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Zhai J, Liu AF, Yu W, Guo T. Baduanjin exercise for chronic non-specific low back pain: protocol for a series of N-of-1 trials. BMJ Open 2023; 13:e070703. [PMID: 37963698 PMCID: PMC10649392 DOI: 10.1136/bmjopen-2022-070703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Chronic non-specific low back pain (CNLBP) is one of the most common health problems worldwide. According to the clinical guideline released by the American College of Physicians, exercise has been recommended for the treatment of chronic LBP. In recent years, traditional Chinese medicine (TCM) is becoming increasingly popular for the management of chronic LBP. Baduanjin exercise is one of the exercise therapies in TCM. N-of-1 trial is a randomised cross-over self-controlled trial suitable for patients with this chronic disease. A series of similar N-of-1 trials can be pooled to estimate the overall and individual therapeutic effects synchronously by hierarchical Bayesian analysis. And N-of-1 trials are considered as a good tool for evaluating the therapeutic effect of TCM. Therefore, this study aims to conduct a series of N-of-1 trials with hierarchical Bayesian analysis for assessing whether Baduanjin exercise is effective and safe for CNLBP. METHODS AND ANALYSIS This study conducts a series of N-of-1 trials on Baduanjin exercise for the management of CNLBP. Fifty participants will receive 1-3 treatment cycles. They will be randomised into a Baduanjin exercise or waiting list group for a week during the two periods of each treatment cycle. The primary outcome is the 10-point Visual Analogue Scale. The secondary outcomes include the Oswestry Disability Index, the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire and the Short Form Health Survey 12. Statistical analysis will be conducted with WinBUGS V.1.4.3 software. Overall and individual therapeutic effects will be estimated synchronously by hierarchical Bayesian analysis. ETHICS AND DISSEMINATION This study is approved by the Medical Ethics Committee of Tianjin University of TCM (reference number TJUTCM-EC20220005). Our findings will be published in a peer-reviewed journal or international conference. TRIAL REGISTRATION NUMBER ChiCTR2200063307.
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Affiliation(s)
- Jingbo Zhai
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ai Feng Liu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Weijie Yu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tianci Guo
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Zhou AF, Li ZY, Cui XJ, Sng KS, Zhu K, Wang YJ, Shu B, Zhang JP, Yao M. Cross-cultural adaptation of The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: A methodological systematic review. J Orthop Sci 2023; 28:984-991. [PMID: 36137918 DOI: 10.1016/j.jos.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is a reliable and sensitive measure of disability to determine functional status and evaluate curative effects in low back pain, it has now been cross-cultural translated into many other languages and adapted for use in different countries. We aim to evaluate the translation procedures and measurement properties of cross-cultural adaptations of the JOABPEQ. METHODS Studies related to cross-cultural adaptation of the JOABPEQ in a specific language/culture were searched in PubMed, Embase, CINAHL, SciELO, PsycINFO, SinoMed, and Web of Science from their inception to March 2022. The Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures and the Consensus-based Standards for the Selection of Health Status Measurement Instruments guideline were used for evaluation. RESULTS Nine different versions of cross-cultural JOABPEQ adaptations in 8 different languages/cultures were included. The adaptation process was not strictly performed, such as standard forward translation and expert committee review were rarely reported. Content validity (8/9), floor and ceiling effects (3/9), reliability (4/9), and interpretability (6/9) were assessed in most of the adaptations, while agreement (2/9), responsiveness (2/9), and the internal consistency (2/9) were not. JOABPEQ can replace functional and quality of life score to reduce the burden of scientific research. CONCLUSION We recommend Persian-Iranian, simplified Chinese-Chinese Mandarin, Thai and Gunaydin G's Turkish adaptations for application. The numerical pain rating scale/visual analogue scale in low back pain and lower extremities, as well as numbness in lower extremities could not be neglected in JOABPEQ adaptations.
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Affiliation(s)
- Ai-Fang Zhou
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China; School of Rehabilitation, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhuo-Yao Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kim Sia Sng
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ke Zhu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yong-Jun Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bing Shu
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Ping Zhang
- Shanghai Jinshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
| | - Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Zhai S, Zhao W, Zhu B, Huang X, Liang C, Hai B, Ding L, Zhu H, Wang X, Wei F, Chu H, Liu X. The effectiveness of percutaneous endoscopic decompression compared with open decompression and fusion for lumbar spinal stenosis: protocol for a multicenter, prospective, cohort study. BMC Musculoskelet Disord 2022; 23:502. [PMID: 35624443 PMCID: PMC9137062 DOI: 10.1186/s12891-022-05440-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Lumbar spinal stenosis (LSS) is one of the most frequent indications for spine surgery. Open decompression and fusion surgery was the most common treatment and used to be regarded as the golden standard treatment for LSS. In recent years, percutaneous endoscopic decompression surgery was also used for LSS. However, the effectiveness and safety of percutaneous endoscopic decompression in the treatment of LSS have not been supported by high-level evidence. Our aim is to 1) compare the effectiveness of percutaneous endoscopic decompression surgery and open decompression and fusion for the treatment of LSS. 2) Investigate the prognosis risk factors for LSS. 3) Evaluate the influence of percutaneous endoscopic decompression for the stability of operative level, and degeneration of adjacent level. Methods It’s a prospective, multicenter cohort study. The study is performed at 4 centers in Beijing. This study plans to enroll 600 LSS patients (300 patients in the percutaneous endoscopic decompression group, and 300 patients in the open decompression and fusion group). The demographic variables, healthcare variables, symptom related variables, clinical assessment (Visual analogue score (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association score (JOA)), and radiological assessment (dynamic X-ray, CT, MRI) will be collected at baseline visit. Patients will follow up at 3, 6, 12 months. The primary outcome is the difference of improvement of ODI between baseline and 12-month follow-up between the two groups. The secondary outcome is the score changes of preoperative and postoperative VAS, the recovery rate of JOA, MacNab criteria, patient satisfaction, degeneration grade of adjacent level, ROM of operative level and adjacent level, complication rate. Discussion In this study, we propose to conduct a prospective registry study to address the major controversies of LSS decompression under percutaneous spinal endoscopy, and investigate the clinical efficacy and safety of percutaneous endoscopic decompression and open decompression in the treatment of LSS. Trial registration This study has been registered on clinicaltrials.gov in January 15, 2020 (NCT04254757). (SPIRIT 2a).
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Affiliation(s)
- Shuheng Zhai
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Wenkui Zhao
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Bin Zhu
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xin Huang
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Chen Liang
- Pain Medicine Center, Peking University Third Hospital, Beijing, China
| | - Bao Hai
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Lixiang Ding
- Department of Orthopedics, Capital Medical University Affiliated Beijing Shijitan Hospital, Beijing, China
| | - Hongwei Zhu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Xianhai Wang
- Department of Orthopedics, Beijing Changping Hospital, Beijing, China
| | - Feng Wei
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Hongling Chu
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China. .,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China. .,Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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Zou CJ, Li JH, Wu FC, Li YZ, Pan HY, Wu T. The effects of core stability training in nurses with nonspecific low back pain. Medicine (Baltimore) 2021; 100:e26357. [PMID: 34160406 PMCID: PMC8238330 DOI: 10.1097/md.0000000000026357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/30/2021] [Indexed: 01/04/2023] Open
Abstract
To investigate the effect of core stability training on nonspecific low back pain (NSLBP) in nurses.The data were collected retrospectively by reviewing the patient's medical records and pain questionnaires in our rehabilitation center. A total of 40 nurses with NSLBP were included and divided into observation group and control group. Each group were given routine health education for NSLBP. Core stability training was performed in observation group for 4 weeks. Surface electromyography (sEMG) evaluation of erector spine and multifidus muscle, pain Numeric Rating Scale (NRS) and Japanese Orthopaedic Association (JOA) scores were evaluated and analyzed before and 4 weeks after intervention.There was no significant difference of NRS score and JOA score between two groups before intervention (P > .05, respectively). The NRS and JOA scores were significantly improved in both two groups after 4 weeks of intervention (P < .05, respectively). Moreover, the improvement of NRS and JOA scores in the observation group were better than those of the control group (P < .05, respectively). No significant difference of average electromyography (AEMG) or median frequency (MF) were noted between the healthy side and the affected side in both groups before or after intervention (P > .05, respectively). After 4 weeks of intervention, the AEMG of the healthy and the affected side of the two groups showed an improved trend without significant difference (P > .05, respectively). The MF of affected side was significantly higher 4 weeks after intervention than those before treatment in the observation and control group (P < .05, respectively).Core stability training can alleviate pain, improve the fatigue resistance of the core muscles and the balance of the functions of bilateral multifidus muscles in nurses with NSLBP.
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Affiliation(s)
- Chao-Jun Zou
- Nursing Department, Sir Run Run Shaw Hospital
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University; Hang Zhou, Zhe Jiang, PR China
| | - Jian-Hua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University; Hang Zhou, Zhe Jiang, PR China
| | - Fang-Chao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University; Hang Zhou, Zhe Jiang, PR China
| | - Yang-Zhen Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University; Hang Zhou, Zhe Jiang, PR China
| | | | - Tao Wu
- Nursing Department, Sir Run Run Shaw Hospital
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Huang B, Liu J, Wei X, Li S, Xiang Y, Wu H, Chen J, Zhao F. Damage to the human lumbar cartilage endplate and its clinical implications. J Anat 2021; 238:338-348. [PMID: 33011984 PMCID: PMC7812127 DOI: 10.1111/joa.13321] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 02/03/2023] Open
Abstract
The cartilaginous endplate (CEP) is a thin layer of hyaline cartilage, and plays an important role in the diffusion of nutrients into the intervertebral discs. Its damage may seriously affect the disc degeneration, and result in low back pain (LBP). However, the structural features of damaged CEPs have not been well characterized, and this hinders our understanding of the etiology of disc degeneration and pain. To present the structural features of micro-damaged CEPs in patients with disc degeneration and LBP that might even be regarded as an initial factor for disc degeneration, we performed a histological study of micro-damaged CEPs harvested from human lumbar intervertebral discs and analyzed its clinical implications. Human lumbar CEPs were excised from 35 patients (mean age 60.91 years) who had disc degeneration and LBP. Control tissue was obtained from 15 patients (mean age 54.67 years) with lumbar vertebral burst fractures. LBP and disability were assessed clinically, and all patients underwent anterior vertebral body fusion surgery. CEPs together with some adjacent nucleus pulposus (NP) were sectioned at 4 µm, and stained using H&E, Safranin O/Fast Green, and Alcian Blue. Immunostaining and PCR were used to identify various markers of degeneration, innervation, and inflammation. Histology demonstrated physical micro-damage in 14/35 CEPs from the disc degeneration group. Six major types of damage could be distinguished: fissure, traumatic nodes, vascular mimicry, incorporation of NP tissue within the CEP, incorporation of bone within the CEP, and incorporation of NP and bone within the CEP. Pain and disability scores (ODI: p = 0.0190; JOA: p = 0.0205; JOABPEQ: p = 0.0034) were significantly higher in those with micro-damaged CEPs (N = 14) than in those with non-damaged CEPs (N = 21). CEP damage was significantly associated with elevated MMP3 (p = 0.043), MMP13 (p = 0.0191), ADAMTS5 (p = 0.0253), TNF-α (p = 0.0011), and Substance P (p = 0.0028), and with reduced Sox9 (p = 0.0212), aggrecan (p = 0.0127), and type II collagen (p = 0.0139). In conclusion, we presented a new classification of human lumbar micro-damaged CEPs. Furthermore, we verify disc degeneration, innervation, and discogenic pain in micro-damaged CEPs.
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Affiliation(s)
- Bao Huang
- Department of Orthopaedic Surgery, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang ProvinceHangzhouChina
| | - Junhui Liu
- Department of Orthopaedic Surgery, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang ProvinceHangzhouChina
| | - Xiaoan Wei
- Department of Orthopaedic Surgery, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang ProvinceHangzhouChina
| | - Shengwen Li
- Department of Orthopedic SurgeryHaining People's HospitalHainingChina
| | - Yufeng Xiang
- Department of Orthopedic SurgeryLinhai Second People's HospitalTaizhouChina
| | - Hao Wu
- Department of Orthopaedics and TraumatologyThe University of Hong KongPokfulamHong Kong, SARChina
| | - Jian Chen
- Department of Orthopaedic Surgery, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang ProvinceHangzhouChina
| | - Fengdong Zhao
- Department of Orthopaedic Surgery, Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina,Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang ProvinceHangzhouChina
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Lo WLA, Lei D, Leng Y, Huang H, Wang B, Yu Q, Li L. Impact of nonsurgical spinal decompression on paraspinal muscle morphology and mechanical properties in young adults with low back pain. J Int Med Res 2020; 48:300060520919232. [PMID: 32723102 PMCID: PMC7391436 DOI: 10.1177/0300060520919232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objective The mechanism underlying the benefit of nonsurgical spinal decompression (NSSD) on low back pain is unclear. This study was performed to investigate the immediate impact of NSSD on the mechanical properties and morphology of the paraspinal muscles. Methods Participants with low back pain were recruited. NSSD therapy was provided on one occasion. A myotonometer was placed perpendicularly on the skin surface over the paraspinal muscle at the level of L3/L4 to measure the mechanical muscle properties. The multifidus thickness was measured using B-mode ultrasound and defined as the distance between the transverse process and subcutaneous tissue fascia. The difference between before and after NSSD was analyzed by a paired t-test. Results Thirty participants (mean age, 20.9 ± 0.8 years; 9 male, 21 female) were recruited. No significant difference was observed in the muscle mechanical properties or morphology between before and after the intervention. Conclusions NSSD intervention did not induce immediate changes in the paraspinal muscle mechanical properties or multifidus thickness in young adults with low back pain. NSSD might produce benefits by stimulating mechanical receptors rather than inducing morphological changes or mechanical property alterations of the muscle fibers. These parameters may not be suitable outcome measures for NSSD intervention.
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Affiliation(s)
- Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Di Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Leng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huanjie Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Biru Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Yao M, Xu BP, Li ZJ, Zhu S, Tian ZR, Li DH, Cen J, Cheng SD, Wang YJ, Guo YM, Cui XJ. A comparison between the low back pain scales for patients with lumbar disc herniation: validity, reliability, and responsiveness. Health Qual Life Outcomes 2020; 18:175. [PMID: 32522196 PMCID: PMC7288427 DOI: 10.1186/s12955-020-01403-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Background Although the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Numerical Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire (RMDQ), and Short Form 36 Health Survey (SF-36) has shown a preferable psychometric properties in patients with low back pain (LBP), but no study has yet determined these in conservative treatment of patients with lumbar disc herniation (LDH). Thus the current study aimed to compare those scales in LDH patients receiving conservative treatment to select the better option to assess the severity of disease. Methods LDH patients were invited to complete the JOABPEQ, NPRS, ODI, RMDQ, and SF-36 twice. The internal consistency was evaluated by the Cronbach’s α. Test-retest reliability was tested by the intraclass correlation coefficient (ICC). The relationships of these scales were evaluated by the Pearson correlation coefficients (r). The responsiveness was operationalised using the receiver operating characteristic (ROC) curve, as well as the comparison of smallest detectable change (SDC), minimum important change (MIC). Results A total of 353 LDH patients were enrolled. Four subscales of the Chinese JOABPEQ were over 0.70, then the ICCs for the test-retest reliability were over 0.75. For functional status, remarked negative correlations could be seen between JOABPEQ Q2-Q4 and ODI, as well as RMDQ (r = − 0.634 to − 0.752). For general health status, remarkable positive correlations could also be seen between Q5 Mental health and SF-36 PCS (r = 0.724) as well as SF-36 MCS (r = 0.736). Besides, the area under of the curves (AUC) of the JOABPEQ ranged from 0.743 to 0.827, indicating acceptale responsiveness, as well as the NPRS, ODI, and RMDQ. Conclusion NPRS, and ODI or RMDQ is recommended in studies related to LDH patients, while if the quality of life also is needed to observe, the NPRS, and JOABPEQ would be more appropriate rather than SF-36.
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Affiliation(s)
- Min Yao
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - Bao-Ping Xu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Lu'an Hospital of Traditional Chinese Medicine, 76 Renmin Road, Anhui Lu'an, 237000, China
| | - Zhen-Jun Li
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Gansu Provincial Hospital of Traditional Chinese Medicine, 418 Guazhou Road, Lanzhou, 730050, Gansu, China
| | - Sen Zhu
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Department of Orthopaedic, Shanghai Pudong Gongli Hospital, Second Military Medical University, 219 Miaopu Road, Shanghai, 200013, China
| | - Zi-Rui Tian
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - De-Hua Li
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China
| | - Jue Cen
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China
| | - Shao-Dan Cheng
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China
| | - Yong-Jun Wang
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China
| | - Yan-Ming Guo
- Shanghai Guanghua Hospital, 540 Xinhua Road, Shanghai, 200052, China.
| | - Xue-Jun Cui
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China. .,Key Laboratory of Theory and Therapy of Muscles and Bones, Ministry of Education, Shanghai University of Traditional Chinese Medicine, 725 South Wanping Road, Shanghai, 200032, China.
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Jiao Y, Yuan Y, Lin Y, Zhou Z, Zheng Y, Wu W, Tang G, Chen Y, Xiao J, Li C, Chen Z, Cao P. Propionibacterium acnes induces discogenic low back pain via stimulating nucleus pulposus cells to secrete pro-algesic factor of IL-8/CINC-1 through TLR2-NF-κB p65 pathway. J Mol Med (Berl) 2018; 97:25-35. [PMID: 30397790 DOI: 10.1007/s00109-018-1712-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/13/2018] [Accepted: 10/28/2018] [Indexed: 12/19/2022]
Abstract
Latent infection of Propionibacterium acnes was considered as a new pathogeny for low back pain (LBP); however, there is no credible animal evidence or mechanism hypothesis. This study proved that P. acnes is a causative pathogen of bacteria-induced LBP and investigated its underlying mechanism. For this, P. acnes was firstly identified in patients' degenerated intervertebral disc (IVDs) samples. The results of patients' Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores indicated that P. acnes-positive patients showed more severe LBP and physical disability. Then, a P. acnes-inoculated lumbar IVDs model was established in rats. The results of paw/foot withdrawal threshold and qRT-PCR indicated that P. acnes-inoculated rats had obvious LBP in behavioral evaluation and over-expression of substance P (SP) and calcitonin gene-related peptide (CGRP) in IVDs. Subsequently, enzyme-linked immunosorbent assay (ELISA) results demonstrated that increased expression of IL-8 or CINC-1 (the homolog of IL-8 in rats) in the P. acnes-positive IVDs of human and rats. The CINC-1 injected animal model proved that the cytokines were able to induce LBP. Finally, the co-culture experiments showed that nucleus pulposus cells (NPCs) were able to respond to P. acnes and secreted IL-8/CINC-1 via TLR-2/NF-κB p65 pathway. In conclusion, P. acnes had strong association with LBP by stimulating NPCs to secrete pro-algesic factor of IL-8/CINC-1 via TLR2/NF-κBp65 pathway. The finding may provide a promising alternative therapy strategy for LBP in clinical. KEY MESSAGES: Patients with P. acnes-positive IVDs tended to have more severe LBP, physical disability, and increased IL-8 expressions. P. acnes can induce LBP via IL-8/CINC-1 in IVDs. P. acnes stimulate the NPCs to secrete pro-algesic factor of IL-8/CINC-1 via TLR2/NF-κBp65 pathway.
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Affiliation(s)
- Yucheng Jiao
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Ye Yuan
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China
| | - Yazhou Lin
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Zezhu Zhou
- Department of Orthopedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, China
| | - Yuehuan Zheng
- Department of Orthopedics, Ruijin Hospital North, School of Medicine, Shanghai Jiaotong University, Shanghai, 201800, China
| | - Wenjian Wu
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China
| | - Guoqing Tang
- Kunshan Hospital of Traditional Chinese medicine, Kunshan, 215300, China
| | - Yong Chen
- Kunshan Hospital of Traditional Chinese medicine, Kunshan, 215300, China
| | - Jiaqi Xiao
- Department of Medical Microbiology and Parasitology, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Changwei Li
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Zhe Chen
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
| | - Peng Cao
- Department of Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
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Simplified Chinese Version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire: Agreement, Responsiveness, and Minimal Important Change for Patients With Chronic Low Back Pain. Spine (Phila Pa 1976) 2018; 43:1438-1445. [PMID: 29659442 DOI: 10.1097/brs.0000000000002692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Psychometric test of the cross-cultural adaptation the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) in low back pain (LBP) patients. OBJECTIVE To investigate the agreement, responsiveness, and minimal important change (MIC) of the simplified Chinese version of the JOABPEQ in LBP patients. SUMMARY OF BACKGROUND DATA The factor structure, internal consistency, test-retest reliability, validity, floor and ceiling effect of simplified Chinese JOABPEQ have been tested, while the agreement, responsiveness, and MIC were required. METHODS The agreement, responsiveness, and MIC of the simplified Chinese version were assessed by completing the Chinese JOABPEQ twice. Agreement was tested with Bland-Altman plot. Responsiveness was operationalized using receiver operating characteristic analyses. The anchor-based method was used to calculate MIC. RESULTS One hundred sixty-two of 184 patients returned to finish the booklet twice were available for analysis (response rate: 88.0%). While the responsiveness, the area under the curves of each subscale were ranged from 0.746 to 0.875, which meant a good responsiveness. While the MIC (MIC%) of simplified Chinese JOABPEQ was 19.28 (44.98%) for Q1 Low back pain, 15.20 (24.13%) for Q2 Lumbar function, 15.79 (22.76%) for Q3 Walking ability, 9.58 (19.86%) for Q4 Social life function, 7.33 (17.28%) for Q5 Mental health. While compared with the MIC, only the Q3 Walking ability had a positive rating for agreement in the Bland-Altman plot. CONCLUSION The simplified Chinese JOABPEQ has positive agreement of Q3 Walk ability and acceptable to excellent responsiveness of all the subscales. The MICs for subscales of the simplified Chinese JOABPEQ ranged from 7.33 to 19.28 points. LEVEL OF EVIDENCE 3.
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Hu X, Lei D, Li L, Leng Y, Yu Q, Wei X, Lo WLA. Quantifying paraspinal muscle tone and stiffness in young adults with chronic low back pain: a reliability study. Sci Rep 2018; 8:14343. [PMID: 30254233 PMCID: PMC6156595 DOI: 10.1038/s41598-018-32418-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/23/2018] [Indexed: 11/09/2022] Open
Abstract
The reliability of a handheld myotonometer when used in a clinical setting to assess paraspinal muscle mechanical properties is unclear. This study aimed to investigate the between-session intra-rater reliability of a handheld myotonometer in young adults with low back pain (LBP) in a clinical environment. One assessor recorded lumbar paraspinal muscle tone and stiffness in an outpatient department on two occasions. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), smallest real difference (SRD) and Bland-Altman analysis were conducted to assess reliability. The results indicated acceptable between-days intra-rater reliability (ICC > 0.75) for all measurements. The SEM of the muscle tone and stiffness measurements ranged between 0.20–0.66 Hz and 7.91–16.51 N/m, respectively. The SRD was 0.44–1.83 Hz for muscle tone and 21.93–52.87 N/m for muscle stiffness. SEM and SRD at L1-L2 were higher than those at other levels. The magnitude of agreement appeared to decrease as muscle tone and stiffness increased. The myotonometer demonstrated acceptable reliability when used in a clinical setting in young adults with chronic LBP. Measurements of the upper lumbar levels were not as reliable as those of the lower lumbar levels. The crural attachment of the diaphragm at L1 and L2 may affect paraspinal muscle tone and stiffness during respiratory cycles.
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Affiliation(s)
- Xiaoqian Hu
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Di Lei
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Le Li
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yan Leng
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiaoyu Wei
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China. .,Department of Electronic and Electrical Engineering, University College London, Torrington Place, London, WC1E 7JE, UK.
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