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

Authors: Oxfeldt, Martin | Tegner, Heidi | Björklund, Martin | Christensen, Jan

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is the leading cause of disability and an increasing sick leave in Denmark. Psychosocial risk factors have been linked to the development of LBP-related disability and work-absenteeism. The short form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-sf) was developed to screen for psychosocial risk factors and assess the risk of long-term disability and work-absenteeism. OBJECTIVE: To translate and cross-culturally adapt ÖMPSQ-sf into Danish and evaluate test-retest reliability with relative and absolute reliability and internal consistency in LBP-patients in a secondary setting. METHODS: A six-step translation and cross-culturally adaptation process …was used. Forty-four patients with subacute and chronic LBP were recruited at an outpatient clinic. RESULTS: Test-retest reliability (n = 37) was found to be excellent (ICC2.1 = 0.92), Internal Consistency (n = 44) was adequate (Cronbach’s alpha = 0.72). Absolute reliability included Standard Error of Measurement (SEM = 3.97 points), 95% Limits of Agreement (95% LOA = 0.08, - 15.90–15.74), and Smallest Detectable Change (SDC = 10.87 points). CONCLUSION: The Danish ÖMPSQ-sf showed acceptable measurements properties in subacute and chronic LBP-patients. Further research is needed to assess other measurement properties of the ÖMPSQ-sf, in relation to validity, responsiveness, and the predictive ability before application in research or clinical practice. Show more

Keywords: Low back pain, Örebro questionnaire, reliability, psychosocial risk factors, disability, work absenteeism

DOI: 10.3233/BMR-230363

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1529-1536, 2024

Authors: Cobanoglu, Gamze | Guzel, Nevin A. | Ecemis, Zeynep Berfu | Demirkan, M. Yusuf

Article Type: Research Article

Abstract: BACKGROUND: The Band Pull-Apart (BPA) exercise is used to strengthen the periscapular muscles. It was recently stated that the lower extremity and trunk movements should be included in the shoulder rehabilitation programs to optimize an effective energy transfer throughout the kinetic chain. OBJECTIVE: The aim of this study is to investigate the effects of kinetic chain based BPA exercise on the muscle activations of the sternocleidomasteideous (SCM) and the trapezius muscles in individuals with and without forward head posture (FHP). METHODS: Eighteen individuals with FHP and 18 individuals without FHP were included. Photographic …measurements were made to identify individuals with FHP. The muscle activations of SCM, Upper Trapezius (UT), Middle Trapezius (MT), and Lower Trapezius (LT) were measured with surface EMG. BPA exercise was performed in the standing, unipedal standing, squat, unipedal squat, and Bulgarian split squat (BSS). RESULTS: There was no Group × Exercise interaction for the SCM, UT, MT, LT muscle activations, or for the UT/MT and UT/LT ratios (p > 0.05). While there was a difference in the activation of all muscles between individuals with and without FHP (p < 0.05), both ratios were similar (p > 0.05). There was a statistically significant difference between exercises for SCM, MT, and LT muscle activations (p < 0.000 for these muscles), UT/MT (p < 0.000) and UT/LT ratios (p = 0.004). SCM muscle activation in squat was lower than activation in standing (Mean Difference (MD) = 2.5% Maximal Voluntary Isometric Contractions (MVIC); p = 0.004) and in unipedal standing (MD = 2.1% MVIC; p = 0.002). MT muscle activation in squat was higher than activation in standing (MD = 9.7% MVIC), unipedal standing (MD = 7.8% MVIC), unipedal squat (MD = 6.9% MVIC) and BSS (MD = 9.4% MVIC; p < 0.000 for these positions). LT muscle activation in the squat was higher than activation in the standing (MD = 8.5% MVIC) and unipedal squat (MD = 8.1% MVIC; p < 0.004 for these positions). UT/MT ratio in the squat was lower than standing (MD = 0.3), unipedal standing (MD = 0.2) and BSS (MD = 0.3; p < 0.000 for these positions). UT/LT ratio in squat was lower than unipedal squat (MD = 0.5) and BSS (MD = 0.6; p = 0.002; for these positions). CONCLUSION: Performing the BPA exercise in the squat position is suggested in cases where lower SCM and UT muscle activation, lower UT/MT, and UT/LT ratios and higher MT and LT muscle activations are needed for individuals with and without FHP. Show more

Keywords: Shoulder, superficial back muscles, electromyography, exercise therapy, posture

DOI: 10.3233/BMR-230397

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1537-1549, 2024

Authors: Shin, Sun-Shil | Yoo, Won-Gyu

Article Type: Research Article

Abstract: BACKGROUND: Trunk rotation is important in many sporting activities The thoracic spine has reciprocal relationships with the lumbar and pelvic spines, such that reduced flexibility in the lumbar or thoracic spine can lead to abnormal patterns of trunk movement and pain. However, few studies have investigated the relative trunk rotation mobilities of the thorax, lumbar, and pelvis. OBJECTIVE: To compare thoracic, lumbar, and pelvic rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups. METHODS: Thirty-two young, active participants were enrolled in this study. After the attachment of inertial …measurement units at the T1, T7, T12, L3, and S2 levels, the participants were required to stand in a comfortable upright posture for 5 s to allow postural measurements before performing the lumbar-locked rotation test. The participants were then divided into hyper thoracic rotation and normal thoracic rotation groups based on T1 angle measurements obtained during the lumbar-locked rotation test. RESULTS: The hyper thoracic rotation group had significantly higher thoracic rotation angles on both the right (p < 0.05) and left (p < 0.05) sides compared with the normal thoracic rotation group. Furthermore, we observed flat lumbar lordosis in the hyper thoracic rotation group compared with the normal thoracic rotation group, particularly in the lower lumbar region in standing posture. CONCLUSION: Our data suggest that evaluations of thoracic mobility should consider relative thoracic, lumbar, and pelvic motions, rather than the T1 angle alone. This study provides a basis for health professionals to evaluate movement dysfunctions associated with thoracic hypermobility. Show more

Keywords: Flat lumbar, lumbar-locked rotation test, relative movement, thoracic hypermobility

DOI: 10.3233/BMR-230404

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1551-1559, 2024

Authors: Mikkonen, Jani | Luomajoki, Hannu | Airaksinen, Olavi | Goubert, Liesbet | Pratscher, Steven | Leinonen, Ville

Article Type: Research Article

Abstract: BACKGROUND: Exercise is a first-line treatment for chronic non-specific low back pain (CNSLBP). Exercise combined with specific breathing techniques have the potential to improve multifactorial outcomes. No previous studies, however, have compared outcomes between identical exercises with or without a specific breathing protocol in a uniform clinical study setting. OBJECTIVES: 1) To investigate the feasibility of combining synchronized breathing with movement control exercises and evaluate eligibility criteria, randomization procedures, and dropout rates. 2) To study the preliminary efficacy of the interventions on multifactorial outcome measures. METHODS: Thirty subjects with CNSLBP were randomized into …two groups. Both groups had four contact clinic visits where they received personalized home movement control exercises to practice over two months. The experimental group included a movement control exercise intervention combined with synchronized breathing techniques. Trial registration number: NCT05268822. RESULTS: Feasibility was demonstrated by meeting the recruitment goal of 30 subjects within the pre-specified timeframe with enrolment rate of 24.8% (30/121). Synchronized breathing techniques were successfully adhered by participants. Home exercise adherence was nearly identical between the groups without any adverse events. Preliminary efficacy findings on pain intensity, disability, and self-efficacy in the experimental group exceeded the minimal clinically important difference. No such findings were observed in any outcome measures within the control group. Overall, multifactorial differences were consistent because nine out of eleven outcome measures showed greater improvements for the experimental group. CONCLUSION: The synchronized breathing with movement control exercises protocol was feasible and may be more beneficial for improving multifactorial outcomes compared to identical exercises alone. Results suggested progression to a full-scale trial. Show more

Keywords: Chronic musculoskeletal pain, feasibility, breathing exercises, specific breathing technique, motor control exercises, yoga, pilates

DOI: 10.3233/BMR-230413

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1561-1571, 2024

Authors: Lu, Yang | Li, Yalei | Wang, Jingru | Zhao, Feng | Zhu, Chaohua | Wang, Hui | Ji, Xiaoli | Zhang, Haijing | Ping, Ya

Article Type: Research Article

Abstract: BACKGROUND: The knee joint anatomical structure is susceptible to external forces, which can lead to functional break down, profoundly affecting the quality of life and daily functioning of individuals. OBJECTIVE: To investigate the effects of continuous nursing intervention on walking function, quality of life, and treatment satisfaction in patients undergoing unicondylar knee replacement. METHODS: This prospective study included 90 patients who underwent unicondylar knee arthroplasty due to unicondylar osteoarthritis. Participants were divided into two groups based on their nursing methods: the control group (n = 45) and the observation …group (n = 45). RESULTS: Three months post-intervention, the observation group demonstrated significant improvements in knee joint range of motion, Hospital for Special Surgery Knee Score score, and Lysholm knee joint score compared to the control group (P < 0.05). The observation group also had a shorter completion time for the Timed Up and Go test and significantly higher SF-36 scores (P < 0.05 for both). Additionally, Knee Injury and Osteoarthritis Outcome Score scores in the observation group were significantly higher after three months of intervention (P < 0.05). And the observation group reported higher satisfaction rates and lower dissatisfaction rates compared to the control group (P < 0.05). CONCLUSION: Early postoperative rehabilitation guidance, regular reviews, and rehabilitation exercise guidance result in better rehabilitation outcomes, enhanced knee joint function, improved walking ability, and overall quality of life for patients undergoing unicondylar knee replacement. Show more

Keywords: Nursing, arthroplasty, replacement, knee, quality of life

DOI: 10.3233/BMR-230414

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1573-1580, 2024

Authors: Kondo, Yu | Higuchi, Daisuke | Miki, Takahiro | Watanabe, Yuta | Takebayashi, Tsuneo

Article Type: Research Article

Abstract: BACKGROUND: There is a paucity of data on physical activity and its effects in patients after cervical spine surgery. OBJECTIVE: This study aimed to examine the association between physical activity and disability in patients after cervical spine surgery while also considering age, sex, pain, and central sensitization (CS)-related symptoms. METHODS: Participants included individuals with a cervical degenerative condition who had undergone surgery. Neck disability index, physical activity frequency, numerical rating scale for pain intensity, and short form of the CS inventory were recorded more than 1 year postoperatively. The linear mixed model was …performed to examine the association between physical activity and disability. RESULTS: The responses of 145 participants were analyzed. The linear mixed model results showed that the stretching and light-intensity exercise frequency (β = - 0.14, p = 0.039) was independently associated with disability, adjusted for age, sex, pain, and CS-related symptoms. Conversely, other physical activities, such as walking and muscle strength exercises, were not associated with a disability. CONCLUSION: The findings emphasize the importance of performing regular physical activity, regardless of pain and CS-related symptoms. Show more

Keywords: Degenerative cervical disease, disability, physical activity, pain

DOI: 10.3233/BMR-230428

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1581-1589, 2024

Authors: Xie, Xing-Wen | Wang, Chun-Xiao | Zhao, Yong-Li | Luo, Yong-Sheng | Wang, Zhong-Hua | Liu, Jing | Li, Hui | Li, Ding-Peng

Article Type: Research Article

Abstract: BACKGROUND: In China, Tongluo-Qutong rubber plaster (TQRP) is commonly used for cervical spondylotic radiculopathy, but lacks high-quality trials. OBJECTIVE: This study aimed to conduct a multicenter, open-label, parallel-group, randomized controlled trial in China to investigate the practical efficacy and safety of TQRP in the treatment of CSR. METHODS: A total of 240 patients diagnosed with CSR were recruited for the investigation from multiple hospitals in Gansu province, China. The patients were randomly assigned to either an experimental or a control group. The experimental group received treatment with TQRP, whereas the control group was …administered a diclofenac sodium patch (DSP) for a maximum duration of 21 days. The visual analogue scale (VAS) score for pain, the proportion of patients experiencing 50% or more pain relief, the neck disability index (NDI), changes as per the Eaton trial, and recurrence during the follow-up period were evaluated for both groups. The safety and adverse events associated with the concurrent drug therapy were also evaluated. RESULTS: At each time point, the mean VAS and NDI scores of both groups demonstrated a downward trend. The experimental group exhibited a greater decline in VAS score at each time point compared to the control group (P < 0.01). In the Eaton trial, both the percentage of patients experiencing pain relief of 50% or more and the number of abnormal results exhibited improvement. However, the outcomes in the 21 ± 3d experimental group were significantly superior to those in the control group (P < 0.01). During the follow-up period, the recurrence events in the experimental group were reduced compared to the control group. The difference between the two groups was statistically significant (P < 0.05). The incidence of adverse reactions was 1.74% for TQRP and 3.54% for DSP. CONCLUSION: TQRP is effective and safe in the treatment of CSR. Show more

Keywords: Cervical spondylotic radiculopathy, Chinese traditional medicine, TQRP, rubber plaster

DOI: 10.3233/BMR-230431

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1591-1599, 2024

Authors: Son, Aria | Johnson, James | Leachman, Jennifer | Bloyder, Joseph | Brant, Jeannine M.

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a significant source of disability and decreased quality of life. The Self-Natural Posture Exercise (SNPE) intervention can be used effectively in many cases, but feasibility and impact has not been fully explored. OBJECTIVE: The current study explores the feasibility and efficacy of face-to-face (FtF) and virtual (Vir) SNPE programs on chronic low back pain. METHODS: This is a randomized single-blinded waitlist control study with 10 participants in the FtF group (age 45.8 ± 2.89) and 9 in the Vir group (age 52.2 ± …2.3). Participants had low to moderate low back pain for > 3 months. Those who would eventually become the Vir group served initially as a waitlist control (Con) group. The FtF group received 12 weeks of in-person exercise training sessions conducted and the Vir group received weekly recorded training videos created by and featuring the same instructor. Measured outcomes included feasibility assessed by rate of retention and rate of attendance, level of low back pain (Oswestry Disability Index, Visual Analogue Scale), quality of life (36-Item Short Form Health Survey 1.0), muscular pressure pain threshold, and muscle tone. Analysis was done via repeated measures ANOVA and Wilcoxon tests. RESULTS: Rates of retention were 80% in the FtF group and 78% in the Vir group. Attendance rates were 88% in the FtF group and 60% in the Vir group. ODI, VAS, and some SF-36 domains improved in both the FtF and Vir groups. Overall, the FtF group improved in more domains and by a larger degree than the Vir group and both groups improved relative to Con. CONCLUSION: A 12-week SNPE program, done virtually or in person, shows promise in improving ODI, VAS, and some SF-36 domains. FtF appears to be more effective. Future studies would benefit from sampling a larger and more diverse population. Show more

Keywords: Chronic low back pain, rehabilitation, tele-rehabilitation, self-natural posture exercise, physical therapy

DOI: 10.3233/BMR-230441

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1601-1616, 2024

Authors: Zengi, Hakan | Safran, Elif Esma | Şevgin, Ömer

Article Type: Research Article

Abstract: BACKGROUND: Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment strategies. This highlights the growing need for innovative approaches to rehabilitation programs in this area. OBJECTIVE: To examine the effects of kinesio taping (KT) on pain, functionality, and work performance in bus drivers experiencing neck pain. METHODS: The study involved 44 participants who were randomised into two different groups: the exercise group (n = 22) and the kinesio tape group (n = …22), with participants in both groups undertaking exercise interventions. Evaluations were made before and after 6 weeks of treatment. At the end of the 6-week, the participants’ ROM, pain evaluations and functional scales were evaluated with disability, and work functionality. RESULTS: Neck pain severity decreased in both groups (p < 0.001 for each value), but there was no difference between the groups (p : 0.071). When disability scores were evaluated, improvement was noted in both groups (p : 0.001 for each value), but no statistically significant difference was found (p : 0.754). When the improvements in ROM values before and after the treatment were examined, the difference between the groups was recorded only in the neck extension ROM value (p : 0.011). Significant improvement was noted in all sub-steps of job performance in both groups (p < 0.05). CONCLUSION: KT added to ergonomic training and home exercise programmes is effective in controlling work-related musculoskeletal pain in drivers with neck pain. However, the addition of KT to exercise therapy was found to be no more effective than exercise therapy alone in improving pain control, functionality and work performance. Show more

Keywords: Ergonomics, muscle stretching exercises, occupational diseases

DOI: 10.3233/BMR-240001

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1617-1630, 2024

Authors: Kim, Jun-Hee

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is one of the most frequently occurring musculoskeletal disorders, and factors such as lifestyle as well as individual characteristics are associated with LBP. OBJECTIVE: The purpose of this study was to develop and compare efficient low back pain prediction models using easily obtainable demographic and lifestyle factors. METHODS: Data from adult men and women aged 50 years or older collected from the Korean National Health and Nutrition Examination Survey (KNHANES) were used. The dataset included 22 predictor variables, including demographic, physical activity, occupational, and lifestyle factors. Four machine …learning algorithms, including XGBoost, LGBM, CatBoost, and RandomForest, were used to develop predictive models. RESULTS: All models achieved an accuracy greater than 0.8, with the LGBM model outperforming the others with an accuracy of 0.830. The CatBoost model had the highest sensitivity (0.804), while the LGBM model showed the highest specificity (0.884) and F1-Score (0.821). Feature importance analysis revealed that EQ-5D was the most critical variable across all models. CONCLUSION: In this study, an efficient LBP prediction model was developed using easily accessible variables. Using this model, it may be helpful to identify the risk of LBP in advance or establish prevention strategies in subjects who have difficulty accessing medical facilities. Show more

Keywords: Chronic pain, artificial intelligence, risk assessment, health surveys, physical activity, quality of life

DOI: 10.3233/BMR-240059

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1631-1640, 2024