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Elabd OM, Oakley PA, Elabd AM. Prediction of Back Disability Using Clinical, Functional, and Biomechanical Variables in Adults with Chronic Nonspecific Low Back Pain. J Clin Med 2024; 13:3980. [PMID: 38999544 PMCID: PMC11242843 DOI: 10.3390/jcm13133980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Researchers are focusing on understanding the etiology and predisposing factors of chronic nonspecific low back pain (CNSLBP), a costly prevalent and disabling disorder. Related clinical, functional, and biomechanical variables are often studied, but in isolation. We aimed to identify key factors for managing CNSLBP by examining the relationship between back disability and related clinical, functional, and biomechanical variables and developed prediction models to estimate disability using various variables. Methods: We performed a cross-sectional correlational study on 100 recruited patients with CNSLBP. Clinical variables of pain intensity (visual analog score), back extensor endurance (Sorenson test), functional variables of the back performance scale, 6 min walk test, and the biomechanical variable C7-S1 sagittal vertical axis were analyzed to predict disability (Oswestry disability index). Results: All variables independently, as well as in multi-correlation, were significantly correlated to disability (p < 0.05). The bivariate regression models were significant between back disability and pain intensity (Y = 11.24 + 2.189x), Sorensen results (Y = 105.48 - 0.911x), the back performance scale (Y = 6.65 + 2.486x), 6 min walk test (Y = 49.20 - 0.060x), and sagittal vertical axis (Y = 0.72 + 4.23x). The multi-regression model showed significant contributions from pain (p = 0.001) and Sorensen results (p = 0.028) in predicting back disability, whereas no significant effect was found for other variables. Conclusions: A multidisciplinary approach is essential not only for the management of but also for the assessment of chronic nonspecific low back pain, including its clinical, functional, and biomechanical characteristics. However, special emphasis should be placed on clinical characteristics, including the intensity of pain and back extensor endurance.
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Affiliation(s)
- Omar M. Elabd
- Department of Orthopedics and Its Surgeries, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa 35712, Egypt;
- Department of Physical Therapy, Aqaba University of Technology, Aqaba 771111, Jordan
| | - Paul A. Oakley
- Private Practice, Newmarket, ON L3Y 8Y8, Canada;
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Aliaa M. Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Benha 13511, Egypt
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Elabd AM, Elabd OM. Efficacy of kinesio tape added to lumbar stabilization exercises on adult patients with mechanical low back pain: A randomized, single-blind clinical trial. J Bodyw Mov Ther 2024; 39:218-224. [PMID: 38876629 DOI: 10.1016/j.jbmt.2024.02.022] [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: 02/18/2023] [Revised: 01/25/2024] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Lumbar stabilization exercises (LSEs) are beneficial for chronic mechanical low back pain (CMLBP). However, further research focusing on intervention combinations is recommended. This study examined the effect of kinesio tape (KT) with LSEs on CMLBP adult patients. METHODS A randomized blinded clinical trial was conducted. Fifty CMLBP patients of both genders were assigned into one of two groups and received 8 weeks of treatment: group A (control): LSEs only, and group B (experimental): KT with LSEs. The primary outcome was back disability, measured by the Oswestry disability index. Secondary outcomes included pain intensity, trunk extensor endurance, and sagittal spinal alignment, as indicated by the visual analog scale, Sorensen-test, and C7-S1 sagittal vertical axis, respectively. The reported data was analyzed by a two-way MANOVA using an intention-to-treat procedure. RESULTS Multivariate tests indicate statistically significant effects for group (F = 4.42, p = 0.005, partial η2 = 0.148), time (F = 219.55, p < 0.001, partial η2 = 0.904), and group-by-time interaction (F = 3.21, p = 0.01, partial η2 = 0.149). Univariate comparisons between groups revealed significant reductions in the experimental group regarding disability (p = 0.029, partial η2 = 0.049) and pain (p = 0.001, partial η2 = 0.102) without a significant difference in the Sorensen test (p = 0.281) or C7-S1 SVA (p = 0.491) results. All within-group comparisons were statistically significant (p < 0.001). CONCLUSION The combination of KT and LSEs is an effective CMLBP treatment option. Although patients in both groups displayed significant changes in all outcomes, the combined interventions induced more significant reductions in back disability and pain intensity.
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Affiliation(s)
- Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt.
| | - Omar M Elabd
- Department of Orthopedics and Its Surgeries, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt; Department of Physical Therapy, Aqaba University of Technology, Aqaba, Jordan
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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.
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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.
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Elabd AM, Elabd OM. Effect of aerobic exercises on patients with chronic mechanical low back pain: A randomized controlled clinical trial. J Bodyw Mov Ther 2024; 37:379-385. [PMID: 38432832 DOI: 10.1016/j.jbmt.2023.12.001] [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: 05/06/2022] [Revised: 06/05/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Chronic mechanical low back pain (CMLBP) is one of the most prevalent and costly disorders. Determining its most effective treatment approach is a priority for researchers. PURPOSE To examine the effects of including aerobic exercise within a conventional therapy regimen for young adults with CMLBP. METHODS Fifty CMLBP patients (22 males and 28 females) were randomly and equally assigned to one of two groups to receive the prescribed treatment for 8 weeks. The control group received the traditional program only (infrared, ultrasound, burst TENS, and exercises); for the experimental group, an aerobic training program using a stationary bicycle was added. Back pain intensity was the primary outcome. Secondary outcomes included the Oswestry disability index, back extensor endurance measured by the Sorensen test, and physical performance indicated by the back performance scale and the 6-min walk test. A Two-way MANOVA was used for data analysis. RESULTS Multivariate tests revealed statistically significant effects of group (p = 0.002, partial η2 = 0.182), time (p < 0.001, partial η2 = 0.928), and group-by-time interaction (p = 0.01, partial η2 = 0.149). Univariate group-by-time interactions were significant for back disability (p = 0.043), extensor endurance (p = 0.023) and results of the 6-min walk test (p = 0.023) showing greater improvement in the experimental group. However, back pain intensity and the back performance scale revealed no significant group-by-time interactions. Within-group comparisons were significant for all measured variables in both groups (p < 0.001). CONCLUSION Although a traditional program of infrared, ultrasound, TENS, and exercises is beneficial for CMLBP treatment, adding aerobic exercises to the program leads to more beneficial outcomes.
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Affiliation(s)
- Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Benha University, Egypt; Basic Science Department, Faculty of Physical Therapy, Pharos University in Alexandria, Egypt.
| | - Omar M Elabd
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt; Department of Physical Therapy, Aqaba University of Technology, Aqaba, Jordan
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Lee GT, Himler P, Rhon DI, Young JL. Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials. J Orthop Sports Phys Ther 2023; 53:120-142. [PMID: 36645192 DOI: 10.2519/jospt.2023.11448] [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] [Indexed: 01/17/2023]
Abstract
OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.
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Elabd AM, Elabd OM. Relationships between forward head posture and lumbopelvic sagittal alignment in older adults with chronic low back pain. J Bodyw Mov Ther 2021; 28:150-156. [PMID: 34776134 DOI: 10.1016/j.jbmt.2021.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Abnormal posture creates abnormal stress and strain in many spinal structures which are considered predisposing factors for chronic mechanical low back pain. PURPOSE To examine the relationships among pain intensity, forward head posture (decreased craniovertebral angle) and lumbopelvic sagittal alignment (pelvic incidence, pelvic tilt, sacral slope, and lumbar lordosis) in chronic mechanical low back pain patients. METHODS A cross-section correlational study was conducted on one hundred patients. A numerical-pain-rating scale was used to determine pain intensity. Standardized standing lateral radiographs were analyzed to measure the spinopelvic angles. Reported data were analyzed using correlation coefficients, and regression analyses. RESULTS Lumbar lordosis had very strong positive correlations with each pain intensity and sacral slope. Pain intensity had a strong positive correlation with sacral slope. Moderate positive correlations highlighted between pelvic tilt and craniovertebral angle. Moreover, the pelvic incidence had weak positive correlations with each sacral slope and pelvic tilt. Negative correlations were strong between pelvic tilt and each of pain intensity, lumbar lordosis and sacral slope. Craniovertebral angle had moderate negative correlations with each of pain, lumbar lordosis, and sacral slope. However, the pelvic incidence had no relations with pain, craniovertebral angle lumbar lordosis. Overall, an association of demographic data and measured variables had a significant effect on the pain multi-regression equation prediction model. They accounted for 76.60% of the variation in pain. CONCLUSION Abnormal spinopelvic posture relates to chronic mechanical low back pain. There are significant associations among pain intensity, FHP and lumbopelvic sagittal alignment in chronic mechanical low back pain patients.
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Affiliation(s)
- Aliaa M Elabd
- Basic Science Department, Faculty of Physical Therapy, Pharos University in Alexandria, Egypt.
| | - Omar M Elabd
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Delta University for Science and Technology, Gamasa, Egypt
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Shousha T, Alayat M, Moustafa I. Effects of low-level laser therapy versus soft occlusive splints on mouth opening and surface electromyography in females with temporomandibular dysfunction: A randomized-controlled study. PLoS One 2021; 16:e0258063. [PMID: 34597318 PMCID: PMC8486092 DOI: 10.1371/journal.pone.0258063] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Low level lasers have been used as an alternative pain relief therapy for muscle and joint pain, since it induces analgesic, anti-inflammatory, and biomodulation effects of the physiological cell functions. The effectiveness of low-level laser therapy in temporomandibular joint dysfunction (TMD) treatment, however, is not well established. Although Surface electromyography (sEMG) has been suggested as a complementary means in TMD diagnosis, the effect of conservative treatments on muscle activity has not yet been thoroughly correlated with (sEMG) findings. Purpose To assess the efficacy of low-level laser therapy (LLLT) as compared to occlusive splint therapy (OST) on the TMJ opening index (TOI) and sEMG of masticatory muscles. Materials and methods 112 female subjects suffering from unilateral myogenous TMD, aged 21–30 years-old, were recruited and divided into three groups: LLLT; soft occlusive splint therapy OST and a waitlist group as controls. Outcome measures TMJ opening index (TOI), Visual analogue scale (VAS), surface electromyography (sEMG). Results A significant reduction was reported in TOI, VAS and the sEMG within the LLLT and OST groups as well as significant decrease in all outcomes between groups in favor of the LLLT group (P< 0.0001). Meanwhile, there was a weak significant difference within the control group probably attributed to the analgesic. Post-hoc pairwise comparisons between groups [control vs occlusive splints, control vs low-level laser and low-level laser vs occlusive splints] revealed significant differences in the VAS and TOI [P = 0.0001; 95% CI: 0.9–2.2, 1.61–4.01, 0.65–1.96]. Conclusions Findings support an evident short term therapeutic effect of the LLLT on improving VAS, TOI and sEMG in females suffering from myogenous TMD.
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Affiliation(s)
- Tamer Shousha
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- * E-mail:
| | - Mohamed Alayat
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Physical Therapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, KSA
| | - Ibrahim Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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