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Shirado O, Arai Y, Iguchi T, Imagama S, Kawakami M, Nikaido T, Ogata T, Orita S, Sakai D, Sato K, Takahata M, Takeshita K, Tsuji T. Formulation of Japanese Orthopaedic Association (JOA) clinical practice guideline for the management of low back pain- the revised 2019 edition. J Orthop Sci 2022; 27:3-30. [PMID: 34836746 DOI: 10.1016/j.jos.2021.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/12/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The latest clinical guidelines are mandatory for physicians to follow when practicing evidence-based medicine in the treatment of low back pain. Those guidelines should target not only Japanese board-certified orthopaedic surgeons, but also primary physicians, and they should be prepared based entirely on evidence-based medicine. The Japanese Orthopaedic Association Low Back Pain guideline committee decided to update the guideline and launched the formulation committee. The purpose of this study was to describe the formulation we implemented for the revision of the guideline with the latest data of evidence-based medicine. METHODS The Japanese Orthopaedic Association Low Back Pain guideline formulation committee revised the previous guideline based on a method for preparing clinical guidelines in Japan proposed by Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Two key phrases, "body of evidence" and "benefit and harm balance" were focused on in the revised version. Background and clinical questions were determined, followed by literature search related to each question. Appropriate articles were selected from all the searched literature. Structured abstracts were prepared, and then meta-analyses were performed. The strength of both the body of evidence and the recommendation was decided by the committee members. RESULTS Nine background and nine clinical qvuestions were determined. For each clinical question, outcomes from the literature were collected and meta-analysis was performed. Answers and explanations were described for each clinical question, and the strength of the recommendation was decided. For background questions, the recommendations were described based on previous literature. CONCLUSIONS The 2019 clinical practice guideline for the management of low back pain was completed according to the latest evidence-based medicine. We strongly hope that this guideline serves as a benchmark for all physicians, as well as patients, in the management of low back pain.
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Affiliation(s)
- Osamu Shirado
- Department of Orthopaedic and Spinal Surgery, Aizu Medical Center (AMEC) at Fukushima Medical University, Japan.
| | - Yoshiyasu Arai
- Department of Orthopaedic Surgery, Saiseikai Kawaguchi General Hospital, Japan
| | - Tetsuhiro Iguchi
- Department of Orthopaedic Surgery, Saiseikai Hyogo Prefectural Hospital, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Japan
| | | | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University, Japan
| | | | - Sumihisa Orita
- Center for Frontier Medical Engineering (CFME), Department of Orthopaedic Surgery, Chiba University, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Japan
| | - Kimiaki Sato
- Department of Orthopaedic Surgery, Kurume University, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Japan
| | | | - Takashi Tsuji
- Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Japan
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Naghdi N, Mohseni-Bandpei MA, Taghipour M, Rahmani N. Lumbar Multifidus Muscle Morphology Changes in Patient with Different Degrees of Lumbar Disc Herniation: An Ultrasonographic Study. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:699. [PMID: 34356981 PMCID: PMC8307190 DOI: 10.3390/medicina57070699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
Background and Objective: Previous studies demonstrated that the prevalence of lumbar disc herniation (LDH) is relatively high. This investigation aimed to evaluate the size of lumbar multifidus (LM) muscle in patients with different degrees of LDH compared to healthy group, during rest and contraction, using ultrasonography. Materials and Methods: In this non-experimental, analytic, and case control study, ultrasound imaging was used to assess cross-sectional area (CSA) and thickness of the LM muscle in 15 healthy subjects and 60 patients with different stages of LDH (bulging group = 15, protrusion group = 15, extrusion group = 15, sequestration group = 15). Measurements were taken bilaterally at the L4-L5 level, during rest and contraction and results were compared between groups. Results: There was a significant difference between healthy subjects and the extrusion and sequestration groups during rest and contraction for LM muscle CSA and thickness (p = 0.001), as LM muscle CSA and thickness were significantly smaller in extrusion and sequestration patient groups compared to healthy subjects. LM atrophy was greater in patients with extrusion and sequestration groups than in patients with bulging and protrusion, both at rest and during contraction. Significant correlations were also observed between functional disability and intensity of pain with LM CSA and thickness measurements. Conclusions: Patients with extrusion and sequestration LDH had smaller LM muscle at rest and during contraction compared to healthy subjects. Larger LDH lesions were associated with decreased LM muscle size. Patient with more pain, disability, and extrusion and sequestration LDH had greater LM size changes. LM muscle size was not correlated with symptom duration. Further investigation with greater sample size is warranted.
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Affiliation(s)
- Neda Naghdi
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada;
| | - Mohammad Ali Mohseni-Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran;
| | - Morteza Taghipour
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran;
| | - Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran 1985713834, Iran;
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Reliability of B-mode ultrasonography to measure lumbar multifidus muscle dimensions in patients with unilateral lumbar disc herniation. J Bodyw Mov Ther 2020; 26:153-157. [PMID: 33992237 DOI: 10.1016/j.jbmt.2020.06.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/30/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To evaluate Ultrasound Imaging (USI) reliability for measurement of lumbar multifidus (LMF) muscle thickness and cross sectional area (CSA) at rest and during contraction in patients with unilateral lumbar disc herniation. SETTING Laboratory. DESIGN Reliability Study. PARTICIPANTS Thirty patients, aged 25-50 years (37.55 ± 9.55), with unilateral L4-L5 lumbar disc herniation participated in this study. MAIN OUTCOME MEASURES Thickness and CSA of LMF were measured using B-mode ultrasound by two raters in prone position. RESULTS Same day and multiple day inter-rater and same day intra-rater reliability showed good to excellent reliability (intraclass correlation coefficients ranged from 0.70 to 0.91). Also standard error of measurement and minimal detectable change for USI reliabilities ranged from 0.06 to 0.57 and 0.16 to 1.31, respectively. CONCLUSIONS Reliability of USI for measurements of LMF muscle thickness and CSA was high, and consistent with previous studies conducted on reliability of USI to measure LMF dimensions in other populations.
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Reliability of sonography in the assessment of lumbar stabilizer muscles size in healthy subjects and patients with scoliosis. J Bodyw Mov Ther 2019; 23:138-141. [DOI: 10.1016/j.jbmt.2018.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/30/2018] [Accepted: 05/12/2018] [Indexed: 11/23/2022]
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Shadani A, Mohseni Bandpei MA, Rahmani N, Bassampour SA. A Comparison of the Abdominal and Lumbar Multifidus Muscle Size in Patients With Lumbar Spondylolisthesis and Healthy Patients at Rest and During Contraction Using Ultrasonography. J Manipulative Physiol Ther 2018; 41:691-697. [PMID: 30594334 DOI: 10.1016/j.jmpt.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Using ultrasonography, this study investigated the abdominal and lumbar multifidus muscle size in patients with lumbar spondylolisthesis compared with healthy patients at rest and during contraction. METHODS This research was a nonexperimental, analytic case-control study. Ultrasound imaging was used to assess the thickness of the abdominal and lumbar multifidus muscles in 25 healthy patients and 25 patients with spondylolisthesis. For the purpose of this study, both men and women, aged 30 to 70 years, were recruited from physiotherapy clinics affiliated with the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Measurements were taken at rest and during contraction. RESULTS There was a significant difference in abdominal and lumbar multifidus muscle size between the healthy and spondylolisthesic groups, both at rest and contraction (P < .05 in all instances). No significant difference was found between the right and left for all measurements (P > .05). CONCLUSION Patients with spondylolisthesis had smaller stabilizer muscle thickness at rest and during contraction compared with the healthy group.
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Affiliation(s)
- Ailin Shadani
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Ali Mohseni Bandpei
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; University Institute of Physical Therapy, Faculty of Allied Health Sciences, University of Lahore, Lahore, Pakistan.
| | - Nahid Rahmani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Mohseni Bandpei MA, Rahmani N, Majdoleslam B, Abdollahi I, Ali SS, Ahmad A. Reliability of Surface Electromyography in the Assessment of Paraspinal Muscle Fatigue: An Updated Systematic Review. J Manipulative Physiol Ther 2014; 37:510-21. [DOI: 10.1016/j.jmpt.2014.05.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/28/2014] [Accepted: 05/01/2014] [Indexed: 12/18/2022]
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Ebadi S, Ansari NN, Naghdi S, Jalaei S, Sadat M, Bagheri H, vanTulder MW, Henschke N, Fallah E. The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial. BMC Musculoskelet Disord 2012; 13:192. [PMID: 23031570 PMCID: PMC3537701 DOI: 10.1186/1471-2474-13-192] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 09/26/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Non-specific chronic low back pain (NSCLBP) is one of the most common musculoskeletal disorders around the world including Iran. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US). Despite its common use, there is still inconclusive evidence to support its effectiveness in patients with NSCLBP. The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP. METHODS In this single blind placebo controlled study, 50 patients with NSCLBP were randomized into two treatment groups: 1) continuous US (1 MHz &1.5 W/cm2) plus exercise 2) placebo US plus exercise. Patients received treatments for 4 weeks, 10 treatment sessions, 3 times per week, every other day. Treatment effects were assessed in terms of primary outcome measures: 1) functional disability, measured by Functional Rating Index, and 2) global pain, measured by a visual analog scale. Secondary outcome measures were lumbar flexion and extension range of motion (ROM), endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test. All outcome variables were measured before, after treatment, and after one-month follow-up. An intention to treat analysis was performed. Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA. RESULTS Analysis showed that both groups had improved regarding function (FRI) and global pain (VAS) (P < .001). Lumbar ROM as well as holding time during the Sorensen test and median frequency slope of all measured paravertebral muscles did not change significantly in either group (P > .05). Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US (P < .05). CONCLUSIONS The study showed that adding continuous US to a semi supervised exercise program significantly improved function, lumbar ROM and endurance time. Further studies including a third group of only exercise and no US can establish the possible effects of placebo US. TRIAL REGISTRATION NTR2251.
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Affiliation(s)
- Safoora Ebadi
- Department of physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Shahnazari St, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Shahnazari St, Tehran, Iran
| | - Soofia Naghdi
- Department of physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Shahnazari St, Tehran, Iran
| | - Shohre Jalaei
- Department of physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Shahnazari St, Tehran, Iran
| | - Mirmostafa Sadat
- Sina Hospital, Medical Faculty, Tehran University of Medical Sciences, Hasanabad St, Tehran, Iran
| | - Hosein Bagheri
- Department of physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Shahnazari St, Tehran, Iran
| | - Maurits W vanTulder
- Department of Health Sciences, VU University, De Boelelaan, Amsterdam, The Netherlands
| | - Nicholas Henschke
- Musculoskeletal Division NHMRC Postdoctoral Fellow, The George Institute for Global Health, Kent St, Sydney, Australia
| | - Ehsan Fallah
- Emam Reza hospital, Medical Faculty, Army University of Medical sciences of the I.R.Iran, Etemadzade St., Tehran, Iran
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Ghamkhar L, Emami M, Mohseni-Bandpei MA, Behtash H. Application of rehabilitative ultrasound in the assessment of low back pain: a literature review. J Bodyw Mov Ther 2010; 15:465-77. [PMID: 21943620 DOI: 10.1016/j.jbmt.2010.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 07/03/2010] [Accepted: 07/07/2010] [Indexed: 02/02/2023]
Abstract
Low back pain (LBP) is one of the most common work-related conditions affecting all populations both in industrialized and non-industrialized countries, with reported high prevalence and incidence rates and huge direct and indirect costs. Among various suggested causes of LBP, dysfunction of back muscles, particularly lumbar multifidus and transverse abdominis, has been the subject of considerable research during last decades. Of the available imaging techniques, ultrasound (US) imaging technique is increasingly used to assess muscle dimensions and function as a valid, reliable and non-invasive approach. The purpose of the present study was to review the previously published studies (1990-2009) concerning the merit of US imaging of lumbar and abdominal muscles with particular attention to its clinical application in patients with LBP. Studies showed wide variation in terms of methodology, sample size, procedure, definition of LBP, heterogeneous sample, method of analyzing US imaging, US imaging parameters, etc. However, a convincing body of evidence was identified that supports US imaging as a reliable and valid tool both to differentiate patients with LBP from normal subjects and to monitor the effect of rehabilitation programs.
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Affiliation(s)
- Leila Ghamkhar
- Department of Physiotherapy, The University of Social Welfare and Rehabilitation Sciences, Student Boulevard, P.O. Box 1985713834, Evin, Tehran, Iran
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Delis AL, Carvalho JLA, da Rocha AF, Ferreira RU, Rodrigues SS, Borges GA. Estimation of the knee joint angle from surface electromyographic signals for active control of leg prostheses. Physiol Meas 2009; 30:931-46. [PMID: 19661566 DOI: 10.1088/0967-3334/30/9/005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The surface electromyographic (SEMG) signal is very convenient for prosthesis control because it is non-invasively acquired and intrinsically related to the user's intention. This work presents a feature extraction and pattern classification algorithm for estimation of the intended knee joint angle from SEMG signals acquired using two sets of electrodes placed on the upper leg. The proposed algorithm uses a combination of time-domain and frequency-domain approaches for feature extraction (signal amplitude histogram and auto-regressive coefficients, respectively), a self-organizing map for feature projection and a Levenberg-Marquardt multi-layer perceptron neural network for pattern classification. The new algorithm was quantitatively compared with the method proposed by Wang et al (2006 Med. Biol. Eng. Comput. 44 865-72), which uses wavelet packet feature extraction, principal component analysis and a multi-layer perceptron neural classifier. The proposed method provided lower error-to-signal percentage and peak error amplitudes, higher correlation and fewer error events. The algorithm presented in this work may be useful as part of a myoelectric controller for active leg prostheses designed for transfemoral amputees.
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Affiliation(s)
- Alberto L Delis
- Department of Electrical Engineering, University of Brasília, Brasília-DF, Brazil
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Delis AL, da Rocha AF, Dos Santos I, Sene IG, Salomoni S, Borges GA. Development of a microcontrolled bioinstrumentation system for active control of leg prostheses. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2008; 2008:2393-2396. [PMID: 19163184 DOI: 10.1109/iembs.2008.4649681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This article describes the design of a microcontrolled bioinstrumentation system for active control of leg prostheses, using 4-channel electromyographic signal (EMG) detection and a single-channel electrogoniometer. The system is part of a control and instrumentation architecture in which a master processor controls the tasks of slave microcontrollers, through a RS-485 interface. Several signal processing methods are integrated in the system, for feature extraction (Recursive Least Squares), feature projection (Self Organizing Maps), and pattern classification (Levenberg-Marquardt Neural Network). The acquisition of EMG signals and additional mechanical information could help improving the precision in the control of leg prostheses.
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Bird AR, Bendrups AP, Payne CB. The effect of foot wedging on electromyographic activity in the erector spinae and gluteus medius muscles during walking. Gait Posture 2003; 18:81-91. [PMID: 14654211 DOI: 10.1016/s0966-6362(02)00199-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The use of foot orthoses for treatment of low back pain (LBP) has received some attention in the literature, mainly from a clinical or theoretical perspective. It has been proposed that this treatment alleviates pain by altering muscle activity in the area of the low back but there is no direct evidence of such an effect. The objective of this study was to determine the effects of different types of foot wedging on the bilateral surface electromyographic activity of erector spinae (ErSp) (L3 level) and gluteus medius (GlMed) of 13 participants without LBP. Activity in ErSp had a significantly earlier onset during the gait cycle with bilateral heel lifts and bilateral lateral forefoot wedging. GlMed activity had a significantly later onset with bilateral heel lifts, and with an unilateral heel lift on the ipsilateral side (P<0.0125). No significant amplitude changes were demonstrated in either muscle for any of the forms of wedging tested. These results show that foot wedging can produce measurable changes in timing of muscle activity within the low back and pelvis during the gait cycle. Further investigation is required to determine whether this effect contributes to the alleviation of LBP.
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Affiliation(s)
- Adam R Bird
- Department of Podiatry, La Trobe University, Bundoora, Melbourne, Vic 3086, Australia.
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