Journal of Back and Musculoskeletal Rehabilitation - Volume Pre-press, issue Pre-press
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: BACKGROUND: Direct access physical therapy (DAPT) may result in improved patient outcomes and reduced healthcare costs. Prognostic factors associated with spine-related outcomes and insurance claims with DAPT are needed. OBJECTIVE: To identify factors that predict variations in outcomes for spine pain and insurance claims using DAPT. METHODS: Individuals (N = 250) with spine pain were analyzed. Outcomes were classified into High, Low, or Did Not Meet minimal clinically important difference (MCID) scores. Claims were categorized into low, medium, or high tertiles. Prognostic variables were identified from patient information.…RESULTS: Females were more likely to meet High MCID (odds ratio [OR] 2.84 (95% CI = 1.32, 6.11) and Low MCID (OR 2.86, 95% CI = 1.34, 6.10). Higher initial ODI/NDI scores were associated with High MCID (OR 1.04, 95% CI = 1.07, 1.22) and Low MCID (OR 0.91, 95% CI = 0.77, 1.07). Odds of a high claim were lowered by the absence of imaging (OR 0.04, 95% CI = 0.02, 0.09) and an active versus passive treatment (OR 0.38, 95% CI = 0.18, 0.80). CONCLUSION: Females and higher initial disability predicted favorable outcomes. The novel introduction of claims into the prognostic modeling supports that active interventions and avoiding imaging may reduce claims.
Keywords: Prognosis, low back pain, neck pain, health care costs, direct access
Abstract: OBJECTIVE: To investigate the efficacy of a 4-week community aquatic physiotherapy program with Ai Chi or the Bad Ragaz Ring Method (BRRM) on pain and disability in adults with chronic low back pain (CLBP). METHODS: Adults with CLBP (n = 44; mean ± SD age, 52.6 ± 5.5 y; 37 women) were randomly assigned to either an Ai Chi (n = 23) or BRRM (n = 21) program (4 weeks, twice weekly). RESULTS:…Both the Ai Chi (- 1.4; 95% CI - 2.6 to - 0.2; p = .025) and BRRM (- 2.0, 95% CI - 3.1 to - 0.8; p = 0.003) groups demonstrated significant pre- to post-treatment decreases in Roland-Morris Disability Questionnaire scores and improvements in prone bridge duration (Ai Chi: 11.7 s; 95% CI 1.6 to 21.8; p = 0.025; BRRM: 19.0 s; 95% CI 6.1 to 31.8; p = 0.006). The Ai Chi group revealed a significant improvement in single-leg stand test duration (2.9 s; 95% CI 0.1 to 5.7; p = 0.045) and the BRRM group reported significant decrease in pain intensity (- 11.6; 95% CI - 19.1 to - 4.2; p = 0.004). CONCLUSIONS: A 4-week aquatic physiotherapy program with Ai Chi or BRRM resulted in significant pre- to post-treatment improvements in disability and global core muscle endurance. Ai Chi appeared to have an additional benefit of improving single-leg standing balance and BRRM an additional benefit of reducing pain.
Keywords: Chronic low back pain, disability, Ai Chi, Bad Ragaz Ring Method, aquatic physiotherapy, water exercise
Abstract: BACKGROUND: Body height (BH) measurement is an important part of the clinical evaluation of children with idiopathic scoliosis (IS) as its progression is defined based on the observation of a growth spurt. OBJECTIVE: The aim of the study is to assess diurnal variation of BH in children with IS. METHODS: BH was measured in 98 children with IS (Cobb angle: 10 ∘ –52 ∘ , mean 21.2 ∘ ± 9.9 ∘ ) both in standing and sitting position. The…measurements were performed 4 times a day – between: (1) 7:00 and 8:00; (2) 11:00 and 12:00; (3) 15:00 and 16:00 and (4) 19:00 and 20:00. RESULTS: A significant decrease in BH during the day was observed in both standing and sitting positions (p < 0.001). The highest decrease in height was observed between the measurements performed between 7:00 and 8:00 and measurements carried out in the evening (19:00–20:00). For standing, the mean loss of height was 0.72 cm (± 0.7), i.e. 0.43% of initial standing height, for sitting the mean decrease in height was 0.69 cm (± 0.7), i.e. 0.79% of initial sitting height. CONCLUSIONS: BH decreases in children with IS during daytime. Due to diurnal BH variation, the time of the day should be recorded when measuring patients with IS.
Keywords: Idiopathic scoliosis, body height, diurnal variation, treatment, evaluation, progression
Abstract: BACKGROUND: Neural mobilization is an effective technique in the management of cervical radiculopathy (CR). However, the difference between active versus passive upper extremity (UE) neural mobilization techniques in the management of cervical radiculopathy is not well established. OBJECTIVE: To determine the role of active versus passive UE neural mobilization in females with cervical radiculopathy. METHODS: A double blind randomized controlled trial was conducted at Shifa International Hospital from Sep 2016 to Feb 2017, and 44 females were included and randomized into 2 groups, receiving 12 treatment sessions in total. Group A received active…whereas Group B received passive UE neural mobilization, along with cervical traction and Unilateral Posterior Anterior (UPA) glide regardless of the group. Numeric pain rating scale (NPRS), Neck Disability Index (NDI) and cervical range of motion (ROM) were used as outcome measurement tools. Non-parametric tests of significance were used for inter group and intra group comparison (Mann-Whitney U test and Wilcoxon test). RESULTS: A statistically significant difference was observed between pre and post NPRS, NDI and ROM scores after 4 weeks of treatment for both groups (p < 0.05). However, no significant differences were observed in post treatment scores of active and passive neural mobilization groups (p > 0.05). CONCLUSION: Both active and passive neural mobilization is effective in the management of cervical radiculopathy. One of the intervention is not superior to the other.
Abstract: BACKGROUND: Non-surgical treatment is the primary approach to degenerative conditions of the lumbar spine and may involve multiple modalities. There is little literature to guide an evidence-based approach to care. OBJECTIVE: To determine the effectiveness of CNT (comprehensive non-surgical treatment) in patients with degenerative spondylolisthesis (DS) and spondylolytic spondylolisthesis (SS), and to identify predictor variables for success of CNT in avoiding surgery. METHODS: All patients who underwent CNT for spondylolisthesis (n : 203) were included. CNT consisted of patient education, pain control with transforaminal epidural steroid injections (TFEs) and/or medications, and…exercise programs. RESULTS: Surgical and non-surgical patients were similar in age, smoking status, comorbidity scores, facet joint widening, and translation of spondylolisthesis. After CNT, only 21.6% of patients with DS and 31.3% of patients with SS chose to have surgery in 3-years follow-up. The non-surgical group reported significantly better pain relief (73.6% vs 55%) after TFEs for a longer period (152.8 vs 45.6 days) and lower opioid use than the surgical group (28.2% vs 55.3%). CONCLUSIONS: CNT is effective in spondylolisthesis and more successful in DS than SS. CNT may decrease the need for surgery, particularly in patients who report pain relief greater than 70% for average five months after TFEs.
Keywords: Spondylolisthesis, back pain, epidural, steroids, non-surgical treatment
Abstract: INTRODUCTION: Running is one of the most common sports practices in the world due to the beneficial impact on the health, despite the relatively high risk of getting injuries. In fact, running is one of the most common sports capable to induce overuse injuries of the lower back and leg. In previous studies, the symptoms in the lower limb have been attributed to lumbosacral degenerative pathology. When the symptoms are unclear, they must be studied with great attention by carrying out an accurate process of screening and differential diagnosis. MATERIALS AND METHODS: A 42-year-old non-competitive male…runner who complained of left leg pain was referred to a physiotherapist. He reported a continuous, deep, sharp, shooting pain of the left leg. The symptoms began one year earlier. Symptoms worsened during prolonged driving and long distance running. The patient had been previously diagnosed with lumbar radicular irradiation in the leg by a general practitioner. Initial management, in another physical therapy outpatient setting, was without any improvement. RESULTS: After surgical excision, symptoms gradually regressed shortly and the patient was referred to a physiotherapist in order to fully recover and restore work and running activities. CONCLUSION: This case report describes the history, assessment and treatment of a runner with a rare cause of leg pain. After surgery excision, treatment focused on education and loading the tissues over many weeks through a graded program of loaded exercises and running retraining.
Abstract: BACKGROUND: Physiotherapy scoliosis specific exercises include exercises to attain and maintain proper posture, as well as flexibility movements such as stretching. OBJECTIVE: To examine the effect of prior muscle stretching on the performance of posture exercise in females with adolescent idiopathic scoliosis (AIS). METHODS: Eighteen females with AIS were randomly assigned to perform a posture maintenance task for three minutes preceded by either stretching protocol (group A) or no-stretching (group B). A second session was carried out after three days, where the same procedure was repeated in a reverse order between groups. During…each session, three outcomes were tested: the ability to complete the task, the ability to maintain postural body alignment, and the perceived effort. RESULTS: All participants completed the task in both sessions. Subjects’ ability to preserve the required lower trunk alignment decreased following stretching compared to no-stretching. Lower-trunk angle changed toward flexion by 10 ∘ and 4.3 ∘ respectively, p = 0.032. There was no difference in perceived effort. CONCLUSIONS: Prior muscle stretching has a negative effect on the ability to preserve body positional alignment during posture exercise. The present findings should be considered by practitioners when designing protocols for scoliosis-specific exercises. Stretching immediately prior to posture maintenance exercises should be avoided.
Abstract: BACKGROUND: Pelvic girdle pain (PGP) is a significant problem that affects daily living activities in postpartum women. OBJECTIVE: This study aimed to investigate the effect of stabilizing exercises with or without pelvic floor muscles (PFM) training on pain, functional disability, trunk range of motion (ROM) and PFM strength in women with PGP. METHODS: Forty postpartum women participated in the study. Their age ranged from 25–35 years and their body mass index (BMI) was 25–29.9 kg/m 2 . They were randomly assigned into two groups equal in number. Group (A) received…local stabilizing exercises, while group (B) received stabilizing exercises and PFM training. Pain, functional disability, trunk ROM and PFM strength have been evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), Schober test and Kegel periniometer respectively. RESULTS: Both groups (A and B) revealed a significant decrease (p = 0.001) in pain and functional disability and a significant increase (p = 0.001) in trunk ROM and PFM strength. However, group (B) showed a significant decrease (p = 0.001) in pain, and functional disability and a significant increase in PFM strength when compared with group (A). CONCLUSIONS: PFM training should be an essential part in rehabilitation programs of PGP postpartum.
Abstract: BACKGROUND: The short foot (SF) exercise is a strengthening exercise for the intrinsic foot muscles that is difficult to master. OBJECTIVE: To examine the effect of three different electromyographic (EMG) biofeedback methods on learning the SF exercise. METHODS: Thirty-six healthy subjects were randomly allocated to the control group (CTG), EMG-controlled electrical stimulation group (ESG), visual EMG biofeedback group (VSG), and combination EMG-controlled electrical stimulation with visual EMG biofeedback group (CBG). The CTG practiced the SF exercise for 5 minutes using the conventional method. The other groups each used the EMG biofeedback method and…the conventional method. The EMG activity of the abductor hallucis (ABH), the medial longitudinal arch (MLA) angle, and the foot length during the SF exercise were measured before and after 5 minutes of practice. RESULTS: The EMG activity of the ABH in the VSG and CBG was significantly higher than that before practice. There were no intergroup differences in MLA morphology. CONCLUSIONS: These results suggest that visual EMG biofeedback is an effective method of increasing the EMG activity of the ABH during the SF exercise in a short practice time.
Abstract: OBJECTIVE: The purpose of this study was to apply the Brief International Classification of Functioning (ICF) Core Set for Hand Conditions to the physical therapy outcome measures, and to evaluate the contribution of these measures to overall health in subjects with ulnar wrist pain. METHODS: Thirty-five subjects with ulnar wrist pain received a 4-week home-based treatment program including orthotics and strengthening exercises. Investigators measured pain, function, grip strength, and overall health four weeks post-intervention. Regression analysis was used to investigate the effect of these variables on overall health represented by the Short Form (SF-36) questionnaire.…RESULTS: Fifty-three percent of the variability in SF-36 physical health summary scores was explained by the studied variables with grip strength predicting 31% of the variability. CONCLUSIONS: The Brief ICF Core Set for Hand Conditions can be a useful abridged list of categories relevant to functioning and health in subjects with ulnar wrist pain.
Keywords: Ulnar wrist pain, Brief International Classification of Functioning Core Set, Hand conditions, physical therapy