1
|
Baroncini A, Maffulli N, Schäfer L, Manocchio N, Bossa M, Foti C, Klimuch A, Migliorini F. Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis. Sci Rep 2024; 14:11546. [PMID: 38773302 PMCID: PMC11109223 DOI: 10.1038/s41598-024-62276-9] [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: 09/12/2023] [Accepted: 05/15/2024] [Indexed: 05/23/2024] Open
Abstract
Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.
Collapse
Affiliation(s)
- Alice Baroncini
- GSpine4, IRCCS Ospedale Galeazzi - Sant'Ambrogio, Milano, Italy
| | - Nicola Maffulli
- Department of Orthopaedics, Faculty of Medicine and Psychology, University of Rome "La Sapienza", Rome, Italy
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke on Trent, ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London, E1 4DG, UK
| | - Luise Schäfer
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Nicola Manocchio
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Michela Bossa
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
| | - Alexandra Klimuch
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| |
Collapse
|
2
|
Wang H, Ding Q, Luo Y, Wu Z, Yu J, Chen H, Zhou Y, Zhang H, Tao K, Chen X, Fu J, Wu J. High-Performance Hydrogel Sensors Enabled Multimodal and Accurate Human-Machine Interaction System for Active Rehabilitation. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2309868. [PMID: 38095146 DOI: 10.1002/adma.202309868] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/03/2023] [Indexed: 12/22/2023]
Abstract
Human-machine interaction (HMI) technology shows an important application prospect in rehabilitation medicine, but it is greatly limited by the unsatisfactory recognition accuracy and wearing comfort. Here, this work develops a fully flexible, conformable, and functionalized multimodal HMI interface consisting of hydrogel-based sensors and a self-designed flexible printed circuit board. Thanks to the component regulation and structural design of the hydrogel, both electromyogram (EMG) and forcemyography (FMG) signals can be collected accurately and stably, so that they are later decoded with the assistance of artificial intelligence (AI). Compared with traditional multichannel EMG signals, the multimodal human-machine interaction method based on the combination of EMG and FMG signals significantly improves the efficiency of human-machine interaction by increasing the information entropy of the interaction signals. The decoding accuracy of the interaction signals from only two channels for different gestures reaches 91.28%. The resulting AI-powered active rehabilitation system can control a pneumatic robotic glove to assist stroke patients in completing movements according to the recognized human motion intention. Moreover, this HMI interface is further generalized and applied to other remote sensing platforms, such as manipulators, intelligent cars, and drones, paving the way for the design of future intelligent robot systems.
Collapse
Affiliation(s)
- Hao Wang
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510275, China
| | - Qiongling Ding
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510275, China
| | - Yibing Luo
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510275, China
| | - Zixuan Wu
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510275, China
| | - Jiahao Yu
- Ministry of Education Key Laboratory of Micro and Nano Systems for Aerospace, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Huizhi Chen
- Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs and School of Pharmacy, Guangdong Medical University, Dongguan, 523808, P. R. China
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, P. R. China
| | - Yubin Zhou
- Guangdong Provincial Key Laboratory of Research and Development of Natural Drugs and School of Pharmacy, Guangdong Medical University, Dongguan, 523808, P. R. China
- The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, 523808, P. R. China
| | - He Zhang
- Guangdong Provincial Key Laboratory of Technique and Equipment for Macromolecular Advanced Manufacturing, National Engineering Research Center of Novel Equipment for Polymer Processing, Key Laboratory of Polymer Processing Engineering (SCUT) Ministry of Education, South China University of Technology, Guangzhou, 510641, P. R. China
| | - Kai Tao
- Ministry of Education Key Laboratory of Micro and Nano Systems for Aerospace, Northwestern Polytechnical University, Xi'an, 710072, China
| | - Xiaoliang Chen
- Micro- and Nano-technology Research Center, State Key Laboratory for Manufacturing Systems Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, 710049, China
| | - Jun Fu
- School of Materials Science and Engineering, Sun Yat-sen University, Guangzhou, 510275, China
| | - Jin Wu
- State Key Laboratory of Optoelectronic Materials and Technologies and the Guangdong Province Key Laboratory of Display Material and Technology, School of Electronics and Information Technology, Sun Yat-sen University, Guangzhou, 510275, China
- Guangdong Provincial Key Laboratory of Technique and Equipment for Macromolecular Advanced Manufacturing, National Engineering Research Center of Novel Equipment for Polymer Processing, Key Laboratory of Polymer Processing Engineering (SCUT) Ministry of Education, South China University of Technology, Guangzhou, 510641, P. R. China
- State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, People's Republic of China
| |
Collapse
|
3
|
Li Y, Yan L, Hou L, Zhang X, Zhao H, Yan C, Li X, Li Y, Chen X, Ding X. Exercise intervention for patients with chronic low back pain: a systematic review and network meta-analysis. Front Public Health 2023; 11:1155225. [PMID: 38035307 PMCID: PMC10687566 DOI: 10.3389/fpubh.2023.1155225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 10/04/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose Chronic low back pain (CLBP) is an aging and public health issue that is a leading cause of disability worldwide and has a significant economic impact on a global scale. Treatments for CLBP are varied, and there is currently no study with high-quality evidence to show which treatment works best. Exercise therapy has the characteristics of minor harm, low cost, and convenient implementation. It has become a mainstream treatment method in clinics for chronic low back pain. However, there is insufficient evidence on which specific exercise regimen is more effective for chronic non-specific low back pain. This network meta-analysis aimed to evaluate the effects of different exercise therapies on chronic low back pain and provide a reference for exercise regimens in CLBP patients. Methods We searched PubMed, EMBASE, Cochrane Library, and Web of Science from inception to 10 May 2022. Inclusion and exclusion criteria were used for selection. We collected information from studies to compare the effects of 20 exercise interventions on patients with chronic low back pain. Results This study included 75 randomized controlled trials (RCTs) with 5,254 participants. Network meta-analysis results showed that tai chi [standardized mean difference (SMD), -2.11; 95% CI, -3.62 to -0.61], yoga (SMD, -1.76; 95% CI -2.72 to -0.81), Pilates exercise (SMD, -1.52; 95% CI, -2.68, to -0.36), and sling exercise (SMD, -1.19; 95% CI, -2.07 to -0.30) showed a better pain improvement than conventional rehabilitation. Tai chi (SMD, -2.42; 95% CI, -3.81 to -1.03) and yoga (SMD, -2.07; 95% CI, -2.80 to -1.34) showed a better pain improvement than no intervention provided. Yoga (SMD, -1.72; 95% CI, -2.91 to -0.53) and core or stabilization exercises (SMD, -1.04; 95% CI, -1.80 to -0.28) showed a better physical function improvement than conventional rehabilitation. Yoga (SMD, -1.81; 95% CI, -2.78 to -0.83) and core or stabilization exercises (SMD, -1.13; 95% CI, -1.66 to -0.59) showed a better physical function improvement than no intervention provided. Conclusion Compared with conventional rehabilitation and no intervention provided, tai chi, toga, Pilates exercise, sling exercise, motor control exercise, and core or stabilization exercises significantly improved CLBP in patients. Compared with conventional rehabilitation and no intervention provided, yoga and core or stabilization exercises were statistically significant in improving physical function in patients with CLBP. Due to the limitations of the quality and quantity of the included studies, it is difficult to make a definitive recommendation before more large-scale and high-quality RCTs are conducted.
Collapse
Affiliation(s)
- Ying Li
- College of Sports Science, Jishou University, Jishou, Hunan, China
| | - Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
- Second Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Lingyu Hou
- Department of Nursing, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaoya Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Hanping Zhao
- College of Nursing, Weifang University of Science and Technology, Weifang, Shandong, China
| | - Chengkun Yan
- School of Nursing, Nanchang University, Nanchang, Jiangxi, China
| | - Xianhuang Li
- Digestive Endoscopy Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuanhe Li
- College of Nursing, Weifang University of Science and Technology, Weifang, Shandong, China
| | - Xiaoan Chen
- College of Sports Science, Jishou University, Jishou, Hunan, China
| | - Xiaorong Ding
- Department of Nursing, Peking University Shenzhen Hospital, Shenzhen, China
| |
Collapse
|
4
|
Gu Y, Zhu H, Wang X, Zhang S, Tong P, Lv S. Exploring the mechanism of Buyang Huanwu decoction in the treatment of lumbar disc herniation based on network pharmacology and molecular docking. Medicine (Baltimore) 2022; 101:e29534. [PMID: 35960059 PMCID: PMC9371581 DOI: 10.1097/md.0000000000029534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Buyang Huanwu decoction (BYHWD), as one of the traditional Chinese medicine formulas, is widely used in the clinical treatment of lumbar disc herniation (LDH) with curative effect. It has the characteristics of multi-component, multi-target, and mutual synergy, but the mechanism of action is often unclear. It needs some research to explore the molecular mechanism of BYHWD in the treatment of LDH based on network pharmacology and molecular docking. Screen the active compounds of BYHWD and predict drug-related gene/protein targets, which could determine the specific target of BYHWD in the treatment of LDH. Construct the "Drugs-Compounds-Targets" network and search for the core targets. Use Gene Ontology functional enrichment analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis, and molecular docking verification to explore the possible molecular mechanism. Eighty-two effective compounds and 666 targets of BYHWD, 187 targets for LDH treatment, and 20 core candidate targets were excavated. A total of 3414 entries were identified by Gene Ontology enrichment analysis, 173 related signal pathways were identified by Kyoto Encyclopedia of Genes and Genomes enrichment analysis, and 5 core compounds were identified by molecular docking, which had a good affinity with core genes STAT3, JUN, AKT1, MAPK1, RELA, and PIK3CA. BYHWD may play the role of analgesic and improving function by synergistic anti-inflammatory and analgesic compounds, regulating cell metabolic differentiation, regulating immunity, and anticoagulation. BYHWD in the treatment of LDH may play a role in analgesia and improve function through multiple signaling pathways, including PI3K-Akt, mitogen-activated protein kinase, tumor necrosis factor, and interleukin-17. The PI3K-Akt signaling may be one of the key mechanisms.
Collapse
Affiliation(s)
- Yong Gu
- Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, China
| | - Haijia Zhu
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaojian Wang
- Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanxing Zhang
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- *Correspondence: Shuaijie Lv, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou
310003, China (e-mail: )
| |
Collapse
|
5
|
Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther 2022; 52:505-521. [PMID: 35722759 DOI: 10.2519/jospt.2022.10671] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP). DESIGN Systematic review with a network meta-analysis (NMA) of randomized controlled trials (RCTs). LITERATURE SEARCH Six electronic databases were systematically searched from inception to July 2021. STUDY SELECTION CRITERIA RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (aged 18-65 years) with chronic LBP. DATA SYNTHESIS We followed the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, incorporating NMAs of health care interventions) statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to surface under the cumulative ranking curve (SUCRA) values. RESULTS We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and the McKenzie method (for reducing disability). The most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises. The most effective interventions for reducing disability were Pilates, strength, and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%). CONCLUSION Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programs were those that included (1) at least 1 to 2 sessions per week of Pilates or strength exercises; (2) sessions of less than 60 minutes of core-based, strength, or mind-body exercises; and (3) training programs from 3 to 9 weeks of Pilates and core-based exercises. J Orthop Sports Phys Ther 2022;52(8):505-521. Epub: 19 June 2022. doi:10.2519/jospt.2022.10671.
Collapse
|
6
|
Anderson BG, Benzinger B, Chickness J, Hietanen C, Hill K, Lucas JMP, Tuck J, Ghassibi M. Effects of Cervical Spine Exercise Protocol on Neck Pain, Pericervical Muscle Endurance, and Range of Motion in Medical Students: A Prospective Study. Cureus 2022; 14:e27160. [PMID: 36017270 PMCID: PMC9393318 DOI: 10.7759/cureus.27160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Neck pain is a common and debilitating ailment that places a significant burden on the healthcare system. No practical protocols have been published utilizing a portable, commercially available, and affordable device that significantly reduces acute and chronic neck pain. Methods Forty-six young adults with or without mild-to-moderate neck pain completed a six-week neck stretching and strengthening protocol with a portable cervical stretching and strengthening device. The primary outcome was changes to pericervical muscle endurance. Secondary outcomes were changes to cervical range of motion (ROM), neck length, circumference, and subjective pain, flexibility, and strength. Measurements were obtained on study days 0, 21, and 42. Results A significant increase in pericervical muscle endurance was demonstrated across all planes of cervical motion, ranging from 84% to 105%. Cervical ROM improved across all planes of motion but was only significant in right-side bending (5.3°), left rotation (6.2°), and right rotation (7.8°). Subjective pain evaluated via the Numeric Rating Scale (NRS) saw statistically significant improvement as well (1.33 to 0.51). Subjective assessment of participant cervical pain, strength, and flexibility improved 61.3%, 95.7%, and 97.8%, respectively. Conclusions A six-week pericervical muscle stretching and strengthening program increased pericervical endurance and ROM in young adults. Decreased cervical pain was seen using the NRS and modified pain scale across most participants.
Collapse
|
7
|
Active, Targeted, and Measured Device-Based Therapy for Low Back Pain With the David Spine Concept. TOPICS IN GERIATRIC REHABILITATION 2021. [DOI: 10.1097/tgr.0000000000000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
8
|
Abstract
BACKGROUND Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs. OBJECTIVES The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments. SEARCH METHODS We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update. SELECTION CRITERIA We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration. DATA COLLECTION AND ANALYSIS Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo. MAIN RESULTS We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias. Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups. AUTHORS' CONCLUSIONS We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
Collapse
Affiliation(s)
- Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Jenna Ellis
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Rachel Ogilvie
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Antti Malmivaara
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
9
|
Mesa-Castrillon CI, Simic M, Ferreira ML, Hatswell K, Luscombe G, de Gregorio AM, Davis PR, Bauman A, Bunker S, Clavisi O, Knox G, Bennell KL, Ferreira PH. EHealth to empower patients with musculoskeletal pain in rural Australia (EMPoweR) a randomised clinical trial: study protocol. BMC Musculoskelet Disord 2021; 22:11. [PMID: 33402161 PMCID: PMC7783996 DOI: 10.1186/s12891-020-03866-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Low back pain (LBP) and knee osteoarthritis (OA) are major contributors to disability worldwide. These conditions result in a significant burden at both individual and societal levels. Engagement in regular physical activity and exercise programs are known to improve physical function in both chronic LBP and knee OA populations. For people residing in rural areas, musculoskeletal conditions are often more frequent and disabling compared to urban populations, which could be the result of reduced access to appropriate health services and resources in rural settings. EHealth is an innovative solution to help provide equitable access to treatment for people with musculoskeletal pain living in rural settings. METHODS/DESIGN We will conduct a randomised clinical trial investigating the effects of an eHealth intervention compared to usual care, for people with chronic non-specific LBP or knee OA in rural Australia. We will recruit 156 participants with non-specific chronic LBP or knee OA. Following the completion of baseline questionnaires, participants will be randomly allocated to either the eHealth intervention group, involving a tailored physical activity and progressive resistance exercise program remotely delivered by a physiotherapist (n = 78), or usual care (n = 78) involving referral to a range of care practices in the community. Outcomes will be measured at baseline, 3 and 6 months post-randomisation. The primary outcome will be physical function assessed by the Patient-Specific Functional Scale (PSFS). Secondary outcomes include pain intensity, physical activity levels, activity limitations, quality of life, pain coping. We will also collect process evaluation data such as recruitment rate, attendance and adherence, follow-up rate, participants' opinions and any barriers encountered throughout the trial. DISCUSSION The findings from this trial will establish the effectiveness of eHealth-delivered interventions that are known to be beneficial for people with LBP and knee OA when delivered in person. As a result, this trial will help to inform health care policy and clinical practice in Australia and beyond for those living in non-urban areas. TRIAL REGISTRATION This study was prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12618001494224 ) registered 09.05.2018.
Collapse
Affiliation(s)
- Carlos I Mesa-Castrillon
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia.
| | - Milena Simic
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| | - Manuela L Ferreira
- Faculty of Medicine and Health, The Institute of Bone and Joint Research, The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
| | - Kristy Hatswell
- Physiotherapy department, Dubbo Health Service, Western NSW Local Health District, Dubbo, NSW, Australia
| | - Georgina Luscombe
- School of Rural Health, The University of Sydney, Orange Campus, Orange, NSW, Australia
| | - Antonio Michell de Gregorio
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| | - Phillip R Davis
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| | - Adrian Bauman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Ornella Clavisi
- Musculoskeletal Australia, Muscle Bone & Joint Health Ltd, Melbourne, Australia
| | - Grahame Knox
- Physiotherapy department, Orange Health Service, Western NSW Local Health District, Orange, NSW, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Paulo H Ferreira
- Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 1825, Australia
| |
Collapse
|
10
|
Idowu OA, Adeniyi AF. Efficacy of Graded Activity with and without Daily-Monitored-Walking on Pain and Back Endurance among Patients with Concomitant Low-Back Pain and Type-2 Diabetes: A Randomized Trial. Ethiop J Health Sci 2020; 30:233-242. [PMID: 32165813 PMCID: PMC7060385 DOI: 10.4314/ejhs.v30i2.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background There is evidence supporting the efficacy of Graded Activity (GA) in managing clinical attributes of patients with Low-Back Pain (LBP) in the general population. However, it is unknown whether GA alone is efficacious in managing these clinical attributes in patients with concomitant LBP and Type-2 Diabetes (T2D) or additional daily-monitored walking will be required. Methods A single-blind controlled trial involving 58 patients (mean age: 48.3±9.4 years, 64.7% females) with concomitant LBP and T2D who received treatment twice weekly for twelve weeks was conducted. Participants were randomized into GA or GA with daily-monitored-walking (GAMW) groups. Pain Intensity (PI), Static Back Extensors Endurance (SBEE), Static Abdominal Muscular Endurance (SAME) and Glycaemic Control (GC) were assessed using Visual Analogue Scale, Biering-Sorensen test, flexor endurance test, and in2itTM device respectively at baseline, 4th, 8th and 12th week. Data were analysed using repeated measures ANOVA and Unpaired t-tests at α = 0.05. Results There were significant differences in PI, SAME and SBEE among participants in each of GA and GAMW groups respectively (p<0.05). Within-group difference on GC was significant for GAMW (6.3±0.9%, 5.7±0.7%) but not GA (6.3±0.9%, 6.3±0.9%). There was significant difference (p<0.05) between GA and GAMW group participants for SBEE (7.2±0.1 sec, 7.3±0.1 sec) at week 8 of the study and GC (-0.5±0.2%, -0.6±0.5%) at the end of the study. No differences were found between GA and GAMW groups for PI and SAME. Conclusion Graded activity with daily-monitored-walking produced positive effects on GC and yielded a better improvement on SAME and SBEE.
Collapse
Affiliation(s)
- Opeyemi Ayodiipo Idowu
- Department of Physiotherapy, School of Basic Medical Sciences, College of Medical Sciences, University of Benin, Benin-City, Nigeria
| | - Ade Fatai Adeniyi
- Department of Physiotherapy, College of Medicine, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
11
|
Integrated Physical Medicine at Employer-Sponsored Health Clinics Improves Quality of Care at Reduced Cost. J Occup Environ Med 2020; 61:382-390. [PMID: 30640844 DOI: 10.1097/jom.0000000000001536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate clinical and economic outcomes associated with integrating physical medicine in employer-sponsored clinics. METHODS Retrospective cohort analysis comparing clinical and economic outcomes of physical medicine services delivered in employer-sponsored clinics with the community. RESULTS Integrating physical medicine in employer-sponsored clinics decreased wait times to access these services to 7 days (2 to 4× faster than in the community). Patients receiving care in employer-sponsored clinics experienced marked improvements in fear of pain avoidance behaviors (P < 0.00001) and functional status (P < 0.01) in eight fewer visits than in the community (P < 0.0001), resulting in $472 to $630 savings/patient episode. Noncancer patients received 1/10th the opioid prescriptions in employer-sponsored clinics compared with the community (2.8% vs 20%). Patients were highly likely to recommend integrated employer-sponsored care (Net Promoter Score = 84.7). CONCLUSIONS Findings suggest robust clinical and economic benefits of integrating physical medicine services into employer-sponsored clinics.
Collapse
|
12
|
Kreiner DS, Matz P, Bono CM, Cho CH, Easa JE, Ghiselli G, Ghogawala Z, Reitman CA, Resnick DK, Watters WC, Annaswamy TM, Baisden J, Bartynski WS, Bess S, Brewer RP, Cassidy RC, Cheng DS, Christie SD, Chutkan NB, Cohen BA, Dagenais S, Enix DE, Dougherty P, Golish SR, Gulur P, Hwang SW, Kilincer C, King JA, Lipson AC, Lisi AJ, Meagher RJ, O'Toole JE, Park P, Pekmezci M, Perry DR, Prasad R, Provenzano DA, Radcliff KE, Rahmathulla G, Reinsel TE, Rich RL, Robbins DS, Rosolowski KA, Sembrano JN, Sharma AK, Stout AA, Taleghani CK, Tauzell RA, Trammell T, Vorobeychik Y, Yahiro AM. Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain. Spine J 2020; 20:998-1024. [PMID: 32333996 DOI: 10.1016/j.spinee.2020.04.006] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016. PURPOSE The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN This is a guideline summary review. METHODS This guideline is the product of the Low Back Pain Work Group of NASS' Evidence-Based Clinical Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members utilized NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guideline was submitted to an internal and external peer review process and ultimately approved by the NASS Board of Directors. RESULTS Eighty-two clinical questions were addressed, and the answers are summarized in this article. The respective recommendations were graded according to the levels of evidence of the supporting literature. CONCLUSIONS The evidence-based clinical guideline has been created using techniques of evidence-based medicine and best available evidence to aid practitioners in the diagnosis and treatment of adult patients with nonspecific low back pain. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flowchart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx.
Collapse
Affiliation(s)
- D Scott Kreiner
- Barrow Neurological Institute, 4530 E. Muirwood Dr. Ste. 110, Phoenix, AZ 85048-7693, USA.
| | - Paul Matz
- Advantage Orthopedics and Neurosurgery, Casper, WY, USA
| | | | - Charles H Cho
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Zoher Ghogawala
- Lahey Hospital and Medical Center, Burlington, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | | | | | - William C Watters
- Institute of Academic Medicine Houston Methodist Hospital, Houston, TX, USA
| | - Thiru M Annaswamy
- VA North Texas Health Care System, UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | - Shay Bess
- Denver International Spine Center, Denver, CO, USA
| | - Randall P Brewer
- River Cities Interventional Pain Specialists, Shreveport, LA, USA
| | | | - David S Cheng
- University of Southern California, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Park
- University Of Michigan, Ann Arbor, MI, USA
| | | | | | - Ravi Prasad
- University of California, Davis, Sacramento, CA, USA
| | | | - Kris E Radcliff
- Rothman Institute, Thomas Jefferson University, Egg Harbor Township, NJ, USA
| | | | | | | | | | | | | | | | | | | | - Ryan A Tauzell
- Choice Physical Therapy & Wellness, Christiansburg, VA, USA
| | | | - Yakov Vorobeychik
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Amy M Yahiro
- North American Spine Society, Burr Ridge, IL, USA
| |
Collapse
|
13
|
|
14
|
Motor Control Training Compared With Transcutaneous Electrical Nerve Stimulation in Patients With Disc Herniation With Associated Radiculopathy: A Randomized Controlled Trial. Am J Phys Med Rehabil 2019; 98:207-214. [PMID: 30247159 DOI: 10.1097/phm.0000000000001048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of the study was to compare the effectiveness of motor control training and transcutaneous electrical nerve stimulation in relieving pain, reducing functional disability, and improving transversus abdominis activation in patients with lumbar disc herniation with associated radiculopathy. DESIGN This is a randomized controlled trial. METHODS Forty patients diagnosed with lumbar disc herniation were randomly divided into two groups: motor control training group (n = 20) and transcutaneous electrical nerve stimulation group (n = 20). INTERVENTIONS The motor control training group and transcutaneous electrical nerve stimulation group attended 60 mini sessions twice a week for 8 wks, totaling to 16 sessions. MAIN OUTCOME MEASURES The main outcome measures are pain, functional disability, and transversus abdominis activation capacity. RESULTS Differences between both groups were observed after 8 wks, favoring the motor control training group. Motor control training was more effective than transcutaneous electrical nerve stimulation in relieving pain (mean difference = 3.3 points, 95% confidence interval = 2.12-4.48), reducing functional disability (mean difference = 8.4 points, 95% confidence interval = 5.44-11.36), improving the quality of pain (mean difference = 17 points, 95% confidence interval = 7.93-26.07), sensory quality of pain (mean difference = 10.3 points, 95% confidence interval = 5.55-15.05), and transversus abdominis activation (mean difference = 1.5 points, 95% confidence interval = 0.90-2.10). CONCLUSIONS The results suggest that motor control training is more effective than transcutaneous electrical nerve stimulation with respect to relieving pain, reducing functional disability, and improving transversus abdominis activation in patients with lumbar disc herniation.
Collapse
|
15
|
Lundwall A, Ryman A, Bjarnegård Sellius A, Mannerkorpi K. Pain requires processing - How the experience of pain is influenced by Basic Body Awareness Therapy in patients with long-term pain. J Bodyw Mov Ther 2019; 23:701-707. [PMID: 31733750 DOI: 10.1016/j.jbmt.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 02/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE Long-term pain is common and entails large costs to society. One physiotherapy treatment with documented positive effects for patients with long-term pain is Basic Body Awareness therapy (BBAT). However, studies are lacking about patients' experience of BBAT's influence on their pain. Therefore, the aim of this study was to investigate how patients experience BBAT's influence on their long-term pain. METHODS For this qualitative interview study, participants were selected from two supervised BBAT groups. To qualify for the study, participants had to meet two inclusion criteria: having pain for at least 6 months, and attending BBAT for at least 6 months. Six females between the ages of 25 and 61 years were included. Pain duration ranged from 9 to 20 years, and duration of practicing BBAT ranged from 8 to 120 months. Semi-structured interviews were conducted and qualitative content analysis was performed. RESULTS The analysis revealed four main categories of BBAT experience: increases motivation, requires processing, increases control over pain and changes attitude to oneself, body and pain. DISCUSSION Patients with long-term pain experienced BBAT as being helpful in processing their pain because they were forced to face the pain instead of trying to ignore it. Participants experienced a decrease in pain through development of an increased sense of control as well as a changed attitude to themselves, their bodies and their pain. It is important for physiotherapists to understand that pain can increase during BBAT and to support the patients in this process during the therapy.
Collapse
Affiliation(s)
- Adam Lundwall
- University of Gothenburg, Sahlgrenska Academy, Inst of Neuroscience and Physiology, Section of Health and Rehabilitation, Unit of Physiotherapy, Sweden.
| | - Anton Ryman
- University of Gothenburg, Sahlgrenska Academy, Inst of Neuroscience and Physiology, Section of Health and Rehabilitation, Unit of Physiotherapy, Sweden
| | - Anna Bjarnegård Sellius
- University of Gothenburg, Sahlgrenska Academy, Inst of Neuroscience and Physiology, Section of Health and Rehabilitation, Unit of Physiotherapy, Sweden
| | - Kaisa Mannerkorpi
- University of Gothenburg, Sahlgrenska Academy, Inst of Neuroscience and Physiology, Section of Health and Rehabilitation, Unit of Physiotherapy, Sweden
| |
Collapse
|
16
|
Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, Bowe SJ, Belavy DL. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med 2019; 54:1279-1287. [PMID: 31666220 PMCID: PMC7588406 DOI: 10.1136/bjsports-2019-100886] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 12/29/2022]
Abstract
Objective Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP). Design Network meta-analysis (NMA). Data sources MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL. Eligibility criteria Exercise training randomised controlled/clinical trials in adults with NSCLBP. Results Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): −1.86 (–2.54 to –1.19)), resistance (SUCRA=80%; −1.14 (–1.71 to –0.56)) and stabilisation/motor control (SUCRA=80%; −1.13 (–1.53 to –0.74)) for physical function and resistance (SUCRA=80%; −1.26 (–2.10 to –0.41)) and aerobic (SUCRA=80%; −1.18 (–2.20 to –0.15)) for mental health. True control was most likely (SUCRA≤10%) to be the worst treatment for all outcomes, followed by therapist hands-off control for pain (SUCRA=10%; 0.09 (–0.71 to 0.89)) and physical function (SUCRA=20%; −0.31 (–0.94 to 0.32)) and therapist hands-on control for mental health (SUCRA=20%; −0.31 (–1.31 to 0.70)). Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function (p>0.095; SUCRA<40%). NMA was not possible for trunk muscle endurance or analgesic medication. The quality of the synthesised evidence was low according to Grading of Recommendations Assessment, Development and Evaluation criteria. Summary/conclusion There is low quality evidence that Pilates, stabilisation/motor control, resistance training and aerobic exercise training are the most effective treatments, pending outcome of interest, for adults with NSCLBP. Exercise training may also be more effective than therapist hands-on treatment. Heterogeneity among studies and the fact that there are few studies with low risk of bias are both limitations.
Collapse
Affiliation(s)
- Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Niamh L Mundell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Simone J J M Verswijveren
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Scott D Tagliaferri
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Helena Brisby
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Steven J Bowe
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
17
|
Edgerton K, Hall J, Bland MK, Marshall B, Hulla R, Gatchel RJ. A physical therapist’s role in pain management: A biopsychosocial perspective. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/jabr.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Jarod Hall
- Greater Therapy Centers Lewisville Texas
| | - Michelle K. Bland
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Blaine Marshall
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Ryan Hulla
- Department of Psychology University of Texas at Arlington Arlington Texas
| | - Robert J. Gatchel
- Department of Psychology University of Texas at Arlington Arlington Texas
| |
Collapse
|
18
|
Youn AM, Hsu TM. Heated carrier fluids in decreasing propofol injection pain: a randomized, controlled trial. Korean J Anesthesiol 2016; 70:33-38. [PMID: 28184264 PMCID: PMC5296385 DOI: 10.4097/kjae.2017.70.1.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/26/2016] [Accepted: 09/30/2016] [Indexed: 11/17/2022] Open
Abstract
Background Propofol is a commonly used intravenous drug during anesthetic induction because of its rapid onset and short duration. However, the injection pain that patients experience is so severe that they recall the induction of anesthesia as the most painful part of the perioperative period. Therefore, the objective of this study was to determine the effect of heated carrier fluids (40℃) in decreasing propofol injection pain. Methods A randomized, controlled clinical trial was conducted in 90 patients aged 18 to 65 who were scheduled for either elective or urgent surgery under general anesthesia classified as American Society of Anesthesiologists physical status I or II. Patients were allocated into the following 3 groups: 1) Group W (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to propofol injection; 2) Group L (n = 30) who received 200 ml of heated carrier fluids for 20 minutes prior to 0.5 mg/kg 1%lidocaine 1 minute before propofol injection; 3) Group C (control group, n = 30) who received 200 ml of room temperature fluids prior to propofol injection. Pain was evaluated using verbal pain score (VPS). Results Group W and Group L showed significant reduction (P = 0.001) in the incidence and severity of injection pain compared to Group C. VPS scores were significantly lower in Group W and Group L compared to those of Group C. Incidence of propofol injection pain was statistically different between Group W (P = 0.005) and Group L (P = 0.037) compared to Group C, but not statistically different between Group W and Group L (P = 0.432). Conclusions Both sole injection of heated carrier fluids and the combination of 0.5 mg/kg 1%lidocaine pretreatment effectively reduced propofol injection pain.
Collapse
Affiliation(s)
- Ann Misun Youn
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Tzung-Min Hsu
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
19
|
Choi YA, Lee SU. The Strengthening Effect of Electrical Stimulation on Lumbar Paraspinal Muscles in the Sitting Position: A Randomized Controlled Trial. PM R 2016; 9:643-651. [PMID: 27840299 DOI: 10.1016/j.pmrj.2016.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 10/14/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sedentary lifestyle, a prevalent finding in modern society, can lead to weakness of the lumbar trunk musculature. Electrical stimulation (ES), in addition to lumbar strengthening exercises, has been shown to increase muscle strength. OBJECTIVE To assess the strengthening effect of ES on the lumbar paraspinal muscles during prolonged sitting. DESIGN Randomized, controlled, single-blind study. SETTING Tertiary hospital. PARTICIPANTS Thirty healthy subjects without low back pain. METHODS Thirty participants were randomly assigned to the ES group (n = 15) or the control group (n = 15). ES was administered over the lumbar paraspinal muscles, while subjects maintained a seated posture, at a maximal tolerable intensity for 60 minutes per day, three times per week, for 4 consecutive weeks. An identical protocol was used in the control group with muscle stimulation provided at the minimal sensory threshold intensity. MAIN OUTCOME MEASUREMENTS The isokinetic strength of the lumbar paraspinal muscles was evaluated at baseline, 4 weeks after the initiation of ES, and 8 weeks after the initiation of ES with an isokinetic dynamometer (Biodex Medical Dynamometer System-4) at 60°/s and 120°/s angular velocities. RESULTS The extension and flexion peak torque at 60°/s showed no significant interaction between the time and intervention or between the interventions. However, after 4 weeks of ES in the sitting position, the isokinetic extensor trunk muscle strength measured at 120°/s angular velocity significantly increased in the ES group (P < .05) compared with that in the control group. This effect was not maintained when measured at 4 weeks after the cessation of ES. CONCLUSIONS ES in a sitting position is a potentially effective and accessible rehabilitation treatment, which can lead to short-term improvement in the extensor trunk muscle strength of the lumbar paraspinal muscles. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Young-Ah Choi
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea(∗)
| | - Shi-Uk Lee
- Department of Physical Medicine & Rehabilitation, Seoul National University College of Medicine, Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea(†).
| |
Collapse
|
20
|
Crawford C, Boyd C, Paat CF, Price A, Xenakis L, Yang E, Zhang W. The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population. PAIN MEDICINE (MALDEN, MASS.) 2016; 17:1353-1375. [PMID: 27165971 PMCID: PMC4925170 DOI: 10.1093/pm/pnw099] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pain is multi-dimensional and may be better addressed through a holistic, biopsychosocial approach. Massage therapy is commonly practiced among patients seeking pain management; however, its efficacy is unclear. This systematic review and meta-analysis is the first to rigorously assess the quality of massage therapy research and evidence for its efficacy in treating pain, function-related and health-related quality of life outcomes across all pain populations. METHODS Key databases were searched from inception through February 2014. Eligible randomized controlled trials were assessed for methodological quality using SIGN 50 Checklist. Meta-analysis was applied at the outcome level. A diverse steering committee interpreted the results to develop recommendations. RESULTS Sixty high quality and seven low quality studies were included in the review. Results demonstrate massage therapy effectively treats pain compared to sham [standardized mean difference (SMD) = -.44], no treatment (SMD = -1.14), and active (SMD = -0.26) comparators. Compared to active comparators, massage therapy was also beneficial for treating anxiety (SMD = -0.57) and health-related quality of life (SMD = 0.14). CONCLUSION Based on the evidence, massage therapy, compared to no treatment, should be strongly recommended as a pain management option. Massage therapy is weakly recommended for reducing pain, compared to other sham or active comparators, and improving mood and health-related quality of life, compared to other active comparators. Massage therapy safety, research challenges, how to address identified research gaps, and necessary next steps for implementing massage therapy as a viable pain management option are discussed.
Collapse
|
21
|
Efficacy of the Multifidus Retraining Program in Computer Professionals with Chronic Low Back Pain. Asian Spine J 2016; 10:450-6. [PMID: 27340523 PMCID: PMC4917762 DOI: 10.4184/asj.2016.10.3.450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/26/2022] Open
Abstract
Study Design Randomized controlled trial. Purpose To contrast the efficacy of two exercise programs—multifidus retraining program (MRP) and traditional back exercises (TBE)—on pain and functional disability in individuals with chronic low back pain. Overview of Literature Low back pain is a common musculoskeletal disorder. Mechanical low back pain does not involve nerve roots. Stability of the spine is provided by the ligaments and muscles of the lower back and abdomen. Although weakness of the superficial trunk and abdominal muscles are the primary risk factors, recent studies have demonstrated the involvement of weakness and lack of control of the deep trunk muscles, especially the multifidus and transverse abdominis muscles. Therefore, exercises to restore optimal lumbar multifidus function are important in rehabilitation strategies. Methods Thirty individuals were randomly assigned to receive TBE, where exercises focused on the superficial muscles of abdomen and low back (control, group A) and MRP, where exercises focused on the deep multifidus muscles fibers (experimental, group B). Groups were examined to find the effect of these exercises on visual analog scale rated pain (visual analogical scale) and functional disability assessed by the Oswestry disability questionnaire. The exercise program lasted for 6 weeks on alternate days, with 20 repetitions of each exercise, with each move held for 5–8 seconds. Subjects were evaluated at the start of the study and after completion of the 6-week exercise program. Results As compared to baseline, both treatments were effective in relieving pain and improving disability (p<0.001). The MRP group had significant gains for pain and functional disability when compared to the TBE group (both p<0.001). Conclusions Both techniques lessen pain and reduce disability. MRP is superior to TBE in reducing pain and improving function.
Collapse
|
22
|
Jeong M, Yoon H. Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized, double-blind controlled trial. Int J Nurs Stud 2016; 61:209-18. [PMID: 27372434 DOI: 10.1016/j.ijnurstu.2016.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/17/2016] [Accepted: 06/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce propofol injection pain. OBJECTIVE To compare the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain. DESIGN Prospective, double-blind, randomized controlled trial. SETTING The 555 bed, non-teaching National Cancer Center in Kyunggido, South Korea. PARTICIPANTS A total of 96 patients who underwent thyroidectomy under total intravenous general anesthesia with propofol were randomly allocated to the control, lidocaine pre-administration (LA) or local warming (LW) group. METHODS All three groups received 2% propofol with an effect-site target at 3μg/mL for induction dose. The control group received 2% propofol with no intervention. The lidocaine pre-administration group received 2% propofol 30s after 1% lidocaine 30mg. The local warming group received 2% propofol after warming of the intravenous access site for 1min using 43°C forced air. Propofol injection pain was assessed by four-point verbal categorial scoring (VCS), numerical rating scale (NRS) and surgical pleth index (SPI). RESULTS Pain VCS of the LA group (mean±SD, 1.11±0.45) was significantly reduced (U=-3.92, p<.001) compared to the control group (mean±SD, 1.71±0.74). Pain VCS of the LW group (mean±SD, 0.76±0.44) was significantly reduced (U=-5.17, p<.001) compared to the control group (mean±SD, 1.71±0.74). Pain VCS of the LW group was significantly reduced compared to the LA group (U=-3.33, p=.001]. Pain NRS of the LA group (mean±SD, 4.31±2.32) was significantly reduced (mean difference, 1.82; 95% CI, 0.63-3.00; p=.003) compared to the control group (mean±SD, 6.13±2.39). Pain NRS of the LW group (mean±SD, 3.06±2.37) was significantly reduced (mean difference, 3.07; 95% CI, 1.63-4.51; p<.009) compared to the control group. There were significant differences in pain NRS between the LA group and the LW group (mean difference, 1.25; 95% CI, 0.09-2.42; p=.035). SPI of the LA group (mean±SD, 64.1±16.3) was significantly reduced (mean difference control versus LA, 8.36; 95% CI, 1.64-15.1; p=.016) compared to the control group (mean±SD, 72.5±9.56). SPI of the LW group (mean±SD, 55.0±16.2) was significantly reduced (mean difference control versus LW, 17.4; 95% CI, 10.8-24.0; p<.001) compared to the control group. There was a significant difference in SPI between the LA group and LW group (mean difference, 9.06; 95% CI, 1.02-17.1; p=.028). CONCLUSION Local warming of the intravenous access site by 43°C forced air for 1min is slightly more effective in reducing propofol injection pain compared to lidocaine pre-administration.
Collapse
Affiliation(s)
- Meejeong Jeong
- Department of Nursing, National Cancer Center, South Korea
| | - Haesang Yoon
- College of Nursing, Gachon University, South Korea.
| |
Collapse
|
23
|
Electromyographic Changes in Trunk Muscles During Graded Lumbar Stabilization Exercises. PM R 2016; 8:979-989. [DOI: 10.1016/j.pmrj.2016.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/09/2016] [Accepted: 05/17/2016] [Indexed: 11/22/2022]
|
24
|
Amano S, Ludin AFM, Clift R, Nakazawa M, Law TD, Rush LJ, Manini TM, Thomas JS, Russ DW, Clark BC. Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial. Trials 2016; 17:81. [PMID: 26867541 PMCID: PMC4751635 DOI: 10.1186/s13063-016-1214-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low back pain is a highly prevalent condition in the United States and has a staggeringly negative impact on society in terms of expenses and disability. It has previously been suggested that rehabilitation strategies for persons with recurrent low back pain should be directed to the medial back muscles as these muscles provide functional support of the lumbar region. However, many individuals with low back pain cannot safely and effectively induce trunk muscle adaptation using traditional high-load resistance exercise, and no viable low-load protocols to induce trunk extensor muscle adaptation exist. Herein, we present the study protocol for a randomized controlled trial that will investigate the "cross-transfer" of effects of a novel exercise modality, blood flow restricted exercise, on cross-sectional area (primary outcome), strength and endurance (secondary outcomes) of trunk extensor muscles, as well as the pain, disability, and rate of recurrence of low back pain (tertiary outcomes). METHODS AND STUDY DESIGN This is a single-blinded, single-site, randomized controlled trial. A minimum of 32 (and up to 40) subjects aged 18 to 50 years with recurrent low back pain and poor trunk extensor muscle endurance will be recruited, enrolled and randomized. After completion of baseline assessments, participants will be randomized in a 1:1 ratio to receive a 10-week resistance exercise training program with blood flow restriction (BFR exercise group) or without blood flow restriction (control exercise group). Repeat assessments will be taken immediately post intervention and at 12 weeks after the completion of the exercise program. Furthermore, once every 4 weeks during a 36-week follow-up period, participants will be asked to rate their perceived disability and back pain over the past 14 days. DISCUSSION This study will examine the potential for blood flow restricted exercise applied to appendicular muscles to result in a "cross-transfer" of therapeutic effect to the lumbar musculature in individuals with low back pain. The results of this study will provide important insights into the effectiveness of this novel exercise modality, which could potentially provide the foundation for a cost-effective and easy-to-implement rehabilitation strategy to induce muscle adaptation in the absence of high mechanical and compressive loading on the spine. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (registration number: NCT02308189, date of registration: 2 December 2014).
Collapse
Affiliation(s)
- Shinichi Amano
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Arimi Fitri Mat Ludin
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA.,Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rachel Clift
- Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Masato Nakazawa
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Office of Research and Grants, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Timothy D Law
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Family Medicine, Ohio University, Athens, OH, 45701, USA.
| | - Laura J Rush
- Clinical and Translational Research Unit (CTRU), Ohio University, Athens, OH, 45701, USA.
| | - Todd M Manini
- Department of Geriatric Medicine, University of Florida, 2004 Mowry Road, PO Box 100107, Gainesville, FL, 32611, USA.
| | - James S Thomas
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Division of Physical Therapy, The School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA.
| | - David W Russ
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Division of Physical Therapy, The School of Rehabilitation and Communication Sciences, Ohio University, Athens, OH, 45701, USA.
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute (OMNI), Ohio University, 250 Irvine Hall, 1 Ohio University, Athens, OH, 43147, USA. .,Department of Biomedical Sciences, Ohio University, Athens, OH, 45701, USA. .,Department of Geriatric Medicine, Ohio University, Institute on Aging, Athens, OH, USA.
| |
Collapse
|
25
|
Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2016; 17:755-74. [PMID: 26844416 DOI: 10.1016/j.jpain.2016.01.473] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 12/05/2015] [Accepted: 01/14/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Nonspecific chronic spinal pain (NSCSP) is highly disabling. Current conservative rehabilitation commonly includes physical and behavioral interventions, or a combination of these approaches. Physical interventions aim to enhance physical capacity by using methods such as exercise, manual therapy, and ergonomics. Behavioral/psychologically informed interventions aim to enhance behaviors, cognitions, or mood by using methods such as relaxation and cognitive behavioral therapy. Combined interventions aim to target physical and also behavioral/psychological factors contributing to patients' pain by using methods such as multidisciplinary pain management programs. Because it remains unclear whether any of these approaches are superior, this review aimed to assess the comparative effectiveness of physical, behavioral/psychologically informed, and combined interventions on pain and disability in patients with NSCSP. Ten electronic databases were searched for randomized controlled trials (RCTs) including participants reporting NSCSP. Studies were required to have an "active" conservative treatment control group for comparison. Studies were not eligible if the interventions were from the same domain (eg, if the study compared 2 physical interventions). Study quality was assessed used the Cochrane Back Review Group risk of bias criteria. The treatment effects of physical, behavioral/psychologically informed, and combined interventions were assessed using meta-analyses. Twenty-four studies were included. No clinically significant differences were found for pain and disability between physical, behavioral/psychologically informed, and combined interventions. The simple categorization of interventions into physical, behavioral/psychologically informed, and combined could be considered a limitation of this review, because these interventions may not be easily differentiated to allow accurate comparisons to be made. Further work should consider investigating whether tailoring rehabilitation to individual patients and their perceived risk of chronicity, as seen in recent RCTs for low back pain, can enhance outcomes in NSCSP. PERSPECTIVE In this systematic review of RCTs in NSCSP, only small differences in pain or disability were observed between physical, behavioral/psychologically informed, and combined interventions.
Collapse
|
26
|
Abstract
BACKGROUND Low-back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. It is experienced by 70% to 80% of adults at some time in their lives. Massage therapy has the potential to minimize pain and speed return to normal function. OBJECTIVES To assess the effects of massage therapy for people with non-specific LBP. SEARCH METHODS We searched PubMed to August 2014, and the following databases to July 2014: MEDLINE, EMBASE, CENTRAL, CINAHL, LILACS, Index to Chiropractic Literature, and Proquest Dissertation Abstracts. We also checked reference lists. There were no language restrictions used. SELECTION CRITERIA We included only randomized controlled trials of adults with non-specific LBP classified as acute, sub-acute or chronic. Massage was defined as soft-tissue manipulation using the hands or a mechanical device. We grouped the comparison groups into two types: inactive controls (sham therapy, waiting list, or no treatment), and active controls (manipulation, mobilization, TENS, acupuncture, traction, relaxation, physical therapy, exercises or self-care education). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures and followed CBN guidelines. Two independent authors performed article selection, data extraction and critical appraisal. MAIN RESULTS In total we included 25 trials (3096 participants) in this review update. The majority was funded by not-for-profit organizations. One trial included participants with acute LBP, and the remaining trials included people with sub-acute or chronic LBP (CLBP). In three trials massage was done with a mechanical device, and the remaining trials used only the hands. The most common type of bias in these studies was performance and measurement bias because it is difficult to blind participants, massage therapists and the measuring outcomes. We judged the quality of the evidence to be "low" to "very low", and the main reasons for downgrading the evidence were risk of bias and imprecision. There was no suggestion of publication bias. For acute LBP, massage was found to be better than inactive controls for pain ((SMD -1.24, 95% CI -1.85 to -0.64; participants = 51; studies = 1)) in the short-term, but not for function ((SMD -0.50, 95% CI -1.06 to 0.06; participants = 51; studies = 1)). For sub-acute and chronic LBP, massage was better than inactive controls for pain ((SMD -0.75, 95% CI -0.90 to -0.60; participants = 761; studies = 7)) and function (SMD -0.72, 95% CI -1.05 to -0.39; 725 participants; 6 studies; ) in the short-term, but not in the long-term; however, when compared to active controls, massage was better for pain, both in the short ((SMD -0.37, 95% CI -0.62 to -0.13; participants = 964; studies = 12)) and long-term follow-up ((SMD -0.40, 95% CI -0.80 to -0.01; participants = 757; studies = 5)), but no differences were found for function (both in the short and long-term). There were no reports of serious adverse events in any of these trials. Increased pain intensity was the most common adverse event reported in 1.5% to 25% of the participants. AUTHORS' CONCLUSIONS We have very little confidence that massage is an effective treatment for LBP. Acute, sub-acute and chronic LBP had improvements in pain outcomes with massage only in the short-term follow-up. Functional improvement was observed in participants with sub-acute and chronic LBP when compared with inactive controls, but only for the short-term follow-up. There were only minor adverse effects with massage.
Collapse
Affiliation(s)
- Andrea D Furlan
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Mario Giraldo
- Hospital Universitario San Vicente FundaciónMedicina Física y RehabilitaciónMedellínColombia
| | - Amanda Baskwill
- Humber Institute of Technology and Advanced LearningMassage Therapy Department205 Humber College BoulevardTorontoONCanadaM9W 5L7
| | - Emma Irvin
- Institute for Work & Health481 University Avenue, Suite 800TorontoONCanadaM5G 2E9
| | - Marta Imamura
- University of São Paulo School of MedicineDivision of Physical Medicine and Rehabilitation, Department of Orthopaedics and TraumatologySão PaoloBrazil
| | | |
Collapse
|
27
|
Galdas P, Darwin Z, Fell J, Kidd L, Bower P, Blickem C, McPherson K, Hunt K, Gilbody S, Richardson G. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSelf-management support interventions can improve health outcomes, but their impact is limited by the numbers of patients able or willing to access them. Men’s attendance at, and engagement with, self-management support appears suboptimal despite their increased risk of developing serious and disabling long-term conditions (LTCs).ObjectivesTo assess the effectiveness, cost-effectiveness, accessibility and acceptability of self-management support interventions in men with LTCs.MethodsA quantitative systematic review with meta-analysis and a qualitative review using a metaethnography approach. The findings of the two reviews were integrated in parallel synthesis.Data sourcesIn the quantitative review, the Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by gender. In the qualitative review, the databases Cumulative Index to Nursing and Allied Health Literature, EMBASE, Medical Literature Analysis and Retrieval System Online, PsycINFO and Social Science Citation Index (July 2013) were searched from inception to July 2013.Review methodsIn the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis.ResultsForty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men.ConclusionsHealth professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities.Study registrationThis study is registered as PROSPERO CRD42013005394.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Zoe Darwin
- School of Healthcare, Faculty of Medicine, University of Leeds, Leeds, UK
| | - Jennifer Fell
- Department of Health Sciences, University of York, York, UK
| | - Lisa Kidd
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christian Blickem
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Kerri McPherson
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Kate Hunt
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | |
Collapse
|
28
|
Shahtahmassebi B, Hebert JJ, Stomski NJ, Hecimovich M, Fairchild TJ. The effect of exercise training on lower trunk muscle morphology. Sports Med 2015; 44:1439-58. [PMID: 25015476 DOI: 10.1007/s40279-014-0213-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Skeletal muscle plays an important role in maintaining the stability of the lumbar region. However, there is conflicting evidence regarding the effects of exercise on trunk muscle morphology. OBJECTIVE To systematically review the literature on the effects of exercise training on lower trunk muscle morphology to determine the comparative effectiveness of different exercise interventions. DATA SOURCE AND STUDY SELECTION A systematic search strategy was conducted in the following databases: PubMed, SportDiscus, CINAHL, the Cochrane Library and PEDro. We included full, peer-reviewed, prospective longitudinal studies, including randomized controlled trials and single-group designs, such as pre- to post-intervention and crossover studies, reporting on the effect of exercise training on trunk muscle morphology. STUDY APPRAISAL AND SYNTHESIS Study quality was assessed with the Cochrane risk-of-bias tool. We classified each exercise intervention into four categories, based on the primary exercise approach: motor control, machine-based resistance, non-machine-based resistance or cardiovascular. Treatment effects were estimated using within-group standardized mean differences (SMDs). RESULTS The systematic search identified 1,911 studies; of which 29 met our selection criteria: motor control (n = 12), machine-based resistance (n = 10), non-machine-based resistance (n = 5) and cardiovascular (n = 2). Fourteen studies (48 %) reported an increase in trunk muscle size following exercise training. Among positive trials, the largest effects were reported by studies testing combined motor control and non-machine-based resistance exercise (SMD [95 % CI] = 0.66 [0.06 to 1.27] to 3.39 [2.80 to 3.98]) and machine-based resistance exercise programmes (SMD [95 % CI] = 0.52 [0.01 to 1.03] to 1.79 [0.87 to 2.72]). Most studies investigating the effects of non-machine-based resistance exercise reported no change in trunk muscle morphology, with one study reporting a medium effect on trunk muscle size (SMD [95 % CI] = 0.60 [0.03 to 1.16]). Cardiovascular exercise interventions demonstrated no effect on trunk muscle morphology (SMD [95 % CI] = -0.16 [-1.14 to 0.81] to 0.09 [-0.83 to 1.01]). LIMITATIONS We excluded studies published in languages other than English, and therefore it is possible that the results of relevant studies are not represented in this review. There was large clinical heterogeneity between the included studies, which prevented data synthesis. Among the studies included in this review, common sources of potential bias were random sequence generation, allocation concealment and blinding. Finally, the details of the exercise parameters were poorly reported in most studies. CONCLUSION Approximately half of the included studies reported an increase in lower trunk muscle size following participation in an exercise programme. Among positive trials, studies involving motor control exercises combined with non-machine-based resistance exercise, as well as machine-based resistance exercises, demonstrated medium to large effects on trunk muscle size. Most studies examining the effect of non-machine-based resistance exercise and all studies investigating cardiovascular exercise reported no effect on trunk muscle morphology. However, these results should be interpreted with caution because of the substantial risk of bias and suboptimal reporting of exercise details in the included studies. Additional research, using methods ensuring a low risk of bias, are required to further elucidate the effects of exercise on trunk muscle morphology.
Collapse
Affiliation(s)
- Behnaz Shahtahmassebi
- School of Psychology and Exercise Science, Murdoch University, SS2.015, 90 South Street, Murdoch, Perth, WA, 6150, Australia
| | | | | | | | | |
Collapse
|
29
|
Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil 2015; 29:1155-67. [PMID: 25681408 DOI: 10.1177/0269215515570379] [Citation(s) in RCA: 310] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/20/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine, for adults with chronic low back pain, which exercise interventions are the most effective at reducing pain compared to other treatments. DATA SOURCES A search of MEDLINE, CINAHL, EMBASE, SPORTDiscus, PsycINFO and The Cochrane Library was conducted up to October 2014. REVIEW METHODS Databases were searched for published reports of randomised trials that investigated the treatment of chronic low back pain of non-specific origin with an exercise intervention. Two authors independently reviewed and selected relevant trials. Methodological quality was evaluated using the Downs and Black tool. RESULTS Forty-five trials met the inclusion criteria and thirty-nine were included in the meta-analysis. Combined meta-analysis revealed significantly lower chronic low back pain with intervention groups using exercise compared to a control group or other treatment group (Standard Mean Deviation (SMD) =-0.32, CI 95% -0.44 to -0.19, P<0.01). Separate exploratory subgroup analysis showed a significant effect for strength/resistance and coordination/stabilisation programs. CONCLUSIONS Our results found a beneficial effect for strength/resistance and coordination/stabilisation exercise programs over other interventions in the treatment of chronic low back pain and that cardiorespiratory and combined exercise programs are ineffective.
Collapse
Affiliation(s)
- Angela Searle
- Discipline of Podiatry, University of Newcastle, NSW, Australia
| | - Martin Spink
- Discipline of Podiatry, University of Newcastle, NSW, Australia
| | - Alan Ho
- School of Psychology, Faculty of Science and Information Technology, University of Newcastle, NSW, Australia
| | - Vivienne Chuter
- Discipline of Podiatry, University of Newcastle, NSW, Australia Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Australia
| |
Collapse
|
30
|
Force Capacity of Back Extensor Muscles in Healthy Males: Effects of Age and Recovery Time. J Appl Biomech 2014; 30:713-21. [DOI: 10.1123/jab.2013-0308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To judge a person’s maximum trunk extension performance as either age-appropriate or deconditioned is challenging. The current study aimed at determining age and anthropometrically adjusted maximum voluntary contraction (MVC) of back extensors considering the number and recovery time between trials. Thirty-one younger (20–30 years) and 33 older (50–60 years) healthy males performed five repetitions of maximal isometric trunk extensions in an upright standing position with randomized recovery times ranging between one to five minutes at one minute intervals. Torque values were normalized according to the individual’s upper body mass resulting in upper body torque ratios (UBTR). To evaluate the impact of age, recovery time, and fatigue on UBTR we applied a linear mixed-effects model. Based on surface EMG data muscular fatigue could be excluded for both groups. For all MVC trials, UBTR levels differed significantly between age groups (range of mean values: younger: 2.26–2.28, older: 1.78–1.87, effect size: 1.00) but were independent from recovery time. However, the older males tended to exert higher UBTR values after shorter recovery periods. The study provides normative values of anthropometrically and age-group adjusted maximum back extensor forces. For the investigated groups, only two MVC trials with a recovery time of about one minute seem appropriate.
Collapse
|
31
|
Kankaanpää M, Colier WN, Taimela S, Anders C, Airaksinen O, Kokko-Aro SM, Hänninen O. Back extensor muscle oxygenation and fatigability in healthy subjects and low back pain patients during dynamic back extension exertion. ACTA ACUST UNITED AC 2014; 12:267-73. [PMID: 16289763 DOI: 10.1016/j.pathophys.2005.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2005] [Revised: 09/12/2005] [Accepted: 09/13/2005] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to assess if chronic low back pain patients have impaired paraspinal muscle O2 turnover and endurance capacity as compared to healthy control subjects during dynamic exercise. Middle-aged healthy male subjects (n = 12, control) and male patients with chronic low back pain (n = 17, CLBP) participated in the study. L4–L5 level paraspinal muscle fatigue was objectively assessed during earlier validated 90 s dynamic back endurance test (spectral EMG, MPFslope). Also EMG amplitude (EMGamplitude) and initial MPF (MPFinitial) were assessed from the initial 5 s of the endurance contraction. Simultaneously near infrared spectroscopy (NIRS) was used for quantitative measurement of local L4–L5 paraspinal muscle O2 consumption. Subcutaneous tissue thickness (ATT) was measured from the EMG and NIRS recording sites. The results indicated that control and CLBP groups were compatible as regarding anthropometric variables, paraspinal muscle activation levels (EMGamplitude), initial MPF (MPFinitial) and ATT. When the ATT was used as a covariate in the ANOVA analysis, CLBP group did not show significantly greater paraspinal muscle fatigability (right MPFslope – 12.2 ± 10.7%/min, left right MPFslope – 12.6 ± 13.3%/min) or O2 consumption (right NIRSslope – 52.8 ± 79.6 μM/l/s) as compared to healthy controls (right MPFslope – 11.9 ± 7.6%/min, left MPFslope – 12.7 ± 8.6%/min, right NIRSslope – 53.7 ± 95.2 μM/l/s). As a conclusion, these CLBP male patients did not show any impaired rate of paraspinal muscle oxygen consumption or excessive paraspinal muscle fatigability during dynamic exercise as compared with healthy controls. Subcutaneous tissue thickness has a strong influence on the NIRS and EMG amplitude measurements and, if unchecked, it could result in the false interpretation of the results.
Collapse
Affiliation(s)
- Markku Kankaanpää
- Department of Physical Medicine and Rehabilitation, Kuopio University Hospital, P.O. Box 1777, 70211 Kuopio, Finland.
| | | | | | | | | | | | | |
Collapse
|
32
|
Chen KB, Ponto K, Sesto ME, Radwin RG. Influence of altered visual feedback on neck movement for a virtual reality rehabilitative system. ACTA ACUST UNITED AC 2014. [DOI: 10.1177/1541931214581162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper investigates altering visual feedback during neck movement through control-display (C-D) gain for a head-mounted display, for the purpose of determining the just noticeable difference (JND) for encouraging individuals with kinesiophobia (i.e. fear avoidance of movement due to chronic pain) to effectively perform therapeutic neck exercises. The JND was defined as .25 probability of detecting a difference from unity C-D gain (gain=1). A target-aiming task with two consecutive neck moves per trial was presented; one neck move had varying C-D gain and the other had unity gain. The VR system was able to influence neck moves without changing locations of the target. Participants indicated whether the two neck movements were the same or different. Logistic regression revealed that the JND gains were 0.903 (lower bound) and 1.159 (upper bound) as the participants could not discriminate a 55° turn, ranging from 49.7° to 63.7°. This preliminary study shows that immersive VR with altered visual feedback influenced movement. The feasibility for rehabilitation of individuals with kinesiophobia will next be assessed.
Collapse
|
33
|
Wong AY, Parent EC, Funabashi M, Kawchuk GN. Do Changes in Transversus Abdominis and Lumbar Multifidus During Conservative Treatment Explain Changes in Clinical Outcomes Related to Nonspecific Low Back Pain? A Systematic Review. THE JOURNAL OF PAIN 2014; 15:377.e1-35. [DOI: 10.1016/j.jpain.2013.10.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/07/2013] [Accepted: 10/17/2013] [Indexed: 01/08/2023]
|
34
|
Abdolahian S, Ghavi F, Abdollahifard S, Sheikhan F. Effect of dance labor on the management of active phase labor pain & clients' satisfaction: a randomized controlled trial study. Glob J Health Sci 2014; 6:219-26. [PMID: 24762366 PMCID: PMC4825221 DOI: 10.5539/gjhs.v6n3p219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/14/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are a wide variety of non- pharmacologic pain relief techniques for labor which include pelvic movement, upright position, back massage and partner support during the first stage of labor. The effectiveness of dance labor- which is a combination of these techniques- has not been evaluated. AIM This study aimed to evaluate the effectiveness of dance labor in pain reduction and woman's satisfaction during the first stage of labor. METHODS 60 primiparous women aged 18-35 years old were randomly assigned to dance labor and control groups. In the dance labor group, women were instructed to do standing upright with pelvic tilt and rock their hips back and forth or around in a circle while their partner massaged their back and sacrum for a minimum of 30 minutes. In the control group, the participants received usual care during physiologic labor. Pain and satisfaction scores were measured by Visual Analogue Scale. Data were analyzed by using the t. test and Chi-square. FINDINGS Mean pain score in the dance labor group was significantly lower than the control group (P < 0.05). The mean satisfaction score in the dance labor group was significantly higher than in the control group (P < 0.05). CONCLUSION Dance labor which is a complementary treatment with low risk can reduce the intensity of pain and increase mothers, satisfaction with care during the active phase of labor.
Collapse
Affiliation(s)
| | - Fatemeh Ghavi
- Department of Nursing and Midwifery, Jahrom University of Medical Sciences, Jahrom, Iran.
| | | | | |
Collapse
|
35
|
Abstract
BACKGROUND AND OBJECTIVES Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. The aim of this paper is to review exercises for nonspecific low back pain treatment. CONTENT This paper provides a definition and classification of back pain. Incidence and mechanisms of nonspecific low back pain and exercises used for its treatment are hereby reported. CONCLUSION The most effective types of exercise therapy for chronic or acute low back pain are still controversial; however, exercise therapy is probably the most widely used conservative treatment throughout the world.
Collapse
|
36
|
Artus M, van der Windt D, Jordan KP, Croft PR. The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies. BMC Musculoskelet Disord 2014; 15:68. [PMID: 24607083 PMCID: PMC4007531 DOI: 10.1186/1471-2474-15-68] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 02/25/2014] [Indexed: 02/07/2024] Open
Abstract
Background Evidence suggests that the course of low back pain (LBP) symptoms in randomised clinical trials (RCTs) follows a pattern of large improvement regardless of the type of treatment. A similar pattern was independently observed in observational studies. However, there is an assumption that the clinical course of symptoms is particularly influenced in RCTs by mere participation in the trials. To test this assumption, the aim of our study was to compare the course of LBP in RCTs and observational studies. Methods Source of studies CENTRAL database for RCTs and MEDLINE, CINAHL, EMBASE and hand search of systematic reviews for cohort studies. Studies include individuals aged 18 or over, and concern non-specific LBP. Trials had to concern primary care treatments. Data were extracted on pain intensity. Meta-regression analysis was used to compare the pooled within-group change in pain in RCTs with that in cohort studies calculated as the standardised mean change (SMC). Results 70 RCTs and 19 cohort studies were included, out of 1134 and 653 identified respectively. LBP symptoms followed a similar course in RCTs and cohort studies: a rapid improvement in the first 6 weeks followed by a smaller further improvement until 52 weeks. There was no statistically significant difference in pooled SMC between RCTs and cohort studies at any time point:- 6 weeks: RCTs: SMC 1.0 (95% CI 0.9 to 1.0) and cohorts 1.2 (0.7to 1.7); 13 weeks: RCTs 1.2 (1.1 to 1.3) and cohorts 1.0 (0.8 to 1.3); 27 weeks: RCTs 1.1 (1.0 to 1.2) and cohorts 1.2 (0.8 to 1.7); 52 weeks: RCTs 0.9 (0.8 to 1.0) and cohorts 1.1 (0.8 to 1.6). Conclusions The clinical course of LBP symptoms followed a pattern that was similar in RCTs and cohort observational studies. In addition to a shared ‘natural history’, enrolment of LBP patients in clinical studies is likely to provoke responses that reflect the nonspecific effects of seeking and receiving care, independent of the study design.
Collapse
Affiliation(s)
- Majid Artus
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, UK.
| | | | | | | |
Collapse
|
37
|
Mbada CE, Ayanniyi O, Ogunlade SO, Orimolade EA, Oladiran AB, Ogundele AO. Influence of Mckenzie protocol and two modes of endurance exercises on health-related quality of life of patients with long-term mechanical low-back pain. Pan Afr Med J 2014; 17 Suppl 1:5. [PMID: 24624241 PMCID: PMC3946222 DOI: 10.11694/pamj.supp.2014.17.1.2950] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Long-term Mechanical Low-Back Pain (LMLBP) negatively impacts on patients' physical capacity and quality of life. This study investigated the relationship between Health-Related Quality of Life (HRQoL) and pain intensity, and the influence of static and dynamic back extensors' endurance exercises on HRQoL in Nigerian patients with LMLBP treated with the McKenzie Protocol (MP). METHODS A single-blind controlled trial involving 84 patients who received treatment thrice weekly for eight weeks was conducted. Participants were assigned to the MP Group (MPG), MP plus Static Back Endurance Exercise Group (MPSBEEG) or MP plus Dynamic Endurance Exercise Group (MPDBEEG) using permuted randomization. HRQoL and pain was assessed using the Short-Form (SF-36) questionnaire and Quadruple Visual Analogue Scale respectively. RESULTS Sixty seven participants aged 51.8 ± 7.35 years completed the study. A total drop-out rate of 20.2% was observed in the study. Within-group comparison across weeks 0-4, 4-8 and 0-8 of the study revealed significant differences in HRQoL scores (p < 0.05). Treatment Effect Scores (TES) across the groups were significantly different (p = 0.001). MPSBEEG and MPDBEEG were comparable in TES on General Health Perception (GHP) at week 4; and GHP and Physical Functioning at week 8 respectively (p > 0.05). However, MPDEEG had significantly higher TES in the other domains of the SF-36 (p = 0.001). CONCLUSION HRQoL in patients with LMLBP decreases with pain severity. Each of MP, static and dynamic back extensors endurance exercises significantly improved HRQoL in LMLBP. However, the addition of dynamic back extensors endurance exercise to MP led to greater improvement in HRQoL.
Collapse
Affiliation(s)
- Chidozie Emmanuel Mbada
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olusola Ayanniyi
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | | | | | | |
Collapse
|
38
|
Nambi GS, Inbasekaran D, Khuman R, Devi S, Shanmugananth, Jagannathan K. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: A randomized controlled study. Int J Yoga 2014; 7:48-53. [PMID: 25035607 PMCID: PMC4097916 DOI: 10.4103/0973-6131.123481] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Nonspecific chronic low back (nCLBP) pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL), and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL) with nCLBP. AIM OF THE STUDY To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL in nonspecific chronic low back pain. MATERIALS AND METHODS Experimental study with random sampling technique. SUBJECTS/INTERVENTION Sixty subjects who fulfilled the selection criteria were randomly assigned to Iyengar yoga (yoga group, n = 30) and control group (exercise group, n = 30). Participants completed low back pain evaluation form and HRQOL-4 questionnaire before their intervention and again 4 weeks and 6 month later. Yoga group underwent 29 yogic postures training and exercise group had undergone general exercise program for 4 weeks. STATISTICS Repeated measures analysis of variance (ANOVA) was used to analyze group differences over time, while controlling for baseline differences. RESULTS Patients in both groups experienced significant reduction in pain and improvement in HRQOL. In visual analogue scale (VAS) yoga group showed reduction of 72.81% (P = 0.001) as compared to exercise group 42.50% (P = 0.001). In HRQOL, yoga group showed reduction of 86.99% (P = 0.001) as compared to exercise group 67.66% (P = 0.001). CONCLUSION These results suggest that Iyengar yoga provides better improvement in pain reduction and improvement in HRQOL in nonspecific chronic back pain than general exercise.
Collapse
Affiliation(s)
- Gopal S Nambi
- Department of Physiotherapy, C.U. Shah Physiotherapy College, Gujarat, India
| | | | - Ratan Khuman
- Department of Physiotherapy, C.U. Shah Physiotherapy College, Gujarat, India
| | - Surbala Devi
- Department of Physiotherapy, C.U. Shah Physiotherapy College, Gujarat, India
| | - Shanmugananth
- Department of Physiotherapy, C.U. Shah Physiotherapy College, Gujarat, India
| | - K Jagannathan
- Department of Physiotherapy, C.U. Shah Physiotherapy College, Gujarat, India
| |
Collapse
|
39
|
Joseph Ford J, John Hahne A, Pui Chan AY, Desmond Surkitt L. A classification and treatment protocol for low back disorders Part 3 – Functional restoration for intervertebral disc related disorders. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
40
|
Yozbatiran N, Yildirim Y, Parlak B. Effects of fitness and aquafitness exercises on physical fitness in patients with chronic low back pain. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856904322858684] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
41
|
Effect of two different exercise regimens on trunk muscle morphometry and endurance in soldiers in training. Phys Ther 2013; 93:1211-24. [PMID: 23064733 DOI: 10.2522/ptj.20120152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Limited evidence exists on how strength and endurance exercises commonly used to prevent low back pain affect muscle morphometry and endurance. OBJECTIVE The purpose of this study was to analyze the effects of 2 exercise regimens on the morphometry and endurance of key trunk musculature in a healthy population. DESIGN The study was designed as a randomized controlled trial. SETTING The study was conducted in a military training setting. PARTICIPANTS A random subsample (n=340; 72% men, 28% women; mean [±SD] age=21.9±4.2 years; mean [±SD] body mass index=24.8±2.8 kg/m2) from the larger Prevention of Low Back Pain in the Military trial (N=4,325) was included. INTERVENTION The core stabilization exercise program (CSEP) included low-load/low-repetition motor control exercises, whereas the traditional exercise program (TEP) included exercises conducted at a fast pace, with the use of high-load, high-repetition trunk strengthening exercises. MEASUREMENTS Baseline and follow-up examinations included ultrasound imaging of the trunk muscles and endurance tests. Linear mixed models were fitted to study the group and time effect and their interactions, accounting for the clustering effect. RESULTS Symmetry generally improved in the rest and contracted states, but there were no differences suggestive of muscle hypertrophy or improved ability to contract the trunk muscles between soldiers receiving the CSEP or the TEP. Total trunk endurance time decreased over the 12-week period, but endurance performance favored soldiers in the CSEP group. Endurance time was not associated with future episodes of low back pain. LIMITATIONS The lack of morphological changes may not be detectable in an already-active cohort, or a more intensive dose was needed. CONCLUSIONS Although improved symmetry was noted, neither the CSEP nor the TEP resulted in muscle hypertrophy. Longer endurance times were noted in individuals who completed the CSEP but were not strongly predictive of future low back pain episodes.
Collapse
|
42
|
Hettinga DM, Jackson A, Moffett JK, May S, Mercer C, Woby SR. A systematic review and synthesis of higher quality evidence of the effectiveness of exercise interventions for non-specific low back pain of at least 6 weeks' duration. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/108331907x222958] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
43
|
Lewis A, Morris ME, Walsh C. Are physiotherapy exercises effective in reducing chronic low back pain? PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x252000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
44
|
Hubley-Kozey CL, McCulloch TA, McFarland DH. Chronic Low Back Pain: A Critical Review of Specific Therapeutic Exercise Protocols on Musculoskeletal and Neuromuscular Parameters. J Man Manip Ther 2013. [DOI: 10.1179/106698103790826419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
45
|
Taavoni S, Abdolahian S, Haghani H. Effect of sacrum-perineum heat therapy on active phase labor pain and client satisfaction: a randomized, controlled trial study. PAIN MEDICINE 2013; 14:1301-6. [PMID: 23746110 DOI: 10.1111/pme.12161] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Reduction of labor pain is one of the most important aspects of obstetric care. Heat therapy, typically applied to the woman's back, lower abdomen, groin, and/or perineum during last stage of labor, is an easy pain relief method that does not require highly skilled care. The effectiveness of heat therapy applied to the perineum during the first stage of labor has not been evaluated. This study aimed to evaluate the effectiveness of heat therapy for pain and woman's satisfaction during physiological labor. SUBJECTS AND METHODS Sixty primiparous women aged 18-35 years old were randomly assigned to heat therapy and control groups. Pain and satisfaction scores were measured by visual analog scale. The measurements of satisfaction were accomplished after birth. Data were analyzed by using the t-test and chi-square RESULTS Mean pain scores in the heat therapy group were significantly lower than the control group (P < 0.05). The mean satisfaction score in the heat therapy group was significantly higher than in the control group (P < 0.05). CONCLUSION Heat therapy, an inexpensive complementary treatment with low risk, can reduce the intensity of pain and increase mothers' satisfaction with care during the active phase of labor.
Collapse
Affiliation(s)
- Simin Taavoni
- Nursing and Midwifery Faculty; Medicine Faculty; Tehran University of Medical Sciences, Research Institute for Islamic & Complementary Medicine (RICM, TUMS), Tehran
| | | | | |
Collapse
|
46
|
EMG activity of trunk stabilizer muscles during Centering Principle of Pilates Method. J Bodyw Mov Ther 2013; 17:185-91. [DOI: 10.1016/j.jbmt.2012.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 05/23/2012] [Accepted: 05/25/2012] [Indexed: 11/23/2022]
|
47
|
Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Br J Sports Med 2013; 48:929-38. [PMID: 23322894 PMCID: PMC4033203 DOI: 10.1136/bjsports-2012-091400] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme—biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence.
Collapse
Affiliation(s)
- Peter Brukner
- Departmernt of Sports Medicine and Sports Science, Liverpool Football Club, , Liverpool, UK
| | | | | | | | | |
Collapse
|
48
|
Ottawa Panel evidence-based clinical practice guidelines on therapeutic massage for low back pain. J Bodyw Mov Ther 2012; 16:424-55. [DOI: 10.1016/j.jbmt.2012.04.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 03/30/2012] [Accepted: 04/05/2012] [Indexed: 11/27/2022]
|
49
|
Richards MC, Ford JJ, Slater SL, Hahne AJ, Surkitt LD, Davidson M, McMeeken JM. The effectiveness of physiotherapy functional restoration for post-acute low back pain: a systematic review. ACTA ACUST UNITED AC 2012; 18:4-25. [PMID: 22796390 DOI: 10.1016/j.math.2012.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 06/06/2012] [Accepted: 06/11/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effectiveness of multidisciplinary treatment for post-acute (>6 weeks) low back pain (LBP) has been established. Physiotherapists have sufficient training to conduct less intensive functional restoration. The effectiveness of physiotherapy functional restoration (PFR) has not been evaluated using current systematic review methodology. OBJECTIVES To determine the effects of PFR for post-acute LBP. DATA SOURCES Electronic databases searched include: MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro and Cochrane CENTRAL. TRIAL ELIGIBILITY CRITERIA: Randomised controlled trials of physiotherapy treatment for post-acute LBP combining exercise and cognitive-behavioural intervention compared with other intervention, no intervention or placebo. TRIAL APPRAISAL AND SYNTHESIS METHODS: Two authors independently extracted data. Risk of bias was assessed using the PEDro scale and overall quality of the body of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Treatment effect sizes and 95% confidence intervals were calculated for pain, function and sick leave. RESULTS Sixteen trials were included. Heterogeneity prevented meta-analysis for most comparisons. Meta-analyses showed moderate to high quality evidence of significant but small effects favouring PFR compared with advice for intermediate term function and intermediate and long term pain. There was however low to moderate quality evidence that PFR was no more effective than a range of other treatment types. Heterogeneous trials frequently contributed to very low quality evidence. CONCLUSIONS Moderate to high quality evidence was found of small effects favouring PFR compared with advice. Preliminary evidence suggested PFR is not different to other treatment types. Further high quality research is required replicating existing trial protocols.
Collapse
Affiliation(s)
- Matthew C Richards
- Low Back Research Team, Musculoskeletal Research Centre, Department of Physiotherapy, School of Allied Health, Faculty of Health Sciences, La Trobe University, 3086, Australia.
| | | | | | | | | | | | | |
Collapse
|
50
|
Namuun G, Endo Y, Abe Y, Nakazawa R, Sakamoto M. The Effect of Muscle Fatigue Using Short Term Transcutaneous Electrical Nerve Stimulation. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ganbaatar Namuun
- School of Health Technology, Health Science University of Mongolia
| | - Yasuhiro Endo
- Graduate School of Health Sciences, Gunma University
| | - Yota Abe
- Graduate School of Health Sciences, Gunma University
| | - Rie Nakazawa
- Graduate School of Health Sciences, Gunma University
| | | |
Collapse
|