Journal of Back and Musculoskeletal Rehabilitation - Volume Pre-press, issue Pre-press

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. Pre-press, no. Pre-press, pp. 1-11, 2024

Authors: Kandeel, Mahmoud | Morsy, Mohamed A. | Khodair, Khalid M. Al | Alhojaily, Sameer

Article Type: Research Article

Abstract: BACKGROUND: Cognitive functional therapy (CFT) aims to address low back pain (LBP) comprehensively by considering physical, psychological, and social factors. OBJECTIVE: The objective was to evaluate the effectiveness of CFT in reducing pain and disability in individuals with LBP over various time intervals. METHOD: A comprehensive literature search was conducted to identify relevant randomized controlled trials (RCTs) assessing the effects of CFT on LBP. RESULTS: In this study, 1510 records were initially identified, and 7 studies were included in the analysis. Disability scores were significantly reduced after CFT had been …applied for 6 to 8 weeks (SMD = - 0.46, 95% CI [- 0.74, - 0.19]), 12 weeks to 3 months (SMD = - 0.54, 95% CI [- 0.72, - 0.36]), 6 months (MD = - 5.82, 95% CI [- 9.82, - 1.82]), and 12 months (SMD = - 0.4, 95% CI [- 0.55, - 0.26]). There were also significant reductions in pain scores observed after 12 weeks to 3 months (SMD = - 0.49, 95% CI [- 0.68, - 0.3]), 6 months (MD = - 0.75, 95% CI [- 1.5, - 0.0001]), and 12 months (SMD = - 0.27, 95% CI [- 0.42, - 0.12]). CONCLUSION: CFT showed potential for improving disability scores for individuals with LBP across various time intervals. However, its impacts on pain scores varied. Show more

Keywords: Cognitive functional therapy, low back pain, randomized controlled trials, meta-analysis, pain scores, disability scores

DOI: 10.3233/BMR-240230

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. Pre-press, no. Pre-press, pp. 1-11, 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. Pre-press, no. Pre-press, pp. 1-8, 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. Pre-press, no. Pre-press, pp. 1-12, 2024

Authors: Ijaz, Madiha | Ahmad, Sajid Rashid | Akram, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: The construction of buildings is risky for workers’ musculoskeleton. OBJECTIVE: This study aims to calculate the significance of risk associated with work-related musculoskeletal disorders. METHOD: 600 workers from 20 construction sites were surveyed using the Nordic Musculoskeletal Questionnaire (modified) and their performance was assessed at seven construction-tasks using RULA and REBA sheets. SPSS v. 26 and R programming were used for statistical analysis. RESULTS: The mean value of workers’ age was 28.4381 years, with 8.8205 working months/year and 65USDs monthly earnings. Maximum reporting of body discomfort was by workers …of window/door framing. Workers’ BMI (35–44 kg/m2 ) and break duration (< 15 minutes) prompted neck pain with OR 7.79 (95% CI 1.135-53.587) and OR 1.179 (95%CI 0.231–6.014) respectively. Bagging was dangerous for the ankle with OR 9.881 (95% CI 5.140–18.994), and window/door framing for feet with OR 2.057 (95% CI 1.196–3.539). The mean value of the RULA grand score ranged from 5.89 (lowest for ‘leveling’) to 9.25 (highest for ‘demolishing’), and the REBA sheet between 8–11 for all seven studied work-stages. CONCLUSION: Workers’ upper and lower limbs are affected by the work-stages they perform and the social lifestyle they live in. These findings from 600 workers are sufficient to be generalized for intervention. Show more

Keywords: Work-related musculoskeletal disorders, construction buildings, socioeconomic plights, upper extremity deformities, arthrogryposis, lower extremity deformities, multiplex congenital

DOI: 10.3233/BMR-240078

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. Pre-press, no. Pre-press, pp. 1-13, 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. Pre-press, no. Pre-press, pp. 1-16, 2024

Authors: Fatima, Sahar | Asif, Mohammad Musa | Zaheer, Anna | Arslan, Syed Asadullah | Qurat-Ul-Ain, Asifa | Farooq, Ayesha Ahmad

Article Type: Research Article

Abstract: BACKGROUND: The Avoidance Endurance Questionnaire (AEQ) successfully measures the fear-avoidance and endurance-related responses to chronic pain. OBJECTIVE: The objective of this study was to translate, cross-culturally adapt AEQ into Urdu and assess the reliability and validity of the Urdu version. METHOD: For the translation and cross-cultural adaptation process, the Beaton Guidelines were followed. A total of 103 participants responded to the Urdu version of the AEQ SF-12, Pain Catastrophizing Scale (PCS) and Numeric Pain Rating Scale (NPRS) at baseline and after 48 hours. The test-retest reliability was assessed using the intraclass correlation coefficient …(ICC). Cronbach’s alpha was used to measure internal consistency. To measure validity, Pearson’s correlation between the subscales of AEQ-Urdu and other outcome measures (SF-12, PCS and NPRS scores) were used (p < 0.05). RESULTS: The mean age of the total 103 participants was 32.7 ± 10.90 among which 45 (43.6%) were male and 58 (56.3%) were female. The pre-final version of the translated AEQ was tested on 40 Urdu speaking participants and no major changes were made. The Cronbach’s alpha for all subscales of the AEQ-Urdu ranged from 0.848–0.990. AEQ-U showed an excellent test-retest reliability with the ICC ranging from 0.775–0.996. The majority of the subscales of AEQ showed significant (p < 0.05) positive correlation with pain scales (PCS and NPRS) and negative correlation with the domains of SF-12. CONCLUSION: The AEQ-U has reliable and valid construct validity, good internal consistency, and test-retest reliability, indicating that it has adequate psychometric features and can be a useful tool for evaluating pain responses in patients with chronic musculoskeletal pain. Show more

Keywords: AEQ, chronic pain, NPRS, PCS, validity, reliability

DOI: 10.3233/BMR-240197

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. Pre-press, no. Pre-press, pp. 1-8, 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. Pre-press, no. Pre-press, pp. 1-10, 2024

Authors: Zhang, Yan | Zhou, Xiuling | Zhu, Yulan | He, Kai | Li, Xueqi | Chen, Hao | Cheng, Yi | Ding, Hong

Article Type: Research Article

Abstract: BACKGROUND: Morphological changes in the abdominal wall muscle in diastasis recti abdominis (DRA) patients with low back pain (LBP) symptoms and whether there is a wider interrectus distance (IRD) remain unclear. OBJECTIVE: The aim of this study was to determine the correlation between DRA severity and LBP and the morphological differences in abdominal wall muscles between patients who presented with symptoms of LBP and those who were asymptomatic. METHODS: A total of 57 postpartum DRA patients were enrolled, including 21 without LBP, 36 with LBP, and 30 healthy nulliparous women. The numerical rating …scale (NRS) was used to evaluate the degree of LBP. The IRD and muscle thickness of the abdominal muscles were measured via an ultrasonography device at the end of a natural breathing cycle. RESULTS: The abdominal muscles of the rectus abdominis (RA), external oblique muscle (EO), and transversus abdominis (TrA) in the DRA patients were significantly thinner than those in the control group (p < 0.05), whereas the difference in the internal oblique muscle (IO) was not significant (p > 0.05). There were no statistically significant differences in abdominal muscle thickness or the IRD regardless of whether the patients with DRA had LBP symptoms, with similar findings between the NRS score and DRA severity (P > 0.05). CONCLUSION: In DRA patients within one year postpartum, no significant difference was found in the severity of DRA or abdominal muscles, regardless of whether they were complicated by LBP symptoms. Shortening the IRD alone may not be beneficial for improving LBP symptoms in DRA patients. The relationship between DRA and LBP and the role of the abdominal muscles in postpartum LBP should be interpreted with caution. Show more

Keywords: Diastasis recti abdominis, low back pain, abdominal wall muscles, ultrasound, interrectus distance

DOI: 10.3233/BMR-240074

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. Pre-press, no. Pre-press, pp. 1-7, 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. Pre-press, no. Pre-press, pp. 1-11, 2024