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: 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.
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.
Keywords: Back pain, resistance training, muscles, disability
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.
Keywords: Autohemotherapy, fibromyalgia, ozone, quality of life, sleep
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.
Keywords: Femoral neck fracture, geriatric, early complication, risk factor, arthroplasty
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.
Keywords: Hyperkyphosis, gerontology, screening, community
Abstract: BACKGROUND: Pole vaulting involves trunk flexion, extension, and rotation, which may place the lumbar spine under stress. Repeated pole vaulting may cause lumbar disc degeneration (DD) and lumbar spondylolysis (LS); however, this phenomenon is yet to be established. OBJECTIVE: This study aimed to determine the difference in the maximum joint angles of the shoulder, hip, and trunk during pole vaulting between male pole vaulters with and without lumbar DD or LS. METHODS: This retrospective study included 17 male pole vaulters. Four high-speed cameras were used to record the pole vaulters at 240 Hz.…Radiography and magnetic resonance imaging were used to examine the lumbar spine in all athletes. Differences in the data between two sets of groups were analyzed using the unpaired t-test or the Mann-Whitney U test. RESULTS: There was a significant difference in the maximum joint angle of hip flexion between pole vaulters with and without lumbar DD (p = 0.03). CONCLUSION: Pole vaulters with lumbar DD may use lumbar flexion instead of hip flexion during the rock-back movement. Moreover, LS may occur due to repeated failed vaulting. Therefore, trunk stability and functional movements should be prioritized to prevent organic changes in the lower back.
Keywords: Lumbar spine, lumbar vertebrae, intervertebral disc degeneration, track and field
Abstract: BACKGROUND: Various tools have been created to measure physical function during intensive care unit (ICU) stay and after ICU discharge, but those have not been validated in coronavirus 2019 (COVID-19) patients. There is a need for a reliable, valid and feasible tool to define the rehabilitation needs of post-ICU COVID-19 patients entering the acute wards and then rehabilitation clinics. OBJECTIVE: This study aims to investigate the validity, inter-rater reliability and feasibility of Chelsea Physical Assessment Tool (CPAx) in assessing the functional status of COVID-19 patients after discharge from the ICU. METHODS: Demographic…and clinical characteristics of the patients were recorded. Patients were evaluated using the modified Medical Research Council (MRC) dyspnea scale, Functional Oral Intake Scale, Glasgow Coma Scale, CPAx, Barthel Index, Katz Index and MRC sum score, measurements of grip strength obtained by dynamometer, the 5 time sit-to-stand test and 30 seconds and sit-to-stand test. CPAx and the other functional assessment tools were administered to 16 patients within 48 hours following ICU discharge. For inter-rater reliability, another physiatrist independently re-assessed the patients. MRC sum score, Barthel and Katz indexes were used to assess construct validity of CPAx. The discriminative validity of CPAx was determined by its ability to differentiate between patients with and without ICU acquired muscle weakness based on MRC sum score. The intra-class correlation coefficients (ICC) were calculated to determine inter-rater reliability for total scores of the functional assessment tools. Cohen’s Kappa (κ ) coefficient and weighed Kappa (κ w ) were calculated to determine inter-rater reliability of individual CPAx items. Ceiling and flooring effects were calculated by percentage frequency of lowest or highest possible score achieved. The number and percentages of the patients who were able to complete each tool were calculated to assess feasibility. RESULTS: The CPAx score was strongly correlated with MRC sum score (rho: 0.83), Barthel Index (rho: 0.87) and Katz Index (rho: 0.89) (p < 0.001) showing construct validity. Area under the ROC curve demonstrated that cut off score for CPAx was ⩽ 12 to discriminate patients with MRC sum score < 48, with a sensitivity and a specificity of 100% and 63%, respectively (AUC = 0.859, p < 0.001). ICC was high for CPAx, MRC sum score, Barthel and Katz indexes, Glasgow Coma Scale, and hand grip strength measurement, with the highest value observed for CPAx (ICC, 0.96; 95% confidence interval (CI), 0.71–0.98). κ and κ w analysis showed good to excellent inter-rater reliability for individual CPAx items. No floor or ceiling effect was observed at CPAx while floor effect was observed at Barthel Index scores (25%) and Katz Index scores (37.5%). All patients could be evaluated using CPAx while less were physically able to complete the 5 time sit-to-stand, 30 seconds sit-to-stand tests (n = 4) and MRC sum score (n = 14). CONCLUSION: CPAx is a valid, reliable, and feasible tool to assess the physical functional state in COVID-19 patients following discharge from the ICU.
Keywords: COVID-19, post-intensive care, physical performance, function, rehabilitation, validity, reliability
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.
Abstract: BACKGROUND: The effectiveness of the muscle energy technique (MET) on postpartum meralgia paresthetica (MP) affecting the lateral femoral cutaneous nerve is unknown. OBJECTIVE: To investigate the effectiveness of the MET on postpartum MP affecting the lateral femoral cutaneous nerve. METHODS: In this randomized controlled trial, 30 patients with postpartum MP were randomly allocated to study and control groups. The study group received the MET with conventional therapeutic exercises and the control group received the conventional exercises alone for four weeks (thrice a week, for 30–40 minutes duration). Lateral femoral cutaneous nerve distal latency,…pain intensity, response to the prone knee bend (PKB) test and pelvic compression test were assessed. RESULTS: Patients allocated to the MET group had improvements compared to the controls in pain intensity (MD: - 1.66, 95%CI - 2.39 to - 0.94), distal latency (MD: - 0.66, 95%CI - 0.94 to - 0.36), and knee range of motion in the PKB test (MD: 19.5 ∘ , 95%CI 13 to 26.1) with high treatment effects, Cohen’s d –ES = 1.71 , 1.86 and 2.24 respectively. However, there was no between-group difference for the pelvic compression test (p = 0.41). CONCLUSION: The MET can reduce pain, distal latency, and increasingly prone knee range of motion in women with MP affecting the lateral femoral cutaneous nerve.
Keywords: Muscle energy technique, lateral femoral cutaneous nerve, distal latency, pain intensity, postpartum, pelvic compression test
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.