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Zou T, Liu XY, Wang PC, Chen H, Wu PG, Feng XM, Sun HH. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis. Clin Spine Surg 2024; 37:256-269. [PMID: 37559207 DOI: 10.1097/bsd.0000000000001490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 06/21/2023] [Indexed: 08/11/2023]
Abstract
STUDY DESIGN A meta-analysis. OBJECTIVE This study aimed to analyze the incidence of spontaneous resorption of lumbar disk herniation (LDH) after conservative treatment. SUMMARY OF BACKGROUND DATA The resorption of intervertebral disks has been more frequently reported, but there is a lack of reference to the probability of resorption. METHODS We strictly refer to the standard established in the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-analysis) statement, comprehensively searched electronic databases using the terms related to the spontaneous resorption of LDH. Two reviewers independently evaluated the potential studies, extracted, and analyzed the enrolled data. RESULTS Thirty-one studies with 2233 patients who received conservative treatment were included for this analysis. We found that the pooled overall incidence of disk resorption was 70.39%, 87.77% for disk sequestration, 66.91% for disk extrusion, 37.53% for disk protrusion, and 13.33% for disk bugle, respectively. The resorption incidence in of 25%≤ reduction of disk herniation (RDH) 50%, RDH≥50%, and RDH=100% were 40.19%, 43.62, and 36.89%. The resorption incidence was 66.98% in Japan, 61.66% in the United States, 83.52% in Korea, 60.68% in China, 78.30% in the UK, 56.70% in Italy, and 83.68% in Turkey, respectively. Subgroup analysis showed that there was no significant difference in resorption incidence among prospective, retrospective studies and randomized controlled trials ( P =0.77), and there was no significant difference in evaluation method among qualitative and quantitative studies ( P =0.05). CONCLUSIONS The existing evidence shows that the overall resorption incidence of LDH was 70.39%, the resorption incidence of ruptured LDH is higher than that of contained LDH. There are significant differences in the resorption incidence among countries. The resorption process mainly occurred within 6 months of conservative treatment.
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Affiliation(s)
- Tao Zou
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
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Nair VV, Kohli S, Vishwakarma N, Mhatre J. Outcome of Transforaminal Endoscopic Discectomy in Rural India in a Single-Level Lumbar Disc Prolapse Under Local Anesthesia. Asian J Neurosurg 2023; 18:312-320. [PMID: 37397052 PMCID: PMC10310452 DOI: 10.1055/s-0043-1769756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Aim The aim of this study was to undertake a clinical study to evaluate the outcomes of transforaminal endoscopic discectomy under local anesthesia and to study the complication rate. Study Design It is a prospective study. Methods We prospectively analyzed outcomes of 60 patients with a single-level lumbar disc prolapse in rural India from December 2018 to April 2020 who underwent endoscopic discectomy under local anesthesia. Follow-up was done using the visual analogue score (VAS) and Oswestry Disability Index (ODI) scoring systems with a minimum follow-up up to 1 year postoperatively. Results In our study of 60 patients, there was 38 cases of L4-L5 disc pathology, 13 L5-S1 discs, and 9 L3-L4 discs. Our study showed a significant clinical reduction in mean VAS score that was 7.07/10 preoperatively and reduced to 3.88/10 at the third month and 3.64/10 at 1 year of follow-up ( p -value < 0.05) showing clinical significance. The ODI scoring done preoperatively was an average mean of 57.37% pointing to how crippled the patients were with lumbar disc prolapse and showed a significant reduction to 29.32% postoperatively at 1 year ( p -value < 0.05) showing clinical significance. This reduction in ODI directly corelates to how almost all patients returned to normal life coping to all activities and were completely pain free at 1 year of follow-up. Conclusion Endoscopic spine surgery in lumbar disc prolapse is highly effective and can deliver a good functional outcome if done with correct preoperative planning and approach.
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Affiliation(s)
- Vishnu Vikraman Nair
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Sarabjeet Kohli
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Nilesh Vishwakarma
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Juilee Mhatre
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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左 如, 马 明, 蒋 毅, 袁 帅, 李 健, 刘 畅, 张 捷. [Comparison of effectiveness of unilateral biportal endoscopy technique and the interlaminar uniportal endoscop technique for treatment of L 5, S 1 lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1192-1199. [PMID: 36310454 PMCID: PMC9626281 DOI: 10.7507/1002-1892.202205038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/12/2022] [Indexed: 01/24/2023]
Abstract
Objective To compare the effectiveness of unilateral biportal endoscopy (UBE) technique with the interlaminar uniportal endoscopy (IUE) technique for the treatment of L 5, S 1 lumbar disc herniation. Methods The clinical data of 69 patients with L 5, S 1 lumbar disc herniation who met the selection criteria between January 2020 and December 2020 were retrospectively analysed. The patients were divided into UBE group (30 cases) and IUE group (39 cases) according to endoscopic surgical technique. The general data, such as gender, age, body mass index, disease duration, and preoperative visual analogue scale (VAS) scores of low back/leg pain and Oswestry disability index (ODI), was not significantly different between the two groups ( P>0.05). Perioperative outcomes [estimated blood loss (EBL), total operation time, extracanal operation time, intracanal decompression time, intraoperative radiation exposure dose, incision length, operative related complications, and postoperative hospitalization stay] and clinical outcomes (VAS score of low back/leg pain before operation and at 3 days, 3 months, 6 months, and 12 months after operation as well as the ODI before operation and at 3 months, 6 months, and 12 months after operation) were recorded and compared between the two groups. Results All patients completed the surgery successfully. The incision length, EBL, and extracanal operation time in UBE group were significantly longer than those in IUE group ( P<0.05), and the intracanal decompression time in UBE group was significantly shorter than that in IUE group ( P<0.05). There was no significant difference in the total operation time, intraoperative radiation exposure dose, and postoperative hospitalization stay between the two groups ( P>0.05). Patients in both groups were followed up 12-15 months (mean, 13.3 months). Dural tear ocurred in 1 patient of the UBE group, and recurrence ocurred in 1 patient of the IUE group, the others of both groups had no surgery-related complications and recovered well after operation. The VAS scores of low back/leg pain and ODI in both groups at each time point after operation significantly improved when compared with those before operation ( P<0.05); there was no significant difference in VAS scores and ODI at each time point after operation between two groups ( P>0.05). Conclusion The effectiveness of UBE technique in the treatment of L 5, S 1 lumbar disc herniation is similar to that of IUE technique, and the efficiency of intraspinal operation is better than that of IUE technique. Although UBE technique is inferior to IUE technique in terms of surgical trauma, there is no significant difference in postoperative recovery between the two techniques.
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Affiliation(s)
- 如俊 左
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
| | - 明 马
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
| | - 毅 蒋
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
| | - 帅 袁
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
| | - 健 李
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
| | - 畅 刘
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
| | - 捷迅 张
- 北京市海淀医院(北京大学第三医院海淀院区)微创脊柱科(北京 100080)Department of Minimally Invasive Spine Surgery, Beijing Haidian Hospital (Haidian Section of Peking University Third Hospital), Beijing, 100080, P. R. China
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Zuo R, Jiang Y, Ma M, Yuan S, Li J, Liu C, Zhang J. The clinical efficacy of biportal endoscopy is comparable to that of uniportal endoscopy via the interlaminar approach for the treatment of L5/S1 lumbar disc herniation. Front Surg 2022; 9:1014033. [PMID: 36238864 PMCID: PMC9553067 DOI: 10.3389/fsurg.2022.1014033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the clinical outcomes of unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS) via the posterior approach with those of interlaminar endoscopic lumbar discectomy (IELD) for the treatment of L5/S1 lumbar disc herniation. Methods We collected the clinical data of patients with L5/S1 lumbar disc herniation who had undergone endoscopic surgery at our center from January 2020 to July 2021, and 92 patients were included. They were divided into UBE/BESS (n = 42) and IELD (n = 50) groups. The incision length, operative time (overall operative, extracanal operative, and intracanal decompression times), intraoperative radiation exposure dose, changes in hemoglobin before and after surgery, postoperative hospital stay, visual analog scale (VAS) score for low back pain and leg, and Oswestry disability index (ODI) were statistically analyzed. Results One case incurred dural tear in the UBE/BESS group, and one case developed recurrence in the IELD group. Postoperatively, the VAS score and ODI index decreased significantly in both groups (P < 0.01). VAS and ODI scores (preoperative as well as 3 days, 3 months, 6 months, and 12 months after surgery), the overall operative time, and postoperative hospital stay were not significantly different between the two groups (P > 0.05). No statistical difference in intraoperative radiation exposure dose was noted between the two groups (P > 0.05). The surgical incision length was greater in the UBE/BESS group (P < 0.01), and pre- and postoperative hemoglobin changes were more pronounced in the UBE/BESS group (P < 0.01). The UBE/BESS group had a longer extracanal operative time and shorter intracanal decompression time (P < 0.01). Conclusions The clinical efficacy of UBE/BESS for L5/S1 lumbar disc herniation is comparable to that of IELD. Intraoperative radiation exposure doses were similar in both techniques. UBE/BESS required more time to identify tissue structures and a larger working space when operating outside the spinal canal; however, the efficiency of nucleus pulposus removal and nerve root release inside the spinal canal superseded that in IELD. Furthermore, the surgical incision in the UBE/BESS technique was longer, with greater actual blood loss during surgery, thus rendering UBE/BESS inferior to the IELD technique in terms of surgical trauma. Nonetheless, no significant difference was noted between the two techniques in the postoperative recovery time of patients.
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Shen T, Ye Y, Fan S, Luo R, Pan J, Tang W. Clinical efficacy of Tuina manipulations for lumbar disc herniation and its influence on posture-associated indicators. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1315-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Zhu DC, Lin JH, Xu JJ, Guo Q, Wang YH, Jiang C, Lu HG, Wu YS. An assessment of morphological and pathological changes in paravertebral muscle degeneration using imaging and histological analysis: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:854. [PMID: 34625068 PMCID: PMC8499494 DOI: 10.1186/s12891-021-04734-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background The high signal of paravertebral muscle (PVM) on T2-weighted image (T2WI) is usually considered to be fatty degeneration. However, it is difficult to distinguish inflammatory edema from fatty degeneration on T2WI. The purpose of this study was to identify different types of PVM high signal in patients with low back pain (LBP) through magnetic resonance imaging (MRI) and histology. Methods Seventy patients with LBP underwent MRI. The signal change of multifidus both on T2WI and fat suppression image (FSI) was quantified by Image J. Furthermore, 25 of the 70 patients underwent surgery for degenerative lumbar disease and their multifidus were obtained during the operation. Histological analysis of the samples was performed by HE staining. Result Three types of PVM signal changes were identified from the MRI. Type 1 (n = 36) indicated fatty degeneration characterized by a high signal on T2WI and low signal on FSI. High signal on both T2WI and FSI, signifying type 2 meant inflammatory edema (n = 9). Type 3 (n = 25) showed high signal on T2WI and partial signal suppression on FSI, which meant a combination of fatty degeneration and inflammatory edema. Histological results were consistent with MRI. Among the 25 patients who underwent surgery, type 1 (n = 14) showed adipocytes infiltration, type 2 (n = 3) showed inflammatory cells infiltration and type 3 (n = 8) showed adipocytes and inflammatory cells infiltration. Conclusion From our results, there are three types of pathological changes in patients with PVM degeneration, which may help to decide on targeted treatments for LBP.
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Affiliation(s)
- Ding-Chao Zhu
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jia-Hao Lin
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jia-Jing Xu
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Qiang Guo
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Yi-Han Wang
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Chao Jiang
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China.,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Hui-Gen Lu
- Department of Orthopaedic Surgery, The Second Hospital of Jiaxing, Jiaxing, China
| | - Yao-Sen Wu
- Department of Orthopedics, Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109# Xueyuan Road, Wenzhou, 325000, China. .,Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China. .,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.
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Jess MA, Hamilton S, Ryan C, Wellburn S, Alexanders J, Spence D, Martin D. Exploring the origin of pain subclassification, with emphasis on low back pain: a scoping review. JBI Evid Synth 2021; 19:308-340. [PMID: 32881730 DOI: 10.11124/jbisrir-d-19-00383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aimed to explore the different working definitions for the duration of acute, subacute, and chronic pain, with emphasis on low back pain, and to establish where these definitions originated and the rationale provided for the time frames used. INTRODUCTION From a global perspective, low back pain is a major social and economic problem. One of the most commonly used methods to stratify and manage low back pain is the traditional duration-based classification (acute, subacute, and chronic). Where these time points lie to differentiate these transitions continues to be debated within the scientific community, which may engender a degree of heterogeneity in study findings. Therefore, applying these findings to clinical practice may be somewhat challenging. This review encapsulates the historical origins of the different duration categories to provide an understanding of how these variations were derived. INCLUSION CRITERIA Studies that included participants with low back pain were the focus of this review. Sources that included children or other specific pain pathologies, such as cancer pain, were excluded. The main concept of interest was that the publication proposed an original definition of the duration of acute, subacute, or chronic low back pain. All study designs were included provided they gave a rationale for the duration that they used. METHODS The following databases were searched: MEDLINE, Embase, CINAHL, and PsycINFO, from the inception of each database until September 18, 2019. This review was limited to studies published in English. Two independent reviewers screened the retrieved articles against the eligibility criteria. Additional studies were searched from the reference lists of studies to find the original source. Some original sources overlapped with general pain duration literature. This led to a deviation from the scoping review protocol, which originally intended to focus on definitions of low back pain duration only. Data extraction was undertaken using a charting table developed specifically for the review objectives. The findings were presented using narrative synthesis. RESULTS Nineteen records were included in this review, and comprised three book chapters, four review articles, four articles that arose following pain expert group discussions, seven primary research studies, and a spinal guideline. Data were extracted from the included studies and categorized into four themes based on the origin of the classification of the duration. The themes included i) work/employment setting, ii) empirical studies, iii) expert reasoning, and iv) pathophysiological explanation. CONCLUSIONS This scoping review compiled the existing literature on the working definitions of the duration of acute, subacute, and chronic low back pain and found a wide variation. These ranged from seven days, 14 days, and seven weeks for the acute and subacute transition points, and seven weeks to three years for chronic low back pain. The duration definitions specifically referring to the general pain literature focused on three and/or six months for the transition to chronic. Better integration of reasoning between the identified themes could facilitate the establishment of more ideal duration definitions in the future. Although inconclusive, the definition most commonly cited, with most consensus, was three months for the transition to chronic low back pain.
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Affiliation(s)
- Mary-Anne Jess
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Sharon Hamilton
- School of Health and Social Care, Teesside University, Middlesbrough, UK.,Teesside Centre for Evidence-Informed Practice: A JBI Affiliated Group, Middlesbrough, UK
| | - Cormac Ryan
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Shaun Wellburn
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Jenny Alexanders
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Daniel Spence
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
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Moore SA, Tipold A, Olby NJ, Stein V, Granger N. Current Approaches to the Management of Acute Thoracolumbar Disc Extrusion in Dogs. Front Vet Sci 2020; 7:610. [PMID: 33117847 PMCID: PMC7521156 DOI: 10.3389/fvets.2020.00610] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Intervertebral disc extrusion (IVDE) is one of the most common neurologic problems encountered in veterinary clinical practice. The purpose of this manuscript is to provide an overview of the literature related to treatment of acute canine thoracolumbar IVDE to help construct a framework for standard care of acute canine thoracolumbar IVDE where sufficient evidence exists and to highlight opportunities for future prospective veterinary clinical research useful to strengthen care recommendations in areas where evidence is low or non-existent. While there exist a number of gaps in the veterinary literature with respect to standards of care for dogs with acute thoracolumbar IVDE, recommendations for standard care can be made in some areas, particularly with respect to surgical decompression where the currently available evidence supports that surgery should be recommended for dogs with nonambulatory paraparesis or worse. While additional information is needed about the influence on timing of decompression on outcome in dogs that are deep pain negative for longer than 48 h duration, there is no evidence to support treatment of the 48 h time point as a cut off beyond which it becomes impossible for dogs to achieve locomotor recovery. Surgical decompression is best accomplished by either hemilaminectomy or mini-hemilaminectomy and fenestration of, at a minimum, the acutely ruptured disc. Adjacent discs easily accessed by way of the same approach should be considered for fenestration given the evidence that this substantially reduces future herniation at fenestrated sites. Currently available neuroprotective strategies such as high does MPSS and PEG are not recommended due to lack of demonstrated treatment effect in randomized controlled trials, although the role of anti-inflammatory steroids as a protective strategy against progressive myelomalacia and the question of whether anti-inflammatory steroids or NSAIDs provide superior medical therapy require further evaluation.
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Affiliation(s)
- Sarah A Moore
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, United States
| | - Andrea Tipold
- Department Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
| | - Veronica Stein
- Division of Clinical Neurology, Department for Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Nicolas Granger
- The Royal Veterinary College, University of London, Hatfield, United Kingdom.,CVS Referrals, Bristol Veterinary Specialists at Highcroft, Bristol, United Kingdom
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Ibrahim W, Harvey-Dunstan TC, Greening NJ. Rehabilitation in chronic respiratory diseases: In-hospital and post-exacerbation pulmonary rehabilitation. Respirology 2019; 24:889-898. [PMID: 30835884 DOI: 10.1111/resp.13516] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/22/2019] [Accepted: 02/13/2019] [Indexed: 12/15/2022]
Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) that require hospitalization are important events for patients. Functional impairment and skeletal muscle dysfunction can increase the risk of hospitalization and readmission, independent of lung function. In addition, once a patient is admitted, multiple factors can lead to worsening outcome including immobility, systemic inflammation and nutritional depletion. These non-pulmonary factors are potentially amenable to exercise therapy, as part of pulmonary rehabilitation (PR). Peri-exacerbation PR has an important role in the management of exacerbations of COPD. In this review, we explore how functional limitation and skeletal muscle dysfunction affect patients having a severe exacerbation of COPD, the systemic impact of hospitalization on patients including potential aetiologies and the role of PR around the time of an exacerbation. This includes rehabilitation during the inpatient phase, post-exacerbation rehabilitation and rehabilitation bridging hospital discharge. We also describe potential future developments in peri-exacerbation PR.
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Affiliation(s)
- Wadah Ibrahim
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Theresa C Harvey-Dunstan
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Neil J Greening
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.,Centre for Exercise and Rehabilitation Science, Institute for Lung Health, Leicester, UK
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Nonsurgical medical treatment in the management of pain due to lumbar disc prolapse: A network meta-analysis. Semin Arthritis Rheum 2019; 49:303-313. [PMID: 30940466 DOI: 10.1016/j.semarthrit.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/20/2019] [Accepted: 02/22/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evaluate the comparative effectiveness of treatment strategies for patients with pain due to lumbar disc prolapse (LDP). METHODS PubMed, EMBASE, and the Cochrane Database were searched through September 2017. Randomized controlled trials on LDP reporting on pain intensity and/or global pain effects which compared included treatments head-to-head, against placebo, and/or against conventional care were included. Study data were independently double-extracted and data on patient traits and outcomes were collected. Risk of bias was assessed using the Cochrane risk of bias tool. Separate Bayesian network meta-analyses were undertaken to synthesize direct and indirect, short-term and long-term outcomes, summarized as odds ratios (OR) or weighted mean differences (WMD) with 95% credible intervals (CI) as well as surface under the cumulative ranking curve (SUCRA) values. RESULTS 58 studies in global effects and 74 studies in pain intensity analysis were included. Thirty-eight (65.5%) of these studies reported a possible elevated risk of bias. Autonomic drugs and transforminal epidural steroid injections (TESIs) had the highest SUCRA scores at short-term follow up (86.7 and 83.5 respectively), while Cytokines/Immunomodulators and TESI had the highest SUCRA values at long-term-follow-up in the global effect's analysis (86.6 and 80.9 respectively). Caudal steroid injections and TESIs had the highest SUCRA scores at short-term follow up (79.4 and 75.9 respectively), while at long-term follow-up biological agents and manipulation had the highest SUCRA scores (86.4 and 68.5 respectively) for pain intensity. Some treatments had few studies and/or no associated placebo-controlled trials. Studies often did not report on co-interventions, systematically differed, and reported an overall elevated risk of bias. CONCLUSION No treatment stands out as superior when compared on multiple outcomes and time periods but TESIs show promise as an effective short-term treatment. High quality studies are needed to confirm many nodes of this network meta-analysis.
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Washif JA, Teichmann J, Kok LY, Schmidtbleicher D. Using stochastic resonance and strength training as part of a rehabilitation programme for recurrent low back pain treatment: a case study. J Exerc Rehabil 2019; 15:139-147. [PMID: 30899750 PMCID: PMC6416500 DOI: 10.12965/jer.1836532.266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/09/2019] [Indexed: 11/22/2022] Open
Abstract
Low back pain (LBP) is a common disabling health problem that can cause decreased spine proprioception. Stochastic resonance (SR) can influence detection performance, besides improving patients with significant sensory deficits, but have not been thoroughly tested for LBP. This study aimed to examine the application of SR therapy (SRT) and strength training for LBP treatment. The subject was a resistance-trained male in his early thirties. His back pain was unbearable after a strength training session. Standard pain relief alleviated the pain but the LBP developed at a similar intensity after 4 weeks. SRT (4-5 sets ×90 sec, 30-sec rest interval, supine position) was prescribed along with other exercises for 3 weeks (phase 1), and followed by tailor-made strength training for 16 weeks (phase 2). The Oswestry Disability Index was 66.7% (interpreted as "crippled") prior to first SRT, and reduced to minimal levels of 15.6% and 6.7% after four and seven SRT sessions, respectively. Similarly, pain intensity was ranging from 5 to 9 (distracting-severe) of the Numeric Rating Scale (NRS-11) prior to the first session but this was reduced considerably after four sessions (NRS-11: 0-1). During phase 2, the patient performed without complaining of LBP, two repetitions of bench press exercise at a load intensity of 1.2 his body weight and attained 4 min of plank stabilisation. This LBP management strategy has a clinically meaningful effect on pain intensity, disability, and functional mobility, by receding the recurrent distracting to severe LBP.
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Affiliation(s)
- Jad Adrian Washif
- Sports Performance Division, National Sports Institute, Kuala Lumpur, Malaysia
| | - Jorg Teichmann
- Sports Medicine Division, National Sports Institute, Kuala Lumpur, Malaysia
| | - Lian-Yee Kok
- Department of Sport Studies, Universiti Putra Malaysia, Serdang, Malaysia
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Liu X, Hanney WJ, Masaracchio M, Kolber MJ, Zhao M, Spaulding AC, Gabriel MH. Immediate Physical Therapy Initiation in Patients With Acute Low Back Pain Is Associated With a Reduction in Downstream Health Care Utilization and Costs. Phys Ther 2018; 98:336-347. [PMID: 29669083 DOI: 10.1093/ptj/pzy023] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/19/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Physical therapy is an important treatment option for patients with low back pain (LBP). However, whether to refer patients for physical therapy and the timing of initiation remain controversial. OBJECTIVE The objective of this study was to evaluate the impact of receiving physical therapy and the timing of physical therapy initiation on downstream health care utilization and costs among patients with acute LBP. DESIGN The design was a retrospective cohort study. METHODS Patients who had a new onset of LBP between January 1, 2009, and December 31, 2013, in New York State were identified and grouped into different cohorts on the basis of whether they received physical therapy and the timing of physical therapy initiation. The probability of service use and LBP-related health care costs over a 1-year period were analyzed. RESULTS Among 46,914 patients with acute LBP, 40,246 patients did not receive physical therapy and 6668 patients received physical therapy initiated at different times. After controlling for patient characteristics and adjusting for treatment selection bias, health care utilization and cost measures over the 1-year period were the lowest among patients not receiving physical therapy, followed by patients with immediate physical therapy initiation (within 3 days), with some exceptions. Among patients receiving physical therapy, those receiving physical therapy within 3 days were consistently associated with the lowest health care utilization and cost measures. LIMITATIONS This study was based on commercial insurance claims data from 1 state. CONCLUSIONS When referral for physical therapy is warranted for patients with acute LBP, immediate referral and initiation (within 3 days) may lead to lower health care utilization and LBP-related costs.
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Affiliation(s)
- Xinliang Liu
- Department of Health Management and Informatics, University of Central Florida, 4000 Central Florida Blvd, HPA II - 204, Orlando, FL 32816-2205 (USA)
| | | | | | - Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, Florida
| | - Mei Zhao
- Department of Health Administration, University of North Florida, Jacksonville, Florida
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Meghan H Gabriel
- Department of Health Management and Informatics, University of Central Florida
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Dennis D, Tampin B, Jacques A, Hebden-Todd T, Carter V, McLintock M, Hurn E, Cooper I. The prevalence of back pain in patients in one Australian tertiary hospital population. Musculoskeletal Care 2017; 16:112-117. [PMID: 29124882 DOI: 10.1002/msc.1219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data; to collect data around the development of BP throughout hospital admission; and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS). METHODS This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner). RESULTS Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89; 95% confidence interval (CI) 3.0 to 11.6; p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days; CI 10.8 to 15.3) than those who did not (median 10 days; CI 8.4 to 11.6; p = 0.034). CONCLUSIONS Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.
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Affiliation(s)
- Diane Dennis
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia
| | - Brigitte Tampin
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia.,Faculty of Business Management and Social Sciences, Hochschule Osnabrück, University of Applied Sciences, Osnabrück, Germany
| | - Angela Jacques
- Department of Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Tracy Hebden-Todd
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Vicki Carter
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Michelle McLintock
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Elizabeth Hurn
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ian Cooper
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, Australia
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Zhang B, Xu H, Wang J, Liu B, Sun G. A narrative review of non-operative treatment, especially traditional Chinese medicine therapy, for lumbar intervertebral disc herniation. Biosci Trends 2017; 11:406-417. [DOI: 10.5582/bst.2017.01199] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bo Zhang
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Haidong Xu
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Juntao Wang
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Bin Liu
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
| | - Guodong Sun
- Department of Traditional Chinese Medicine Orthopedics, Affiliated Hospital of Shandong Academy of Medical Sciences
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Collins MW, Kontos AP, Okonkwo DO, Almquist J, Bailes J, Barisa M, Bazarian J, Bloom OJ, Brody D, Cantu R, Cardenas J, Clugston J, Cohen R, Echemendia R, Elbin R, Ellenbogen R, Fonseca J, Gioia G, Guskiewicz K, Heyer R, Hotz G, Iverson GL, Jordan B, Manley G, Maroon J, McAllister T, McCrea M, Mucha A, Pieroth E, Podell K, Pombo M, Shetty T, Sills A, Solomon G, Thomas DG, Valovich McLeod TC, Yates T, Zafonte R. Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015. Neurosurgery 2016; 79:912-929. [PMID: 27741219 PMCID: PMC5119544 DOI: 10.1227/neu.0000000000001447] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment. OBJECTIVE To describe the current landscape of treatment for concussion and to provide summary agreements related to treatment to assist clinicians in the treatment of concussion. METHODS On October 14 to 16, 2015, the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion meeting was convened in Pittsburgh, Pennsylvania. Thirty-seven concussion experts from neuropsychology, neurology, neurosurgery, sports medicine, physical medicine and rehabilitation, physical therapy, athletic training, and research and 12 individuals representing sport, military, and public health organizations attended the meeting. The 37 experts indicated their agreement on a series of statements using an audience response system clicker device. RESULTS A total of 16 statements of agreement were supported covering (1) Summary of the Current Approach to Treating Concussion, (2) Heterogeneity and Evolving Clinical Profiles of Concussion, (3) TEAM Approach to Concussion Treatment: Specific Strategies, and (4) Future Directions: A Call to Research. Support (ie, response of agree or somewhat agree) for the statements ranged from to 97% to 100%. CONCLUSION Concussions are characterized by diverse symptoms and impairments and evolving clinical profiles; recovery varies on the basis of modifying factors, injury severity, and treatments. Active and targeted treatments may enhance recovery after concussion. Research is needed on concussion clinical profiles, biomarkers, and the effectiveness and timing of treatments. ABBREVIATIONS ARS, audience response systemCDC, Centers for Disease Control and PreventionDoD, Department of DefensemTBI, mild traumatic brain injuryNCAA, National Collegiate Athletic AssociationNFL, National Football LeagueNIH, National Institutes of HealthRCT, randomized controlled trialRTP, return to playSRC, sport- and recreation-related concussionTBI, traumatic brain injuryTEAM, Targeted Evaluation and Active Management.
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Affiliation(s)
- Michael W. Collins
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony P. Kontos
- Department of Orthopaedic Surgery, UPMC Sports Medicine Concussion Program, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon Almquist
- Fairfax Family Practice Comprehensive Concussion Center, Fairfax, Virginia
| | - Julian Bailes
- Department of Neurosurgery, NorthShore University Health System, Chicago, Illinois
| | - Mark Barisa
- Baylor Institute for Rehabilitation, Frisco, Texas
| | - Jeffrey Bazarian
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - O. Josh Bloom
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - David Brody
- Department of Neurology, Washington University, St. Louis, Missouri
| | - Robert Cantu
- Dr. Robert C. Cantu Concussion Center, Emerson Hospital, Boston University, Concord, Massachusetts
| | - Javier Cardenas
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona
| | - Jay Clugston
- Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Randall Cohen
- Athletics Department, University of Arizona, Tucson, Arizona
| | - Ruben Echemendia
- Psychological and Neurobehavioral Associates, State College, Pennsylvania
| | - R.J. Elbin
- Office for Sports Concussion Research, University of Arkansas, Fayetteville, Arkansas
| | - Richard Ellenbogen
- Department of Neurological Surgery University of Washington, Seattle, Washington
| | - Janna Fonseca
- Carolina Sports Concussion Clinic, Cary, North Carolina
| | - Gerard Gioia
- Division of Neuropsychology, Children’s National Health System, Washington, District of Columbia
| | - Kevin Guskiewicz
- College of Arts and Sciences, University of North Carolina, Chapel Hill, North Carolina
| | - Robert Heyer
- Carolinas Medical Center, Charlotte, North Carolina
| | - Gillian Hotz
- Neuroscience Center, University of Miami Miller School of Medicine, Miami, Florida
| | - Grant L. Iverson
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barry Jordan
- Neurorehabilitation, Burke Rehabilitation & Research, White Plains, New York
| | - Geoffrey Manley
- Department of Neurological Surgery, University of California at San Francisco, San Francisco, California
| | - Joseph Maroon
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Michael McCrea
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anne Mucha
- University of Pittsburgh Medical Center Centers for Rehabilitation Services, Pittsburgh, Pennsylvania
| | - Elizabeth Pieroth
- Neurological Institute, NorthShore University Health System, Chicago, Illinois
| | - Kenneth Podell
- Houston Methodist Concussion Center, Houston Methodist Hospital, Houston, Texas
| | - Matthew Pombo
- Department of Orthpoedics, Emory University Healthcare, Atlanta, Georgia
| | - Teena Shetty
- Department of Neurology, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York
| | - Allen Sills
- Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee
| | - Gary Solomon
- Department of Neurosurgery, Vanderbilt University, Vanderbilt Sports Concussion Center, Nashville, Tennessee
| | - Danny G. Thomas
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Pediatric Emergency Medicine, Children’s Hospital of Wisconsin, Wauwatosa, Wisconsin
| | | | - Tony Yates
- Pittsburgh Steelers, Pittsburgh, Pennsylvania
| | - Ross Zafonte
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Deursen LV, Snijders CJ, Patun J. Influence of Daily Life Activities on Pain in Patients with Low Back Pain. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/1355297x.2002.11736168] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Blickenstaff C, Pearson N. Reconciling movement and exercise with pain neuroscience education: A case for consistent education. Physiother Theory Pract 2016; 32:396-407. [DOI: 10.1080/09593985.2016.1194653] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Affiliation(s)
- Richard A Deyo
- From the Departments of Family Medicine, Medicine, and Public Health and Preventive Medicine, and the Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland (R.A.D.); and the Department of Orthopaedic Surgery and the Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, NH (S.K.M.)
| | - Sohail K Mirza
- From the Departments of Family Medicine, Medicine, and Public Health and Preventive Medicine, and the Oregon Institute of Occupational Health Sciences, Oregon Health and Science University, Portland (R.A.D.); and the Department of Orthopaedic Surgery and the Dartmouth Institute, Dartmouth Geisel School of Medicine, Hanover, NH (S.K.M.)
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Donovan J, Cancelliere C, Cassidy JD. Summary of the findings of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Chiropr Man Therap 2014; 22:38. [PMID: 25379171 PMCID: PMC4221725 DOI: 10.1186/s12998-014-0038-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/21/2014] [Indexed: 11/10/2022] Open
Abstract
In 2004, the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation Task Force published the first large systematic review and best evidence synthesis on the clinical course and prognosis for recovery after MTBI. Ten years later, the International Collaboration on Mild Traumatic Brain Injury Prognosis (ICoMP) formed to update the original WHO Task Force results. This summary review highlights important clinical findings from the full ICoMP results including the current evidence on the course and prognosis of recovery after MTBI in diverse patient populations (e.g., adults, athletes and children) and injury environments (e.g., motor vehicle collisions) as well as on the risk of long-term outcomes after MTBI, such as Parkinson's disease and dementia. Additional clinical areas of interest in MTBI are also discussed including the similarities between MTBI and other traumatic injuries and the risk of Second Impact Syndrome after sport concussion. Clinicians can use this information to help inform patients on the likely course of recovery after MTBI/concussion and guide better decision-making in the care of these patients.
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Affiliation(s)
- James Donovan
- />Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Carol Cancelliere
- />Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - J David Cassidy
- />Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Canada
- />Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- />Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark
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Johanne Vézina M, Hubley-Kozey CL, Egan DA. A Review of the Muscle Activation Patterns Associated with the Pelvic Tilt Exercise Used in the Treatment of Low Back Pain. J Man Manip Ther 2013. [DOI: 10.1179/jmt.1998.6.4.191] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Carlson H, Carlson N. An overview of the management of persistent musculoskeletal pain. Ther Adv Musculoskelet Dis 2012; 3:91-9. [PMID: 22870469 DOI: 10.1177/1759720x11398742] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Musculoskeletal pain is a common reason for patients to seek care from healthcare providers. These conditions are predominantly nontraumatic injuries with a broad differential diagnosis and often without a specific diagnosis despite thorough history and examination. The management of these conditions is often discouraging for patients with continued chronic symptoms despite numerous diagnostic workups and treatment options. Effective communication with respect to the patient's goals is the key to a good outcome. The combination of an accurate diagnosis, an informed, motivated patient and a comprehensive review of the potential treatment options is beneficial for long-term success.
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Affiliation(s)
- Hans Carlson
- Oregon Health and Sciences University, Orthopaedics and Rehabilitation, Portland, OR, USA
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Liebenson C. What can I do for sciatica? J Bodyw Mov Ther 2012; 16:369-371. [DOI: 10.1016/j.jbmt.2012.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND The benefits of postoperative mobilization include decreased incidence of pulmonary complications, pressure ulcers, and progression of deep vein thrombosis. However, the complexity of certain spinal reconstructions and the patient's physiologic condition may preclude the possibility of early mobilization. Prolonged bed rest after spine surgery is controversial. QUESTIONS/PURPOSES We evaluated the efficacy of prolonged bed rest after complex spine surgery to determine (1) patient characteristics that led to prescribing bed rest, (2) clinical and radiographic outcomes, (3) complications, and (4) estimated direct costs. METHODS We retrospectively reviewed all 11 patients (median age, 50 years) who underwent complex spine surgery followed by prolonged bed rest between 2005 and 2010. All patients were deemed at high risk for developing pseudarthrosis or instrumentation failure without postoperative bed rest. One patient died of complications related to pulmonary tuberculosis at 4 months. The patients averaged 3 months of bed rest. Minimum followup was 24 months (median, 30 months; range, 4-52 months). RESULTS All patients had (1) tenuous or limited fixation after correction of severe deformity, (2) previously failed spine reconstruction after early mobilization, or (3) limited treatment options if failure occurred again. No patient experienced pseudarthrosis, failure of instrumentation, thromboembolic disease, pressure ulcers, or pneumonia. One patient had a delayed union and one developed late urosepsis. The median cost of skilled nursing facilities during the period of bed rest was $16,702, while the median cost of home health nursing was $5712. CONCLUSIONS For patients with contraindications to early postoperative mobilization, prolonged bed rest may be useful to minimize the risk of complications that can occur with mobilization. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To evaluate the relationship between early physical therapy (PT) for acute low back pain and subsequent use of lumbosacral injections, lumbar surgery, and frequent physician office visits for low back pain. SUMMARY OF BACKGROUND DATA Wide practice variations exist in the treatment of acute low back pain. PT has been advocated as an effective treatment in this setting although disagreement exists regarding its purported benefits. METHODS A national 20% sample of the Centers for Medicare and Medicaid Services physician outpatient billing claims was analyzed. Patients were selected who received treatment for low back pain between 2003 and 2004 (n = 439,195). To exclude chronic low back conditions, patients were excluded if they had a prior visit for back pain, lumbosacral injection, or lumbar surgery within the previous year. Main outcome measures were rates of lumbar surgery, lumbosacral injections, and frequent physician office visits for low back pain during the following year. RESULTS Based on logistic regression analysis, the adjusted odds ratio for undergoing surgery in the group of enrollees that received PT in the acute phase (<4 weeks) compared to those receiving PT in the chronic phase (>3 months) was 0.38 (95% confidence interval [CI], 0.360.41), adjusting for age, sex, diagnosis, treating physician specialty, and comorbidity. The adjusted odds ratio for receiving a lumbosacral injection in the group receiving PT in the acute phase was 0.46 (95% CI, 0.44-0.49), and the adjusted odds ratio for frequent physician office usage in the group receiving PT in the acute phase was 0.47 (95% CI, 0.44-0.50). CONCLUSION There was a lower risk of subsequent medical service usage among patients who received PT early after an episode of acute low back pain relative to those who received PT at later times. Medical specialty variations exist regarding early use of PT, with potential underutilization among generalist specialties.
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Buranapanitkit B, Tautakul K, Lim A, Geater A, Chomchan U. CLINICAL PREDICTORS FOR OUTCOME OF TREATMENT OF LUMBAR HERNIATED NUCLEUS PALPOSUS. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0218957703000971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Herniated nucleus palposus is a common and important cause of low back pain. Despite over 90% of the patients responding to conservative treatment, some patients still need operation. This study aimed to analyze the clinical predictors for the outcome of conservative treatment in herniated nucleus palposus. Two hundred and fifty-one patients who were diagnosed as lumbar herniated nucleus palposus and admitted to Prince of Songkla University during the period of 1995–2000 were included in the study. Patients who had absolute indications for surgery or had previous back surgery were excluded. Data were collected on demographic characteristics (age, sex, occupation, level of study, marital status), patient symptoms (including duration, characteristic and severity of pain) and result of physical examination (including result of straight leg raising test (SLRT), cross SLRT, motor power, sensory deficit and reflex). The mean age of the patients was 38 years and the mean duration of pain was 4.1 months. Eighty percent of the patients had positive SLRT and abnormal neurological function was found in 73%. One hundred and eighty-six patients underwent surgery owing to failure of conservative treatment. From multivariate logistic analysis, five independent factors affecting failure of conservative treatment of herniated nucleus palposus were pain intensity, duration of symptoms, positive cross SLRT, grade of muscle power and number of dermatome deficit. When constructing the parameters into a scoring system, we found that if the patient had a score less than 45, 80% of them respond to conservative treatment, in contrast to those who scored more than 65, the probability of conservative failure was 80%. This study implies that clinical predictors can be used for determining probability of conservative failure in herniated nucleus palposus.
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Affiliation(s)
- B. Buranapanitkit
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Haadyai, Songkhla, Thailand 90110, Thailand
| | - K. Tautakul
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Haadyai, Songkhla, Thailand 90110, Thailand
| | - A. Lim
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Haadyai, Songkhla, Thailand 90110, Thailand
| | - A. Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Haadyai, Songkhla, Thailand 90110, Thailand
| | - U. Chomchan
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Haadyai, Songkhla, Thailand 90110, Thailand
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Abstract
Degenerative cervical spine disorders will affect up to two-thirds of the population in their lifetime. While often benign and episodic in nature, cervical disorders may become debilitating resulting in severe pain and possibly neurologic sequelae. Non-operative treatment continues to play an important role in treating these patients, with medications, therapy and interventional pain injections playing increasing roles in treatment. Surgical treatment including anterior and posterior decompression and fusion have been effective treatments of many cervical disorders, but may lead to significant problems including adjacent level disease. Laminotomy/foraminotomy and total disc arthroplasty may avoid some of these problems while providing similar clinical results. Ongoing clinical trials and studies are helping to define the role of these new technologies in treatment of patients with degenerative cervical disorders, although their greater benefit has yet to be proven.
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Affiliation(s)
- Andrew G Todd
- Southern Orthopedic Specialists, 2731 Napoleon Ave., New Orleans, LA, 70115, USA,
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Kennedy DJ, Noh MY. The Role of Core Stabilization in Lumbosacral Radiculopathy. Phys Med Rehabil Clin N Am 2011; 22:91-103. [DOI: 10.1016/j.pmr.2010.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Isaac Z, Katz JN. Lumbar spine disorders. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
STUDY DESIGN A prospective longitudinal study. OBJECTIVE To identify factors that influence absenteeism among soldiers with acute low back pain (ALBP). SUMMARY OF BACKGROUND DATA Recommendations for the treatment of low back pain include continuing physical activity. Ninety-seven percent of patients return to work within 1 month. METHODS This was a prospective longitudinal study using a questionnaire to assess morbidity from ALBP and the job being carried out by the soldier at the time of referral to the army clinic and 6 weeks later. Potential associations were investigated between prolonged absenteeism and variables including disease indexes, use of healthcare services, the soldier's army job, and their satisfaction with it. RESULTS.: The study population consisted of 160 soldiers with uncomplicated ALBP. Eighty-six percent of the participants returned to their job within 6 weeks. The rates of improvement in pain, the mental functioning under pain, satisfaction with jobs, and having combat status were higher among soldiers who returned to their jobs as compared with those who did not. Those who did not return to their jobs had higher rates of utilization of healthcare services. CONCLUSION Nondisease factors are associated with the duration of absenteeism among soldiers with ALBP. Absenteeism is directly related to use of healthcare services.
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Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev 2010:CD007612. [PMID: 20556780 DOI: 10.1002/14651858.cd007612.pub2] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acute low-back pain (LBP) is a common reason to consult a general practitioner. Debate continues on the comparative effectiveness of advice on bed rest and staying active as part of the primary care management. OBJECTIVES To determine the effects of advice to rest in bed or stay active for patients with acute low-back pain or sciatica. SEARCH STRATEGY We searched the Cochrane Back Review Group Trials Register, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to May 2009, reference lists of relevant articles, and contacted authors of relevant articles. SELECTION CRITERIA Randomised trials of the effectiveness of advice to stay active or rest in bed for patients with acute LBP or sciatica. The main outcomes were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed the risk of bias and extracted data. The trials were combined qualitatively or statistically, depending on data availability and presentation. MAIN RESULTS We included ten RCTs with varying risk of bias. For patients with acute LBP, results from two trials (N = 401) suggest small improvements in pain relief (SMD 0.22 (95% CI: 0.02 to 0.41) and functional status (SMD 0.29 (95% CI: 0.09 to 0.49) in favour of advice to stay active. For patients with sciatica, there is moderate quality evidence of little or no difference in pain relief (SMD -0.03 (95% CI: -0.24 to 0.18)) or functional status (SMD 0.19 (95% CI: -0.02 to 0.41)), between advice to rest in bed or stay active.Low quality evidence (3 RCTs, N = 931) suggests little or no difference between exercises, advice to rest in bed or stay active for patients with acute LBP. Low quality evidence (1 RCT, N = 250) suggests little or no difference between physiotherapy, advice to rest in bed or stay active for patients with sciatica. No trials that compared different ways of delivering advice. AUTHORS' CONCLUSIONS Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches. Low quality evidence suggests little or no difference between those who received advice to stay active, exercises or physiotherapy. Further research is very likely to have an important impact on the estimate of effect and is likely to change our confidence in it.
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Affiliation(s)
- Kristin Thuve Dahm
- Norwegian Knowledge Centre for the Health Services, PO Box 7004, St. Olavs Plass, Oslo, Norway, N-0130
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Abstract
BACKGROUND Low-back pain (LBP) is a common reason for consulting a general practitioner, and advice on daily activities is an important part of the primary care management of low-back pain. OBJECTIVES To assess the effects of advice to rest in bed for patients with acute LBP or sciatica. SEARCH STRATEGY We searched the Cochrane Back Group Specialized Registry, CENTRAL, MEDLINE, EMBASE, Sport, and SCISEARCH to March 2003, reference lists of relevant articles, and contacted authors of relevant articles. SELECTION CRITERIA Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, where the effectiveness of advice to rest in bed was evaluated. The main outcomes of interest were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS Two authors independently selected trials for inclusion, assessed the internal validity of included trials and extracted data. Investigators were contacted to obtain missing information. MAIN RESULTS Eleven trials (1963 patients) were included in this updated version. There is high quality evidence that people with acute LBP who are advised to rest in bed have a little more pain [Standardised Mean Difference (SMD) 0.22 (95% Confidence Interval (CI): 0.02, 0.41)] and a little less functional recovery [SMD 0.29 (95% CI: 0.05, 0.45)] than those advised to stay active. For patients with sciatica, there is high quality evidence of little or no difference in pain [SMD -0.03 (95% CI: -0.24, 0.18)] or functional status [SMD 0.19 (95% CI: -0.02, 0.41)], between bed rest and staying active.For patients with acute LBP, there is moderate quality evidence of little or no difference in pain intensity or functional status between bed rest and exercises. For patients with sciatica, there is moderate quality evidence of little or no difference in pain intensity between bed rest and physiotherapy, but small improvements in functional status [Weighted Mean Difference 6.9 (on a 0-100 scale) (95% CI: 1.09, 12.74)] with physiotherapy. There is moderate quality evidence of little or no difference in pain intensity or functional status between two to three days and seven days of bed rest. AUTHORS' CONCLUSIONS For people with acute LBP, advice to rest in bed is less effective than advice to stay active. For patients with sciatica, there is little or no difference between advice to rest in bed and advice to stay active. There is little or no difference in the effect of bed rest compared to exercises or physiotherapy, or seven days of bed rest compared with two to three.
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Affiliation(s)
- Kåre Birger Hagen
- Diakonhjemmet HospitalNational Resource Centre for Rehabilitation in RheumatologyPO Box 23 Vindern0319 OsloNorway
| | - Gunvor Hilde
- 38 Patterson Close SWCalgaryAlbertaCanadaT3H 3K2
| | - Gro Jamtvedt
- Norwegian Knowledge Centre for the Health ServicesPO Box 7004, St. Olavs PlassOsloNorwayN‐0130
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Challenges in using evidence to inform your clinical practice in low back pain. Best Pract Res Clin Rheumatol 2010; 24:281-9. [PMID: 20227648 DOI: 10.1016/j.berh.2009.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of evidence-based medicine (EBM) from its early days was to provide the appropriate means for making effective clinical decisions, not only for avoiding habitual practice but also for enhancing clinical performance. It is, however, unrealistic to simply assume that the results of research will soon evolve into practice. In this article, when aiming to translate results from research into practice, we focus on certain challenges, which can be broadly categorised into two: how the evidence is generated, and how the evidence is implemented. When focussing on generating evidence, a major barrier to the rapid passage of research into clinical practice is that the 'practice' in trials or research settings could be a long way from the setting, circumstances, patient groups and resources available in the daily practice of many clinicians. This is the consequence of the several choices that researchers have to make in designing a trial regarding population, measurement tools and interventions. For implementing the evidence, clinical guidelines appear to be one of the most promising and effective tools for improving the quality of care. Although the importance of implementing clinical guidelines is widely recognised, little is known about the optimal implementation strategy. We present two examples of implementing low back pain guidelines, illustrating that it remains difficult to develop effective implementation strategies. Finally, we discuss some future directions that have been proposed for EBM, which aim to overcome the essential tension between internal validity and external validity (generalisability), specifically in fields where complex syndromes and complex interventions are the focus of attention.
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Szpalski M, Hayez JP. How many days of bed rest for acute low back pain? Objective assessment of trunk function. 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 2010; 1:29-31. [PMID: 20054944 DOI: 10.1007/bf00302139] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Bed rest is usually considered an efficient treatment for acute low back pain. However, the optimal duration of bed rest is still being discussed. The recommended periods vary from 2 days to 2 weeks. The duration of optimum length is an important topic given the economical and physiological drawbacks of prolonged inactivity. The purpose of this work is to measure objectively the efficacy of two different durations of bed rest through a dynamometric measure of trunk function. Some 51 male patients, students or self-employed, being treated for acute low back pain were randomized into two groups. Group I was prescribed a bed rest period of 3 days and group II, a period of 7 days. We used a multi-axis isoinertial trunk testing dynamometric device (Isostation B200, Isotechnologies, USA). Patients were all assessed on day 1 and also on day 5 for group I or on day 9 for group II. The variables measured in the sagittal plane were isometric torques in flexion and extension, unresisted range of motion, average dynamic torques and average velocities. Patients were also asked to fill in a visual analogue pain scale on both assessment days. The improvement of all performance measures were important and highly significant (P < 0.001) in both groups. The results of the functional testing and the visual analogue pain scale showed no significant differences between the groups. In these relatively young and motivated patients, a duration of bed rest of 3 days resulted in the same objective functional improvement of trunk function and pain rating as a period of 7 days. This shorter duration should be considered as preferable, given the same objective results but important physiological and economical advantages.
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Affiliation(s)
- M Szpalski
- Department of Orthopaedic Surgery, Centre Hospitalier Molière Longchamp, Bruxelles, Belgium
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Leckie S, Sowa G. Emerging technologies for degenerative disk disease: potential synergy between biochemical signaling and spinal biomechanics. PM R 2009; 1:466-70. [PMID: 19627934 DOI: 10.1016/j.pmrj.2009.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 02/20/2009] [Accepted: 02/26/2009] [Indexed: 01/07/2023]
Abstract
Interventional spinal procedures are performed with increasing frequency, and they remain an important tool for physiatrists treating patients with spine pain. As the potential treatment options expand with novel technologies on the horizon, such as gene- and cell-based therapies, the physiatrist will be uniquely poised to deliver such treatments in conjunction with exercise-based therapies. Therefore, the development of novel technologies requires particular attention to the potential synergy between biochemical signaling and spinal biomechanics. It is hoped that such insight will result in improved treatment options for patients with pain related to degenerative disk disease, leading to improved nonoperative outcomes. This article reviews the current knowledge of precipitants of disk degeneration, the effects of beneficial and traumatic levels of disk loading, and how each of these can be impacted by novel treatment options.
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Affiliation(s)
- Steven Leckie
- Department of Orthopaedic Surgery, Ferguson Laboratory for Orthopaedic Research, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
STUDY DESIGN Comparative knowledge survey. OBJECTIVE This study compared the knowledge of orthopaedic surgeons and family practitioners in managing simple low back pain (LBP) with reference to currently published guidelines. SUMMARY OF BACKGROUND DATA LBP is the most prevalent of musculoskeletal conditions. It affects nearly everyone at some point in time and about 4% to 33% of the population at any given point. Treatment guidelines for LBP should be based on evidence-based medicine and updated to improve patient management and outcome. Studies in various fields have assessed the impact of publishing guidelines on patient management, but little is known about the physicians' knowledge of the guidelines. METHODS Orthopedic surgeons and family practitioners participating in their annual professional meetings were requested to answer a questionnaire regarding the management of simple low back pain. Answers were scored based on the national guidelines for management of low back pain. RESULTS One hundred forty family practitioners and 253 orthopaedists responded to the questionnaire. The mean family practitioners' score (69.7) was significantly higher than the orthopaedists' score (44.3) (P < 0.0001). No relation was found between the results and physician demographic factors, including seniority. Most orthopaedists incorrectly responded that they would send their patients for radiologic evaluations. They would also preferentially prescribe cyclo-oxygenase-2-specific nonsteroidal anti-inflammatory drugs, despite the guidelines recommendations to use paracetamol or nonspecific nonsteroidal anti-inflammatory drugs. Significantly less importance was attributed to patient encouragement and reassurance by the orthopaedists as compared with family physicians. CONCLUSION Both orthopaedic surgeons' and family physicians' knowledge of treating LBP is deficient. Orthopedic surgeons are less aware of current treatment than family practitioners. Although the importance of publishing guidelines and keeping them up-to-date and relevant for different disciplines in different countries cannot be overstressed, disseminating the knowledge to clinicians is also very important to ensure good practice.
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Abstract
General internists and family practitioners play an important role in the initial evaluation and treatment of acute low back pain and chronic low back pain. Given the usual time constraints placed on the primary care physician for evaluation of a patient with back pain, it is imperative that the generalist be acquainted and comfortable with the salient points in the history, the essentials of the examination, the appropriate use of diagnostic tests, and the effectiveness (or lack thereof) of available treatments.
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Affiliation(s)
- Michael Devereaux
- Neurological Institute, University Hospitals, Case Medical Center, Cleveland, OH 44106, USA.
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Panel Discussion. Am J Ther 2008; 15 Suppl 10:S24-7. [DOI: 10.1097/mjt.0b013e31818be683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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