Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 6

Authors: Invernizzi, Marco | de Sire, Alessandro

Article Type: Editorial

DOI: 10.3233/BMR-245005

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1423-1426, 2024

Authors: Sadiq, Samreen | Noor, Rabiya | Akram, Rizwan

Article Type: Review Article

Abstract: BACKGROUND: Total knee arthroplasty (TKA) is a widely performed surgical procedure aimed at alleviating pain and restoring functionality in individuals suffering from knee osteoarthritis. Despite substantial benefits of TKA, patients are exposed to potential risks, including the occurrence of falls during their recovery period following discharge from the hospital. OBJECTIVE: This integrative review endeavors to comprehensively investigate the existing body of literature to identify and assess the diverse factors that contribute to occurrence of post-discharge falls among TKA patients. Through the synthesis of available research, this study seeks to offer valuable insights that can guide clinical …practices and interventions designed to mitigate the incidence of post-TKA falls, ultimately enhancing patient outcomes and quality of healthcare. METHODS: An integrative review was conducted and databases were searched including Pubmed, PEDro, Cochrane, and SPORTDiscus from 2000 to 2024. A thorough search was performed to retrieve articles missed through databases as well as unpublished grey literature. Methodological quality assessment was performed using Newcastle-Ottawa Scale for Case Control and Cohort studies and AXIS tool for cross-sectional study. RESULTS: Eleven articles finally met the inclusion criteria and were included in the review based on eligibility. There were 8 cohort studies (7 prospective cohorts, 1 retrospective cohort), 2 case control studies, and 1 cross-sectional study. The prospective cohort studies included in the review collected data in real-time as events occurred, making them particularly relevant for studying post-TKA falls. CONCLUSION: Patients who underwent TKA are at risk of post-discharge falls. Several key risk factors have been identified, including advancing age, female gender, reduced proprioception, psychiatric disorders, living alone, and knee pain in the operated knee. It is important to recognize that the significance of these risk factors can vary depending on individual circumstances and contexts. Show more

Keywords: Balance, discharge planning, risk of falls, total knee replacement

DOI: 10.3233/BMR-230165

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1427-1439, 2024

Authors: Sia, Lee Lee | Sharma, Shobha | Ing, Janet Bong May | Kumar, Saravana | Singh, Devinder Kaur Ajit

Article Type: Review Article

Abstract: BACKGROUND: The growing use of telerehabilitation within the healthcare community has garnered substantial attention. In congruence with other healthcare fields, examining perceptions, barriers, and facilitators assumed paramount significance in the continuation and fortification of telerehabilitation practices among physiotherapists. OBJECTIVE: In this scoping review, we aimed to systematically map the literature on the perceptions of physiotherapists as well as the barriers and enablers of telerehabilitation in their daily practice. METHODS: The five-stage methodological framework recommended by Arksey and O’Malley (2005) was used for this scoping review. In the framework, eight databases were searched using …key search terms such as “telerehabilitation”, “physiotherapists”, “readiness”, “enablers” and “barriers” All findings were organised into perceptions and readiness, enablers, and barriers. RESULTS: Fourteen articles met the inclusion criteria and were categorized as: (1) perception and readiness, (2) enablers, and (3) barriers. In the perception and readiness category, new trends in healthcare, advancement in physiotherapy practices and the benefits to clients were identified. The enablers identified included prior training, personal experience, familiarity with technology, functional equipment and space, and client selection. The barriers to the adoption of telerehabilitation in physiotherapy practice are pinpointed to poor technology, communication hurdles, limited availability, lack of familiarity, and client-related concerns. CONCLUSION: While initial evidence suggests a generally positive perceptions it is important to consider both facilitators and barriers when understanding adoption. This review’s findings revealed a wide research gap, with unequal weightage towards barriers compared to enablers, and highlights the need for further research. Developing telerehabilitation guidelines that cater to both physiotherapists and clients is necessary. Show more

Keywords: Physiotherapists, telerehabilitation, perceptions, enablers, barriers

DOI: 10.3233/BMR-240009

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1441-1454, 2024

Authors: Aslan, Sefa Gümrük | de Sire, Alessandro | Köylü, Sinem Uyar | Tezen, Özge | Atar, Merve Örücü | Korkmaz, Nurdan | Lippi, Lorenzo | Invernizzi, Marco | Longo, Umile Giuseppe | Kesikburun, Serdar

Article Type: Research Article

Abstract: BACKGROUND: Osteoarthritis (OA) is a widely-known disease distinguished by the breakdown of joint cartilage, leading to pain and morning stiffness. In this context, the role of corticosteroids is well known, but there is still a gap of knowledge on the duty of oxygen-ozone therapy (O2-O3). OBJECTIVE: To evaluate for effectiveness of ultrasound-guided O2-O3 injections compared with corticosteroid injections among patients diagnosed with knee OA. METHODS: This randomized controlled clinical trial was conducted on participants with knee OA who were randomly sorted into two groups: group A, undergoing corticosteroid group (n = …47) and group B, undergoing O2-O3 (n = 49) were injected within the knee joint under ultrasound guidance. The primary outcome measure was the change in the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score between baseline and 12-weeks post-injection. Secondary outcome measures included visual analog scale scores, joint effusion and a knee flexion ROM. Assessments were recorded at baseline and 4-weeks and 12-weeks post-injection. For the examination of intra- and inter-group variations at various time points, a repeated-measure analysis of variance (two-way ANOVA) was employed. RESULTS: Ninety-six participants completed this study. Based on repeated measurement analysis of variance, a significant effect of time was found for all outcome measures in both groups. Both groups showed clinically significant improvements in knee pain, quality of life and, function. Baseline, 4-week post-injection and 12-week post-injection WOMAC scores (mean ± standard deviation) were 72.54 ± 18.89, 45,95 ± 13.30 and 37.10 ± 19.87 (p = 0.00, p = 0.00, p = 0.00; respectively) in the corticosteroid group, respectively and 68.23 ± 20.18, 42.99 ± 18.67, and 33.43 ± 18.24 (p = 0.00, p = 0.00, p = 0.00; respectively) in the ozone group, respectively. However, no significant group × time interaction was determined regarding all outcome measures. CONCLUSION: The study demonstrates the efficacy of O2-O3 compared to steroid injections regarding functioning and pain relief among patients with diagnosed knee OA. Show more

Keywords: Ozone, knee osteoarthritis, corticosteroids, rehabilitation, oxygen-ozone therapy

DOI: 10.3233/BMR-240023

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1455-1466, 2024

Authors: Roberts, Katharine E. | Ho, Emma | Gassen-Fritsch, Carolina | Halliday, Mark | Mattinty, Manasi Murthy | Ferreira, Paulo

Article Type: Research Article

Abstract: BACKGROUND: Initiating and maintaining physical activity is particularly difficult for at-risk groups such as those with chronic low back pain (LBP). OBJECTIVE: This study aimed to assess whether there is a relationship between perceived social support (e.g., emotional and physical support) in individuals recently discharged from treatment for chronic LBP and the number of exercise sessions and total amount of exercise they perform over a 6-month period. This study also aimed to investigate a possible mediation effect of exercise self-efficacy on the relationship between perceived social support and exercise adherence (number of exercise sessions and total …amount of exercise). METHODS: This prognostic study employed a secondary analysis of data collected for The Buddy Study; Data was collected through online weekly diaries over a 6-month period. Poisson regression analyses were used to quantify the relationship between social support at baseline and total number of exercise sessions, and total amount of exercise performed (frequency and duration) in the 6-month follow-up period. Where a relationship was observed, the Stata SEM command was used for the mediation analysis. RESULTS: A positive relationship was found between participants’ perceived levels of social support at baseline and the total number of exercise sessions they performed (IRR = 1.56, 95%CI: 1.18 to 2.06) and the total amount of exercise they performed (IRR = 1.57, 95%CI: 1.05 to 2.35) during the 6-month follow-up period. No mediating relationship was found between exercise self-efficacy at 3-months and the total number of exercise sessions performed (β 3.96, 95% CI: - 4.91 to 12.84), or the total amount of exercise performed (β 243.96, 95% CI: - 258.08 to 746.01). CONCLUSION: Social support is potentially an important aspect of exercise adherence, following discharge from treatment, for those with chronic LBP. People’s self-efficacy to exercise does not appear to mediate this relationship. Harnessing social support following physiotherapy treatment may increase exercise adherence and may therefore improve long term outcomes for those with chronic LBP. Show more

Keywords: Exercise therapy, rehabilitation, perceived social support, self-efficacy, physiotherapy

DOI: 10.3233/BMR-230239

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1467-1477, 2024

Authors: Santos, Ruben | Pires, Diogo

Article Type: Research Article

Abstract: BACKGROUND: Musculoskeletal conditions are the leading cause of disability, requiring continuous outcome measurement, including the utilization of patient-reported outcome measures (PROMs). OBJECTIVE: The aims of the study were a) to characterize the use PROMs by Portuguese physiotherapists in patients with musculoskeletal conditions; b) to analyze the associated factors of their use and; c) to identify the barriers and facilitators to their implementation. METHODS: A cross-sectional online survey was carried out with musculoskeletal physiotherapists working in Portugal. Closed questions were used to describe the use of PROMs. The factors associated with the non-use of …PROMs were analysed through logistic regression models (p = 0.05). Barriers and facilitators were assessed through open questions and analyzed using thematic analysis. RESULTS: One hundred and fifty-six physiotherapists answered the online survey. Most physiotherapists do not use outcome measures consistently and physical tests are often chosen (70.5%) over PROMs (17.3%). The work sector (p = 0.01; p = 0.015; p = 0.009). the workplace stimulus (p = 0.001) and the physiotherapists’ knowledge about PROMs (p = 0.017) were identified as factors associated with the non-use of PROMs. Barriers and facilitators to the use of PROMs are related to physiotherapists’ skills, the patients’ characteristics, the workplace conditions, and the instruments’ characteristics. CONCLUSION: This study showed the poor use of PROMs by musculoskeletal physiotherapists and identified the associated factors, barriers, and facilitators that should be considered to increase its future use by musculoskeletal physiotherapists in Portugal. Show more

Keywords: Outcome measurement, patient reported outcome measures, musculoskeletal pain

DOI: 10.3233/BMR-230208

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1479-1488, 2024

Authors: Abiko, Teppei | Murata, Shin | Shigetoh, Hayato | Ohyama, Michie | Sakata, Eiji

Article Type: Research Article

Abstract: BACKGROUND: Caregivers in Japan experience a high prevalence of low back pain (LBP), with age, sex, individual pain experiences, and central sensitization symptoms potentially influencing its chronic progression. OBJECTIVE: To determine the prevalence of LBP among caregivers, as well as its relation to age and sex, and explore work status, psychological factors, and central sensitization symptoms as contributing factors to chronic LBP (CLBP). METHODS: A large-scale cross-sectional survey was conducted among 1214 caregivers in 35 geriatric healthcare facilities. The survey assessed LBP and CLBP prevalence, work status, psychological factors, and central sensitization-related symptoms. …Multivariate logistic regression analysis was used to identify factors influencing CLBP. RESULTS: Among 936 valid respondents, the LBP prevalence was 69.2%. No significant sex differences were found in the prevalence of LBP and CLBP. Old age, higher pain severity, and severe symptoms related to central sensitization increased the risk of CLBP. However, work status and psychological factors did not significantly contribute to CLBP. CONCLUSION: There is a high prevalence of LBP among caregivers, age and individual pain experience significantly impact CLBP. These findings emphasize the need for therapeutic strategies to manage pain intensity, especially in the acute phase, to prevent the progression to chronicity. Show more

Keywords: Chronic pain, central nerve system sensitization, prevalence, risk factors, psychology

DOI: 10.3233/BMR-230319

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1489-1498, 2024

Authors: Yang, Zhen | Liu, Qiping | Bi, Yongyan | He, Yongping | Wang, Miaomiao | Gao, Qiang | Xiang, Lian | Li, Xiaoliu

Article Type: Research Article

Abstract: BACKGROUND: Scoliosis secondary to cerebral palsy is one of the common complications of cerebral palsy in children with cerebral palsy. OBJECTIVE: This study aimed to explore the efficacy of rehabilitation combined with brace correction in patients with scoliosis secondary to cerebral palsy. METHODS: A total of 52 patients with scoliosis secondary to cerebral palsy were selected from our hospital from April 2019 to April 2022 and divided into the control group and experimental group according to the statistical randomization method (n = 26 in each group). Control group: …mean age (14.28 ± 2.31) years; 16 males and 10 females. Experimental group: average age (14.24 ± 2.35) years; 15 males and 11 females. The control group wore scoliosis orthopedic brace, while the experimental group was treated with rehabilitation manipulation and rehabilitation training (including gymnastic training and weight training) on the basis of the control group for 1 year. The clinical efficacy of the two groups was compared and observed; the number of degrees of scoliosis (Cobb angle), the angle of vertebral rotation (AVR) and the distance of the parietal vertebrae from the sacral midline (AVT) were compared before and after treatment; the incidence of adverse events during treatment was observed in the two groups. RESULTS: After treatment, both groups showed significant improvement in the overall effectiveness of treatment, Cobb’s angle, AVR and AVT compared with those before treatment (P < 0.05). The experimental group had a significantly higher overall effective rate of treatment than the control group (P < 0.05), a significantly smaller Cobb’s angle and AVR than the control group (P < 0.05) and a significantly shorter AVT than the control group (P < 0.05). The incidence of adverse events during treatment was lower in both groups and was not significantly different (P > 0.05). CONCLUSION: The combination of rehabilitation physiotherapy and bracing is effective in optimizing the clinical outcome of patients with scoliosis secondary to cerebral palsy, improving their scoliosis dysfunction and providing a high level of safety in treatment. Show more

Keywords: Rehabilitation, brace correction, cerebral palsy, scoliosis, outcome

DOI: 10.3233/BMR-230336

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1499-1506, 2024

Authors: Amin, Doaa I. | Mohamed, Ghada I. | ElMeligie, Mohamed M.

Article Type: Research Article

Abstract: BACKGROUND: Chronic nonspecific neck pain is a common disorder that causes disability and reduced quality of life. Effective conservative treatment options are needed to manage this condition. OBJECTIVE: This randomized trial compared the efficacy of McKenzie exercises alone versus McKenzie plus cervical and scapulothoracic stabilization training for patients with chronic nonspecific neck pain. METHODS: A randomized controlled trial was conducted in an outpatient physical therapy clinic. 76 patients with chronic (> 3 months) neck pain were randomized to 6 weeks of either McKenzie exercises alone (n = …38) or McKenzie plus stabilization exercise (n = 38). The McKenzie protocol included posture correction, range of motion exercises, and lateral neck stretches. The stabilization program added targeted exercises for the neck and scapula. RESULTS: The combination of McKenzie plus stabilization exercises resulted in significantly greater reduction in current neck pain intensity compared to McKenzie alone at 6 weeks (mean difference: - 1.2 points on 0–10 scale, 95% CI - 1.8 to - 0.6; p < 0.001). Neck disability improved in both groups. Cervical range of motion also improved more with the addition of stabilization, except for extension. CONCLUSION: Adding specific cervical and scapulothoracic stabilization exercises to a standard McKenzie protocol led to clinically meaningful reductions in neck pain compared to McKenzie therapy alone in patients with chronic nonspecific neck pain. This combined approach can improve outcomes. Show more

Keywords: Musculoskeletal diseases, Cervicalgia, exercise therapy, manual therapy, randomized controlled trial

DOI: 10.3233/BMR-230352

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1507-1517, 2024

Authors: Kim, Tae-Gyu | Kim, Young-Hoon | Ma, Rui | Kim, Soo-Yong

Article Type: Research Article

Abstract: BACKGROUND: An evaluation of scapula position is important to predict spine curvature and shoulder function in patients with adolescent idiopathic scoliosis (AIS). Therefore, a reliable scapula position is required to assess posture in patients with AIS. OBJECTIVE: This study investigated the reliabilities of scapula position tests and differences in scapula position and shoulder function between individuals with and without AIS. METHODS: The study compared 18 patients with AIS and 18 healthy controls to identify differences in scapula position and shoulder function. The acromion-table distance, lateral displacement of the scapula, acromion depression, winged scapula, …upward rotation of the scapula, and anterior tilt of the scapula were measured. Scapula position test reliabilities were assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum clinically important difference (MCID). Shoulder function was measured using the Shoulder Pain and Disability Index. RESULTS: The reliabilities of scapula position tests (ICC 0.85–0.93, SEM 0.1–1.2, and MCID 0.2–2.5) were good. There were significant differences in scapula position and shoulder function between patients with AIS and healthy controls (p < 0.05). CONCLUSION: Scapula position tests were highly reliable in patients with AIS; they can be used to evaluate scapula position during clinical assessment of posture in patients with AIS. Show more

Keywords: Muscle strength, posture, spine

DOI: 10.3233/BMR-230357

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1519-1528, 2024