Journal of Back and Musculoskeletal Rehabilitation - Volume Preprint, issue Preprint
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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: Manual physical therapists (MPTs) working in primary care get limited information about patient’s courses of (chronic) low back pain (LBP). Identification of kinesiophobia is mostly based on clinical perception. OBJECTIVE: The aim of this study was to evaluate the association between the scores with which manual physical therapists in a primary care setting identify kinesiophobia in patients with low back pain, and the patients’ self-reported measures of kinesiophobia. METHODS: The cross-sectional study comprised 104 patients with LBP and 17 MPTs. Patients first independently completed the Tampa Scale for Kinesiophobia (TSK-17). The therapists,…blinded to the TSK-scores, rated their perception of a patient’s kinesiophobia using the Visual Analogue Scale-Estimation (VAS-est) and the accuracy of their ratings using the Visual Analogue Scale-Accuracy (VAS-ac). Kendall’s tau b was used to determine the level of correlation between scores on the TSK-17 and the VAS-est.
Abstract: OBJECTIVE: To evaluate the reliability and validity of an adapted Korean version of the Spinal Appearance Questionnaire (SAQ). METHODS: Translation/retranslation of the English version of the SAQ was conducted, and all steps of the cross-cultural adaptation process were performed. The Korean version of the SAQ (K-SAQ) and the previously validated appearance domain of the Korean version of the Scoliosis Research Society-22 Outcomes questionnaire (K-SRS-22) were mailed to 160 patients with adolescent idiopathic scoliosis (AIS). Reliability assessments were conducted using kappa statistics to assess item agreements, and intraclass correlation coefficients (ICC) and Cronbach’s α…values were calculated. Convergent validity was evaluated by comparing K-SAQ and K-SRS-22 appearance domain scores and discriminant validity by analyzing relationships between K-SAQ scores and patient characteristics. RESULTS: All items of the K-SAQ had kappa values of agreement of > 0.6. The K-SAQ showed excellent test/re-test reliability with an intraclass correlation coefficient of 0.922. Internal consistency of the K-SAQ was found to be very good (α = 0.883). Convergent validity testing demonstrated a moderate correlation between the K-SAQ and K-SRS-22 (r = - 451). The correlation between the K-SAQ and major curve magnitude was significant (r = 0.812). Discriminant validity was confirmed by significant differences in K-SAQ scores and individual K-SAQ domain scores among patients requiring observation, bracing, or surgery. CONCLUSIONS: The adapted Korean version of the SAQ showed satisfactory reliability and validity, and thus, is considered suitable for the evaluation of spinal deformity appearance in Korean speaking patients with adolescent idiopathic scoliosis.
Keywords: Adolescent idiopathic scoliosis, Spinal Appearance Questionnaire, Korean version
Abstract: BACKGROUND: Patellofemoral pain syndrome particularly impairs quality of life in young, physically active subjects. The exact etiology remains unknown, and so this syndrome is a challenging condition to treat. Some patients continue to experience pain and dysfunction after receiving one or more guidelines-compliant conservative treatments. Reducing the likelihood of patellofemoral pain syndrome is an important way of preventing the onset of debilitating anterior knee pain at all ages of life. CASE: A 24-year-old sportswoman with a 15-month history of anterior knee pain and failure of previous guidelines-compliant treatments. We treated this patient with techniques derived…from the paradigm of inductive physiotherapy, in which tone disorders with a central origin may contribute to musculoskeletal disorders. One distinctive feature of inductive physiotherapy relates to the fact that the painful area is not manipulated directly. RESULTS: The effects of physiotherapy were evaluated after ten weekly sessions and then 15 months later. The changes in the visual analogue pain scale score and the Knee Lequesne Index were clinically significant. We also observed an unexpected reduction in the static varus misalignment. CONCLUSION: This case could pave the way to an innovative neurological approach to the management of patellofemoral pain syndrome in the young adult.
Abstract: OBJECTIVE: This study aimed to evaluate the effect of one workday on pain and perceived exertion, muscular strength, and electromyographic activity of the erector spinae muscles in welders with and without low back pain. This is an observational cross-sectional study. PARTICIPANTS: Twenty-two welders, metallurgical shipbuilding, were equally divided into 2 groups: low back pain and no low back pain. Pain and perceived exertion. Muscular strength by maximal voluntary contractions and electromyographic activity of right and left erector spinae muscles during maximal voluntary contractions and in the 3 welding positions for 2 periods of the workday (in…the morning and at the end of the workday). RESULTS: At the end of workday, the pain increased significantly for the low back pain group (t(22) = 2.448; P = 0.023). The perceived exertion also increased significantly for both groups at the end of workday groups (F(1,22) = 8.570, P = 0.000) and periods (F(1,22) = 8.142, P = 0.000). There were no significant differences between groups and workday periods for muscular strength and electromyographic activity during maximal voluntary contractions of the erector spinae. There was no significance difference for electromyographic activity between groups and workday period and in the 3 welding positions. CONCLUSION: Although the pain and perceived exertion increased at the end of the workday, these results did not interfere in muscular strength and electromyographic activity of right and left erector spinae muscles. Thus, we can conclude that welders with chronic low back pain had a good physical capacity (muscular strength) and that muscle performance was maintained.
Keywords: Occupational biomechanics, electromyographic, workplace, low back pain, ergonomics
Abstract: BACKGROUND: Knee proprioception is an integral component of neuromuscular control system that stabilizes the joints, reducing incidence of injury. Knee injuries’ incidences differ between genders. Knee rotation is a component of different knee injury mechanisms. Gender differences in knee proprioception in internal (IR) and external (ER) rotations are not sufficiently studied. OBJECTIVE: To check whether proprioceptive acuity in IR and ER directions of knee rotation is inherently lower in women compared to men. Moreover, to assess gender difference in ranges of knee rotation. METHODS: Thirty volunteers (15 women and 15 men) participated. Knee…proprioception acuity and ranges of knee rotation were assessed using the knee rotatory kinesthetic device (KRKD). Proprioception was tested using absolute judgment task, subject’s ability to discriminate different rotation movements (stimuli) randomly presented, then just notable difference (JND) was calculated; least difference accurately discriminated in 75% of trials. RESULTS: Women had lower proprioception acuity in IR than men (1.70 ∘ ± 0.79 ∘ and 1.12 ∘ ± 0.32 ∘ , p = 0.011) respectively. Active IR (women: 41.29 ∘ ± 7.46 ∘ , men 32.80 ∘ ± 3.64 ∘ , p = 0.000), and passive IR (women: 53.43 ∘ ± 11.67 ∘ , men: 37.94 ∘ ± 5.22 ∘ , p = 0.000) were higher in women compared to men. Active ER (women: 49.71 ∘ ± 11.37 ∘ , men: 39.16 ∘ ± 5.46 ∘ , p = 0.003), and passive ER (women: 62.29 ∘ ± 13.74 ∘ , men: 48.89 ∘ ± 7.09 ∘ , p = 0.002) were, also, higher in women. CONCLUSION: Gender difference in knee proprioception acuity was found in IR, which is the direction of rotation that anterior cruciate ligament (ACL) stabilize. Women’s ranges of knee rotation are greater than men in both IR and ER.
Keywords: Proprioception, knee rotation, JND, joint position sense
Abstract: BACKGROUND: Low back pain is a common complaint in emergency departments (ED), where deviations from standard of care have been noted. OBJECTIVE: To relate the ordering of advanced imaging and opioid prescriptions with the presentation of low back pain in ED. METHODS: Six hundred adults with low back pain from three centers were prospectively analyzed for history, examination, diagnosis, and the ordering of tests and treatments. RESULTS: Of 559 cases the onset of pain was less than one week in 79.2%; however, most had prior low back pain, 63.5% having…warning signs of a potential serious condition, and 83.9% had psychosocial risk factors. Computer tomography (CT) or magnetic resonance imaging (MRI) were ordered in 16.6%, opioids were prescribed in 52.6%, and hospital admission in 4.5%. A one-year follow-up of 158 patients found 40.8% received subsequent spine care and 5.1% had a medically serious condition. Caucasian race, age 50 years or older, warning signs, and radicular findings were associated with advanced imaging. Severe pain and psychosocial factors were associated with opioid prescribing. CONCLUSIONS: Most patients present to the ED with acute exacerbations of chronic low back pain. Risk factors for a serious condition are common, but rarely do they develop. Racial disparities and psychosocial factors had concerning relationships with clinical decision-making.
Keywords: Low back pain, emergency medicine, radiology, opioids, evidence based medicine, racial disparity, magnetic resonance imaging, computer tomography, work disability
Abstract: OBJECTIVE: This study aims to evaluate the effect of high intensity laser therapy (HILT) in patients with lumbar disc protrusion (LDP). METHODS: This study included 63 patients suffering from protrusion of lumbar intervertebral disc; they were divided into Groups 1 (n = 32) and 2 (n = 31). Group 1 was treated with HILT and spinal decompression system (SDS). Patients in Group 2 received SDS alone. Evaluations were conducted on Oswestry Disability Index (ODI), lumbosacral portion pain, and lower limb radiation pain with visual analogue scale (VAS)…of two patient groups before treatment, two weeks after treatment, and 1 month after follow-up visit. Lumbar flexion range and angle of straight leg raising before treatment and 2 weeks after treatment. RESULTS: After two weeks of treatment of two patient groups, ODI, VAS, lumbar flexion range and angle of straight leg raising significantly improved compared with their conditions before treatment (P < 0.01). A significant difference was noted in ODI, lumbar flexion range, and angle of straight leg raising between groups after two weeks of treatment (P < 0.05). Non-statistical significant difference was observed in lumbosacral portion pain and lower limb radiation pain with VAS (P > 0.05). However, difference in was VAS smaller in Group 1. All groups showed significantly different results in terms of ODI, lumbosacral portion pain, and lower limb radiation pain with VAS. CONCLUSION: As one of available treatments for LDP, HILT can speed up improvement in lumbar segment motion, angle of straight leg raising, and overall function and allow early return of patients to their family and society. Treatment effect is long-lasting and can be widely promoted and applied clinically.
Keywords: High intensity laser, lumbar disc protrusion, spinal decompression system
Abstract: BACKGROUND AND OBJECTIVE: We report the case of a patient who presented with right dorsal scapular neuropathy after a trigger point injection into the right rhomboid major muscle. Through a nerve conduction study and electromyography, we demonstrated dorsal scapular nerve injury in this patient. CASE REPORT: A 38-year-old man complained that his right shoulder functioned less optimally during push-up exercises after a trigger point injection 4 weeks prior. Physical examination revealed mildly reduced right shoulder retractor muscle strength compared with the left side. We performed a nerve conduction velocity test and electromyography 5 weeks after the injection. The…compound muscle action potential of the right dorsal scapular nerve showed low amplitude (left vs. right side: 5.2 vs. 1.6 mV) and delayed latency (left vs. right side: 4.9 vs. 6.8 ms). Positive sharp wave (1+ ) and mildly reduced recruitment were seen on electromyography of the rhomboid major muscle. The findings of the nerve conduction velocity test and electromyography indicated partial right dorsal scapular neuropathy. The nerve injury seemed to have been caused by the needle inserted during trigger point injection. CONCLUSION: Clinicians should pay attention to the occurrence of dorsal scapular nerve injury when performing trigger point injection into the rhomboid muscle.
Abstract: BACKGROUND: The Quality of Life Profile for Spinal Deformities (QLPSD) is the first specific questionnaire to evaluate health-related quality-of-life (HRQoL) in adolescents with spinal deformities. Measuring HRQoL is important because spinal deformities and their management may negatively affect quality of life (QoL), thereby importantly affecting treatment effectiveness. OBJECTIVE: This study aimed to examine the validity and reliability of a Persian version of the QLPSD through patients with adolescent idiopathic scoliosis and Scheuermann’s kyphosis. METHODS: A cross-sectional design was used to determine the validity and reliability of the Persian version of the QLPSD based…on the IQOLA protocols. RESULTS: The QLPSD was successfully culturally adapted, showing acceptable internal consistency (cronbach’s α = 0.88) and intraclass correlation coefficients (ICC = 0.91). Concurrent validity was supported by comparing scores on corresponding dimensions of the Persian versions of QLPSD and the Scoliosis Research Society-22r (SRS-22r) questionnaires (function, pain, and body-image). Discriminant validity was supported though observation of significant differences between participants who had different clinical characteristics (p < 0.05). CONCLUSIONS: The Persian QLPSD is valid and reliably measures QoL among adolescents with spinal deformities; it may be used in clinical evaluations and future research.
Keywords: QLPSD, quality of life, spinal deformities, adaptation, validity, reliability
Abstract: BACKGROUND: Neurodevelopmental treatment (NDT), neuromuscular electrical stimulation (NMES), and Kinesio Taping (KT) applications are separately used to improve postural control and sitting balance in children with cerebral palsy (CP). OBJECTIVE: The aim of this study is to examine the combined effect of NDT, NMES and KT applications on postural control and sitting balance in children with CP. METHODS: Forty five children, in 3 groups, between the ages 5–12 years were included in the study. Group 1 received NDT; group 2 received NDT + NMES; and the group 3 received NDT +…NMES + KT for 6 weeks. Sitting function evaluated by the sitting section of the gross motor function measure (GMFM), and postural control assessed with the seated postural control measurement (SPCM). RESULTS: Seating section of GMFM was improved significantly in all the groups; however, increases in the group 3 were higher than groups 1 and 2 (p = 0.001). While significant differences were observed in all groups in the SPCM posture (p < 0.001), function (p < 0.001), and the total scores (p < 0.001); the change in the third group was higher according to the comparison of the three groups within each other. CONCLUSIONS: Implementation of the NMES, and KT additionally to NDT improve the sitting posture, postural control, seating function, and gross motor function in children with CP.
Keywords: Motor control, physiotherapy, kinesio taping, electrical stimulation, cerebral palsy