation rate, FJDG deterioration, or FJ angle between the two groups (P > 0.05). FJDG deterioration showed a weak positive correlation with FJI and FJT before fixation, and the angular change in FJI (P < 0.05); and FJT before fixation and the angular change in FJI were risk factors for FJDG deterioration (P < 0.01). CONCLUSION: The Wiltse approach did not increase the rate of FJDG deterioration and FJs angle changes. However, the FJT before fixation and the angular change in FJI were risk factors for FJDG deterioration. Show more

Keywords: Thoracolumbar fracture, wiltse approach, pedicle screw fixation, facet joint degeneration, facet joint tropism

DOI: 10.3233/BMR-210235

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 337-346, 2023

Authors: Özyürek, Seher | Cansu Kalkan, Aybüke | Doğan, Ersoy | Melike Bülbül, Hande | Akif Kamar, Mehmet | Balci, Ali | Ömer İkiz, Ahmet | Keskinoğlu, Pembe | Genç, Arzu

Article Type: Research Article

Abstract: BACKGROUND: Shoulder disability is a common problem following neck dissection. Even if nerve structures are preserved, this may occur after the surgery. OBJECTIVE: The primary aim was to research changes in rotator cuff and scapular muscles strength, and scapular muscle endurance after neck dissection in patients with head and neck cancer. The secondary aim was to investigate the relationship between these changes and postoperative shoulder function. METHODS: This cross-sectional and prospective follow-up study included 14 patients who underwent neck dissection (9 unilateral and 5 bilateral). Evaluations were performed preoperatively and at 3 months postoperatively. Muscle strength measurements, …including trapezius, serratus anterior, and rotator cuff muscles, were obtained using a handheld dynamometer. The scapular muscle endurance test was used for muscle endurance assessment. Postoperative shoulder function was evaluated using Constant-Murley shoulder score. RESULTS: A decrease in muscle strength and the scapular muscle endurance test was found at 3 months postoperatively, except for the subscapularis muscle strength (p < 0.05). There were moderate to strong correlations between Constant-Murley shoulder score and percentage changes in muscle strength and the scapular muscle endurance test, except for the upper trapezius muscle strength (p < 0.05). CONCLUSIONS: Muscle strength and scapular muscle endurance may reduce following neck dissection. These reductions are associated with postoperative shoulder function. Thus, muscle strength and endurance training may be beneficial for early postoperative rehabilitation in patients with head and neck cancer. Show more

Keywords: Shoulder, dysfunction, muscles, neck dissection, head and neck cancer

DOI: 10.3233/BMR-210270

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 347-355, 2023

Authors: Sucuoğlu, Hamza | Soydaş, Nalan

Article Type: Research Article

Abstract: BACKGROUND: Fibromyalgia (FM) is a chronic disease that causes widespread pain, fatigue, and sleep disturbance. There is still no effective definitive treatment method; therefore, the search for treatment continues. OBJECTIVE: The purpose of this study is to investigate the effectiveness of ozone therapy (OT), which has been used in FM treatment in recent years, as an additional treatment. METHODS: The patients were divided into OT (n = 26) and placebo control (PC) (n = 28) groups. Both groups received OT in the form …of major autohemotherapy (MaAHT) and minor autohemotherapy (MiAHT) for two sessions per week for a total of 10 sessions. The fibromyalgia impact questionnaire (FIQ), Pittsburgh sleep quality index (PSQI), and 12-item short-form health survey (SF-12) were used for evaluation pre- and post-intervention. RESULTS: In the between-group comparison, the OT group showed significant post-treatment improvements in FIQ subscales (feel good, fatigue) and PSQI total score and subscales (subjective sleep quality, sleep latency and sleep disturbances) compared to the PC group (p < 0.05). Although there were improvements in the FIQ total score post-treatment in both groups, there was no significant difference between the groups (p > 0.05). CONCLUSION: OT, which is applied as an additional treatment with the autohemotherapy method, simultaneously improves the subscale scores (feel good and fatigue) of FM and sleep quality in the treatment period. However, changes in the post-treatment FIQ total score were not different in the ozone therapy group from the placebo control group. Show more

Keywords: Autohemotherapy, fibromyalgia, ozone, quality of life, sleep

DOI: 10.3233/BMR-210368

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 357-366, 2023

Authors: Dai, Jun | Liu, Xiao-Feng | Wang, Qian-Liang | Peng, Yu-Jian | Zhang, Qian-Zhong-Yi | Jiang, Feng-Xian | Yan, Jun

Article Type: Research Article

Abstract: BACKGROUND: The unilateral biportal endoscopic (UBE) technique has been widely used in spine surgery. At present, a traditional rigid working channel is available for the UBE system. A metal semicircular canal is located in the working channel. However, due to the metal material of the working channel, arthroscopy and instruments are constrained from moving in UBE surgery. Additionally, an assistant is needed during the procedure to hold the traditional working channel. OBJECTIVE: For simplicity of operation and convenient movement of the arthroscopy and instrument, we describe a new method for establishing operative channels in UBE surgery. …METHODS: We retrospectively reviewed 50 patients who underwent unilateral biportal endoscopic discectomy (UBED) from February 2020 to August 2020 via our new method. The Oswestry Disability Index (ODI) and visual analogue scale (VAS) score were measured preoperatively and 1 month, 3 months, 6 months and 12 months postoperatively. Statistical comparisons were made using analysis of covariance and paired t tests. RESULTS: The VAS scores for back pain at the five time points were 5.20 ± 2.57, 1.96 ± 0.95, 1.50 ± 0.84, 1.64 ± 1.08 and 1.18 ± 0.39. The leg pain VAS scores were 7.02 ± 2.25, 2.02 ± 1.27, 1.48 ± 0.89, 1.32 ± 0.79 and 0.88 ± 0.52. The ODI values were 51.08 ± 19.97, 19.62 ± 15.51, 8.26 ± 7.40, and 7.54 ± 6.42 to 3.24 ± 1.10. The postoperative ODIs and VAS scores of low back pain and leg pain were significantly lower than those before surgery, and differences were statistically significant (all p < 0.05). The pressure of the closed outflow was significantly higher than that of the open outflow (37.35 ± 13.11 mm Hg vs. 24.55 ± 12.64 mm Hg p = 0.003). After we tightened the infusion strap to open the outflow, the pressure decreased significantly (26.4 ± 14.08 mm Hg vs. 37.35 ± 13.11 mm Hg p = 0.015). There were 2 cases of complications, including 1 case of postoperative recurrence and 1 case of dural tears. CONCLUSION: This study demonstrates the technical feasibility, safety, and efficacy of modified channel establishment in UBE surgery. Show more

Keywords: Degenerative disc disease, minimally invasive surgery, operative channel establishment, unilateral biportal endoscopy

DOI: 10.3233/BMR-220005

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 367-375, 2023

Authors: Kaske, Sigune | Tjardes, Thorsten | Lefering, Rolf | Bouillon, Bertil | Maegele, Marc

Article Type: Research Article

Abstract: BACKGROUND: Persisting back pain is a frequent consequence after severe trauma including injury to the spine. Reports on the incidence and relevance of back pain in severely injured patients in the absence of direct injury to the spine are scarce. OBJECTIVE: To assess the frequency of relevant back pain and its effect on health-related quality of life (HRQoL) in trauma patients with spine injury compared to patients without direct impact to spine postdischarge and two years after trauma within an observational study. METHODS: A two-year follow-up survey by using the Polytrauma Outcome Chart …(PoloChart) and a set of specific questionnaires on socioeconomic and other HRQoL aspects was conducted among adult patients that had been treated for severe traumatic injuries (ISS ⩾ 9) at a German level 1 trauma center between 2008 and 2017. Patient subgroups included patients with relevant (VAS ⩾ 3) versus non-relevant back pain (VAS < 3) stratified by visual analogue scale (VAS 0–10). Patients with relevant back pain were separated into patients with (AIS spine ⩾ 1) and without spine injury (AIS spine = 0) according to the Abbreviated Injury Score (AIS). RESULTS: 543/1010 questionnaires were returned yielding a response rate of 54%. Patients were predominantly male (n = 383/543; 71%) with a mean age 45 ± 19 years, mostly blunt trauma (n = 524/543; 97%) and a mean ISS 18 ± 12 points. 32.4% of patients had sustained a spine injury defined by an AIS spine ⩾ 1 (n = 176/543). Half of these patients suffered from relevant back pain two years after trauma (n = 90/176; 51.1%); in contrast, in non-spine injured patients one in three patients reported relevant back pain (n = 127/367; 34.6%). Patients with relevant back pain reported significantly lower HRQoL as measured by the 36-Item Short Form Health Survey and the Trauma Outcome Profile. The use of pain medication after discharge and at two years after trauma was significantly higher in patients with relevant back pain (n = 183/211; 86.7% vs. n = 214/318; 75.8%; p < 0.001; pain medication 2 years after trauma: n = 113/210, 53.8% vs. 68/317, 21.5%, p < 0.001). CONCLUSION: Persisting back pain is frequent at two years after trauma independent of presence or absence of initial injury to the spine and associated with lower HRQoL in almost every dimension including physical, mental and social domains. Show more

Keywords: Spine injury, quality of life, severe injury, trauma, pain, outcome research

DOI: 10.3233/BMR-220011

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 377-385, 2023

Authors: Yan, Zhi-Wei | Yang, Zhen | Zhao, Feng-Long | Gao, Yan | Wu, Zhen-Kun | Wang, Jie-Long | Zhou, Mei

Article Type: Research Article

Abstract: BACKGROUND: The persistence of symptoms in patients with chronic neck pain is considered to be associated with variation in the neck muscle structure and associated neuromuscular control. Sling exercise therapy (SET) has been demonstrated to relieve the symptoms of chronic neck pain, whereas it is controversial whether this benefit is correlated to altered neck muscle structure and associated neuromuscular control in the patients. OBJECTIVE: To investigate the effect of SET on cervical muscle structure (thickness) and associated neuromuscular control in patients with chronic neck pain. METHODS: Twenty-five patients with chronic neck pain were …randomly assigned to the SET group (n = 12) or the control group (n = 13). The SET group received the SET intervention for 4 weeks, while the control group maintained normal activities of daily living. At baseline and after 4 weeks of intervention, Visual analogue scale and neck disability index were measured in both groups, and changes in the thickness of the superficial cervical muscles were assessed using musculoskeletal ultrasound. Surface electromyography (EMG) was adapted to assess the neuromuscular control of the neck while the participant was performing the cranio-cervical flexion test. RESULTS: At 4 weeks, the SET group had a significant reduction of RMS in both UT and SCM of EMG compared to the control group (p < 0.05). Regarding ultrasound, the SET group had significantly lower muscle thickness compared to the control group in both the rest position and the MVIC position (p < 0.05). There were no within-group differences in the control group (p > 0.05), while the SET group showed significant reductions in both RMS and muscle thickness (p < 0.05). CONCLUSION: 4-week SET was effective in reducing pain and dysfunction in patients with chronic neck pain, which may be related to improved neck muscle thickness and neuromuscular control of the neck. Show more

Keywords: Exercise prescription, musculoskeletal disorders, pain, ultrasonography

DOI: 10.3233/BMR-220030

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 387-397, 2023

Authors: Wada, Osamu | Yamada, Minoru | Kamitani, Tsukasa | Mizuno, Kiyonori | Tadokoro, Kou | Kurita, Noriaki

Article Type: Research Article

Abstract: BACKGROUND: Whether the lower phase angle associated with worse physical function is a result of pain and muscle weakness in patients with lumbar spinal stenosis (LSS) is unclear. OBJECTIVE: To evaluate the association between phase angle and back pain-specific disabilities in patients with LSS. METHODS: In this single-center, cross-sectional study, 491 participants with LSS were enrolled. The phase angle and back pain-specific disability were measured using bioelectrical impedance analysis and the Oswestry Disability Index, respectively. General linear models were used to examine associations between phase angle and the Oswestry Disability Index with or …without adjustment for age, sex, low back and lower limb pain, numbness in the lower extremities, total fat mass, and lower limb muscle mass. RESULTS: The mean (SD) phase angle was 4.4 ∘ (1.0 ∘ ), and the mean Oswestry Disability Index was 36.1 (14.1) points. Greater phase angles were associated with less Oswestry Disability Index points (p = 0.037) independent of fat mass, low back pain, and hip or lower limb pain. CONCLUSIONS: A lower phase angle was associated with worse functional disability. Low phase angle may be an indicator of functional impairment due to low back pain associated with LSS. Show more

Keywords: Phase angle, bioelectrical impedance analysis, functional disability, lumbar spinal stenosis, Oswestry Disability Index

DOI: 10.3233/BMR-220038

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 399-405, 2023

Authors: Alshami, Ali M. | Alqassab, Fadhila H.

Article Type: Research Article

Abstract: BACKGROUND: Despite being used as a manipulation technique, no studies have examined the effectiveness of physiotherapy instrument mobilization (PIM) as a mobilization technique on pain and functional status in patients with low back pain (LBP). OBJECTIVE: To investigate the effectiveness of PIM in patients with LBP and to compare it with the effectiveness of manual mobilization. METHODS: This is a double blind, randomized clinical trial. Thirty-two participants with LBP were randomly assigned to one of two groups. The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education; and the …manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education. Both groups had a total of 4 treatment sessions over 2–3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions: Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) scale, Pressure pain threshold (PPT), lumbar spine range of motion (ROM), and lumbar multifidus muscle activation. RESULTS: There were no differences between the PIM group and the manual group in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm 2 ), lumbar spine ROM (PIM: ⩽ 9.49 ∘ , Manual: ⩽ 0.88 ∘ ), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm). CONCLUSIONS: Both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other. Show more

Keywords: Activator, manual therapy, physical therapy, lumbar spine

DOI: 10.3233/BMR-220042

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 407-418, 2023

Authors: Bagcaci, Sinan | Unuvar, Bayram Sonmez | Gercek, Hasan | Ugurlu, Ibrahim | Sert, Ozlem Akkoyun | Yilmaz, Kamil

Article Type: Research Article

Abstract: BACKGROUND: Lateral elbow tendinopathy (LET) is one of the most common lesions of the upper extremity. The level of evidence from studies on LET treatment protocols is insufficient. OBJECTIVE: The aim of this study was to compare the acute effects of mobilization with movement (MWM) and muscle energy technique (MET) on pain, grip strength, and functionality in patients diagnosed with LET. METHODS: Forty-five patients with LET aged 30–55 years were enrolled in this study. Patients were divided into three groups: MWM, MET, and control group. The control group received a 4-week home exercise …program. In addition to the home exercise program in the MWM group, 12 sessions of MWM and 12 sessions of MET were performed in the MET group. Participants’ pain, grip strength, and functionality were assessed before and after the study. RESULTS: After the treatment period, greater improvement in pain, grip strength, finger strength, and functionality were observed in the MWM and MET groups than in the control group (p < 0.05), but no statistically significant difference was found between the MWM and MET groups (p > 0.05). CONCLUSIONS: This study shows that MWM and MET, used in addition to home exercises, can be used to relieve pain and increase grip strength, finger strength, and functionality. Show more

Keywords: Tennis elbow, musculoskeletal manipulations, pain, muscle strength

DOI: 10.3233/BMR-220061

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 419-427, 2023

Authors: Samarah, Omar Q. | Maden, Hana A. | Sanwar, Basheer O. | Farhad, Abdallah P. | Alomoush, Forat | Alawneh, Anas | Hadidi, Fadi Al | Bashaireh, Khaldoon | Hammad, Yazan S.

Article Type: Research Article

Abstract: BACKGROUND: Musculoskeletal (MSK) pain is a debilitating multi-perceptual condition afflicting many individuals, especially individuals in the medical profession. OBJECTIVE: To analyze and evaluate the prevalence of musculoskeletal pain among medical students at Jordanian universities during the complete virtual learning process. METHODS: A cross-sectional study of 593 medical students at two Jordanian universities was conducted. A modified Nordic questionnaire was used to assess musculoskeletal pain in three body regions. RESULTS: Five hundred ninety-three students at the two Jordanian universities participated in this study. The prevalence of having MSK pain during the …past week in the neck, shoulder, and lower back was 34.6%, 27%, and 41%, respectively; during the past 12 months, it was 61.2%, 45.5%, and 63.1%, respectively. Overall prevalence of having MSK pain was 58.9% in the last week and 78.1% in the past 12 months. 66.8% of students who had psychosomatic symptoms and 62.3% of those with depressive symptoms in the past week had MSK pain. Students who studied 8 hours per day had higher percentages of MSK pain (68.4%) (OR 1.12, 95% CI 0.965–1.312). The average number of hours using a computer per day was significantly associated with MSK pain (p = 0.032). MSK pain during the last week was significantly associated with psychosomatic symptoms (OR 1.842, 95% CI 1.272–2.668, p = 0.001). Family history of MSK pain was significantly related to the presence of the problem in participants (OR 1.732, 95% CI 1.182–2.538, p = 0.005). Gender, depressive symptoms, average hours of computer use per day, and average hours of study at home per day did not show significant relationships with MSK pain over the year. CONCLUSIONS: High prevalence of MSK pain was observed among medical students. Measures to balance in-person and virtual learning should be considered in medical schools to minimize the risk of MSK pain. Show more

Keywords: Musculoskeletal pain, neck, shoulder, low back pain, Jordan

DOI: 10.3233/BMR-220065

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 429-436, 2023

Authors: Takahashi, Makoto | Iwamoto, Koji | Tomita, Kazuhide | Ueda, Shinji | Igawa, Takeshi | Miyauchi, Yukio

Article Type: Research Article

Abstract: BACKGROUND: Determining the association between radiographic spinal instability assessment and lower back lumbar diseases with lower limb symptoms can contribute to evidence-based assessment and treatment in clinical practice and rehabilitation. Therefore, radiological evidence of lumbar spine instability assessment, such as sagittal translation (ST) and segmental angulation (SA), is clinically important. OBJECTIVE: To identify factors associated with the assessment of spinal instability in lumbar disc herniation with leg pain and discogenic low back pain using ST and SA. METHODS: We examined 112 patients with lumbar disc herniation with leg pain and 116 with discogenic …low back pain at our clinic from 2016 to 2021. Data on age, gender, sports activities, and occupation were collected from medical records. Additionally, ST and SA of L4 and L5 during maximum trunk flexion and extension were measured using radiography. Simple and multiple logistic regression analyses were used for statistical analysis. RESULTS: Simple logistic regression analysis showed that ST and SA (odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.03–1.19) were associated with lumbar disc herniation. Multiple logistic regression analysis showed that only ST was associated with lumbar disc herniation (OR: 2.29; 95% CI: 1.78–3.00). CONCLUSION: Multiple logistic regression analysis showed that ST was associated with lumbar disc herniation with leg pain and had a stronger association than SA. Show more

Keywords: Sagittal translation, segmental angulation, lumbar disc herniation, discogenic low back pain, leg pain, spinal instability

DOI: 10.3233/BMR-220067

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 437-444, 2023

Authors: Chen, Zhibiao | Xian, Zuxin | Chen, Huanzhou | Zhong, Yuan | Wang, Feng

Article Type: Research Article

Abstract: BACKGROUND: Patients exhibit considerable variations in gait patterns especially in knee hyperextension in the stance phase after stroke. If knee hyperextension is untreated it may lead to pain, reduced independence in activities of daily living, deformities and instability. OBJECTIVE: The aim of this study was to investigate the immediate effects of a buffered knee orthosis on gait of stroke patients with knee hyperextension. METHODS: A total of nine patients with knee hyperextension after stroke were selected to wear buffered knee orthosis developed by Zhongshan Traditional Chinese Medicine Hospital and Ruike Medical Technology (Shanghai) …Co., Ltd during walking training and daily walking. Then the gait analysis system of Motionanalysis was used to analyze and evaluate kinematic and spatiotemporal parameters of the gait in patients with independent walking or walking with a buffered knee orthosis. RESULTS: After wearing the buffered knee brace, initial contact, maximum and minimum angles of support phase, the toe off the ground, maximum and minimum angles of swing phase on the injured side of knee and ankle increased. Minimum angle of support phase and maximum angle of swing phase on the uninjured side of ankle decreased, while the toe off the ground and minimum angles of swing phase increased significantly (all P < 0.05); There was no significant difference in other kinematics, in parameters between time and space, in walking speed among subjective gait parameters (P > 0.05). Walking distance, confidence, sense of security, and the feeling of walking hyperextension were all improved. In addition, the number of asymmetric kinematic parameters and spatiotemporal parameters decreased. CONCLUSION: The buffered knee orthosis can effectively prevent knee hyperextension after stroke, improve the knee and ankle sagittal motion, gait asymmetry, gait subjective feeling, and does not affect gait space-time parameters. Show more

Keywords: Stroke, knee hyperextension, buffered knee orthosis, gait

DOI: 10.3233/BMR-220069

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 445-454, 2023

Authors: de Alegria, Samantha Gomes | Azevedo, Beatriz Luiza Pinheiro Alves | Oliveira, Jéssica Gabriela Messias | da Silva, Matheus Mello | Gardel, Damara Guedes | Mafort, Thiago Thomaz | Lopes, Agnaldo José

Article Type: Research Article

Abstract: BACKGROUND: Recent initiatives, such as earlier diagnosis and treatment, have enhanced the survival of patients with systemic sclerosis (SSc). Despite these initiatives, there is extreme variability in rehabilitation strategies for these patients. In 2006, the Glittre-ADL test (TGlittre) was developed to evaluate functional capacity using multiple tasks similar to the activities of daily living (ADLs). OBJECTIVES: To evaluate the impact of therapist-oriented home rehabilitation (TOHR) on functional capacity using TGlittre and to examine the effects of TOHR on physical function, hand function, and quality of life (QoL) among women with SSc. METHODS: This …quasi-experimental and longitudinal study included 12 women with SSc who underwent TOHR 3 times per week for 12 weeks. Before and after TOHR, functional capacity was assessed using TGlittre, physical function was examined by the Health Assessment Questionnaire Disability Index (HAQ-DI), hand function was evaluated using the Cochin Hand Functional Scale (CHFS) and handgrip strength (HGS), and QoL was evaluated using the Short Form-36 Health Survey Questionnaire (SF-36). RESULTS: When comparing the pre- and post-TOHR values of TGlittre, a significant reduction was found in total time (p = 0.002) and manual time (p = 0.010). There was a nonsignificant decrease in HAQ-DI scores between pre- and post-TOHR (p = 0.07). Regarding hand function, there was a significant reduction in the CHFS between pre- and post-TOHR (p = 0.036), although no significant difference was observed in HGS between pre- and post-TOHR (p = 0.08). Regarding QoL, there was an increase in all SF-36 categories, although physical function was the only category that was significantly increased (p = 0.008). CONCLUSION: After TOHR, patients with SSc are able to more quickly perform TGlittre tasks when considering both total and manual times. TOHR also positively affects manual skills and QoL. Show more

Keywords: Systemic sclerosis, rehabilitation, exercise, functional capacity

DOI: 10.3233/BMR-220077

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 455-463, 2023

Authors: Tavares, Luiz Felipe | Gadotti, Inae Caroline | Ferreira, Lidiane Macedo | Maciel, Alvaro Campos Cavalcanti | Carvalho, Bruna Guimaraes | Barbosa, Gustavo Seabra | Almeida, Erika Oliveira | Ribeiro, Karyna Figueiredo

Article Type: Research Article

Abstract: BACKGROUND: Otological complaints (OC) are highly prevalent in subjects with temporomandibular disorders (TMD) and so is the risk of neck dysfunctions. OBJECTIVE: To evaluate pain, deep neck flexor (DNF) performance, disability, and head and neck posture of individuals with TMD with and without OC. METHODS: In this cross-sectional study, 57 individuals were divided into a group with TMD and OC (n = 31) and a group with TMD without OC (n = 26). Self-reported pain intensity, masticatory and neck muscles pressure pain thresholds, …DNF performance, neck disability, and head and neck posture were evaluated. Data were compared between groups using the independent t test and Mann-Whitney test with Bonferroni correction for multiple comparisons. Effect sizes were evaluated using Cohen’s index. RESULTS: The TMD with OC group presented less muscle activation [26 (24–28) vs. 24 (24–26) mmHg; p < 0.05], less endurance [105 (46–140) vs. 44 (28–78) points; p < 0.05], and greater neck disability (8.15 ± 5.89 vs. 13.32 ± 6.36 points; p < 0.05). No significant difference was observed in self-reported pain, head and neck posture, or pressure pain thresholds. CONCLUSION: Individuals with TMD with OC presented decreased DNF performance and increased neck disability compared to individuals with TMD without OC. Show more

Keywords: Neck muscles, neck pain, dizziness, tinnitus, temporomandibular joint

DOI: 10.3233/BMR-220079

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 465-475, 2023

Authors: Dudoniene, Vilma | Balnytė, Milda | Kuisma, Raija

Article Type: Research Article

Abstract: BACKGROUND: Plantar fasciitis (PF) is a common condition amongst athletes as well as in non-sporting population. It is characterised by a sharp pain under the calcaneus during walking. The impact of pain due to PF on gait and static balance is examined in this observational study. OBJECTIVE: To compare gait and balance between individuals with PF and age-matched controls without PF. METHOD: A cross-sectional observational study was executed in an Outpatient Rehabilitation Centre. Twenty-nine participants were included, 14 with PF, and 15 age-matched healthy asymptomatic individuals. Main outcome measures were foot pain, foot …function index (FFI), static balance measured with modified Romberg test, static balance measured on the TYMO ® system, and gait with the G-Walk System. RESULTS: Foot pain and FFI were adversely related to balance and gait parameters in subjects with PF. Static balance with eyes open and eyes closed on firm and soft surface measured on the TYMO ® balance platform as well as gait parameters measured with the G-Walk system, were significantly lower in subjects with PF compared to age-matched healthy controls. CONCLUSION: PF negatively affects parameters of static balance measured with TYMO ® system and gait parameters measured with the G-Walk System. However, the Romberg balance test did not detect differences between subjects with PF and age-matched healthy controls. Show more

Keywords: Pain, walking, foot function

DOI: 10.3233/BMR-220092

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 477-484, 2023

Authors: Chankavee, Nanniphada | Amatachaya, Sugalya | Hunsawong, Torkamol | Thaweewannakij, Thiwabhorn | Mato, Lugkana

Article Type: Research Article

Abstract: BACKGROUND: Thoracic hyperkyphosis is common in the elderly, especially in women, and results in impaired balance control, impaired functional mobility and an increased risk of multiple falls. The 7 th cervical vertebra wall distance (C7WD) is a practical method for evaluating thoracic hyperkyphosis. OBJECTIVE: This study calculated C7WD cut-off scores that may identify impaired balance control, impaired functional mobility and an increased risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis. This study also explored the correlation between C7WD, balance control and functional mobility. METHODS: Sixty participants …were assessed for thoracic hyperkyphosis using the C7WD, balance control using the functional reach test (FRT), functional mobility using the timed up-and-go test (TUG) and a history of falls using their personal information. RESULTS: The data indicated that a C7WD of at least 7.95 cm, 8.1 cm and 8.8 cm had a good to excellent capability of identifying impaired balance control, impaired functional mobility and an increased risk of multiple falls, respectively. The C7WD results were significant and correlated with balance control (r s = - 0.68) and functional mobility (r s = 0.41). CONCLUSIONS: The C7WD may be utilised as a screening tool for these three impairments in this population. Show more

Keywords: Hyperkyphosis, gerontology, screening, community

DOI: 10.3233/BMR-220105

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 485-492, 2023

Authors: Grosdent, Stéphanie | Grieven, Luisa | Martin, Emilie | Demoulin, Christophe | Kaux, Jean-François | Vanderthommen, Marc

Article Type: Research Article

Abstract: BACKGROUND: Resisted training of the trunk muscles improves outcomes in chronic low back pain (CLBP). The Itensic b-effect machine was designed to provide resisted training through posterior translation of the pelvis in a seated, forward-tilted position, in contrast with traditional machines that involve extension of the trunk. OBJECTIVE: To study the effectiveness of lumbopelvic training on the Itensic b-effect machine in individuals with CLBP. METHODS: Participants were allocated to 4 weeks of either progressive Itensic (I) training in addition to an education/exercise (EE) program (I+ EE group, n …= 23) or the education/exercise program alone (EE group, n = 22). Primary outcome: Roland Morris Disability Questionnaire (RMDQ). Secondary outcomes: pain (0–10 numeric rating scale), trunk extensor endurance (Sorensen test), motor control (thoraco-lumbar dissociation test) and mobility (finger-to-floor test). RESULTS: RMDQ score improved more in the I+ EE group than in the EE group (with a between-group difference at the pos-test). Pain and mobility improved in the I+ EE group only, motor control improved in both groups with no between-group difference and the Sorensen test did not improve significantly in either group. CONCLUSIONS: Resisted posterior pelvic translation using the Itensic machine in addition to an education/exercise program improved disability, pain and mobility more than the education/exercise program alone. Show more

Keywords: Back pain, resistance training, muscles, disability

DOI: 10.3233/BMR-220119

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 493-502, 2023

Authors: Su, Peng | Liu, Feng | Zhang, Yi | Zhu, Jian Hua | Zhang, Li Chao

Article Type: Research Article

Abstract: BACKGROUND: Due to the influence of spinal and respiratory movements, it is difficult to accurately measure the range of motion of each joint. OBJECTIVE: To conduct a three-dimensional (3D) measurement of each joint in the shoulder complex in different postures in the sagittal plane of the upper extremity. METHODS: Thirteen healthy adults with no history of shoulder surgery for trauma or chronic pain were enrolled in the present study. The computed tomography (CT) imaging data of the shoulder complex were acquired in four postures via the reconstruction and alignment of 3D images. The …angles of the postural changes were measured, and rotation vectors were used for descriptions and statistical analyses. RESULTS: There was a statistical difference in the rotation angles between the dominant and non-dominant sides of the sternoclavicular joint when the posture changed from a resting position to a posterior inferior position. During the postural change from a resting position to a horizontal position, the regression coefficient (β ) of the humerothoracic joint to the sternoclavicular joint was 0.191, and the β of the humerothoracic joint to the glenohumeral joint was 0.621. During the postural change from the horizontal position to the rear upper position, the β of the humerothoracic joint to the sternoclavicular joint was 0.316, and the β of the humerothoracic joint to the glenohumeral joint was 0.845. During the postural change from the resting position to the rear lower position, the β of the humerothoracic joint to the glenohumeral joint was 0.991. CONCLUSION: The application of the image alignment technique enabled the direct and accurate measurement of the bony structures of the shoulder joint. The helical approach accurately described the scapulohumeral rhythm during 3D motion. There was a scapulohumeral rhythm of the shoulder complex during 3D composite sagittal movement, with different ratios for different joints and postures. Show more

Keywords: CT image alignment, shoulder complex, rotation vector, scapulohumeral rhythm

DOI: 10.3233/BMR-220132

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 503-515, 2023

Authors: Li, Hui | Hu, Ying | Gan, Lin | Wang, YiXuan

Article Type: Research Article

Abstract: BACKGROUND: An osteoporotic fracture (OPF) can significantly affect patients’ activities of daily living (ADLs). OBJECTIVE: This study observed the effects of evidence-based nursing (EBN) on the occurrence of postoperative complications and ADLs in patients with a vertebral OPF. METHODS: A total of 90 patients with vertebral OPF were divided into two groups. The conventional orthopedic nursing method was conducted for the control group, and the EBN model was delivered for the observation group. RESULTS: Differences in the Barthel index (BI) score on the first day of admission were not statistically …significant between the two groups. The BI scores on the day before discharge, compared with the day of admission, had improved in both groups. The BI score on the day before discharge was 83.67 ± 6.94 in the observation group, and the difference was statistically significant (P < 0.05) compared with the control group (76.56 ± 6.89). The rate of satisfaction with nursing in the observation group (100.0%) was significantly higher than in the control group (82.2%) (P < 0.05). The incidence of postoperative complications in the observation group (2.2%) was significantly lower than in the control group (24.4%) (P < 0.05). CONCLUSIONS: The implementation of EBN in patients with vertebral OPF improved the postoperative ADLs, reduced the incidence of postoperative complications, and improved the patients’ satisfaction with nursing. Show more

Keywords: Osteoporotic fracture, evidence-based nursing, activities of daily living, postoperative complication, observation of clinical effectiveness

DOI: 10.3233/BMR-220161

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 2, pp. 517-523, 2023