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Hutton D, Mohamed B, Mehmood K, Magro J, Shekhar H, Solth A, Pulhorn H, Bennett D, Okasha M. COVID-19 and Spontaneous Resolution of Lumbar Disk Prolapse: A Retrospective Cohort Study of Patients Awaiting Microdiscectomy. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 37940114 DOI: 10.1055/a-2206-2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
BACKGROUND Between individual patients with lumbar disk prolapse (LDP), the natural course of disease is significantly variable. Spontaneous resolution is reported to occur in up to 70% of cases. However, we currently cannot predict for whom and when this will occur. Neurosurgical intervention is indicated for LDP patients with nontolerable pain after at least 8 to 12 weeks of conservative management, or significant neurologic deficit. Channeling essential resources in the National Health Service (NHS) to fight the COVID-19 pandemic led to the postponement of most elective operations, including microdiskectomy. This left many LDP patients previously considered to be surgical candidates with conservative-only options in the interim. To our knowledge, we are the first center to report the specific impact of the peri- and postpandemic period on waiting list times, delayed elective microdiskectomy, and the incidence of spontaneous LDP resolution. METHODS Retrospective case series of a prospectively collected electronic departmental database identified LDP patients who would have been impacted by the COVID-19 pandemic at some point in their care pathway (March 2020-February 2022). Further information was obtained from electronic patient records. RESULTS In total, 139 LDP patients were listed for elective microdiskectomy at the time of postponement of elective surgery. Over a third of LDP patients (n = 47, 33.8%), in shared decision with the responsible neurosurgeon, had their rescheduled microdiskectomy canceled due to clinical improvement (14.1%), radiologic regression (6.5%), or both (12.2%). CONCLUSION Our single-center retrospective analysis revealed that for over a third of LDP patients, the prolonged postpandemic waiting list times for elective microdiskectomy resulted in their surgery not taking place either due to spontaneous clinical improvement or proven radiologic regression. Considering this, a prolonged conservative approach to LDP may be appropriate in some patients, allowing time for natural resolution, while avoiding perioperative risks.
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Affiliation(s)
- Dana Hutton
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
- Freeman Hospital, Newcastle Upon Tyne NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Belal Mohamed
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Khalid Mehmood
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - James Magro
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Himanshu Shekhar
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Heinke Pulhorn
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - David Bennett
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Mohamed Okasha
- Department of Neurosurgery, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom of Great Britain and Northern Ireland
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Ramond-Roquin A, Bègue C, Vizzini J, Chhor S, Bouchez T, Parot-Schinkel E, Loiez A, Petit A, Ghali M, Peurois M, Bouton C. Effectiveness of coordinated care to reduce the risk of prolonged disability among patients suffering from subacute or recurrent acute low back pain in primary care: protocol of the CO.LOMB cluster-randomized, controlled study. Front Med (Lausanne) 2023; 10:1156482. [PMID: 37409270 PMCID: PMC10318135 DOI: 10.3389/fmed.2023.1156482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 07/07/2023] Open
Abstract
Background Low back pain (LBP) is a common musculoskeletal condition and, globally, a leading cause of years lived with disability. It leads to reduced social participation, impaired quality of life, and direct and indirect costs due to work incapacity. A coordinated approach focusing on psychosocial risk factors, active reeducation, and the early use of tools to maintain employment, may be effective for improving prognosis of patients with LBP. Primary care professionals and multidisciplinary teams, who see patients in the early stages of LBP may be in the best position to implement such a coordinated approach. We designed this study to assess a coordinated multi-faceted strategy in primary care for patients with subacute or recurrent acute LBP. Methods The CO.LOMB study was designed as a multicentric, cluster-randomized, controlled study. Patients aged 18-60 years, with subacute or recurrent acute LBP are eligible. Patients also need to be employed (but can be on sick leave) with access to occupational health services. The clusters of GPs will be randomized (1:1) to either the Coordinated-care group or the Usual-care group. Patients will be assigned the group allocated to their GP. The healthcare professionals (GPs and associated physiotherapists) allocated to the Coordinated-care group will perform a 2-session study training. The following interventions are planned in the Coordinated-care group: exploration and management of psychosocial factors, active reeducation with a physiotherapist, the implementing of tools to maintain employment, and a reinforced cooperation between primary healthcare professionals. The primary objective is to assess the benefit of coordinated primary care to reduce disability in LBP patients at 12 months after enrollment: measure using the validated French version of the Roland Morris Disability Questionnaire. Secondary objectives include the evaluation of pain, work status, and quality of life at various time points. The study plans to enroll 500 patients in 20 GP clusters. Patients will be followed up for 12months. Discussion This study will evaluate the benefit of a coordinated multi-faceted strategy in primary care for patients with LBP. Notably whether this approach will alleviate the associated disability, attenuate pain, and promote the maintenance or return to work. Clinical Trial Registration NCT04826757.
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Affiliation(s)
- Aline Ramond-Roquin
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
- Département de Médecine de Famille et de Médecine d’Urgence, Université de Sherbrooke, Québec, QC, Canada
| | - Cyril Bègue
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Jonathan Vizzini
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Sidonie Chhor
- Département de Médecine Générale, Univ Rennes, Rennes, France
| | - Tiphanie Bouchez
- Département d'Enseignement et de Recherche en Médecine Générale, RETINES, HEALTHY, Université Côte d'Azur, Nice, France
| | - Elsa Parot-Schinkel
- Biostatistics and Methodology Department, University Hospital of Angers, Angers, France
| | - Anthéa Loiez
- Département de Médecine Générale, Univ Angers, Angers, France
- Delegation for Clinical Research and Innovation, University Hospital of Angers, Angers, France
| | - Audrey Petit
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Maria Ghali
- Département de Médecine Générale, Univ Angers, Angers, France
| | - Matthieu Peurois
- Département de Médecine Générale, Univ Angers, Angers, France
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
| | - Céline Bouton
- Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, Angers, France
- Département de Médecine Générale, Univ Nantes, Nantes, France
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Fallon J, Katz AD, Vatsia S, DeGouveia W, Song J, Strigenz A, Seitz M, Silber J, Essig D, Qureshi S, Virk S. Duration of Back Pain Symptoms and Its Relationship to Paralumbar Muscle Volume. World Neurosurg 2023; 172:e406-e411. [PMID: 36649858 DOI: 10.1016/j.wneu.2023.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Paralumbar muscle volume has been indicated as an important factor for patients reporting back pain. Our goal was to determine if there is a statistically significant relationship between the duration of patients' back pain symptoms (>12 weeks or ≤12 weeks) and paralumbar muscle volume. METHODS In this retrospective cohort study, paralumbar muscles on axial T2-weighted lumbar magnetic resonance images were outlined using ImageJ to determine the paralumbar cross-sectional area (PL-CSA) and lumbar indentation value (LIV) at the center of disc spaces from L1 to L5. The Goutallier classification was determined by the primary author. Quantile regression was performed to compare the PL-CSA, PL-CSA normalized by body mass index, and LIV between the 2 cohorts. Cohort A consisted of patients reporting symptoms ≤12 weeks, and cohort B included patients with symptoms >12 weeks. Negative binomial regression was used to compare Goutallier class. RESULTS A total of 551 patients operated on by a single surgeon with lumbar magnetic resonance imaging within the past 12 months and recorded duration of symptoms were included. Cohort A consisted of 229 patients (41.6%), and cohort B included 322 patients (58.4%). Statistical significance was not found at any lumbar level for PL-CSA, PL-CSA normalized by body mass index, Goutallier class, and LIV. CONCLUSIONS Our results suggest that duration of symptoms may not be an accurate indicator for lumbar muscle volume. These novel findings are clinically valuable because lumbar muscle volume has been shown to be a marker for recovery. With this information, patients previously believed to be inoperable because of long-standing symptoms can be reevaluated.
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Affiliation(s)
- John Fallon
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA; Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
| | - Austen D Katz
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA
| | - Sohrab Vatsia
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA; Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - William DeGouveia
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA
| | - Junho Song
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA; Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Adam Strigenz
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA; Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Mitchell Seitz
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA; Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jeff Silber
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA
| | - David Essig
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA
| | - Sheeraz Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Sohrab Virk
- Department of Orthopedic Surgery, Northwell Health Long Island Jewish Medical Center, Queens, New York, USA
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Gouteron A, Tabard-Fougère A, Moissenet F, Bourredjem A, Rose-Dulcina K, Genevay S, Laroche D, Armand S. Sensitivity and specificity of the flexion and extension relaxation ratios to identify altered paraspinal muscles' flexion relaxation phenomenon in nonspecific chronic low back pain patients. J Electromyogr Kinesiol 2023; 68:102740. [PMID: 36549262 DOI: 10.1016/j.jelekin.2022.102740] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Among the main methods used to identify an altered flexion relaxation phenomenon (FRP) in nonspecific chronic low back pain (NSCLBP), it has been previously demonstrated that flexion relaxation ratio (FRR) and extension relaxation ratio (ERR) are more objective than the visual reference method. OBJECTIVE To determine the sensitivity and specificity of the different methods used to calculate the ratios in terms of their ability to identify an altered FRP in NSCLBP. METHODS Forty-four NSCLBP patients performed a standing maximal trunk flexion task. Surface electromyography (sEMG) was recorded along the erector spinae longissimus (ESL) and multifidus (MF) muscles. Altered FRP based on sEMG was visually identified by three experts (current standard). Six FRR methods and five ERR methods were used both for the ESL and MF muscles. ROC curves (with areas under the curve (AUC) and sensitivity/specificity) were generated for each ratio. RESULTS All methods used to calculate these ratios had an AUC higher than 0.9, excellent sensitivity (>90 %), and good specificity (80-100 %) for both ESL and MF muscles. CONCLUSION Both FRP ratios (FRR and ERR) for MF and ESL muscles, appear to be an objective, sensitive and specific method for identifying altered FRP in NSCLBP patients.
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Affiliation(s)
- Anaïs Gouteron
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, Faculty of Sport Sciences, Burgundy, Dijon, France; Department of Physical Medicine and Rehabilitation, University Hospital Dijon, Burgundy, Dijon, France; INSERM CIC 1432, Clinical Investigation Center P Module, Technological Investigation Platform University Hospital Dijon, Burgundy, Dijon, France; Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
| | - Anne Tabard-Fougère
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon, Burgundy, Dijon, France
| | - Kévin Rose-Dulcina
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Genevay
- Division of Rheumatology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Davy Laroche
- INSERM UMR 1093-CAPS, Bourgogne Franche-Comté University, Faculty of Sport Sciences, Burgundy, Dijon, France; INSERM CIC 1432, Clinical Investigation Center P Module, Technological Investigation Platform University Hospital Dijon, Burgundy, Dijon, France
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Physical Activity in Healthcare Workers With Low Back Pain: Effects of the Back-FIT Randomized Trial. J Occup Environ Med 2021; 62:e245-e249. [PMID: 32097286 DOI: 10.1097/jom.0000000000001844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effects of physical activity program in healthcare workers with low back pain (LBP). METHODS A group of healthcare workers participated voluntarily to a meeting about LBP and to be accepted, were randomly allocated to workplace program or to home-based exercises, illustrated in a booklet and in a video available on the company intranet website. Both programs consisted in 7 weeks of moderate intensity exercises adapted to LBP. RESULTS Most outcomes improved in both groups, however with larger improvement of the Oswestry Disability Index in the workplace group (P = 0.02). CONCLUSIONS Regular physical exercise, at home or at the workplace among healthcare workers with LBP, represents a great opportunity to improve health and reduce disability.
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Illusion-enhanced Virtual Reality Exercise for Neck Pain: A Replicated Single Case Series. Clin J Pain 2021; 36:101-109. [PMID: 31714324 DOI: 10.1097/ajp.0000000000000780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Body illusions have shown promise in treating some chronic pain conditions. We hypothesized that neck exercises performed in virtual reality (VR) with visual feedback of rotation amplified would reduce persistent neck pain. METHODS In a multiple-baseline replicated single case series, 8 blinded individuals with persistent neck pain completed a 4-phase intervention (initial n=12, 4 dropouts): (1) "baseline"; (2) "VR" during which participants performed rotation exercises in VR with no manipulation of visual feedback; (3) "VR enhanced" during which identical exercises were performed but visual feedback overstated the range of motion being performed; (4) "follow-up." Primary outcomes were twice-daily measures of pain-free range of motion and pain intensity. During the baseline and follow-up phases, measures were taken but no intervention took place. RESULTS No differences in primary outcomes were found between VR and baseline, VR enhanced and VR, or VR enhanced and follow-up. DISCUSSION Our hypothesis, that neck exercises performed in VR with visual feedback of rotation amplified, would reduce persistent neck pain was not supported. Possible explanations and future directions are discussed.
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Effects of a movement control and tactile acuity training in patients with nonspecific chronic low back pain and control impairment - a randomised controlled pilot study. BMC Musculoskelet Disord 2020; 21:794. [PMID: 33256694 PMCID: PMC7702711 DOI: 10.1186/s12891-020-03727-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/16/2020] [Indexed: 12/04/2022] Open
Abstract
Background Nonspecific chronic low back pain (NSCLBP) is a heterogeneous condition that is associated with complex neuromuscular adaptations. Exercise is a widely administered treatment, but its effects are small to moderate. Tailoring patient-specific exercise treatments based on subgroup classification may improve patient outcomes. Objective In this randomised controlled pilot study, our objective was to compare the feasibility and possible effects of a specific sensorimotor treatment (SMT) with those of a general exercise (GE) programme on patients with NSCLBP and control impairment (CI). Methods Patients with NSCLBP and CI were randomised into an SMT or a GE programme spanning 6 sessions each. The feasibility criteria included the study design, assessments, interventions and magnitudes of effects, and costs. Adverse events were documented. Primary (pain, physical function, and quality of life) and secondary outcomes were assessed three times: twice at baseline (t1a and t1b) to estimate parameter stability and once after the intervention (t2). Results Two-hundred and twenty-seven patients were screened to include 34 participants with NSCLBP and CI. Both treatment programmes and the assessments seemed feasible because their durations and contents were perceived as adequate. The total cost per participant was €321. Two adverse events occurred (one not likely related to the SMT, one likely related to the GE intervention). The SMT showed a tendency for superior effects in terms of pain severity (SMT t1a 3.5, t2 1.1; GE t1a 3.0, t2 2.0), pain interference (SMT t1a 1.9, t2 0.4; GE t1a 1.5, t2 0.9), physical component of quality of life (SMT t1a 39, t2 46; GE t1a 45, t2 48), and movement control. Conclusions The SMT approach proposed in this study is feasible and should be tested thoroughly in future studies, possibly as an addition to GE. To ensure the detection of differences in pain severity between SMT and GE in patients with NSCLBP with 80% power, future studies should include 110 patients. If the current results are confirmed, SMT should be considered in interventions for patients with NSCLBP and CI. Trial registration Registered in the German Register for Clinical Trials (Trial registration date: November 11, 2016; Trial registration number: DRKS00011063; URL of trial registry record); retrospectively registered.
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Komesh S, Nakhostin Ansari N, Naghdi S, Alaei P, Hasson S, Kordi R. Responsiveness and longitudinal validity of the Persian version of COMI to physiotherapy in patients with non-specific chronic low back pain. Scand J Pain 2020; 20:483-490. [PMID: 32101531 DOI: 10.1515/sjpain-2019-0156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/24/2020] [Indexed: 02/05/2023]
Abstract
Background and aims The Core Outcome Measures Index (COMI) is a short, self-reported questionnaire for assessing important outcomes in patients with low back pain (LBP). The present study was conducted to explore the responsiveness and longitudinal validity of the Persian COMI (COMI-P) in patients with non-specific chronic LBP. Methods In this prospective cohort study of patients with non-specific chronic LBP receiving physiotherapy, patients completed a booklet containing the COMI-P, Persian Functional Rating Index (FRI-P), and a visual analogue scale (VAS) for pain before and after the end of ten-sessions of physiotherapy. Patients also completed a global rating of change scale (GRCS) at the end of the physiotherapy. Responsiveness was examined by means of internal responsiveness methods [t-test, standard effect size (SES); standardized response mean (SRM), and Guyatt responsiveness index (GRI)] and external responsiveness methods [correlation with external criteria and receiver operating characteristics (ROC) curve]. Results Fifty patients with a mean age of 50.62 ± 13.8 years participated. The paired t-test showed significant changes in COMI-P scores (p < 0.001). The effect sizes for COMI-P were large (range 0.96-1.23). The score changes for the COMI-P revealed significant correlations with FRI-P (r = 0.67, p < 0.001), the VAS (r = 0.65, p < 0.001), and the GRCS (r = 0.34, p = 0.02). The COMI-P change scores showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (r = 0.83, p < 0.001). The ROC area under the curve for the COMI-P based on the dichotomized SDC criterion was perfect. The minimal clinically important change was estimated 2.15 points (sensitivity 94% and specificity 100%). Conclusions The COMI-P appears to have responsiveness and longitudinal validity in detecting changes after physiotherapy for non-specific chronic LBP. An improvement of 2.15 points in COMI-P total score is required to be interpreted as minimally clinically important change in individual patients.
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Affiliation(s)
- Shiva Komesh
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Parisa Alaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Scott Hasson
- Department of Physical Therapy, Augusta University, Augusta, GA, USA
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Assessment of Lumbar Lordosis Distribution with a Novel Mathematical Approach and Its Adaptation for Lumbar Intervertebral Disc Degeneration. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:7312125. [PMID: 32377225 PMCID: PMC7180428 DOI: 10.1155/2020/7312125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/09/2020] [Accepted: 02/04/2020] [Indexed: 11/21/2022]
Abstract
Introduction Low back pain and disc degeneration could be linked to global spinal geometry. Our study aimed to develop a reliable new mathematical method to assess the local distribution of total lumbar lordosis with a single numeric parameter and compare it with lumbar intervertebral disc degeneration using routine MRI scans. Methods An online, open access, easy-to-use platform for measurements was developed based on a novel mathematical approach using MRIs of 60 patients. Our Spinalyze Software can be used online with uploaded MRIs. Several new parameters were introduced and assessed to describe variation in segmental lordosis distribution with a single numerical value. The Pfirrmann grading system was used for the classification of lumbar intervertebral disc degeneration. Relationships were investigated between the grade categories of L1-S1 lumbar discs and the MRI morphological parameters with correlation analysis. Results Results confirm that the determination of measurement points and calculated parameters are reliable (ICCs and Pearson r values > 0.90), and these parameters were independent of gender. The digression percentage (K%), one of our new parameters, did not show a statistical relationship with the Cobb-angle. According to our results, the maximum deflection breaking-point of lumbar lordosis and its location can be different with the same Cobb-angle and the distribution of global lordosis is uneven because the shape of the lumbar lordosis is shifted downward and centered around the L4 lumbar vertebra. The interobserver reliability of the Pfirrmann grades reading was in the excellent agreement category (88.33% agreement percentage, 0.84 kappa), and digression percentage (K%) showed a significant negative correlation with all L1-S1 disc grades with increasing r correlation values. This means that the smaller the value of digression percentage (K%), the more the number of worn discs in the lower lumbar sections. Conclusions Spinalyze Software based on a novel mathematical approach provides a free, easy-to-use, reliable, and online measurement tool using standard MRIs to approximate the curvature of lumbar lordosis. The new reliable K% (digression percentage) is one single quantitative parameter to assess the local distribution of total lumbar lordosis. The results indicate that digression percentage (K%) may possibly be associated with the development of lumbar intervertebral disc degeneration. Further evaluation is needed to assess its behavior and advantage.
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Choo YJ, Chang MC. Effectiveness of orthoses for treatment in patients with spinal pain. Yeungnam Univ J Med 2020; 37:84-89. [PMID: 32204582 PMCID: PMC7142031 DOI: 10.12701/yujm.2020.00150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients’ lifestyle.
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Affiliation(s)
- Yoo Jin Choo
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
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Variation in Offer of Operative Treatment to Patients With Trapeziometacarpal Osteoarthritis. J Hand Surg Am 2020; 45:123-130.e1. [PMID: 31859053 DOI: 10.1016/j.jhsa.2019.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 09/09/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Operative treatment of trapeziometacarpal osteoarthritis (TMC OA) is discretionary. There is substantial surgeon-to-surgeon variation in offers of surgery. This study assessed factors associated with variation in recommendation of operative treatment to patients with TMC OA. Secondarily, we studied factors associated with preferred operative technique and surgeon demographic factors variability in recommendation for operative treatment. METHODS We invited all hand surgeon members of the Science of Variation Group to review 16 scenarios of patients with TMC OA and asked the surgeons whether they would recommend surgical treatment for each patient and, if yes, which surgical technique they would offer (trapeziectomy, trapeziectomy with ligament reconstruction and/or tendon interposition, joint replacement, or arthrodesis). Scenarios varied in pain intensity, relief after injection, radiographic severity, and psychosocial symptoms. RESULTS Patient characteristics associated with greater likelihood to recommend surgical treatment were substantial pain, a previous injection that did not relieve pain, radiograph with severe TMC OA, and few symptoms of depression. Practice region was the only factor associated with preferred surgical technique and trapeziectomy with ligament reconstruction and/or tendon interposition the most commonly recommended treatment. There was low agreement among surgeons regarding treatment recommendations. CONCLUSIONS The notable variation in offers of operative treatment for TMC OA is largely associated with variable attention to subjective factors. Future studies might address the relative influence of surgeon incentives and beliefs, objective pathophysiology, and subjective patient factors on variation in surgeon recommendations. CLINICAL RELEVANCE Surgeons' awareness of the potential influence of subjective factors on their recommendations might contribute to efforts to ensure that patient choices reflect what matters most to them and are not based on misconceptions.
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Kallewaard JW, Edelbroek C, Terheggen M, Raza A, Geurts JW. A Prospective Study of Dorsal Root Ganglion Stimulation for Non-Operated Discogenic Low Back Pain. Neuromodulation 2020; 23:196-202. [PMID: 30821901 DOI: 10.1111/ner.12937] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/02/2019] [Accepted: 01/09/2019] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Disruptions of lumbar intervertebral discs may lead to severe discogenic low back pain (LBP). Severe pain has a deleterious effect on physical function and quality of life. Spinal cord stimulation (SCS) is a robust treatment for many neuropathic pain conditions. New innovations may be well-suited to treat neuropathic chronic LBP, including discogenic pain. The aim of this prospective study was to determine the effect of dorsal root ganglion (DRG) stimulation for a well-selected group of patients with discogenic LBP with no history of previous back surgeries. METHODS Twenty subjects with confirmed discogenic LBP and no prior history of back surgery underwent trials of DRG stimulation and, if successful with at least 50% pain reduction, were permanently implanted. Subjects rated their pain, disability, quality of life, and mood at baseline, and 14 subjects were followed through 12 months of treatment. RESULTS Treatment with DRG stimulation reduced LBP ratings (68.3% reduction), from mean 7.20 ± 1.3 at baseline to 2.29 ± 2.1 after 12 months (p = < 0.001). Oswestry ratings of disability significantly decreased (p = < 0.001) from 42.09 ± 12.9 at baseline to 21.54 ± 16.4 after six months of treatment and to 20.1 ± 16.6 after 12 months. The average quality of life EQ-5D index score at baseline was 0.61 ± 0.12 and 0.84 ± 0.13 after 12 months. DISCUSSION DRG stimulation treatment for discogenic LBP improved the level of pain, function, and quality of life. Further research is necessary into efficacy of DRG stimulation in patients with chronic discogenic LBP and to determine the place of SCS in the treatment algorithm.
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Affiliation(s)
- Jan Willem Kallewaard
- Department of Anesthesiology and Pain Medicine, Rijnstate Hospital Arnhem, Velp, The Netherlands
| | - Caro Edelbroek
- Department of Anesthesiology and Pain Medicine, Rijnstate Hospital Arnhem, Velp, The Netherlands
| | - Michel Terheggen
- Department of Anesthesiology and Pain Medicine, Rijnstate Hospital Arnhem, Velp, The Netherlands
| | | | - Jose W Geurts
- Department of Anesthesiology and Pain Medicine, Rijnstate Hospital Arnhem, Velp, The Netherlands
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Do sociodemographic features, pain sensitivity or pain catastrophizing relate to clinic-based adherence to physiotherapy in people suffering from chronic spinal pain? Secondary analysis of a randomized clinical trial. Musculoskelet Sci Pract 2019; 44:102066. [PMID: 31605983 DOI: 10.1016/j.msksp.2019.102066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/09/2019] [Accepted: 09/25/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE Examining whether socio-demographic variables, pain or functionality are related to the degree of clinic-based therapy adherence in patients suffering from nonspecific chronic spinal pain (nCSP). DESIGN Secondary analysis of a randomized clinical trial. SETTING University hospital of Ghent and Brussels. METHODS Dutch speakers, 18-65 years old, experiencing nCSP for at least 3 months. 120 participants were randomly allocated to two interventional groups, of which 94 completed all therapy sessions. MAIN OUTCOME MEASURES Degree of clinic-based adherence, defined as the amount of completed therapy sessions. RESULTS Demographic data (sex, age or education) were not significantly associated with adherence in the total sample or the neuroscience group. For the traditional physiotherapy group, educational level was associated with attendance of at least 50% of the therapy sessions. Regarding pain-, belief- and function-related measures, only the association between change in kinesiophobia and adherence was significant for the traditional physiotherapy group. CONCLUSIONS Factors related to therapy adherence in the total group or the neuroscience group could not be found. Educational level and change in kinesiophobia were however related to therapy adherence in the traditional physiotherapy group.
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Bai R, Li C, Xiao Y, Sharma M, Zhang F, Zhao Y. Effectiveness of spa therapy for patients with chronic low back pain: An updated systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17092. [PMID: 31517832 PMCID: PMC6750337 DOI: 10.1097/md.0000000000017092] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a major health problem around the world. Two previous meta-analyses showed that the spa therapy has a positive effect on reducing pain among patients with LBP based on studies published before 2006 and studies published between 2006 and 2013. In recent years, more studies reported the effect of spa therapy on treating chronic low back pain (CLBP). Our study aimed to update the meta-analysis of randomized controlled trials (RCTs) about the effect of spa therapy on treating CLBP and to examine the effect of spa therapy based on different interventions. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched until May 2018 to identify RCTs about spa therapy among patients with CLBP. Summary effect estimates were calculated by using a random-effects model. The quality of each eligible study was evaluated by Jadad checklist. RESULTS Twelve studies met the inclusion criteria for the systematic review and were included in meta-analysis. There was a significant decrease in pain based on visual analogue scale (VAS) (mean difference [MD] 16.07, 95% confidence interval [CI] [9.57, 22.57], P < .00001, I = 88%, n = 966), and lumbar spine function in Oswestry disability index (ODI) (MD 7.12, 95% CI [3.77, 10.47], P < .00001, I = 87%, n = 468) comparing spa therapy group to control group. Methodological assessment for included studies showed that the study's quality is associated with lacking blinding. CONCLUSION This updated meta-analysis confirmed that spa therapy can benefit pain reliving and improve lumbar spine function among patients with CLBP. Physiotherapy of subgroup analysis indicated that it can improve lumbar spine function. However, these conclusions should be treated with caution due to limited studies. More high-quality RCTs with double-blind design, larger sample size, and longer follow-up should be employed to improve the validity of study results.
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Affiliation(s)
- Ruixue Bai
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
- Health Management (Physical Examination) Center, The Second Affiliated Hospital, Chongqing Medical University, Chongqing
| | - Chihua Li
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Henan, China
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Yangxue Xiao
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS
| | - Fan Zhang
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
| | - Yong Zhao
- School of Public Health and Management
- Research Center for Medicine and Social Development
- Innovation Center for Social Risk Governance in Health
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The Chinese Association for the Study of Pain (CASP): Consensus on the Assessment and Management of Chronic Nonspecific Low Back Pain. Pain Res Manag 2019; 2019:8957847. [PMID: 31511784 PMCID: PMC6714323 DOI: 10.1155/2019/8957847] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/06/2019] [Accepted: 07/11/2019] [Indexed: 02/05/2023]
Abstract
Chronic nonspecific low back pain (CNLBP) is defined as pain or discomfort originating from the waist, which lasts for at least 12 weeks, but no radiculopathy or specific spinal diseases. CNLBP is a complicated medical problem and places a huge burden on healthcare systems. Clinical manifestation of CNLBP includes discogenic LBP, zygapophyseal joint pain, sacroiliac joint pain, and lumbar muscle strain. Further evaluation should be completed to confirm the diagnosis including auxiliary examination, functional assessment, and clinical assessment. The principle of the management is to relieve pain, restore function, and avoid recurrence. Treatment includes conservative treatment, minimally invasive treatment, and rehabilitation. Pharmacologic therapy is the first-line treatment of nonspecific LBP, and it is most widely used in clinical practice. Interventional therapy should be considered only after failure of medication and physical therapy. Multidisciplinary rehabilitation can improve physical function and alleviate short-term and long-term pain. The emphasis should be put on the prevention of NLBP and reducing relevant risk factors.
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Prado ÉRA, Meireles SM, Carvalho ACA, Mazoca MF, Motta Neto ADM, Barboza Da Silva R, Trindade Filho EM, Lombardi Júnior I, Natour J. Influence of isostretching on patients with chronic low back pain. A randomized controlled trial. Physiother Theory Pract 2019; 37:287-294. [PMID: 31161855 DOI: 10.1080/09593985.2019.1625091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: This study investigated the influence of isostretching on patients with chronic low back pain. Methods: It was a randomized, controlled trial with concealed allocation, intention-to-treat analysis, and blind assessment. Fifty-four patients with chronic low back pain were randomized to an experimental group and a control group. The experimental group performed isostretching twice a week for 45 days, while the control group remained on the waiting list for physical therapy. Patients were submitted to evaluations at baseline, after 20 and 45 days of treatment with regard to pain, quality of life, functional capacity, and satisfaction. Results: The experimental group exhibited statistically significant improvements in comparison to the control group with regard to pain (p = .003), functional capacity (p = .026), patient satisfaction (p < .001), and quality of life as determined by the functional capacity (p = .012), physical aspects (p = .011) and pain (p = .006) subscales of the SF-36. The experimental group used a significantly lesser amount of pain medication than the control group (p = .03). Conclusion: Isostretching was effective in reducing pain and in improving function, patient satisfaction and some aspects of quality of life in patients with chronic low back pain.
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Affiliation(s)
| | - Sandra Mara Meireles
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, (UNIFESP) , São Paulo, SP, Brazil
| | | | | | | | | | | | - Império Lombardi Júnior
- Department of Human Movement Sciences, Universidade Federal de São Paulo (UNIFESP) , São Paulo, Brazil
| | - Jamil Natour
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, (UNIFESP) , São Paulo, SP, Brazil
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Lheureux A, Berquin A. Comparison between the STarT Back Screening Tool and the Örebro Musculoskeletal Pain Screening Questionnaire: Which tool for what purpose? A semi-systematic review. Ann Phys Rehabil Med 2019; 62:178-188. [PMID: 30342997 DOI: 10.1016/j.rehab.2018.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prevention of chronicization of low back pain requires accurate detection of at-risk patients. Questionnaires have been validated, including the STarT Back Screening Tool (SBST) and the Örebro Musculoskeletal Pain Screening Questionnaire (OMPSQ). This review aims to compare these questionnaires in terms of predictive value and in terms of aims, to guide the choice in clinical practice. METHODS This study is a semi-systematic literature review. Studies evaluating at least one of the questionnaires and written between 1997 and October 10th 2017 were selected from Pubmed database. Inclusion criteria were pain duration<3months, outcomes including pain, function and/or global recovery. For work outcomes, inclusion criteria were extended to chronic patients. Studies had to provide information on sensitivity, specificity and area under the ROC Curve (AUC). RESULTS Twenty-eight studies met our inclusion criteria (7 SBST, 21 original OMPSQ, 3 short OMPSQ). The OMPSQ best predicted a Pain NRS≥3 at 3 months (AUC=0.64 (0.50-0.78)) and at 6 months (AUC between 0.70 (no confidence interval provided) and 0.84 (0.71-0.97)). The SBST and the OMPSQ are comparable to predict an Oswestry Disability Index≥30% at 6 months. A single study showed no difference between the SBST and the OMPSQ to predict absenteeism≥30 days at 6 months. The two questionnaires cannot be compared for "global recovery" outcomes. CONCLUSION The OMPSQ seems better than the SBST for predicting "pain" and "work" outcomes, the SBST may be better for "function" outcomes. These results should be taken with caution because of the high heterogeneity between studies. It should be noted that the OMPSQ was elaborated with the aim of creating a prognostic tool while the SBST was devised as a treatment-allocating tool and is easier to use in clinical practice. This should guide the choice of using one questionnaire rather than the other.
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Affiliation(s)
- Alexis Lheureux
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal lab, Avenue Mounier 53/B1.53.07, 1200 Brussels, Belgium.
| | - Anne Berquin
- Department of Physical and Rehabilitation Medicine, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10/1650, 1200 Brussels, Belgium.
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Baillie L, Bacon CJ, Hewitt CM, Moran RW. Predictors of functional improvement in people with chronic low back pain following a graded Pilates-based exercise programme. J Bodyw Mov Ther 2019; 23:211-218. [PMID: 30691755 DOI: 10.1016/j.jbmt.2018.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 03/31/2018] [Accepted: 05/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have investigated subgroups of patients with low back pain (LBP) most likely to benefit from Pilates or movement control exercises, but none have determined prognostic factors specifically for chronic LBP. This prospective cohort study aimed to determine predictors of change in disability in people with chronic LBP following a Pilates-based exercise programme and reports summarised integrated prediction statistics to aid clinical utility for determination of subgroups likely to benefit or not benefit from treatment. METHODS Healthy adults (n = 55) with non-specific chronic LBP undertook a graded 6-week programme involving two 1-hour Pilates sessions/week (1 mat and 1 equipment-based) led in small groups by a trained Pilates instructor. Predictors of change in Patient-Specific Functional Scale (PSFS) were identified through regression analysis and used to develop clinical prediction statistics. RESULTS Clinically important improvement (n = 14 of 48 analysed) was predicted by four variables: gradual rather than sudden onset of LBP, PSFS <3.7 points, absence of aberrant motions on forward bending, and body mass index >24.5 kg/m2. Presence of ≥3 improved probability of success from 29% to 73%. Failure to improve (n = 18) was predicted by three variables: sudden onset of low back pain, patient-specific functional score ≥3.7, and difference between left and right active straight leg raise >7°. Presence of all three increased probability of failure from 38% to 80%. CONCLUSIONS A combination of five, easily measured variables were able to predict disability outcome following a graded programme of Pilates-based exercises in people with chronic LBP. Two common movement deficits were inversely related to positive changes in function which may call into question the structural mechanism of improvements observed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12616001588482.
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Affiliation(s)
- Leyla Baillie
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | | | - Claire M Hewitt
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
| | - Robert W Moran
- Osteopathy, Unitec Institute of Technology, Auckland, New Zealand
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A multicenter randomized controlled trial on the efficacy of intradiscal methylene blue injection for chronic discogenic low back pain: the IMBI study. Pain 2019; 160:945-953. [DOI: 10.1097/j.pain.0000000000001475] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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20
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Ganesh GS, Sahu PK, Das SP, Mishra C, Dhiman S. A subgroup analysis to compare patients with acute low back pain classified as per treatment-based classification. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2018; 24:e1747. [PMID: 30226651 DOI: 10.1002/pri.1747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/17/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES The evidence for the effectiveness of interventions targeting acute low back pain (LBP) is suboptimal. It is difficult to identify those patients who are more likely to develop chronic pain and disability after an acute episode of LBP. These shortcomings may be attributed to considering LBP as one homogenous condition. METHODS In this quasi-experimental study, we examined and analysed a prospective cohort of 267 patients with first-onset LBP and classified them into one of the groups based on treatment-based classification: direction-specified exercises (Group 2), manipulation (Group 3), stabilization exercises (Group 4), traction (Group 5), and a physician care group (Group 1). Disability and pain were assessed at baseline, after treatment, and at 6 months using the Oswestry Disability Index and the Numerical Rating Scale, respectively. Comparisons were made between the groups, and we predicted measures of disability and pain intensity at 6 months with age, gender, fear avoidance behaviour, centralization phenomenon (CP), expectations about recovery, CP, group classification, baseline pain, and disability. RESULTS Analysis showed that all the heterogeneous groups of LBP improved their outcomes with the respective treatment provided. However, when the entire sample was considered as one homogenous group of LBP, the results showed improvement with time (p < 0.05) only and no difference was found between groups (p > 0.05). None of the studied factors, except baseline pain (R = 0.227, R2 = 0.051, p < 0.05), were able to accurately predict the development of chronic pain in our study sample. CONCLUSION Though our results showed no differences between the subgroups in the reduction of pain and disability, we conclude that classifying and treating patients with LBP into subgroups based on signs and symptoms produce better outcomes. Baseline pain alone may predict a small percentage of people who may develop chronic pain.
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Affiliation(s)
- G Shankar Ganesh
- Department of Physiotherapy, Composite Regional Centre for Persons with Disabilities, Lucknow, India
| | - Pradeep Kumar Sahu
- Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sakti Prasad Das
- Department of Physical Medicine and Rehabilitation, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Chittaranjan Mishra
- Department of Physiotherapy, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, India
| | - Sapna Dhiman
- Department of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
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Affiliation(s)
- Nini G L Callan
- Department of Family and Child Nursing, University of Washington Seattle, WA Helfgott Research Institute National University of Natural Medicine Portland, OR Department of Biobehavioral Nursing and Health Informatics University of Washington Seattle, WA
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Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE The aim of the present study was first to compare monthly measurements of low back pain (LBP) with quarterly and yearly retrospective measurements of LBP, and second to investigate possible bias effects for recall bias of LBP. SUMMARY OF BACKGROUND DATA LBP is a subjective experience often measured by a single rating of recalled pain over a certain time interval. However, retrospectively reported pain may be subject to recall bias. METHODS The agreement between monthly measurements of LBP and quarterly and yearly retrospective measurements of LBP was evaluated by Spearman rank order correlation coefficients, intraclass correlation coefficients, and Bland-Altman plots. Bias effects for recall bias were investigated by a linear regression model. RESULTS There were no statistical significant differences in mean values of monthly measurements of LBP compared with quarterly and yearly retrospective measurements of LBP on a group level. However, the Bland-Altman plots revealed that within individuals, the difference between monthly measurements of LBP and quarterly and yearly retrospective measurements of LBP was highly variable. For both quarterly and yearly recall, social support from colleagues and average LBP days were significantly associated with the recall bias. CONCLUSION The agreement of pain recall among workers in the current study seems to be good on a group level, but both between and within individuals, the difference between monthly and quarterly and yearly retrospective measurements was quite high. Factors that impacted the recall bias were social support from colleagues and average LBP days over the recall period. LEVEL OF EVIDENCE 3.
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Integrative treatment package for degenerative disc disease in the lumbar spine: A retrospective case series. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Many factors seem to be causal for non-specific low back pain and are sometimes controversially discussed. Some years ago the concept of subjective body image attracted attention but due to the inconsistent use of terms and concepts it is difficult to classify publications in the literature. Studies confirmed a difference between the body images of patients with low back pain and healthy controls so that an inclusion of body image concepts could be relevant for causation and therapy. OBJECTIVE This article presents an overview of the current state of research on the association between body image and low back pain and with respect to the allocation of body image in psychosocial concepts of low back pain. MATERIAL AND METHODS Relevant studies on body image and low back pain were reviewed and are discussed with respect to the different use of terms and concepts of body image. Moreover, an approach for integration of the body image into current psychosocial concepts and therapy of low back pain is presented. Finally, it is discussed whether consideration of the body image could be of value in the therapy of low back pain. RESULTS Studies have shown that low back pain patients have a more negative body image compared to healthy controls. There is a lack of studies on clinical evidence for the application and effectiveness of interventions that influence the body image in low back pain. CONCLUSION Further studies are necessary which include body image concepts as a possible psychosocial risk factor, in particular studies on the mechanism of body image procedures.
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Affiliation(s)
- C G Levenig
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Ruhr-Universität Bochum, Bochum, Deutschland.
| | - M I Hasenbring
- Abteilung für Medizinische Psychologie und Medizinische Soziologie, Medizinische Fakultät, Ruhr-Universität Bochum, Bochum, Deutschland
| | - J Kleinert
- Abteilung für Gesundheits- und Sozialpsychologie, Deutsche Sporthochschule Köln, Köln, Deutschland
| | - M Kellmann
- Lehr- und Forschungsbereich Sportpsychologie, Fakultät für Sportwissenschaft, Ruhr-Universität Bochum, Bochum, Deutschland
- School of Human Movement Studies and School of Psychology, The University of Queensland, Brisbane, Australien
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A cross sectional study on complementary and alternative medicine use among a sample of Turkish hospital outpatients with chronic lower back pain. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Student Physical Therapists Achieve Similar Patient Outcomes as Licensed Physical Therapists. ACTA ACUST UNITED AC 2017. [DOI: 10.1097/jte.0000000000000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Miyagishima K, Tsushima E, Ishida K, Sato S. Factors affecting health-related quality of life one year after lumbar spinal fusion. Phys Ther Res 2017; 20:36-43. [PMID: 29333361 DOI: 10.1298/ptr.e9919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify preoperative factors that affect the medical outcome study 36-item short form health survey (SF-36) score 1 year after lumbar spinal fusion. METHODS Participants were selected from among 624 patients who underwent lumbar spinal fusion between April 1, 2009 and March 31, 2011 who were followed up for 1 year or more. The SF-36 version 2 was used to evaluate HRQOL. The following preoperative parameters were investigated: sex, age, body mass index (BMI), employment status (other than home-making), living with other family members, smoking, orthopedic disorder in another part of the body (other than lumbar spinal disease), history of lumbar spinal surgery, bladder function, and leg muscle strength. RESULTS 94 patients were included. None of the independent preoperative factors exhibited a high degree of correlation, and the absence of multicollinearity was confirmed before further analysis was performed. The first canonical variates were age and leg muscle strength, which had a major effect on physical functioning, role physical, and role emotional 1 year after surgery, and the second canonical variates were employment status, sex, and orthopedic disorder in another part of the body, which had a major effect on general health 1 year after surgery. CONCLUSIONS The SF-36 score 1 year after lumbar spinal fusion was affected by the preoperative factors of age, leg muscle strength, living with other family members, employment status, sex, and orthopedic disorders in another part of the body.
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Affiliation(s)
- Kazufumi Miyagishima
- Department of Rehabilitation, Eniwa Hospital.,Graduate School of Health Science, Hirosaki University
| | - Eiki Tsushima
- Graduate School of Health Science, Hirosaki University
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Schnelle C, Messerschmidt S, Minford EJ, Greenaway-Twist K, Szramka M, Masiorski M, Sheldrake M, Jones M. Esoteric Connective Tissue Therapy for chronic low back pain to reduce pain, and improve functionality and general well-being compared with physiotherapy: study protocol for a randomised controlled trial. Trials 2017; 18:328. [PMID: 28716108 PMCID: PMC5513109 DOI: 10.1186/s13063-017-2055-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 06/08/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Low back pain causes more global disability than any other condition. Once the acute pain becomes chronic, about two-thirds of sufferers will not fully recover after 1-2 years. There is a paucity of effective treatments for non-specific, chronic low back pain. It has been noted that low back pain is associated with changes in the connective tissue in the affected area, and a very low-impact treatment, Esoteric Connective Tissue Therapy (ECTT), has been developed to restore flexibility in connective tissue. ECTT uses patterns of very small, circular movements, to the legs, arms, spine, sacrum and head, which anecdotally are effective in pain relief. In an unpublished single-arm phase I/II trial with chronic pain patients, ECTT showed a 56% reduction in pain after five treatments and 45% and 54% improvements at 6 months and 7-9 years of follow-up respectively. METHODS The aim of this randomised controlled trial is to compare ECTT with physiotherapy for reducing pain and improving physical function and physical and mental well-being in patients with chronic low back pain. The trial will be held at two hospitals in Vietnam. One hundred participants with chronic low back pain greater than or equal to 40/100 on the visual analogue scale will be recruited and randomised to either ECTT or physiotherapy. Four weekly treatments will be provided by two experienced ECTT practitioners (Treatment Group, 40 minutes each) and hospital-employed physiotherapy nurses (Control Group, 50 minutes). The primary outcomes will be changes in pain, physical function per the Quebec Pain Functionality Questionnaire and physical and mental well-being recorded by the Short Form Health Survey (SF-36), with mixed modelling used as the primary statistical tool because the data are longitudinal. Initial follow-up will be at either 4 or 8 months, with a second follow-up after 12 months. DISCUSSION The trial design has important strengths, because it is to be conducted in hospitals under medical supervision, because ECTT is to be compared with a standard therapy and because the assessor and analyst are to be blinded. The findings from this trial will provide evidence of the efficacy of ECTT for chronic low back pain compared with standard physiotherapy treatment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12616001196437 . Registered on 30 August 2016.
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Affiliation(s)
- Christoph Schnelle
- School of Public Health, University of Queensland, Herston Road, Herston, QLD Australia
| | | | - Eunice J. Minford
- Department of Surgery, Antrim Area Hospital, 45 Bush Rd, Antrim, BT41 2RL UK
- Queen’s University Belfast, University Rd, Belfast, BT7 1NN UK
| | | | | | | | | | - Mark Jones
- School of Public Health, University of Queensland, Herston Road, Herston, QLD Australia
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Malfliet A, Kregel J, Meeus M, Cagnie B, Roussel N, Dolphens M, Danneels L, Nijs J. Applying contemporary neuroscience in exercise interventions for chronic spinal pain: treatment protocol. Braz J Phys Ther 2017; 21:378-387. [PMID: 28736211 PMCID: PMC5628368 DOI: 10.1016/j.bjpt.2017.06.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Nonspecific chronic spinal pain is a common problem within the chronic pain population and is characterized by high social, economic and personal impact. To date, therapists are still struggling in adequately treating these types of patients, as seen in the small and short-term benefits of frequently applied primary care treatments. It is remarkable that despite the well-documented presence of abnormalities in central nociceptive processing in nonspecific chronic spinal pain patients, the implementation of this knowledge in clinical practice is still nearly non-existent. METHODS This paper provides the treatment protocol used in a large randomized controlled trial that aimed to assess the effectiveness of a modern neuroscience approach compared to usual care evidence-based physiotherapy. This comprehensive pain neuroscience treatment program combines pain neuroscience education and cognition-targeted exercise therapy. CONCLUSION Based on previous small-scaled studies, this treatment protocol is expected to normalize central alterations by addressing central nervous system dysfunctions, psychological factors, as well as peripheral dysfunctions in a broader biopsychosocially-driven framework.
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Affiliation(s)
- Anneleen Malfliet
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group(1); Research Foundation - Flanders (FWO), Brussels, Belgium.
| | - Jeroen Kregel
- Pain in Motion International Research Group(1); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group(1); Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nathalie Roussel
- Pain in Motion International Research Group(1); Department of Rehabilitation Sciences and Physiotherapy (REVAKI), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerpen, Belgium
| | - Mieke Dolphens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Lieven Danneels
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jo Nijs
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion International Research Group(1); Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium
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Abstract
STUDY DESIGN Unbalanced 3-factor design with repeated measures on 1 factor. OBJECTIVE To determine the effect of manual treatment (MT) on cytokine and pain sensations in those with and without low back pain (LBP). SUMMARY OF BACKGROUND DATA Evidence suggests that MT reduces LBP but by unknown mechanisms. Certain cytokines have been elevated in patients with LBP and may be affected by MT. METHODS Participants aged 20-60 years with chronic LBP or without LBP were recruited and randomly assigned to MT, sham ultrasound treatment, or no treatment groups. Venous blood samples were collected and pain levels assessed at baseline, 1 hour later, and 24 hours later. Blood was analyzed for interleukin (IL)-1β, IL-6, tumor necrosis factor-α, and C-reactive protein. Pain levels were measured by pressure pain threshold (PPT), mechanical detection threshold (MDT), dynamic mechanical allodynia, and self-report. RESULTS Forty (30 women, age 36±11 y) participants completed the study, 33 with LBP (13 MT, 13 sham ultrasound treatment, and 7 no treatment) and 7 without LBP. Participants with or without LBP could not be differentiated on the basis of serum cytokine levels, PPT, or MDT (P≥0.08). There were no significant differences between the groups at 1 hour or 24 hours on serum cytokines, PPT, or MDT (P≥0.07). There was a significant decrease from baseline in IL-6 for the no treatment (LBP) group (P=0.04), in C-reactive protein for the sham ultrasound treatment group (P=0.03), in MDT for all 3 LBP groups (P≤0.02), and in self-reported pain for the MT and sham ultrasound treatment groups (P=0.03 and 0.01). CONCLUSIONS Self-reported pain was reduced with MT and sham ultrasound treatment 24 hours after treatment, but inflammatory markers within venous circulation and quantitative sensory tests were unable to differentiate between study groups. Therefore, we were unable to characterize mechanisms underlying chronic LBP.
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Harvie DS, Smith RT, Hunter EV, Davis MG, Sterling M, Moseley GL. Using visuo-kinetic virtual reality to induce illusory spinal movement: the MoOVi Illusion. PeerJ 2017; 5:e3023. [PMID: 28243537 PMCID: PMC5324774 DOI: 10.7717/peerj.3023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/24/2017] [Indexed: 12/16/2022] Open
Abstract
Background Illusions that alter perception of the body provide novel opportunities to target brain-based contributions to problems such as persistent pain. One example of this, mirror therapy, uses vision to augment perceived movement of a painful limb to treat pain. Since mirrors can’t be used to induce augmented neck or other spinal movement, we aimed to test whether such an illusion could be achieved using virtual reality, in advance of testing its potential therapeutic benefit. We hypothesised that perceived head rotation would depend on visually suggested movement. Method In a within-subjects repeated measures experiment, 24 healthy volunteers performed neck movements to 50o of rotation, while a virtual reality system delivered corresponding visual feedback that was offset by a factor of 50%–200%—the Motor Offset Visual Illusion (MoOVi)—thus simulating more or less movement than that actually occurring. At 50o of real-world head rotation, participants pointed in the direction that they perceived they were facing. The discrepancy between actual and perceived direction was measured and compared between conditions. The impact of including multisensory (auditory and visual) feedback, the presence of a virtual body reference, and the use of 360o immersive virtual reality with and without three-dimensional properties, was also investigated. Results Perception of head movement was dependent on visual-kinaesthetic feedback (p = 0.001, partial eta squared = 0.17). That is, altered visual feedback caused a kinaesthetic drift in the direction of the visually suggested movement. The magnitude of the drift was not moderated by secondary variables such as the addition of illusory auditory feedback, the presence of a virtual body reference, or three-dimensionality of the scene. Discussion Virtual reality can be used to augment perceived movement and body position, such that one can perform a small movement, yet perceive a large one. The MoOVi technique tested here has clear potential for assessment and therapy of people with spinal pain.
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Affiliation(s)
- Daniel S Harvie
- Recover Injury Research Centre, Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute QLD, Griffith University, Griffith University , Gold Coast , Australia
| | - Ross T Smith
- Wearable Computer Lab, University of South Australia , Adelaide , Australia
| | - Estin V Hunter
- Recover Injury Research Centre, Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute QLD, Griffith University, Griffith University , Gold Coast , Australia
| | - Miles G Davis
- Wearable Computer Lab, University of South Australia , Adelaide , Australia
| | - Michele Sterling
- Recover Injury Research Centre, Centre of Research Excellence in Road Traffic Injury, Menzies Health Institute QLD, Griffith University, Griffith University , Gold Coast , Australia
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia; Neuroscience Research Australia, Sydney, Australia
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Park J, Lee JC. Effects of complex rehabilitation training on low back strength in chronic low back pain. J Phys Ther Sci 2016; 28:3099-3104. [PMID: 27942128 PMCID: PMC5140808 DOI: 10.1589/jpts.28.3099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to assess the effects of complex rehabilitation training on chronic low back pain. [Subjects and Methods] Complex rehabilitation training for lumbar isometric muscle strength was conducted for 12 weeks for males (n=10) and females (n=10) with chronic low back pain, who were aged in their 30s. [Results] Isometric strength of lumbar extension was increased post-test, and significant differences were found between males and females, at MedX angle of 0, 48, and 60. [Conclusion] This study showed that complex rehabilitation training had a beneficial effect on the muscle strength of lumbar extension in patients with chronic low back pain.
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Affiliation(s)
- Jaeyong Park
- Institute of Sports Health Science, Sunmoon University, Republic of Korea
| | - Jung Chul Lee
- Department of Exercise Prescription, Dongshin University, Republic of Korea
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Ruhlen RL, Singh VK, Pazdernik VK, Towns LC, Snider EJ, Sargentini NJ, Degenhardt BF. Changes in rat spinal cord gene expression after inflammatory hyperalgesia of the joint and manual therapy. J Osteopath Med 2016; 114:768-76. [PMID: 25288712 DOI: 10.7556/jaoa.2014.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Mobilization of a joint affects local tissue directly but may also have other effects that are mediated through the central nervous system. OBJECTIVE To identify differential gene expression in the spinal cords of rats with or without inflammatory joint injury after manual therapy or no treatment. METHODS Rats were randomly assigned to 1 of 4 treatment groups: no injury and no touch (NI/NT), injury and no touch (I/NT), no injury and manual therapy (NI/MT), and injury and manual therapy (I/MT). We induced acute inflammatory joint injury in the rats by injecting carrageenan into an ankle. Rats in the no-injury groups did not receive carrageenan injection. One day after injury, rats received manual therapy to the knee of the injured limb. Rats in the no-touch groups were anesthetized without receiving manual therapy. Spinal cords were harvested 30 minutes after therapy or no touch, and spinal cord gene expression was analyzed by microarray for 3 comparisons: NI/NT vs I/NT, I/MT vs I/NT, and NI/NT vs NI/MT. RESULTS Three rats were assigned to each group. Of 38,875 expressed sequence tags, 755 were differentially expressed in the NI/NT vs I/NT comparison. For the other comparisons, no expressed sequence tags were differentially expressed. Cluster analysis revealed that the differentially expressed sequence tags were over-represented in several categories, including ion homeostasis (enrichment score, 2.29), transmembrane (enrichment score, 1.55), and disulfide bond (enrichment score, 2.04). CONCLUSIONS An inflammatory injury to the ankle of rats caused differential expression of genes in the spinal cord. Consistent with other studies, genes involved in ion transport were among those affected. However, manual therapy to the knees of injured limbs or to rats without injury did not alter gene expression in the spinal cord. Thus, evidence for central nervous system mediation of manual therapy was not observed.
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Affiliation(s)
- Rachel L Ruhlen
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
| | - Vineet K Singh
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
| | - Vanessa K Pazdernik
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
| | - Lex C Towns
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
| | - Eric J Snider
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
| | - Neil J Sargentini
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
| | - Brian F Degenhardt
- From the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri (Drs Snider, Sargentini, and Degenhardt); the departments of microbiology /immunology (Drs Singh and Sargentini), anatomy (Dr Towns), and osteopathic manipulative medicine (Dr Snider) at A.T. Still University-Kirksville College of Osteopathic Medicine in Missouri; and Research Support at A.T. Still University in Mesa, Arizona (Ms Pazdernik). Dr Ruhlen was affiliated with the A.T. Still Research Institute at A.T. Still University in Kirksville, Missouri, at the time of this study
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Amorin-Woods LG, Parkin-Smith GF, Cascioli V, Kennedy D. Manual care of residents with spinal pain within a therapeutic community. THERAPEUTIC COMMUNITIES 2016. [DOI: 10.1108/tc-06-2015-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to examine the outcomes of chiropractic manipulative and manual therapy (MMT) provided to residents experiencing spinal pain in a substance misuse therapeutic community (TC).
Design/methodology/approach
Clinical audit to explore the potential benefits of the interventions offered to residents experiencing spinal pain in a TC. Residents seeking care underwent an assessment by either general practitioner or chiropractic intern. Eligible participants could choose one of the four interventions: usual care without any additional treatment (Group 1), usual care with simple analgesics (Group 2), usual care plus MMT without simple analgesics (Group 3), or usual care plus MMT with simple analgesics (Group 4). Outcome measures were the RAND-36-item short form health-related quality-of-life survey and the patient satisfaction questionnaire (PSQ). Data were collected at baseline and after six weeks for each participant, with those participants choosing MMT receiving up to six treatments over the study period. Two cycles of six weeks of data collection was used. Data were analysed for statistically significant (repeated measures ANOVA with Bonferroni correction) and clinically meaningful changes in scores.
Findings
Of 71 self-presenting residents seeking care, 68 were eligible to participate. Of these, 32 chose usual care with simple analgesics (Group 2) and 36 chose usual care plus the package of MMT but without simple analgesics (Group 3). None chose usual care without additional treatment or usual care plus the package of MMT with analgesics, thus offering only the data from two groups for analysis. Group allocation was non-random and based on patient choice. Between-group analysis of the cumulative and component RAND-36 data indicated a significant difference between the two groups (p=0.034), particularly in the physical outcomes (p=0.012), indicating that Group 3 had improved scores over Group 2. Group 3 showed a significant change in RAND-36 scores (p<0.01) when compared with Group 2 (p=0.23) over the six-week treatment period. The PSQ scores of the two groups showed a statistically significant difference (p=0.0093), suggesting that Group 3 had greater patient satisfaction with care. The outcomes suggest that the package of MMT in Group 3, delivered by an appropriately trained clinician may have added to therapeutic effect that extended beyond physical outcomes but also influenced psychological outcomes.
Research limitations/implications
The results of this clinical outcome-based audit suggest that the addition of a package of chiropractic MMT to usual care may be of benefit over usual care with simple analgesics for residents of a TC with spinal pain. The results intimate that benefits may extend across both the physical and psychological components of the pain experience, although a confirmatory study is recommended to substantiate these insights.
Originality/value
As far as the authors are aware, this trial is the first of this type in a TC, with the insights and experience gained supporting a definitive trial.
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Surkitt LD, Ford JJ, Chan AYP, Richards MC, Slater SL, Pizzari T, Hahne AJ. Effects of individualised directional preference management versus advice for reducible discogenic pain: A pre-planned secondary analysis of a randomised controlled trial. ACTA ACUST UNITED AC 2016; 25:69-80. [PMID: 27422600 DOI: 10.1016/j.math.2016.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Low back disorders are prevalent and directional preference management is a common treatment with mixed evidence for effectiveness. OBJECTIVES To determine the effectiveness of individualised directional preference management plus guideline-based advice versus advice alone in participants with reducible discogenic pain of 6-week to 6-month duration. DESIGN Pre-planned secondary analysis of a multicentre, parallel group randomised controlled trial. METHODS Participants were randomly allocated to receive a 10-week physiotherapy program of 10-sessions of individualised directional preference management plus guideline-based advice (n = 40) or 2-sessions of advice alone (n = 38). Primary outcomes were back pain, leg pain and activity limitation. Outcomes were taken at baseline and 5, 10, 26, and 52-weeks. RESULTS Between-group differences significantly favoured directional preference management compared with advice for back pain at 5-weeks (1.28; 95% CI 0.34-2.23) and 10-weeks (1.45; 95% CI 0.51-2.40), and leg pain at 10-weeks (1.21; 95% CI 0.04-2.39). These short-term differences were not maintained. There were no significant differences between-groups for activity limitation. Secondary outcomes and responder analyses favoured directional preference management suggesting between-group differences were clinically important. CONCLUSIONS In people with reducible discogenic pain, individualised directional preference management plus guideline-based advice resulted in significant and rapid improvement in short-term back and leg pain compared with advice alone. These effects were not maintained at long-term and there were no differences in activity limitation. Individualised directional preference management could be considered for patients with reducible discogenic pain seeking rapid pain relief however further research is indicated.
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Affiliation(s)
- Luke D Surkitt
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Alexander Y P Chan
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Matthew C Richards
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Sarah L Slater
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Tania Pizzari
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
| | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria 3085, Australia.
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Abstract
The number of patients with a diagnosis of lumbar spinal stenosis (LSS) is steadily increasing and the expectations of patients are high; however, valid data for an appropriate therapy are lacking. Treatment is mostly the result of the surgeon's experience and the clinical focus. The findings in magnetic resonance imaging (MRI) often do not correlate with the patient's symptoms. It is proposed that treatment should start with a conservative multimodal approach. Increased pain with neurogenic claudication symptoms under conservative treatment should be treated surgically. Absolute indications for surgery, such as a conus cauda syndrome are rare. The goal of all surgical procedures is to decompress the spinal canal without compromising the stability of the motion segment. This can also make an additional fusion necessary.
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The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial. J Orthop Sports Phys Ther 2016; 46:144-54. [PMID: 26813755 DOI: 10.2519/jospt.2016.6238] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized clinical trial. Background The recommended initial management strategy for patients with low back pain and signs of nerve root compression is conservative treatment, but there is little evidence to guide the most appropriate management strategy. Preliminary research suggests that a treatment protocol of mechanical traction and extension-oriented exercises may be effective, particularly in a specific subgroup of patients. OBJECTIVE To examine the effectiveness of mechanical traction in patients with lumbar nerve root compression and within a predefined subgroup. METHODS One hundred twenty patients with low back pain with nerve root compression were recruited from physical therapy clinics. Using predefined subgrouping criteria, patients were stratified at baseline and randomized to receive an extension-oriented treatment approach with or without the addition of mechanical traction. During a 6-week period, patients received up to 12 treatment visits. Primary outcomes of pain and disability were collected at 6 weeks, 6 months, and 1 year by assessors blinded to group allocation. Outcomes were examined using linear mixed-model analyses examining change over time by treatment and the interaction between treatment and subgrouping status. RESULTS The mean ± SD age of participants was 41.1 ± 11.3 years, median duration of symptoms was 62 days, and 57% were male. No significant differences in disability or pain outcomes were noted between treatment groups at any time point, nor was any interaction found between subgroup status and treatment. CONCLUSION Patients with lumbar nerve root compression presenting for physical therapy can expect significant changes in disability and pain over a 6-week treatment period. There is no evidence that mechanical lumbar traction in combination with an extension-oriented treatment is superior to extension-oriented exercises alone in the management of these patients or within a predefined subgroup of patients. The study protocol was registered with ClinicalTrials.gov (NCT00942227). Level of Evidence Therapy, level 2b.
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Qian L, Li P, Wu W, Fang Y, Zhang J, Ouyang J. Restoration of the spinal canal volume in stenosis dependent on pedicle-lengthening distance in pedicle-lengthening osteotomy: A three dimensional simulation. Bone Joint J 2016; 98-B:238-43. [PMID: 26850430 DOI: 10.1302/0301-620x.98b2.35644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to determine the relationship between pedicle-lengthening distance and bulge-canal volume ratio in cases of lumbar spinal stenosis, to provide a theoretical basis for the extent of lengthening in pedicle-lengthening osteotomies. METHODS Three-dimensional reconstructions of CT images were performed for 69 patients (33 men and 36 women) (mean age 49.96 years; 24 to 81). Simulated pedicle-lengthening osteotomies and disc bulge and spinal canal volume calculations were performed using Mimics software. RESULTS The mean spinal canal volume of the two groups, L4 and L5, were 14 646.81 mm(3) (5918.60 to 22 717.77) and 16 408.47 mm(3) (8678.21 to 31 204.79), respectively. The mean lengthening distance was 2.17 mm (0.5 to 4.8) and the mean bulge-canal volume ratio was 0.23 (0.05 to 0.48). The pedicle-lengthening distance of the two groups were very strongly correlated with disc bulge volume and bulge-canal volume ratio (p < 0.001); the predictive equation was established as L = 0.06 + 9.06R (where L equals the pedicle-lengthening distance and R represents the bulge-canal volume ratio). DISCUSSION Our findings indicated that lumbar pedicle-lengthening distance strongly correlates with bulge-canal volume ratio, which can be estimated before surgery from CT images. TAKE HOME MESSAGE The predictive equation could help surgeons to decide the pedicle lengthening distance according to individual's condition and guide the surgery effectively.
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Affiliation(s)
- L Qian
- Southern Medical University, 1023 Shatai South Road, Guangzhou, 510515 P.R., China
| | - P Li
- Department of Orthopedic Surgery, Guzhen People's Hospital of Zhongshan City, 15 Dongxing Middle Road, Zhongshan, 528421, P.R., China
| | - W Wu
- Wuzhou Red Cross Hospital, 3-1 Xinxing First Road, Wuzhou, 543000, P.R., China
| | - Y Fang
- Zhengzhou University, 288 Zhongzhou Middle Road, Luoyang, 471009, P.R., China
| | - J Zhang
- Southern Medical University, 1023 Shatai South Road, Guangzhou, 510515 P.R., China
| | - J Ouyang
- Southern Medical University, 1023 Shatai South Road, Guangzhou, 510515 P.R., China
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Ford JJ, Hahne AJ, Surkitt LD, Chan AYP, Richards MC, Slater SL, Hinman RS, Pizzari T, Davidson M, Taylor NF. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br J Sports Med 2015; 50:237-45. [PMID: 26486585 DOI: 10.1136/bjsports-2015-095058] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Many patients with low-back disorders persisting beyond 6 weeks do not recover. This study investigates whether individualised physiotherapy plus guideline-based advice results in superior outcomes to advice alone in participants with low-back disorders. METHODS This prospective parallel group multicentre randomised controlled trial was set in 16 primary care physiotherapy practices in Melbourne, Australia. Random assignment resulted in 156 participants receiving 10 sessions of physiotherapy that was individualised based on pathoanatomical, psychosocial and neurophysiological barriers to recovery combined with guideline-based advice, and 144 participants receiving 2 sessions of physiotherapist-delivered advice alone. Primary outcomes were activity limitation (Oswestry Disability Index) and numerical rating scales for back and leg pain at 5, 10, 26 and 52 weeks postbaseline. Analyses were by intention-to-treat using linear mixed models. RESULTS Between-group differences showed significant effects favouring individualised physiotherapy for back and leg pain at 10 weeks (back: 1.3, 95% CI 0.8 to 1.8; leg: 1.1, 95% CI 0.5 to 1.7) and 26 weeks (back: 0.9, 95% CI 0.4 to 1.4; leg: 1.0, 95% CI 0.4 to 1.6). Oswestry favoured individualised physiotherapy at 10 weeks (4.7; 95% CI 2.0 to 7.5), 26 weeks (5.4; 95% CI 2.6 to 8.2) and 52 weeks (4.3; 95% CI 1.4 to 7.1). Responder analysis at 52 weeks showed participants receiving individualised physiotherapy were more likely to improve by a clinically important amount of 50% from baseline for Oswestry (relative risk (RR=1.3) 1.5; 95% CI 1.2 to 1.8) and back pain (RR 1.3; 95% CI 1.2 to 1.8) than participants receiving advice alone. CONCLUSIONS 10 sessions of individualised physiotherapy was more effective than 2 sessions of advice alone in participants with low-back disorders of ≥6 weeks and ≤6 months duration. Between-group changes were sustained at 12 months for activity limitation and 6 months for back and leg pain and were likely to be clinically significant. CLINICAL TRIAL REGISTRATION ACTRN12609000834257.
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Affiliation(s)
- Jon J Ford
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Andrew J Hahne
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Luke D Surkitt
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Alexander Y P Chan
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Matthew C Richards
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Sarah L Slater
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Rana S Hinman
- School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Tania Pizzari
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Megan Davidson
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Low Back Research Team, College of Science, Health & Engineering, La Trobe University, Bundoora, Victoria, Australia
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Steffens D, Hancock MJ, Pereira LSM, Kent PM, Latimer J, Maher CG. Do MRI findings identify patients with low back pain or sciatica who respond better to particular interventions? A systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:1170-87. [PMID: 26329648 DOI: 10.1007/s00586-015-4195-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 08/14/2015] [Accepted: 08/15/2015] [Indexed: 01/11/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) can reveal a range of degenerative findings and anatomical abnormalities; however, the clinical importance of these remains uncertain and controversial. We aimed to investigate if the presence of MRI findings identifies patients with low back pain (LBP) or sciatica who respond better to particular interventions. METHODS MEDLINE, EMBASE and CENTRAL databases were searched. We included RCTs investigating MRI findings as treatment effect modifiers for patients with LBP or sciatica. We excluded studies with specific diseases as the cause of LBP. Risk of bias was assessed using the criteria of the Cochrane Back Review Group. Each MRI finding was examined for its individual capacity for effect modification. RESULTS Eight published trials met the inclusion criteria. The methodological quality of trials was inconsistent. Substantial variability in MRI findings, treatments and outcomes across the eight trials prevented pooling of data. Patients with Modic type 1 when compared with patients with Modic type 2 had greater improvements in function when treated by Diprospan (steroid) injection, compared with saline. Patients with central disc herniation when compared with patients without central disc herniation had greater improvements in pain when treated by surgery, compared with rehabilitation. CONCLUSIONS Although individual trials suggested that some MRI findings might be effect modifiers for specific interventions, none of these interactions were investigated in more than a single trial. High quality, adequately powered trials investigating MRI findings as effect modifiers are essential to determine the clinical importance of MRI findings in LBP and sciatica ( PROSPERO CRD42013006571).
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Affiliation(s)
- Daniel Steffens
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, P.O. Box M201, Missenden Rd, Sydney, NSW, 2050, Australia. .,Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Mark J Hancock
- Discipline of Physiotherapy, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Leani S M Pereira
- Department of Physiotherapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Peter M Kent
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Research Department, The Spine Centre of Southern Denmark, Institute of Regional Health Services Research, University of Southern Denmark, Middelfart, Denmark
| | - Jane Latimer
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, P.O. Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
| | - Chris G Maher
- Musculoskeletal Division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, P.O. Box M201, Missenden Rd, Sydney, NSW, 2050, Australia
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Olaya-Contreras P, Styf J, Arvidsson D, Frennered K, Hansson T. The effect of the stay active advice on physical activity and on the course of acute severe low back pain. BMC Sports Sci Med Rehabil 2015; 7:19. [PMID: 26322232 PMCID: PMC4551375 DOI: 10.1186/s13102-015-0013-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 08/19/2015] [Indexed: 12/19/2022]
Abstract
Background Disability due to acute low back pain (ALBP) runs parallel with distress and physical inactivity. If low back pain persists, this may lead to long-term sick leave and chronic back pain. This prospective randomized study evaluated the effect on physical activity and on the course of ALBP of two different treatment advices provided in routine care. Methods Ninety-nine patients with acute severe LBP examined within 48 h after pain onset were randomized to the treatment advices “Stay active in spite of pain” (stay active group) or “Adjust activity to the pain” (adjust activity group). Pedometer step count and pain intensity (Numeric Rating Scale, NRS, 0–10) were followed daily during seven days. Linear mixed modeling were employed for statistical analyses. Results The step count change trajectory showed a curvilinear shape with a steep initial increase reaching a plateau after day 3 in both groups, followed by an additional increase to day 7 in the stay active group only. At day 1, the step count was 4560 in the stay active group compared to 4317 in adjust activity group (p = 0.76). Although there were no statistical differences between the two groups in the parameters describing the change trajectory for step count, the increase in step count was larger in the stay active group. At day 7 the step count was 9865 in the stay active group compared to 6609 in the adjust activity group (p = 0.008). The pain intensity (NRS) trajectory was similar in the two groups. Between day 1 and day 7 it decreased linearly from 5.0 to 2.8 in the stay active group (p < 0.001), and from 4.8 to 2.3 in the adjust activity group (p < 0.001). Conclusions Patients with acute severe LBP advised to stay active in spite of the pain exhibited a considerable more active behavior compared to patients adjusting their activity to pain. This result confirms compliance to the treatment advice as well as the utility of the stay active advice to promote additional physical activity for more health benefits in patients with ALBP. There was minimal effect of the treatment advice on the course of ALBP. Trial registration ClinicalTrials.gov (NCT02517762).
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Affiliation(s)
- Patricia Olaya-Contreras
- Department of Orthopedics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Department of Postgraduate Studies, Faculty of Nursing, University of Antioquia, Calle 70 No 52-21, Apartado Aereo, 1226 Medellín, Antioquia Colombia ; Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - Jorma Styf
- Department of Orthopedics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Arvidsson
- Unit of Clinical Physiology and Nuclear Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden ; RICH/EXE, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karin Frennered
- Department of Orthopedics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Tommy Hansson
- Department of Orthopedics, Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Wellington J. Noninvasive and alternative management of chronic low back pain (efficacy and outcomes). Neuromodulation 2015; 17 Suppl 2:24-30. [PMID: 25395114 DOI: 10.1111/ner.12078] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 03/04/2013] [Accepted: 04/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The goal of this article is to provide a thorough literature review of available noninvasive and alternative treatment options for chronic low back pain. In particular, the efficacy of each therapy is evaluated and pertinent outcomes are described. MATERIALS AND METHODS A comprehensive search for available literature was done through PubMed and Cochrane data base for topics discussed in this paper. RESULTS Relevant current and past references were reviewed and presented to reflect the efficacy of each therapy and related outcomes. CONCLUSIONS There are a wide variety of noninvasive and alternative therapies for the treatment of chronic low back pain. Those with the strongest evidence in the literature for good efficacy and outcomes include exercise therapy with supervised physical therapy, multidisciplinary biopsychosocial rehabilitation, and acupuncture. Therapies with fair evidence or moderately supported by literature include yoga, back schools, thermal modalities, acupressure, and cognitive-behavioral therapy. Those therapies with poor evidence or little to no literature support include manipulation, transcutaneous electrical nerve stimulation, low-level laser therapy, reflexology, biofeedback, progressive relaxation, hypnosis, and aromatherapy. Providers delivering care for patients with chronic low back pain must carefully evaluate these available treatment options related to their efficacy or lack thereof as well as relevant outcomes.
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What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies. Clin J Pain 2015; 30:995-1005. [PMID: 24300225 DOI: 10.1097/ajp.0000000000000044] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The global burden of low back pain is the highest ranked condition contributing to years of living with disability. Exercise is moderately effective, and adherence to exercise may improve if participants are engaged. Identification of elements that enhance engagement would enable clinicians to prescribe appropriate interventions. The review objective was to identify and synthesize qualitative empirical studies that have explored beliefs about exercise therapy of people with nonspecific chronic low back pain. METHODS Two independent reviewers conducted a structured review and metasynthesis informed by Cochrane and Campbell Collaboration guidelines and the PRISMA statement. Fifteen papers were included for data extraction, method quality assessment, and thematic analysis. RESULTS Four key themes emerged: (1) perceptions and classification of exercise; (2) role and impact of the health professional; (3) exercise and activity enablers/facilitators; (4) exercise and activity barriers. Participants believed that there were distinctions between general activity, real/fitness exercise, and medical exercise. Levels of acquired skills and capability and participant experience with exercise culture require consideration in program design. People participating in exercise classes and group work may be more comfortable when matched for abilities and experience. When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement, people make a reasoned decision to discontinue. DISCUSSION People are likely to prefer and participate in exercise or training programs and activities that are designed with consideration of their preferences, circumstances, fitness levels, and exercise experiences.
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Gorini A, Marzorati C, Casiraghi M, Spaggiari L, Pravettoni G. A neurofeedback-based intervention to reduce post-operative pain in lung cancer patients: study protocol for a randomized controlled trial. JMIR Res Protoc 2015; 4:e52. [PMID: 25940965 PMCID: PMC4436521 DOI: 10.2196/resprot.4251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 03/08/2015] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
Background Thoracic surgery appears to be the treatment of choice for many lung cancers. Nevertheless, depending on the type of surgery, the chest area may be painful for several weeks to months after surgery. This painful state has multiple physical and psychological implications, including respiratory failure, inability to clear secretions by coughing, and even anxiety and depression that have negative effects on recovery. Objective The aim of this study is to evaluate the effect of a neurofeedback-based intervention on controlling acute post-surgery pain and improving long-term recovery in patients who undergo thoracotomy for lung resection for non-small cell lung cancer (NSCLC) at an academic oncologic hospital. Methods This study will be based on a 2-parallel group randomized controlled trial design, intervention versus usual care, with multiple in-hospital assessments and 2 clinical, radiological, and quality of life follow-ups. Participants will be randomized to either the intervention group receiving a neurofeedback-based relaxation training and usual care, or to a control group receiving only usual care. Pain intensity is the primary outcome and will be assessed using the Numeric Pain Rating Scale (NRS) in the days following the operation. Secondary outcomes will include the effect of the intervention on hospital utilization for pain crisis, daily opioid consumption, anxiety, patient engagement, blood test and chest x-ray results, and long-term clinical, radiological, and quality of life evaluations. Outcome measures will be repeatedly taken during hospitalization, while follow-up assessments will coincide with the follow-up visits. Pain intensity will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations. Results We expect to have results for this study before the end of 2016. Conclusions The proposed innovative, neurofeedback- and relaxation-based approach to support post-surgery pain management could lead to significant improvements in patient short and long-term outcomes.
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[Effects of interdisciplinary functional restoration treatment with cognitive behavior therapy in patients with chronic back pain: healthcare research in the context of selective contracts]. Schmerz 2015; 27:566-76. [PMID: 24337423 DOI: 10.1007/s00482-013-1377-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The efficacy of functional restoration programs for the treatment of chronic back pain is well documented. Nevertheless, there are only a few such centres in Germany and few trials have been conducted in German-speaking regions to demonstrate that implementing such programs in everyday clinical settings with large numbers of patients is just as effective as in a research setting. The present study examined whether the positive effects of such programs can also be observed in the clinically relevant context of a standardized day clinic treatment regimen. MATERIAL AND METHODS A total of 681 back pain patients in 2 German cities were examined at 4 measurement points (before and immediately after the program, as well as 6 and 12 months after treatment) using a comprehensive questionnaire on perceived pain and symptoms of anxiety and depression, as well as the work situation. RESULTS In both cities significant and long-term improvements in back pain, pain-related impairment and degree of chronification were observed, as well as a high return-to-work rate after treatment. Hence, the quality of such programs was also confirmed for a large patient population.
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Jacobson EE, Meleger AL, Bonato P, Wayne PM, Langevin HM, Kaptchuk TJ, Davis RB. Structural integration as an adjunct to outpatient rehabilitation for chronic nonspecific low back pain: a randomized pilot clinical trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2015; 2015:813418. [PMID: 25945112 PMCID: PMC4405211 DOI: 10.1155/2015/813418] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/08/2015] [Accepted: 01/08/2015] [Indexed: 12/19/2022]
Abstract
Structural Integration (SI) is an alternative method of manipulation and movement education. To obtain preliminary data on feasibility, effectiveness, and adverse events (AE), 46 outpatients from Boston area with chronic nonspecific low back pain (CNSLBP) were randomized to parallel treatment groups of SI plus outpatient rehabilitation (OR) versus OR alone. Feasibility data were acceptable except for low compliance with OR and lengthy recruitment time. Intent-to-treat data on effectiveness were analyzed by Wilcoxon rank sum, n = 23 per group. Median reductions in VAS Pain, the primary outcome, of -26 mm in SI + OR versus 0 in OR alone were not significantly different (P = 0.075). Median reductions in RMDQ, the secondary outcome, of -2 points in SI + OR versus 0 in OR alone were significantly different (P = 0.007). Neither the proportions of participants with nor the seriousness of AE were significantly different. SI as an adjunct to OR for CNSLBP is not likely to provide additional reductions in pain but is likely to augment short term improvements in disability with a low additional burden of AE. A more definitive trial is feasible, but OR compliance and recruitment might be challenging. This trial is registered with ClinicalTrials.gov (NCT01322399).
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Affiliation(s)
- Eric E. Jacobson
- Department of Global Health & Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Alec L. Meleger
- Department of Physical Therapy & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Avenue, Charleston, MA 02129, USA
- Spine Center, Newton-Wellesley Hospital, 159 Wells Avenue, Newton, MA 02459, USA
| | - Paolo Bonato
- Department of Physical Therapy & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, 300 First Avenue, Charleston, MA 02129, USA
- Motion Analysis Laboratory, Department of Physical Therapy & Rehabilitation, Spaulding Rehabilitation Hospital, 300 First Avenue, Charleston, MA 02129, USA
- Harvard-MIT Division of Health Sciences and Technology, 45 Carleton Street, Cambridge, MA 02142, USA
| | - Peter M. Wayne
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA 02215, USA
| | - Helene M. Langevin
- Osher Center for Integrative Medicine, Division of Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, 900 Commonwealth Avenue, Boston, MA 02215, USA
- Department of Neurological Sciences, College of Medicine, University of Vermont, 89 Beaumont Avenue, Burlington, VT 05401, USA
| | - Ted J. Kaptchuk
- Division of General Medicine & Primary Care, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Roger B. Davis
- Division of General Medicine & Primary Care, Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA
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Semrau J, Hentschke C, Buchmann J, Meng K, Vogel H, Faller H, Bork H, Pfeifer K. Long-term effects of interprofessional biopsychosocial rehabilitation for adults with chronic non-specific low back pain: a multicentre, quasi-experimental study. PLoS One 2015; 10:e0118609. [PMID: 25768735 PMCID: PMC4359119 DOI: 10.1371/journal.pone.0118609] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 01/19/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Improvement of the long-term effectiveness of multidisciplinary ortho-paedic rehabilitation (MOR) in the management of chronic non-specific low back pain (CLBP) remains a central issue for health care in Germany. We developed an interprofessional and interdisciplinary, biopsychosocial rehabilitation concept named "PASTOR" to promote self-management in adults with CLBP and compared its effectiveness with the current model of MOR. METHODS A multicentre quasi-experimental study with three measurement time points was implemented. 680 adults aged 18 to 65 with CLBP were assed for eligibil-ity in three inpatient rehabilitation centres in Germany. At first the effects of the MOR, with a total extent of 48 hours (control group), were assessed. Thereafter, PASTOR was implemented and evaluated in the same centres (intervention group). It consisted of six interprofessional modules, which were provided on 12 days in fixed groups, with a total extent of 48 hours. Participants were assessed with self-report measures at baseline, discharge, and 12 months for functional ability (primary outcome) using the Hannover Functional Ability Questionnaire (FFbH-R) and vari-ous secondary outcomes (e.g. pain, health status, physical activity, pain coping, pain-related cognitions). RESULTS In total 536 participants were consecutively assigned to PASTOR (n=266) or MOR (n=270). At 12 months, complete data of 368 participants was available. The adjusted between-group difference in the FFbH-R at 12 months was 6.58 (95% CI 3.38 to 9.78) using complete data and 3.56 (95% CI 0.45 to 6.67) using available da-ta, corresponding to significant small-to-medium effect sizes of d=0.42 (p<0.001) and d=0.10 (p=0.025) in favour of PASTOR. Further improvements in secondary out-comes were also observed in favour of PASTOR. CONCLUSION The interprofessional and interdisciplinary, biopsychosocial rehabilita-tion program PASTOR shows some improvements of the long-term effectiveness of inpatient rehabilitation in the management of adults with CLBP. Further insights into mechanisms of action of complex intervention programs are required. TRIAL REGISTRATION ClinicalTrials.gov NCT02056951.
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Affiliation(s)
- Jana Semrau
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Sport Science and Sport, Erlangen, Germany
| | - Christian Hentschke
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Sport Science and Sport, Erlangen, Germany
| | - Jana Buchmann
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Karin Meng
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Heiner Vogel
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Hermann Faller
- University of Würzburg, Department of Medical Psychology, Medical Sociology, and Rehabilitation Sciences, Würzburg, Germany
| | - Hartmut Bork
- Reha-Zentrum am Sankt Josef-Stift, Sendenhorst, Germany
| | - Klaus Pfeifer
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute of Sport Science and Sport, Erlangen, Germany
- * E-mail:
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Abstract
Chronic pain is a common and disabling disorder with major consequences for patient quality of life and it is also a major economic burden to society. The management of chronic pain comprises a large range of different intervention strategies including pharmacological therapy, non-medicinal and invasive therapeutic options. While non-pharmacological and multimodal options are underused, monomodal options, especially pharmacotherapy and invasive therapies are overused. The effectiveness of multidisciplinary and multimodal treatment programs including physical and rehabilitation interventions and psychological treatment has been extensively studied in the last two decades. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy alone, there is some evidence for the effectiveness of behavioral therapy and there is at least moderate evidence for the effectiveness of multidisciplinary and multimodal treatment and other active treatment reducing pain and increasing functional capacity at short and intermediate term. Therefore, blanket coverage with provision of adequate treatment programs for chronic pain as well as studies evaluating the best composition of treatment elements are needed. The characteristics of chronic pain, the necessary assessment procedures and treatment types are described.
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Nuclear magnetic resonance therapy in lumbar disc herniation with lumbar radicular syndrome: effects of the intervention on pain intensity, health-related quality of life, disease-related disability, consumption of pain medication, duration of sick leave and MRI analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1296-308. [PMID: 25326180 DOI: 10.1007/s00586-014-3601-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE The objective was to assess the effects of therapeutic nuclear magnetic resonance (tNMR) as a conservative treatment for lumbar radicular syndrome (LRS) in patients with lumbar disc herniation. METHODS The prospective, randomised, double-blind, placebo-controlled trial included 94 patients, aged 20-60 years (44.79 ± 8.83), with LRS caused by lumbar disc herniation confirmed by MRI scans and with clinical signs of a radicular lesion without indication for surgical intervention. Treatment group (TG) and control group (CG) received standard non-surgical therapy. Additionally, the TG had seven sessions with the tNMR device with a magnetic flux density of 2.3 mT and a frequency of 85 kHz; the CG received 7 sham treatments. Outcome parameters were the treatment effect on pain intensity (Visual Analogue Scale-VAS), health-related quality of life (36-item Short Form Health Survey-SF-36), disease-related disability (Roland Morris Disability Questionnaire-RMDQ), pain medication intake, duration of sick leave and morphological changes assessed by MRI scan analysis. RESULTS VAS scores improved significantly in both groups (p < 0.000). Only in week 4, improvement in the TG significantly surpassed that of the CG (morning pain p = 0.011, evening pain = 0.001). In both groups, SF-36 scores reflected a significant amendment in the physical component score (p < 0.000) and a significant deterioration in the mental component score (p < 0.000). SF-36 scores did not differ significantly between groups. RMDQ showed a significant amelioration in both groups (TG and CG p < 0.000), with a tendency to a superior benefit in the TG (p = 0.083). Patients in the TG recorded significantly fewer days of sick leave in month 3 after treatment (p = 0.026). MRI scan summary scores improved significantly in both groups (L4/5 p < 0.000, L5/S1 p < 0.001) and did not differ significantly between the groups. CONCLUSIONS This trial was the first to investigate the effects of tNMR as an additional treatment of lumbar disc herniation with LRS. The application of tNMR did not meet MCID criteria. It rendered few statistically significant differences between patient groups. The overall results of this trial make a clinical implementation of tNMR in the treatment of lumbar disc herniation with LRS appear premature. Further research is needed to better understand the mode of action of tNMR on compressed neural tissue and to elucidate the issue of the cost/benefit ratio.
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Amorin-Woods LG, Beck RW, Parkin-Smith GF, Lougheed J, Bremner AP. Adherence to clinical practice guidelines among three primary contact professions: a best evidence synthesis of the literature for the management of acute and subacute low back pain. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2014; 58:220-37. [PMID: 25202150 PMCID: PMC4139767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To determine adherence to clinical practice guidelines in the medical, physiotherapy and chiropractic professions for acute and subacute mechanical low back pain through best-evidence synthesis of the healthcare literature. METHODS A structured best-evidence synthesis of the relevant literature through a literature search of relevant databases for peer-reviewed papers on adherence to clinical practice guidelines from 1995 to 2013. Inclusion of papers was based on selection criteria and appraisal by two reviewers who independently applied a modified Downs & Black appraisal tool. The appraised papers were summarized in tabular form and analysed by the authors. RESULTS The literature search retrieved 23 potentially relevant papers that were evaluated for methodological quality, of which 11 studies met the inclusion criteria. The main finding was that no profession in the study consistently attained an overall high concordance rating. Of the three professions examined, 73% of chiropractors adhered to current clinical practice guidelines, followed by physiotherapists (62%) and then medical practitioners (52%). CONCLUSIONS This review showed that quality papers in this area of research are very limited. Notwithstanding, chiropractors appear to adhere to clinical practice guidelines more so than physiotherapists and medical practitioners, although there is scope for improvement across all three professions.
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Affiliation(s)
- Lyndon G Amorin-Woods
- Senior Clinical Supervisor, School of Health Professions [Discipline of Chiropractic], Murdoch University, Enrolled student, Master of Public Health, School of Population Health Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia, , Postal Address: Murdoch University, South Street Campus, 90 South Street, MURDOCH Western Australia 6150, Telephone: +61 8-93601202
| | - Randy W Beck
- Senior Clinical Supervisor, School of Health Professions [Discipline of Chiropractic], Murdoch University, Enrolled student, Master of Public Health, School of Population Health Faculty of Medicine, Dentistry and Health Sciences The University of Western Australia, , Postal Address: Murdoch University, South Street Campus, 90 South Street, MURDOCH Western Australia 6150, Telephone: +61 8-93601202
| | - Gregory F Parkin-Smith
- Registrar in Emergency Medicine, Registered Medical Practitioner, Rockingham General Hospital; Registered Chiropractor
| | - James Lougheed
- Senior Research Assistant, Institute of Functional Neuroscience, PERTH, Australia
| | - Alexandra P Bremner
- Associate Professor, School of Population Health, Faculty of Medicine and Dentistry and Health Sciences, The University of Western Australia PERTH, Australia
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