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: Regular exercise activities affect blood cells. OBJECTIVE: The purpose of this study was to evaluate the seasonal evaluation of some hematological and biochemical parameters of the Olympic Greco-Roman wrestlers. METHODS: A total of 3 measurements were performed on wrestlers: immediately before the training period, three months and six months after the training session. Hematological and biochemical parameters were analyzed by taking sufficient blood samples from the athletes before and after exercise. RESULTS: The total leukocyte, lymphocyte, and neutrophil values were found to be significantly higher (p <…0.05) in all three measures (beginning, 3rd and 6th months) in comparison with the values before exercise. When biochemical analyses were examined, blood glucose levels were significantly decreased after exercise in all three measures compared to before exercise. Post-exercise HDL cholesterol concentrations significantly increased (p < 0.05) while LDL cholesterol concentrations significantly decreased (p < 0.05). CONCLUSION: On all three measures fatigue exercise has significantly increased the total leukocyte, lymphocyte and neutrophil values of wrestlers, while other hematological parameters were not affected evenly. Fatigue exercise also significantly reduced blood glucose levels and LDL cholesterol concentrations, while HDL cholesterol concentrations were increased. The six-month period training did not have a significant effect on both hematologic and biochemical parameters in all three measurements.
Keywords: Biochemical parameters, exercise, hematological parameters, skeletal muscle damage, wrestling
Abstract: BACKGROUND: Numerous classification systems have been proposed to interpret lumbar MRI scans. The clinical impact of the measured parameters remains unclear. To evaluate the clinical significance of imaging results in patients with multisegmental degenerative pathologies, treating specialists can perform image-guided local injections to target defined areas such as the epidural space. OBJECTIVE: The aim of this retrospective study was to evaluate the correlation between lumbar spinal stenosis measurements obtained by MRI and improvement obtained through local epidural injection. METHODS: In this retrospective study various measurement and classification systems for lumbar spinal stenosis were…applied to MRI scans of 100 patients with this pathological condition. The reported effect of epidural bupivacaine/triamcinolone injections at the site was recorded in these patients and a comparative analysis performed. RESULTS: MRI features assessed in this study did not show any relevant correlation with reported pain relief after epidural injection in patients with chronic lumbar stenosis, with the exception of posterior disc height with a weak Kendall’s tau of - 0.187 (p = 0.009). CONCLUSIONS: Although MRI is crucial for evaluating lumbar spinal stenosis, it cannot replace but is rather complementary to a good patient history and clinical examination or the results of local diagnostic injections.
Abstract: BACKGROUND: Recent technologies, such as the iPod, are often equipped with an accelerometer and magnetometer, which, through software applications, can perform various inclinometric functions. These applications have the potential to measure and quantify range of motion (ROM). OBJECTIVE: The purpose of this study was to estimate the iPod “Gyroscope” application intra- and inter-rater reliability as well as its criterion validity in healthy participants lumbar ROM assessment. METHODS: The sample consisted of 29 healthy participants. For the estimation of intra- and inter-reliability, two examiners measured the lumbar ROM of each participant twice using the…iPod. To estimate the criterion validity, the measures were compared to those obtained with the Back Range of Motion Device (BROM; lateral flexion) and the double inclinometer (flexion and extension). Reliability and validity were then established using the intraclass correlation coefficient (ICC). RESULTS: We observed a moderate to high intra-rater reliability (ICCs = 0.67–0.91) and a moderate to high inter-rater reliability for each movement (ICCs = 0.72–0.89). For the criterion validity, the ICCs were all high (ICCs = 0.65–0.89). CONCLUSION: Our results provide evidence that the iPod “Gyroscope” application can be used to assess lumbar ROM for all movements.
Keywords: Range of motion, outcome measures, reliability, criterion validity, iPod, lumbar spine, digital inclinometer
Abstract: BACKGROUND: Lumbar disc herniation (LDH) can affect lower limb muscle function resulting in an abnormal gait. This study aims to use surface electromyography (SEMG) to evaluate patients with L 4 /L 5 and L 5 /S 1 LDH throughout muscle movement. METHODS: Twenty L 4 /L 5 LDH patients (L5 Group), twenty L 5 /S 1 LDH patients (S1 Group), and twenty healthy controls (Healthy) were recruited for…the study. SEMG of bilateral tibialis anterior (TA) and lateral gastrocnemius (LG) muscles of patients were recorded using the DELSYS Wireless EMG System (Trigno TM Wireless Systems, Delsys Inc., USA). Root-mean-square (RMS), mean power frequency (MPF), and median frequency (MF) were compared between bilateral limbs in each participant. RESULTS: Reduced MPF and MF was found in TA measurements of the L5 Group and LG measurements of the S1 Group. The MPF and MF of the TA of symptomatic limbs of the L5 Group were reduced when compared to asymptomatic limbs (p = 0.006, p = 0.012, p < 0.05), and there were no significant differences in LG measurements (p > 0.05). The LG MPF and MF of the S1 Group in symptomatic limbs were reduced when compared to asymptomatic limbs (p = 0.006, p = 0.017, p < 0.05), and there were no significant differences in TA measurements (p > 0.05). Although there were no significant differences in RMS between bilateral limbs of the L5 and S1 Groups, we found some changes in RMS curves. First, compared to asymptomatic limbs of L 4 /L 5 LDH patients, β -peaks in the TA of symptomatic limbs appeared earlier. Second, two peaks in the LG of symptomatic limbs were found in L 5 /S 1 LDH patients. CONCLUSION: TA is affected in patients with LDH of L 4 /L 5 , and LG is affected in patients with LDH of L 5 /S 1 . As demonstrated, SEMG can identify LDH-related muscle dysfunction.
Keywords: Lumbar disc herniation, gait, surface electromyography, root mean square, median frequency
Abstract: BACKGROUND: The STarT Back Screening Tool (SBT) is a multidimensional questionnaire consisting of physical and psychological factors which categorizes the patients in the low, medium or high risk subgroups. OBJECTIVE: To investigate the relationship between SBT-based subgrouping and clustering of patients with LBP using uni-dimensional psychological, clinical and physical examination measures. METHODS: One hundred and fifty-seven patients with chronic LBP completed the SBT and uni-dimensional psychological, disability and pain questionnaires. Physical impairments were evaluated through the Physical Impairment Index (PII). Hierarchical and K-means methods were used for cluster analysis. Between-clusters differences and the…association between the clusters and SBT-based subgrouping were investigated. RESULTS: Three clusters were identified. The derived clusters were labeled severe, moderate and mild physical-psychological-distress clusters, because pain intensity, disability, psychological and physical factors were relatively high, moderate or low, respectively. Most of the patients in moderate and mild physical-psychological distress clusters were categorized as medium risk based on SBT. The mean difference for the PII was higher than that of psychological factors between moderate and mild physical-psychological-distress clusters. CONCLUSIONS: Patients in low and high risk subgroups of SBT were sufficiently differentiated, but patients in a medium risk subgroup had a different profile based on PII. Including additional physical factors in the SBT may be required to better differentiate among patients.
Keywords: Physical factors, psychological factors, low back pain, clustering, STarT Back Screening Tool
Abstract: OBJECTIVE: We developed an innovative exercise device for the abdominal trunk muscles (ATMs) that has a built-in system to measure muscle strength. We aimed to examine the reliability of the strength measurement as well as the effect of strengthening using the device. METHODS: Twenty healthy adults participated in a reliability study of the muscle strength measurement. The first and second measurement were done in one day with an hour rest interval by raters 1 and 2, and the third by rater 1 following a one-week interval. We calculated the intraclass correlation coefficient (ICC). Another seven healthy…men participated in a training program using the device, consisting of strengthening twice a week for 5 weeks. ATM strength was measured before and after the training period, and a positron emission tomography (PET) scan series was performed, consisting of examinations during rest before training (control condition) and during exercise after training (training condition). RESULTS: The intra-rater (ICC = 0.95) and inter-rater (ICC = 0.99) reliability of the strength measurement were excellent. ATM strength was significantly higher after training than before. 18 F-fluorodeoxyglucose accumulation within the diaphragm, abdominal rectus, abdominal external and internal oblique, transverse abdominal, and levator ani muscles was significantly higher in the training condition than in the control. CONCLUSIONS: Our innovative device showed excellent reliability to quantify ATM strength. Strengthening using the device increased strength and activated the abdominals, diaphragm, and pelvic floor muscles.
Abstract: BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a progressive disease negatively affecting health-related quality of life. The related scales in Turkish are limited in number and generalizability. OBJECTIVE: To perform validity and reliability studies of the Turkish version of the Clinical Chronic Obstructive Pulmonary Disease Questionnaire (CCQ). METHODS: This study was conducted at the Department of Chest Diseases, with 100 volunteer COPD patients with a mean age of 67.72 ± 9.78 years. After obtaining the necessary permission, translation procedures were applied for Turkish cultural adaptation. Finally, a single Turkish translation…was created, and this questionnaire was evaluated by linguists. Incomprehensible items were corrected in a pilot study. Baseline and test-retest measurements after 2 weeks were performed. Internal consistency analysis was made for validity, and correlations were calculated with the 36-Item Short Form Health Survey (SF-36), the modified Medical Research Council (mMRC) Dispne Scale and Respiratory Function Tests (RFTs). RESULTS: Cronbach’s alpha value was found to be 0.90 for the first obtained data and 0.91 for the second obtained data. There was similarity at the rate of 0.97 between the first and second measurements in terms of total scores of the CCQ. The questionnaire significantly correlated with the SF-36, mMRC and RFTs (- 0.85 ⩽ r ⩽ 0.69, p < 0.05). CONCLUSIONS: As a result of this study, the Turkish version of CCQ was determined to be reliable and valid. The CCQ is an easy-to-use questionnaire in terms of application-calculation and can be safely used for the clinical assessment and monitoring of patients.
Keywords: Chronic obstructive pulmonary disease, quality of life, reproducibility of results, dyspnea, respiratory function test, cross-cultural adaptation
Abstract: BACKGROUND: Osteopathic manipulation treatment is widely used in the clinical practice in the care of patients with chronic nonspecific low back pain, however, its benefits still seem uncertain. OBJECTIVE : This study aimed to verify the efficacy of osteopathic manipulation for chronic nonspecific low back pain. MATERIALS AND METHODS: Forty-two participants with chronic nonspecific low back pain were selected and randomized into two groups: Active Control Group (ACG – n = 19) and Osteopathic Manipulation Treatment Group (OMTG – n = 23). Therapeutic exercises…were performed with the ACG and osteopathic manipulation techniques with the OMTG. The interventions were carried out over 5 weeks of treatment, totaling 10 treatments for the ACG and 5 for the OMTG. The visual analogue scale (VAS) was used to measure chronic nonspecific low back pain and the Oswestry Disability Index 2.0, Tampa Scale of Kinesiophobia and Beck Depression Inventory were used to measure disability, kinesiophobia and depression, respectively. RESULTS: The final chronic nonspecific low back pain in both groups was significantly lower than the initial low back pain (p ⩽ 0.01) and the final chronic nonspecific low back pain of the OMTG was significantly lower than that of the ACG (p = 0.001). CONCLUSION: This study demonstrated that the treatments were effective in both groups. However, the efficacy of the osteopathic manipulation treatment was greater than that of the therapeutic exercises.
Keywords: Osteopathy, osteopathic manipulation treatment, chronic nonspecific low back pain
Abstract: BACKGROUD: Although the effect of exercise in patients during the subacute and/or chronic subacromial impingement syndrome has been reported, only a few studies have examined the effect of pain free exercise in the acute phase of this disorder. OBJECTIVE: To compare the effect of training using the Neurac technique which combines body segments suspension and vibration vs. manual therapy, on various relevant outcome parameters in patients with acute subacromial impingement syndrome (PASIS). METHOD: Twenty-six patients underwent a 4 week intervention program. Using random assignment, half of the patients were treated using the Neurac…device group while the other half was treated using manual therapy. The outcome parameters consisted of shoulder pain, shoulder function, range of motion (ROM) and the isokinetic strength of the external and internal rotators at 60 and 180 ∘ /s. RESULTS: Following either modes of interventions, the pain, function, and ROM improved significantly compared to pre-intervention levels in both groups. Time-by-group interaction was observed for the rotational strength which increased significantly and exclusively in the Neurac group. CONCLUSIONS: Given its positive effect on shoulder pain, function, ROM and the isokinetic strength of the external and internal rotators, we recommend the application of the Neurac technique in PASIS.
Abstract: BACKGROUND: Respiratory muscle training (RMT) has been recommended to mitigate impacts of spinal cord injuries (SCI), but the optimal dosage in terms of the frequency, intensity, time, and type (FITT principle) to promote health in SCI individuals remains unclear. OBJECTIVE: To discuss research related to the effects of RMT on pulmonary function, respiratory muscle strength and cardiorespiratory fitness in athletes and non-athletes with SCI, presenting the FITT principle. METHODS: We performed a systematic review. PubMed, Lilacs, Scopus, Web of Science, PEDro, SciELO and Cochrane databases were searched between 1989 and August 2018. Participants…were athletes and non-athletes with SCI. RESULTS: 4,354 studies were found, of which only 17 met the eligibility criteria. Results indicated that RMT is associated with beneficial changes in pulmonary function and respiratory muscle strength and endurance among athletes and non-athletes, whereas no effect was reported for maximal oxygen uptake. It was not possible to establish an optimal RMT dose from the FITT principle, but combined inspiratory/expiratory muscle training seems to promote greater respiratory changes than isolated IMT or EMT. CONCLUSION: The use of RMT elicits benefits in ventilatory variables of athletes and non-athletes with SCI. However, it remains unclear which RMT type and protocol should be used to maximize benefits.