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Molina-Hernández N, Rodríguez-Sanz D, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Vicente-Campos D, Marugán-Rubio D, Gutiérrez-Torre SE, Calvo-Lobo C. A Secondary Analysis of Gender Respiratory Features for Ultrasonography Bilateral Diaphragm Thickness, Respiratory Pressures, and Pulmonary Function in Low Back Pain. Tomography 2024; 10:880-893. [PMID: 38921944 PMCID: PMC11209459 DOI: 10.3390/tomography10060067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/27/2024] Open
Abstract
The aim of the present study was to determine the gender respiratory differences of bilateral diaphragm thickness, respiratory pressures, and pulmonary function in patients with low back pain (LBP). A sample of 90 participants with nonspecific LBP was recruited and matched paired by sex (45 women and 45 men). Respiratory outcomes included bilateral diaphragm thickness by ultrasonography, respiratory muscle strength by maximum inspiratory (MIP) and expiratory (MEP) pressures, and pulmonary function by forced expiratory volume during 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC spirometry parameters. The comparison of respiratory outcomes presented significant differences (p < 0.001), with a large effect size (d = 1.26-1.58) showing means differences (95% CI) for MIP of -32.26 (-42.99, -21.53) cm H2O, MEP of -50.66 (-64.08, -37.25) cm H2O, FEV1 of -0.92 (-1.18, -0.65) L, and FVC of -1.00 (-1.32, -0.69) L, with lower values for females versus males. Gender-based respiratory differences were presented for maximum respiratory pressures and pulmonary function in patients with nonspecific LBP. Women presented greater inspiratory and expiratory muscle weakness as well as worse lung function, although these differences were not linked to diaphragm thickness during normal breathing.
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Affiliation(s)
- Nerea Molina-Hernández
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | | | - Ricardo Becerro-de-Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | | | - Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain;
| | - Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
- Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
| | - Samuel Eloy Gutiérrez-Torre
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (N.M.-H.); (R.B.-d.-B.-V.); (D.M.-R.); (S.E.G.-T.); (C.C.-L.)
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Wang XQ, Wang YL, Witchalls J, Han J, Zhang ZJ, Page P, Zhu Y, Stecco C, Lin JH, El-Ansary D, Ma QS, Qi Q, Oh JS, Zhang WM, Pranata A, Wan L, Li K, Ma M, Liao LR, Zhu YL, Guo JW, Chen PJ. Physical therapy for acute and sub-acute low back pain: A systematic review and expert consensus. Clin Rehabil 2024; 38:715-731. [PMID: 38317586 DOI: 10.1177/02692155241229398] [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] [Indexed: 02/07/2024]
Abstract
OBJECTIVE To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions. DATA SOURCES A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years. REVIEW METHODS Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts. RESULTS Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain. CONCLUSIONS The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years.
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Affiliation(s)
- Xue-Qiang Wang
- Rehabilitation Medicine Center, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- School of Rehabilitation Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yu-Ling Wang
- Department of Rehabilitation Medicine, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jeremy Witchalls
- Research Institute for Sports and Exercise, University of Canberra, Bruce, ACT, Australia
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zhi-Jie Zhang
- Rehabilitation Therapy Center, Henan Luoyang Orthopedic Hospital (Henan Provincial Orthopedic Hospital), Luoyang, China
| | - Phillip Page
- Franciscan University, Franciscan Missionaries of Our Lady University, Baton Rouge, LA, USA
| | - Yi Zhu
- Department of Pain and Musculoskeletal Rehabilitation, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Jian-Hua Lin
- Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Doa El-Ansary
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Quan-Sheng Ma
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qi Qi
- Department of Rehabilitation Therapy, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), Tongji University School of Medicine, Shanghai, China
| | - Jae-Seop Oh
- Department of Physical Therapy, INJE University, Gimhae, Republic of Korea
| | - Wei-Ming Zhang
- Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Adrian Pranata
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Li Wan
- Rehabilitation Center, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Kui Li
- Department of the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ming Ma
- Department of Rehabilitation Medicine, Zhongda Hospital Southeast University, Nanjing, Jiangsu, China
| | - Lin-Rong Liao
- Department of Rehabilitation, Yixing JORU Rehabilitation Hospital, Wuxi, China
| | - Yu-Lian Zhu
- Department of Rehabilitation, Huashan Hospital Fudan University, Shanghai, China
| | - Jing-Wei Guo
- Department of Rehabilitation Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Pei-Jie Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
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Xia Q, Zhao Y, Dong H, Mao Q, Zhu L, Xia J, Weng Z, Liao W, Hu Z, Yi J, Feng S, Jiang Y, Xin Z. Progress in the study of molecular mechanisms of intervertebral disc degeneration. Biomed Pharmacother 2024; 174:116593. [PMID: 38626521 DOI: 10.1016/j.biopha.2024.116593] [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: 02/03/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/18/2024] Open
Abstract
Degenerative intervertebral disc disease (IVDD) is one of the main spinal surgery, conditions, which markedly increases the incidence of low back pain and deteriorates the patient's quality of life, and it imposes significant social and economic burdens. The molecular pathology of IVDD is highly complex and multilateral however still not ompletely understood. New findings indicate that IVDD is closely associated with inflammation, oxidative stress, cell injury and extracellular matrix metabolismdysregulation. Symptomatic management is the main therapeutic approach adopted for IVDD, but it fails to address the basic pathological changes and the causes of the disease. However, research is still focusing on molecular aspects in terms of gene expression, growth factors and cell signaling pathways in an attempt to identify specific molecular targets for IVDD treatment. The paper summarizes the most recent achievements in molecularunderstanding of the pathogenesis of IVDD and gives evidence-based recommendations for clinical practice.
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Affiliation(s)
- Qiuqiu Xia
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Yan Zhao
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Huaize Dong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Qiming Mao
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Lu Zhu
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Jiyue Xia
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Zijing Weng
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Wenbo Liao
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China
| | - Zongyue Hu
- Department of Pain Rehabilitation, Affiliated Sinopharm Gezhouba Central Hospital, Third Clinical Medical College of Three Gorges University, Yichang, Hubei Province 443003, China
| | - Jiangbi Yi
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Shuai Feng
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Youhong Jiang
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; First School of Clinical Medicine, Zun yi Medical University, Zunyi 563000, China
| | - Zhijun Xin
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou 563000, China; Institut Curie, PSL Research University, CNRS UMR3244, Dynamics of Genetic Information, Sorbonne Université, Paris 75005, France.
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Oertel J, Sharif S, Zygourakis C, Sippl C. Acute low back pain: Epidemiology, etiology, and prevention: WFNS spine committee recommendations. World Neurosurg X 2024; 22:100313. [PMID: 38510335 PMCID: PMC10951075 DOI: 10.1016/j.wnsx.2024.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/21/2024] [Indexed: 03/22/2024] Open
Abstract
Objective Acute low back pain is a highly prevalent condition that poses significant challenges to healthcare systems worldwide. In this manuscript, we present the most current, evidence-based guidelines from the World Federation of Neurosurgical Societies (WFNS) Spine Committee on the epidemiology, etiology, and prevention of acute low back pain (LBP) lasting ≤ 4 weeks. Methods We performed a literature review 2012-2022 using the PubMed, Medline, and CENTRAL databases with the keywords "acute low back pain", "acute back pain", "low back pain", "epidemiology", "etiology", "costs", "risk factor", "cultural", "developed", "developing" and "prevention". Systematic screening criteria were applied, resulting in 13 final articles on epidemiology and etiology of LBP, 2 manuscripts on costs, 5 articles on risk factors, and 23 articles on prevention strategies for acute LBP. These were presented at two separate international meetings, where members of the WFNS Spine Committee voted on five final consensus statements presented here. Results and Conclusions: There is a high incidence and prevalence of acute LBP, particularly in high-income countries, which is felt to be at least partially due to demographic shifts with an aging population and lifestyle changes including higher rates of obesity and physical inactivity. Acute LBP has a significant impact on quality of life and ability to work, resulting in high direct and indirect costs worldwide. Early diagnosis and appropriate management of acute LBP is recommended to prevent this pain from turning into chronic LBP. The WFNS Spine Committee's recommendations respresent the latest guidelies to help improve patient care for acute LBP worldwide.
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Affiliation(s)
- Joachim Oertel
- Department of Neurosurgery, Saarland University Medical Centre, Kirrbergerstrasse 100, Gebaeude 90.5, 66421 Homburg Saar, Germany
| | - Salman Sharif
- Department of Neurosurgery, Liaqat National Hospital and Medical School, Stadium Road, Karachi 74800, Pakistan
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christoph Sippl
- Department of Neurosurgery, Saarland University Medical Centre, Kirrbergerstrasse 100, Gebaeude 90.5, 66421 Homburg Saar, Germany
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Oh TK, Song IA. Association between socioeconomic status and treatment in patients with low back or neck pain: a population-based cross-sectional study in South Korea. Reg Anesth Pain Med 2023; 48:561-566. [PMID: 37045556 DOI: 10.1136/rapm-2022-104246] [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: 12/05/2022] [Accepted: 03/25/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Socioeconomic status affects the treatment of patients with low back pain and/or neck pain. We examined the relationship between socioeconomic status (occupation and household income level) and treatments such as chronic opioid use and interventional procedures among these patients. METHODS Data from the National Health Insurance Service database in South Korea were used in this population-based cross-sectional study. Approximately 2.5% of adult patients diagnosed with low back pain and/or neck pain between 2010 and 2019 were selected using a stratified random sampling technique and included in the analysis. RESULTS We analyzed the data of 5,861,007 patients with low back pain and/or neck pain in total. Among them, 4.9% were chronic opioid users and 17.7% underwent interventional procedures. Healthcare workers and unemployed individuals had 18% lower and 6% higher likelihood of chronic opioid use compared with office workers, respectively. Those with a very low household income had 18% higher likelihood of chronic opioid use than those with a poor household income. Other workers and unemployed individuals had 4% and 8% higher likelihood of undergoing interventional procedures than office workers, respectively. Healthcare workers had 5% lower likelihood of undergoing interventional procedures than office workers. Patients with middle, high, and very poor household incomes had a higher likelihood of undergoing interventional procedures, while those in the very high household income group had a lower likelihood of undergoing interventional procedures than those with poor household incomes. CONCLUSIONS Socioeconomic status factors are associated with treatment in patients with low back pain and/or neck pain.
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Affiliation(s)
- Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
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Capel-Alcaraz AM, Castro-Sánchez AM, Matarán-Peñarrocha GA, Antequera-Soler E, Lara-Palomo IC. Effects of Motor Control Exercises in Patients With Chronic Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis. Clin J Sport Med 2023; 33:579-597. [PMID: 37432388 DOI: 10.1097/jsm.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVE The primary objective of this systematic review is to assess whether motor control exercises consisting of the methodology described by Richardson and Hodges improve the pain and disability of patients with nonspecific low back pain. DESIGN Systematic review and a meta-analysis. SETTING A literature review was conducted using PubMed, PEDro, Scielo, CINAHL, Web of Science, Dialnet, Scopus, and MEDLINE from inception to November 2021. PATIENTS Patients with chronic nonspecific low back pain. INTERVENTIONS Randomized controlled trials assessing motor control exercises versus inactive control, placebo or minimal intervention, and other exercises. MAIN OUTCOME MEASURES Pain intensity, disability, and physical activity were considered as primary outcomes. RESULTS Eighteen studies with 1356 patients were finally included in the systematic review, of which only 13 randomized clinical trials could be meta-analyzed. Statistically significant results were found in favor of the motor control group for the comparison with other exercises in disability at postintervention term (Mean Difference, 95% Confidence Interval [CI], -3.13 [-5.87 to -0.38], P = 0.03); for the comparison with inactive control, placebo, or minimal intervention in pain at postintervention term (MD, 95% CI, -18.10 [-30.79 to -5.41], P = 0.008); and for comparison with general exercises (MD, 95% CI, -12.70 [-20.80 to -4.60], P = 0.002). CONCLUSIONS Moderate-quality evidence regarding the effectiveness of motor control exercises to reduce pain intensity and disability exists, but the reduction should be interpreted with caution.
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Affiliation(s)
- Ana M Capel-Alcaraz
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain; and
| | | | | | - Eduardo Antequera-Soler
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain; and
| | - Inmaculada C Lara-Palomo
- Department of Nursing, Physical Therapy and Medicine, University of Almeria, Almeria, Spain; and
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Wu R, Huang L, Xia Q, Liu Z, Huang Y, Jiang Y, Wang J, Ding H, Zhu C, Song Y, Liu L, Zhang L, Feng G. Injectable mesoporous bioactive glass/sodium alginate hydrogel loaded with melatonin for intervertebral disc regeneration. Mater Today Bio 2023; 22:100731. [PMID: 37533731 PMCID: PMC10393589 DOI: 10.1016/j.mtbio.2023.100731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Intervertebral disc degeneration (IDD) is a major contributing factor to both lower back and neck pain. As IDD progresses, the intervertebral disc (IVD) loses its ability to maintain its disc height when subjected to axial loading. This failure in the weight-bearing capacity of the IVD is a characteristic feature of degeneration. Natural polymer-based hydrogel, derived from biological polymers, possesses biocompatibility and is able to mimic the structure of extracellular matrix, enabling them to support cellular behavior. However, their mechanical performance is relatively poor, thus limiting their application in IVD regeneration. In this study, we developed an injectable composite hydrogel, namely, Mel-MBG/SA, which is similar to natural weight-bearing IVD. Mesoporous bioactive glasses not only enhance hydrogels, but also act as carriers for melatonin (Mel) to suppress inflammation during IDD. The Mel-MBG/SA hydrogel further provides a mixed system with sustained Mel release to alleviate IL-1β-induced oxidative stress and relieve inflammation associated with IDD pathology. Furthermore, our study shows that this delivery system can effectively suppress inflammation in the rat tail model, which is expected to further promote IVD regeneration. This approach presents a novel strategy for promoting tissue regeneration by effectively modulating the inflammatory environment while harnessing the mechanical properties of the material.
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Affiliation(s)
- Ruibang Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Leizhen Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University / West China School of Nursing, Sichuan University, Chengdu, 610041, China
| | - Zheng Liu
- Analytical and Testing Center, Sichuan University, Chengdu, 610065, China
| | - Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yulin Jiang
- Analytical and Testing Center, Sichuan University, Chengdu, 610065, China
| | - Juehan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hong Ding
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ce Zhu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Li Zhang
- Analytical and Testing Center, Sichuan University, Chengdu, 610065, China
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
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Fortin M, Rye M, Roussac A, Montpetit C, Burdick J, Naghdi N, Rosenstein B, Bertrand C, Macedo LG, Elliott JM, Dover G, DeMont R, Weber MH, Pepin V. The Effects of Combined Motor Control and Isolated Extensor Strengthening versus General Exercise on Paraspinal Muscle Morphology, Composition, and Function in Patients with Chronic Low Back Pain: A Randomized Controlled Trial. J Clin Med 2023; 12:5920. [PMID: 37762861 PMCID: PMC10532355 DOI: 10.3390/jcm12185920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Low back pain (LBP), a globally widespread and persistent musculoskeletal disorder, benefits from exercise therapy. However, it remains unclear which type leads to greater changes in paraspinal muscle health. This study aimed to (1) compare the effects of a combined motor control and isolated lumbar extension exercise (MC+ILEX) versus a general exercise (GE) intervention on paraspinal muscle morphology, composition, and function, and (2) examine whether alterations in paraspinal muscle health were correlated with improvements in pain, function, and quality of life. Fifty participants with chronic LBP were randomly assigned to each group and underwent a 12-week supervised intervention program. Magnetic resonance imaging and ultrasound assessments were acquired at baseline, 6 and 12 weeks to examine the impact of each intervention on erector spinae (ES) and multifidus (MF) muscle size (cross-sectional area, CSA), composition, and function at L4-L5 and L5-S1. Self-reported questionnaires were also acquired to assess participant-oriented outcomes. Our findings indicated that the MC+ILEX group demonstrated greater improvements in MF and ES CSA, along with MF thickness at both levels (all p < 0.01). Both groups significantly improved in pain, function, and quality of life. This study provided preliminary results suggesting that an MC+ILEX intervention may improve paraspinal morphology while decreasing pain and disability.
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Affiliation(s)
- Maryse Fortin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
| | - Meaghan Rye
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Alexa Roussac
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Chanelle Montpetit
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Jessica Burdick
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Neda Naghdi
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Brent Rosenstein
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Cleo Bertrand
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Luciana G. Macedo
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 1C7, Canada;
| | - James M. Elliott
- Faculty of Medicine and Health, School of Health Sciences, The Kolling Institute, University of Sydney, Sydney, NSW 2050, Australia;
- Northern Sydney Local Health District, St. Leonards, NSW 2065, Australia
| | - Geoffrey Dover
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Richard DeMont
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
| | - Michael H. Weber
- Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC H3J 1A4, Canada;
| | - Véronique Pepin
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC H4B 1R6, Canada; (M.R.); (A.R.); (C.M.); (J.B.); (N.N.); (B.R.); (C.B.); (G.D.); (R.D.); (V.P.)
- School of Health, Concordia University, Montreal, QC H4B 1R6, Canada
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9
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Lucha-López MO, Hidalgo-García C, Monti-Ballano S, Márquez-Gonzalvo S, Ferrández-Laliena L, Müller-Thyssen-Uriarte J, Lucha-López AC. Body Mass Index and Its Influence on Chronic Low Back Pain in the Spanish Population: A Secondary Analysis from the European Health Survey (2020). Biomedicines 2023; 11:2175. [PMID: 37626672 PMCID: PMC10452522 DOI: 10.3390/biomedicines11082175] [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: 06/29/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Risk factors such as obesity and a sedentary lifestyle contribute to the development of chronic low back pain. PURPOSE To describe how body mass index (BMI) influences the prevalence of chronic low back pain in the general Spanish population and assess this influence given other factors as sex, age, physical occupational demands, and recreational physical activity. METHODS An analytical cross-sectional design was performed based on secondary data from the European Health Survey in Spain (2020). Data on age, gender, physical occupational demands, physical activity, BMI, and presence of chronic low back pain were extracted. RESULTS A total of 19,716 (52.2% women) subjects with a median age of 53 years old were analyzed. Of these, 18.3% had chronic low back pain, 39% were overweight, and 16.1% were obese. The adjusted generalized linear model showed that being obese increased the odds of chronic low back pain by 1.719 times (p < 0.001). Being a woman increased the odds by 1.683 times (p < 0.001). Performing occupational tasks requiring high physical demands increased the odds by 1.403 times (p < 0.001). Performing physical activity in leisure time several times a week decreased the odds by 0.598 times (p < 0.001). For every additional year of age, the odds of chronic low back pain increased by 3.3% (p < 0.001). CONCLUSIONS Obesity is related with the presence of chronic low back pain in the general Spanish population. This association persists, being the more relevant factor, after adjusting the association of BMI and chronic low back pain with other factors such as sex, age, physical occupational demands, and recreational physical activity.
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Affiliation(s)
- María Orosia Lucha-López
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (L.F.-L.); (J.M.-T.-U.)
| | - César Hidalgo-García
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (L.F.-L.); (J.M.-T.-U.)
| | - Sofía Monti-Ballano
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (L.F.-L.); (J.M.-T.-U.)
| | - Sergio Márquez-Gonzalvo
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (L.F.-L.); (J.M.-T.-U.)
| | - Loreto Ferrández-Laliena
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (L.F.-L.); (J.M.-T.-U.)
| | - Julián Müller-Thyssen-Uriarte
- Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain; (S.M.-B.); (S.M.-G.); (L.F.-L.); (J.M.-T.-U.)
| | - Ana Carmen Lucha-López
- Unidad de Investigación en Fisioterapia, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain;
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10
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James-Belin E, Ostertag A, Couzi E, Petrover D, Yelnik A, Orcel P, Beaudreuil J. [Impact économique de l'incapacité professionnelle au cours des lombalgies disco-vertébrales communes chroniques dans la perspective du patient]. Rev Epidemiol Sante Publique 2023; 71:101858. [PMID: 37271081 DOI: 10.1016/j.respe.2023.101858] [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: 09/26/2022] [Revised: 02/16/2023] [Accepted: 04/12/2023] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVES Low back pain (LBP) is one of the main expenditure items for health systems. Data on the economic impact of LBP are uncommon from the patient perspective. The aim of this study was to estimate the economic impact of work disability related to chronic LBP from the patient perspective. METHODS We conducted a cross-sectional analysis from patients aged over 17 years suffering from non-specific LBP for at least 3 months. Systematic medical, social and economic assessments were collected: pain duration and intensity; functional disability with the Quebec Back Pain Disability Scale (0-100); quality of life with the Dallas Pain Questionnaire; job category; employment status; duration of work disability due to LBP, and income. Factors associated with loss of income were identified by multivariable logistic regression analysis. RESULTS We included 244 workers (mean age 43 ± 9 years; 36% women); 199 patients had work disability, including 196 who were on sick leave, 106 due to job injury. Three were unemployed due to layoff for incapacity. The mean loss of income for patients with work disability was 14% [SD 24, range -100 to 70] and was significantly less for patients on sick leave due to job injury than on sick leave not related to job injury (p < 0.0001). On multivariable analysis, the probability of loss of income with LBP was about 50% less for overseers and senior managers than workers or employees (odds ratio 0.48 [95% confidence interval 0.23-0.99]). CONCLUSION Work disability due to LBP resulted in loss of income in our study. The loss of income depended on the type of social protection and job category. It was reduced for patients on sick leave related to work injury and for overseers and senior managers.
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Affiliation(s)
- Etienne James-Belin
- Service de Médecine Physique et de Réadaptation, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France.
| | - Agnès Ostertag
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Emmanuel Couzi
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - David Petrover
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Alain Yelnik
- Service de Médecine Physique et de Réadaptation, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Philippe Orcel
- Service de Rhumatologie, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
| | - Johann Beaudreuil
- Service de Médecine Physique et de Réadaptation, Hôpital Lariboisère-Fernand Widal, Département Médico-Universitaire Locomotion, Groupe Hospitalo-Universitaire AP-HP.Nord - Université de Paris, Paris, France
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11
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Hochheim M, Ramm P, Amelung V. The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: A systematic review with meta-analysis. Pain Pract 2023; 23:409-436. [PMID: 36565010 DOI: 10.1111/papr.13198] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 11/02/2022] [Accepted: 11/28/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of low-dosed outpatient biopsychosocial interventions versus active physical interventions on pain intensity and disability in adults with nonspecific chronic low back pain. INTRODUCTION Research has shown that primary care biopsychosocial interventions (PCBI) can reduce pain intensity and disability. While scattered studies support low-dosed (≤ 15 treatment hours) PCBI, no systematic review exists comparing the effectiveness of low-dosed PCBI treatment with traditional physical activity interventions in adults with nonspecific chronic low back pain (CLBP). INCLUSION CRITERIA Randomized controlled trials that evaluate low-dosed PCBI compared to physical treatment with an active component such as exercise, physical activity or usual physiotherapy treatment for adult participants (18 years or older), who suffer from CLBP were included. Not recommended interventions that feature only passive therapies, spinal surgery or pharmacological treatment, and studies with inpatient multidisciplinary-based rehabilitation (MBR) were excluded. METHODS Databases were searched from inception to December 31, 2021. Language was restricted to English or German. Keywords and derivatives of "chronic back pain", "exercise intervention", "cognitive-behavioral therapy", "primary care" and "randomized controlled trials" were used. Sources were CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science. Search was finished on March 08, 2022. Data appraisal, extraction and synthesis followed JBI guidance for systematic reviews of effectiveness. Risk of Bias was assessed using JBI 13-item checklist for randomized controlled trials. The GRADE approach for grading the certainty of evidence was followed. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2022 CRD42022302771. RESULTS Eighteen RCTs were found eligible and 15 trials comprising a total of 1531 participants suffering from CLBP were entered in the meta-analyses. Risk of Bias was low. Overall evidence was moderate. Significant effects in favor of PCBI were found for pain intensity post-treatment (standardized mean difference (SMD) = -1.09, 95% confidence interval (CI) = -1.84 to -0.34, I2 = 97%, p = 0.004) as well as at short-term (SMD = -0.23, 95% CI = -0.39 to -0.08, I2 = 0%, p = 0.004), long term (SMD = -0.79, 95% CI = -1.42 to -0.17, I2 = 96%, p = 0.01) and very long-term (SMD = -1.13, 95% CI = -1.93 to -0.33, I2 = 94%, p = 0.005) follow-up. Significant effects in favor of PCBI for physical function were found post-treatment (SMD = -1.33, 95% CI = -2.17 to -0.49, I2 = 97%, p = 0.002) at short-term (SMD = -0.20, 95% CI = -0.36 to -0.04, I2 = 0%, p = 0.01) and at long-term follow-up (SMD = -1.17, 95% CI = -2.06 to -0.28, I2 = 98%, p = 0.01). The results were characterized by high heterogeneity due to different types (cognitive behavioral therapy, pain-neuroscience education, mindfulness, and motivation), delivery modes (individual and/or group), durations (3-12 weeks) and contact times (2-15 h) of PCBI. In sensitivity analysis outliers were removed to reduce heterogeneity. The results remained significant for pain intensity at short-term (SMD = -0.23, 95% CI = -0.39 to -0.08, I2 = 0%, p = 0.004) and long-term follow-up (SMD = -0.22, 95% CI = -0.41 to -0.03, I2 = 39%, p = 0.02). CONCLUSIONS This meta-analysis suggests that low-dosed PCBI has favorable effects in terms of disability and pain intensity compared to active physical treatments alone. All conducted meta-analyses indicate that biopsychosocial interventions produce better outcomes than active physical treatment alone. Therefore, we strongly recommend decision makers and clinical practitioners to analyze how psychosocial elements can be introduced into outpatient (low-dosed) CLBP interventions.
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Affiliation(s)
- Martin Hochheim
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Hannover, Germany
- Generali Health Solutions GmbH (GHS), Köln, Germany
| | - Philipp Ramm
- Generali Health Solutions GmbH (GHS), Köln, Germany
| | - Volker Amelung
- Institute of Epidemiology, Social Medicine and Health System Research, Medizinische Hochschule Hannover (MHH), Hannover, Germany
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Jia Z, Liu D, Xu J, Wang Q, Zhang L, Yin S, Qian B, Li X, Wu Y, Zhang Y, Li W, Wen T. An international analysis of stem cell research in intervertebral disc degeneration. Stem Cell Res 2023; 67:103044. [PMID: 36796251 DOI: 10.1016/j.scr.2023.103044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
Stem cell therapy has been increasingly investigated as a promising strategy for intervertebral disc degeneration (IDD). However, no international analysis of stem cell research has yet been conducted. This study aimed to analyze the major characteristics of published reports of stem cell use for IDD and to present a global insight into stem cell research. The study period spanned from the inception of the Web of Science database to 2021. A search strategy using specific keywords was implemented to retrieve relevant publications. The numbers of documents, citations, countries, journals, article types, and stem cell types were evaluated. A total of 1170 papers were retrieved. The analysis showed a significant increase in the number of papers over time (p < 0.001). High-income economies accounted for the majority of papers (758, 64.79 %). China produced the most articles (378, 32.31 %), followed by the United States (259, 22.14 %), Switzerland (69, 5.90 %), United Kingdom (54, 4.62 %), and Japan (47, 4.02 %). The United States ranked first in terms of the number of citations (10,346), followed by China (9177) and Japan (3522). Japan ranked first in terms of the number of citations per paper (74.94), followed by United Kingdom (58.54) and Canada (53.74). When standardized by population, Switzerland ranked first, followed by Ireland and Sweden. When gross domestic product was considered, Switzerland ranked first, followed by Portugal and Ireland. The number of papers was positively correlated with gross domestic product (p < 0.001, r = 0.673); however, there was no significant correlation with population (p = 0.062, r = 0.294). Mesenchymal stem cells were the most investigated stem cells, followed by nucleus pulposus-derived stem cells and adipose-derived stem cells. A sharp increase in stem cell research was observed in the field of IDD. China produced the most, although several European countries were more productive relative to their populations and economies.
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Affiliation(s)
- Zhiwei Jia
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Donghua Liu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiao Xu
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qiang Wang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Longyu Zhang
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shi Yin
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bo Qian
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xingxuan Li
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yaohong Wu
- Department of Spine Surgery, Ganzhou People's Hospital, Ganzhou, China.
| | - Yan Zhang
- Department of TCM Orthopedics, Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Wei Li
- Department of Sports Medicine, Fourth Medical Center of PLA General Hospital, Beijing, China.
| | - Tianlin Wen
- Department of Orthopedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
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13
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Huang J, Xie ZF. Dried fruit intake causally protects against low back pain: A Mendelian randomization study. Front Nutr 2023; 10:1027481. [PMID: 37032770 PMCID: PMC10076586 DOI: 10.3389/fnut.2023.1027481] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/20/2023] [Indexed: 04/11/2023] Open
Abstract
Background Low back pain is the leading cause of years lived with disability worldwide. The aim of this study was to evaluate whether dried fruit intake causally protects against low back pain using two-sample Mendelian randomization (MR). Methods We obtained summary-level data for dried fruit intake (N = 421,764) from the IEU Open GWAS Project. Forty-one independent genetic variants proxied dried fruit intake. The corresponding data for low back pain were derived from the FinnGen project (13,178 cases and 164,682 controls; discovery data) and the Neale lab (5,423 cases and 355,771 controls; replication data). We conducted univariable and multivariable MR analyses. Results In the univariable MR analysis, the inverse variance weighted estimate showed that greater dried fruit intake was associated with decreased risk of low back pain [odds ratio (OR) = 0.435, 95% confidence interval (CI): 0.287-0.659, P = 8.657 × 10-5]. Sensitivity analyses using the MR-Egger (OR = 0.078, 95% CI: 0.013-0.479, P = 0.009), maximum likelihood (OR = 0.433, 95% CI: 0.295-0.635, P = 1.801 × 10-5), weighted median (OR = 0.561, 95% CI: 0.325-0.967, P = 0.038) and Mendelian Randomization Pleiotropy RESidual Sum and Outlier (MR-PRESSO) (OR = 0.454, 95% CI: 0.302-0.683, P = 4.535 × 10-4) methods showed consistent results. No evidence of directional pleiotropy was identified according to the Egger intercept (intercept P-value = 0.065) or applying the MR-PRESSO method (global test P-value = 0.164). The replication analysis yielded similar results. The multivariable MR revealed that the inverse association between dried fruit intake and low back pain was consistent after adjustment for fresh fruit intake, body mass index, current tobacco smoking, alcohol intake frequency, total body bone mineral density, serum 25-hydroxyvitamin D levels, and vigorous physical activity. Conclusion This MR study provides evidence to support that dried fruit intake causally protects against low back pain.
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Affiliation(s)
- Jian Huang
- Clinical Laboratory Center, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zheng-Fu Xie
- Geriatrics Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Zheng-Fu Xie
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14
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Smajic S, Vujadinovic A, Kasapovic A, Aldakheel DA, Charles YP, Walter A, Steib JP, Maffulli N, Migliorini F, Baroncini A. The influence of total disc arthroplasty with Mobidisc prosthesis on lumbar spine and pelvic parameters: a prospective in vivo biomechanical study with a minimum 3 year of follow-up. J Orthop Surg Res 2022; 17:456. [PMID: 36243710 PMCID: PMC9571419 DOI: 10.1186/s13018-022-03352-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022] Open
Abstract
Background This study examined the impact of Mobidisc implant on spinopelvic parameters, with particular focus on the preservation of the lumbar lordosis (LL) and on the segmental lordosis (SL) of the treated and adjacent segments.
Methods A prospective study was conducted on 63 consecutive patients with symptomatic degenerative disc disease who underwent Mobidisc implantation at the Clinic for Spinal Diseases in Strasbourg, France. Based on the profile images of the whole, the following static spinopelvic parameters were measured and analysed: lumbar lordosis L1-S1 (LL), SL for L3-L4, L4-L5 and L5-S1, sacral slope (SS), pelvic tilt (PT) and pelvic incidence. In the lumbar spine images, the anterior (ADH) and posterior disc height (PDH) were measured prior to surgery and at the different follow-up appointments. The preoperative and postoperative values were compared and statistically analysed at different time intervals.
Results Sixty-three patients were included in the study. The average age of the patients was 41.4 years (range 27–59 years). The mean follow-up was 44 months (range 36–71 months). Overall, total disc replacement (TDR) led to an increase in LL which increased TED over time. The preoperative LL measured 48.9° ± 10.1° and 53.4° ± 9.9° at 3 years follow-up (p < 0.0001). In the cohort of patients who underwent TDR at L4-5, the LL increased from 51.6° ± 10° to 56.2° ± 9.2° at the last FU (p = 0.006). All other spinopelvic parameters remained stable between the preoperative values and the last follow-up. In the patients who underwent L5-S1 TDR, a significant increase in LL was also observed between preoperative data and at the last FU (from 47.8° ± 10.1° to 53.3° ± 10.1°, p < 0.0001). Following L5-S1 TDR, the SS increased from 32.9° ± 8.3° to 35.6° ± 7.4° (p = 0.05) and the PT decreased from 15.4° ± 6.2° to 11.6° ± 5.7° between preoperative values and the last follow-up. Considering the entire cohort, the SL L5-S1 increased significantly from 5.9° ± 4.2° preoperatively to 8.1° ± 4.4° (p < 0.01) at the last FU, while at the L4-L5 level, the SL remained stable from 9.9 ± 4.5° to 10.7° ± 3.8° (p = 0.3). After L4-5 TDR, an increase in ADH and PDH at the treated level was observed, while these parameters progressively decreased in the adjacent segment. In patients who underwent L5-S1 TDR, a significant increase in L5-S1 ADH and PDH was observed from 18.8 ± 9.1 to 28.4 ± 11.1 and from 9.5 ± 3.8 to 17.6 ± 9.5 pixels, respectively. ADH and PDH at the proximal adjacent levels L3-4 and L4-5 were reduced. We did not observe any case of implant failure or damage to the bone/implant interface. Conclusion TDR with Mobidisc allows for an improvement of LL and SL at the treated level. An increase in both anterior and posterior disc height was observed at the treated level. While disc height decreased at the adjacent level, further studies are required to investigate whether these changes are clinically relevant.
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Affiliation(s)
- Samir Smajic
- Department of Orthopedic, Trauma and Spine Surgery, St. Josef Hospital, Linnich, Germany
| | - Aleksandar Vujadinovic
- Department of Orthopedic and Trauma Surgery, Tuzla University Hospital, Tuzla, Bosnia and Herzegovina.,Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.,Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Adnan Kasapovic
- Department of Orthopedic and Trauma Surgery, University Hospital of Bonn, Bonn, Germany
| | - Dakheel A Aldakheel
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France.,Department of Orthopedic Surgery, Imam Abdulrahman Bin Faisal University of Dammam, Dammam, Kingdom of Saudi Arabia
| | - Yann Philippe Charles
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - Axel Walter
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - Jean-Paul Steib
- Department of Spine Surgery, Strasbourg University Hospital, Avenue Molière, 67200, Strasbourg, France
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.,Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke on Trent, ST4 7QB, England, 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, England, UK
| | - Filippo Migliorini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany. .,Department of Orthopaedic and Trauma Surgery, Eifelklinik St.Brigida, 52152, Simmerath, Germany.
| | - Alice Baroncini
- Department of Orthopedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
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15
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Hochheim M, Ramm P, Wunderlich M, Amelung V. A cross-sectional study to validate an administrative back pain severity classification tool based on the graded chronic pain scale. Sci Rep 2022; 12:16927. [PMID: 36209228 PMCID: PMC9547910 DOI: 10.1038/s41598-022-21422-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/27/2022] [Indexed: 12/29/2022] Open
Abstract
Treatment of chronic lower back pain (CLBP) should be stratified for best medical and economic outcome. To improve the targeting of potential participants for exclusive therapy offers from payers, Freytag et al. developed a tool to classify back pain chronicity classes (CC) based on claim data. The aim of this study was to evaluate the criterion validity of the model. Administrative claim data and self-reported patient information from 3,506 participants (2014-2021) in a private health insurance health management programme in Germany were used to validate the tool. Sensitivity, specificity, and Matthews' correlation coefficient (MCC) were calculated comparing the prediction with actual grades based on von Korff's graded chronic pain scale (GCPS). The secondary outcome was an updated view on direct health care costs (€) of patients with back pain (BP) grouped by GCPS. Results showed a fair correlation between predicted CC and actual GCPS grades. A total of 69.7% of all cases were correctly classified. Sensitivity and specificity rates of 54.6 and 76.4% underlined precision. Correlation between CC and GCPS with an MCC of 0.304 also indicated a fair relationship between prediction and observation. Cost data could be clearly grouped by GCPS: the higher the grade, the higher the costs and the use of health care. This was the first study to compare the predicted severity of BP using claim data with the actual severity of BP by GCPS. Based on the results, the usage of CC as a single tool to determine who receives CLBP treatment cannot be recommended. CC is a good tool to segment candidates for specific types of intervention in BP. However, it cannot replace a medical screening at the beginning of an intervention, as the rate of false negatives is too high. Trial registration The study was conducted using routinely collected data from an intervention, which was previously evaluated and registered retrospectively in the German Registry of Clinical Trials under DRKS00015463 (04/09/2018). Informed consent and the self-reported questionnaire have remained unchanged since the study and, therefore, are still valid according to the ethics proposal.
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Affiliation(s)
- M Hochheim
- Institute of Epidemiology, Social Medicine, and Health System Research, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
- Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany.
| | - P Ramm
- Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany
| | - M Wunderlich
- Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany
| | - V Amelung
- Generali Health Solutions GmbH (GHS), Hansaring 40 - 50, 50670, Köln, Germany
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Treatment of low back pain with exercise language Author: Amir Mohammadamini Published by Lambert Publications, No. Shaik ISBN: 978-613-9-95598-5 This book is in Farsi, Kurdish, English, Russian, Italian, Polish, Dutch, French languages. , German, Spanish, Portuguese
edition Kurdish 9786229434529
”Treatment of low back pain with exercise language“
Author:Amir Mohammadamini
Edition Persian
9876229876886
”Treatment of low back pain with exercise language“
Author:Amir Mohammadamini
ISBN-13
978-6200987136
Amir Mohammadamini
Traitement de la lombalgie par l'exercice du langage
Edition Français
ISBN-13
978-6200987082
Amir Mohammadamini
Behandeling van lage rugpijn met oefentaal (Dutch Edition)
Dutch Edition ISBN-13
978-6200987112
Амир Мохаммадамини
Лечение болей в пояснице с помощью языка упражнений
Edition Russe
ISBN-13
978-6200987129
Tratamiento del dolor de espalda baja con lenguaje de ejercicios-edition Spanish
ISBN
9786200987099
Amir Mohammadamini
Amir Mohammadamini
Behandlung von Kreuzschmerzen mit Bewegungssprache (German Edition)
German Edition ISBN-13
978-6200987075
Amir Mohammadamini
Leczenie bólu w okolicy lędźwiowej kręgosłupa za pomocą języka ćwiczeń
Edition Polonais
ISBN-13
978-6200987143
Amir Mohammadamini
Tratamento de dores lombares (Portuguese Edition)
Portuguese Edition
ISBN-13
978-6200987105
https://www.lap-publishing.com/. PLoS One 2022; 17:e0273983. [PMID: 36048791 PMCID: PMC9436074 DOI: 10.1371/journal.pone.0273983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Best outpatient treatment of nonspecific chronic low back pain is high-dosed exercise that is maintained after therapy. Primary care biopsychosocial intervention (PCBI) is an outpatient multicomponent intervention that includes an active component (exercise, physical activity, or physiotherapy) and at least one psychological, social, or occupational component. Research has shown that PCBI can reduce pain intensity and disability. While scattered studies support low-dosed (<15 treatment hours) PCBI, there is no systematic review comparing the effectiveness of low-dosed PCBI treatment with traditional physical activity interventions in adults with nonspecific chronic low back pain (CLBP). Inclusion criteria Randomised controlled trials that evaluate low-dosed outpatient biopsychosocial interventions compared to physical treatment with an active component such as exercise, physical activity or usual physiotherapy treatment for adult participants (18 years or older) who suffer from nonspecific CLBP will be included. Methods A comprehensive search of multiple databases will be used to find relevant studies. The databases will be searched from inception to December 2021, with English or German language restrictions imposed. Keywords and derivatives of “chronic back pain”, “exercise intervention”, “cognitive-behavioral therapy”, “primary care” and “randomized controlled trials” will be used. Sources will include CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline, Physiotherapy Evidence Database (PEDro), PubMed and Web of Science. Discussion To our knowledge, this will be the first systematic review and meta-analysis of narrowly defined low- dosed PCBI across populations with nonspecific chronic low back pain. The objective of this review is to evaluate the effectiveness of low-dosed outpatient biopsychosocial interventions versus physical active interventions on pain intensity and disability in adults with CLBP. This study will provide evidence that could improve treatment options for patients with nonspecific CLBP. Trail registration Systematic review registration number: PROSPERO 2022 CRD42022302771. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022302771
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Medrano-Escalada Y, Plaza-Manzano G, Fernández-de-las-Peñas C, Valera-Calero JA. Structural, Functional and Neurochemical Cortical Brain Changes Associated with Chronic Low Back Pain. Tomography 2022; 8:2153-2163. [PMID: 36136876 PMCID: PMC9498382 DOI: 10.3390/tomography8050180] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 12/19/2022] Open
Abstract
Chronic low back pain (CLBP) is one of the most prevalent musculoskeletal disorders, being one of the leading contributors to disability worldwide and involving an important economic and social burden. Up to 90% of CLBP is non-specific (not associated with specific injuries), with a chronicity expectation estimated at 10%. Currently, motivational and emotional central circuits are being investigated due to their role in CLBP persistency and chronification. Therefore, this narrative review aimed to summarize the evidence regarding the cortical brain changes described for proposing novel multidisciplinary approaches. Novel advances in neuroimaging techniques demonstrated structural (e.g., decrease in the grey matter located at the dorsolateral prefrontal cortex), functional (e.g., connectivity impairments in those areas involved in pain processing), and neurochemical changes (e.g., decrease in cerebral metabolites). In addition, significant changes were found in the primary somatosensory and motor cortex, contributing to the alteration of low back muscles activation and function.
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Affiliation(s)
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Grupo InPhysio, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: ; Tel.: +34-913-941-545
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Clínica e Investigación en Fisioterapia, Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
| | - Juan Antonio Valera-Calero
- VALTRADOFI Research Group, Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
- Department of Physiotherapy, Faculty of Health, Universidad Camilo José Cela, Villanueva de la Cañada, 28692 Madrid, Spain
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Effectiveness of Ultrasonography Visual Biofeedback of the Diaphragm in Conjunction with Inspiratory Muscle Training on Muscle Thickness, Respiratory Pressures, Pain, Disability, Quality of Life and Pulmonary Function in Athletes with Non-Specific Low Back Pain: A Randomized Clinical Trial. J Clin Med 2022; 11:jcm11154318. [PMID: 35893409 PMCID: PMC9332609 DOI: 10.3390/jcm11154318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/04/2022] Open
Abstract
Diaphragmatic weakness and thickness reduction have been detected in athletes with lumbopelvic pain (LPP). Strength training of inspiratory muscles may be necessary for athletes with LPP. Inspiratory muscle training (IMT) and visual biofeedback by rehabilitative ultrasound imaging (RUSI) have been proposed as possible interventions. Here, we determine the effectiveness of visual biofeedback by RUSI with a proposed novel thoracic orthotic device to facilitate diaphragmatic contraction in conjunction with high-intensity IMT in athletes with non-specific LPP. A single-blinded, parallel-group, randomized clinical trial was performed (NCT04097873). Of 86 participants assessed for eligibility, 64 athletes with non-specific LPP (39 males and 25 females; mean age, 33.15 ± 7.79 years) were recruited, randomized, analyzed and received diaphragm visual biofeedback by RUSI in conjunction with high-intensity IMT (RUSI+IMT; n = 32) or isolated high-intensity IMT (IMT; n = 32) interventions for 8 weeks. Diaphragmatic thickness during normal breathing, maximum respiratory pressures, pain intensity, pressure pain threshold on lumbar musculature, disability by the Roland−Morris questionnaire, quality of life by the SF-12 questionnaire and spirometry respiratory parameters were assessed at baseline and after the 8-week intervention. There were significant differences (p = 0.015), within a medium effect size (Cohen’s d = 0.62) for the forced expiratory volume in 1-s (FEV1), which was increased in the RUSI+IMT intervention group relative to the IMT alone group. Adverse effects were not observed. The rest of the outcomes did not show significant differences (p > 0.05). Diaphragm visual biofeedback by RUSI with the proposed novel thoracic orthotic device in conjunction with high-intensity IMT improved lung function by increasing FEV1 in athletes with non-specific LPP.
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Llamas-Ramos I, Cortés-Rodríguez M, Llamas-Ramos R. Kinesiotape effectiveness in mechanical low back pain: A randomized clinical trial. Work 2022; 72:727-736. [DOI: 10.3233/wor-210693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Low back pain (LBP) is the most common musculoskeletal disorder work-related health problem in Europe, affecting millions of workers. It is estimated that 60–80% of the population will suffer at least one episode of mechanical LBP during their life. OBJECTIVE: To evaluate the kinesiotape (KT) effectiveness in mechanical LBP. METHODS: This was a double blinded, randomized-controlled clinical trial. Twenty-eight nursing and cleaning auxiliaries from Salamanca received a manual therapy program and a bandage of KT or false kinesiotape (FKT). They received two sessions a week for three weeks and a follow-up one month after the last session. Pain, range of motion and function were measured at baseline, at the end of each session and a month after the last session. RESULTS: Work-related musculoskeletal disorders and LBP are responsible for a high prevalence of sick-leave and absenteeism. Manual therapy and KT has demonstrated to reduce pain and to increase range of motion and function being effective in this population. There are statistically significant results in both groups in all measurements for all variables. KT seems to be superior, however, both have a positive effect on LBP. Although benefits decrease, long-term treatments focusing on pain alleviation and functional recovery is needed to maintain the benefits achieved. CONCLUSION: KT was an effective complement for this treatment. Although both show improvements, KT is recommended. Future studies are needed to demonstrate KT properties, to establish a treatment protocol to prevent chronic LBP and to avoid sick leave and absenteeism.
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Affiliation(s)
- Inés Llamas-Ramos
- Faculty of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
- University Hospital of Salamanca, Salamanca, Spain
| | | | - Rocío Llamas-Ramos
- Faculty of Nursing and Physiotherapy, University of Salamanca, Salamanca, Spain
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Guan J, Yuan C, Tian X, Cheng L, Gao H, Yao Q, Wang X, Wu H, Chen Z, Jian F. SPECT Imaging of Acute Disc Herniation by Targeting Integrin α5β1 in Rat Models. Front Neurol 2022; 13:782967. [PMID: 35614922 PMCID: PMC9124789 DOI: 10.3389/fneur.2022.782967] [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: 11/20/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Traditional morphological imaging of intervertebral disc herniation (IVDH) is challenging in early disease diagnosis. Aiming at the early diagnosis of IVD by non-invasive molecular imaging targeting of integrin α5β1, we performed novel imaging in rats with acute IVDH for the first time. Methods Animal models were prepared by conducting an established needle puncture procedure through the normal intervertebral disc (IVD). The disc-injured rats underwent SPECT/CT imaging of the 99mTc-3PisoDGR2 peptide at 1 day to 2 months postinjury. The expression change of integrin α5β1 was determined by anti-integrin α5 and anti-integrin α5β1 immunohistochemistry (IHC). Magnetic resonance imaging (MRI) was performed for comparison during disease progression. The morphological changes of the disc were determined by safranin-O staining. Results Rats with acute IVDH showed gradually increased disc uptake of 99mTc-3PisoDGR2 from 1 to 7 days posttreatment, which was a significantly higher level than that of the normal disks in degenerative diseases. IHC results showed the expression of integrin α5β1 on the surface of annulus fibrosus (AF) cells and nucleus pulposus (NP) cells, which agreed with the uptake data. MRI showed a progressively decreased T2 density and MRI index throughout the investigation. Hematoxylin and eosin (HE) staining and safranin-O staining revealed a disorganized structure of the IVD as well as loss of proteoglycans after puncture. Conclusions The present study demonstrated a good correlation between integrin α5β1 expression and acute disc herniation. The SPECT/CT imaging of 99mTc-3PisoDGR2 targeting integrin α5β1 may diagnose IVDH in an acute phase for early disease management.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
| | - Chenghua Yuan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
| | - Xin Tian
- Center for Experimental Animals, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lei Cheng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
| | - Hannan Gao
- Medical Isotopes Research Center and Department of Radiation Medicine, State Key Laboratory of Natural and Biomimetic Drugs, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Qingyu Yao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
| | - Xinyu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
| | - Hao Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
| | - Zan Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
- *Correspondence: Zan Chen
| | - Fengzeng Jian
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- Spine Center, China International Neuroscience Institute (CHINA-INI), Beijing, China
- Research Center of Spine and Spinal Cord, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- National Center for Neurological Disorders, Xuanwu Hospital, Beijing, China
- Fengzeng Jian
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Effectiveness of Negative Pulsed-Pressure Myofascial Vacuum Therapy and Therapeutic Exercise in Chronic Non-Specific Low Back Pain: A Single-Blind Randomized Controlled Trial. J Clin Med 2022; 11:jcm11071984. [PMID: 35407595 PMCID: PMC8999761 DOI: 10.3390/jcm11071984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 02/06/2023] Open
Abstract
Non-specific low back pain is defined as pain located in the lumbar region; this condition is the most frequent musculoskeletal disorder. Negative pulsed-pressure myofascial vacuum therapy (vacuum treatment (VT)) devices mobilize tissue according to previously programmed parameters of force, time and frequency. The purpose of this study was to compare the effects of VT combined with core therapeutic exercise versus a physical therapy program (PTP) based only on core therapeutic exercise. Fifty participants with chronic non-specific low back pain were randomly assigned to two treatment groups, the VT group (n = 25) or the PTP group (n = 25). Pain, pressure-pain threshold, range of motion, functionality and quality of life were measured before treatment, at the end of treatment, and at one-month and three-month follow-ups. Both groups received 15 therapy sessions over 5 weeks. Statistically significant differences in favor of the VT group were shown in the results. In conclusion, the intervention based on myofascial vacuum therapy improved pain, mobility, pressure pain threshold, functionality and quality of life.
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Sarria-Santamera A, Kuntuganova A, Alonso M. Economic Costs of Pain in the Spanish Working Population. J Occup Environ Med 2022; 64:e261-e266. [DOI: 10.1097/jom.0000000000002497] [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]
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Hradetzky E, Ohlmeier C, Brinkmann C, Schild M, Galetzka W, Schmedt N, John T, Kaleth D, Gothe H. Epidemiology and routine care treatment of patients with hip or knee osteoarthritis and chronic lower back pain: real-world evidence from Germany. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01700-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Aim
Musculoskeletal disorders are a major public health problem in most developed countries. As a main cause of chronic pain, they have resulted in an increasing prescription of opioids worldwide. With regard to the situation in Germany, this study aimed at estimating the prevalence of musculoskeletal diseases such as chronic low back pain (CLBP) and hip/knee osteoarthritis (OA) and at depicting the applied treatment patterns.
Subject and methods
German claims data from the InGef Research Database were analyzed over a 6-year period (2011–2016). The dataset contains over 4 million people, enrolled in German statutory health insurances. Inpatient and outpatient diagnoses were considered for case identification of hip/knee OA and CLBP. The World Health Organization (WHO) analgesic ladder was applied to categorize patients according to their pain management interventions. Information on demographics, comorbidities, and adjuvant medication was collected.
Results
In 2016, n = 2,693,481 individuals (50.5% female, 49.5% male) were assigned to the study population; 62.5% of them were aged 18–60 years. In 2016, n = 146,443 patients (5.4%) with CLBP and n = 307,256 patients (11.4%) with hip/knee OA were identified. Of those with pre-specified pain management interventions (CLBP: 66.3%; hip/knee OA: 65.1%), most patients received WHO I class drugs (CLBP: 73.6%; hip/knee OA: 68.7%) as the highest level.
Conclusion
This study provides indications that CLBP and hip/knee OA are common chronic pain conditions in Germany, which are often subjected to pharmacological pain management. Compared to non-opioid analgesic prescriptions of the WHO I class, the dispensation of WHO class II and III opioids was markedly lower, though present to a considerable extent.
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Soliman O, Pflugmacher R, Koch EM, Mohamed H, van der Beck S, Abdallah H, Bornemann R. One-year results of minimally invasive fusion surgery of the sacroiliac joint as an alternative treatment after failed endoscopic thermal coagulation. Technol Health Care 2022; 30:1125-1138. [PMID: 35342062 DOI: 10.3233/thc-213183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While pain in the severe sacroiliac joint (SIJ) is a common cause of lower back pain, SIJ disease is often overlooked as a diagnosis. OBJECTIVE This study examines the extent of sufficient long-term pain relief and functional improvement in patients with SIJ syndrome that are treated with thermocoagulation. Some patients treated with thermocoagulation noted initial improvement, but the functionality and pain relief had limited duration and efficacy. Patients with insufficient improvement were recommended to undergo fusion surgery as an option for better and longer lasting results. METHOD Patients with a long history of back or pelvic problems were selected for the study. Endoscopic thermal coagulation of the SIJ was carried out. The follow-up examinations took place after 1, 3, 6, 12 months. In patients with insufficient pain relief and functionality after thermocoagulation, a fusion surgery was performed. The results of the fusion surgery were documented over a 12-month follow-up period. To carry out the statistical evaluation visual analog scale (VAS), Oswestry-Disability-Index (ODI) and the consumption of opioids were recorded. RESULTS Forty-eight patients were included. The mean VAS values 12 months after thermocoagulation were 68.9. The ODI after 12 months was very near or somewhat higher than their baseline prior to the thermocoagulation. Thus, a fusion surgery was recommended. Thirty-three patients agreed to the fusion operation. The VAS values 12 months after fusion surgery decreased to 53.1. Analogous to the VAS values, the Oswestry index (ODI) showed a significant improvement after the fusion operation. CONCLUSION The success of surgical intervention in 88% of the SIJ syndrome patients with inadequate results 12 months after thermocoagulation proves the superiority of SIJ fusion surgery. This study showed long-lasting pain relief by an average of 65% and a median improvement in functional impairments of 60%. In view of these results, fusion surgery should be considered for patients without sufficient success of thermocoagulation.
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Affiliation(s)
- Osama Soliman
- Department of Orthopaedics and Spine Surgery, Krankenhaus Mechernich, Mechernich, Germany
| | - Robert Pflugmacher
- Department of Orthopaedics and Spine Surgery, Krankenhaus Mechernich, Mechernich, Germany
| | | | - Hesham Mohamed
- Faculty of medicine, Alexandria University, Alexandria, Egypt
| | | | - Hany Abdallah
- Department of Orthopaedics and Spine Surgery, Wadi el Neel Military Hospital, Cairo, Egypt
| | - Rahel Bornemann
- Department of Orthopaedics and Spine Surgery, Krankenhaus Mechernich, Mechernich, Germany
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Kahere M, Hlongwa M, Ginindza TG. A Scoping Review on the Epidemiology of Chronic Low Back Pain among Adults in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052964. [PMID: 35270657 PMCID: PMC8910337 DOI: 10.3390/ijerph19052964] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The global burden of chronic low back pain (CLBP) is a major concern in public health. Several CLBP epidemiological studies have been conducted in high-income-countries (HICs) with little known in low-and-middle-income-countries (LMICs) due to other competing priorities of communicable diseases. The extrapolation of results of studies from HICs for use in LMICs is difficult due to differences in social norms, healthcare systems, and legislations, yet there is urgent need to address this growing burden. It is against this backdrop that we conducted this review to map the current evidence on the distribution of CLBP in Sub-Saharan Africa (SSA). METHODS A comprehensive literature search was conducted from the following databases: PubMed, Google Scholar, Science Direct databases, World Health Organizations library databases, EMBASE, EBSCOhost by searching the following databases within the platform; academic search complete, CINAHL with full text, health sources: nursing/academic and MEDLINE. The title, abstract and the full text screening phases were performed by two independent reviewers with the third reviewer employed to adjudicate discrepancies. The reference list of all included articles was also searched for eligible articles. This scoping review was reported in accordance with the PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation, as well as guided by Arksey and O'Malley's scoping review framework. A thematic content analysis was used to give a narrative account of the review. RESULTS The electronic search strategy retrieved 21,189 articles. Title/abstract and full text screening only identified 11 articles, which were included in this review. The prevalence of CLBP among the general population ranged from 18.1% to 28.2% and from 22.2% to 59.1% among LBP patients. The prevalence of occupation based CLBP ranged from 30.1% to 55.5%. Identified risk factors for CLBP are multifactorial and included biomechanical, psychological, socioeconomic and lifestyle factors, with psychosocial factors playing a significant role. Hypertension, diabetes mellitus, peptic ulcer disease were the most common comorbidities identified. CLBP disability was significantly associated with psychosocial factors. The management of CLBP in primary care follows the traditional biomedical paradigm and primarily involves pain medication and inconsistent with guidelines. CONCLUSIONS There are limited epidemiological data on CLBP in SSA, however, this study concluded that the prevalence and risk factors of CLBP in SSA are comparable to reports in HICs. Considering the projected increase in the burden of CLBP in LMICs extensive research effort is needed to close this knowledge gap.
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Affiliation(s)
- Morris Kahere
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (M.H.); (T.G.G.)
- Correspondence: ; Tel.: +27-836153446
| | - Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (M.H.); (T.G.G.)
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa; (M.H.); (T.G.G.)
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Aleku M, Nelson K, Abio A, Lowery Wilson M, Lule H. Lower Back Pain as an Occupational Hazard Among Ugandan Health Workers. Front Public Health 2021; 9:761765. [PMID: 34926384 PMCID: PMC8671744 DOI: 10.3389/fpubh.2021.761765] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Lower back pain is a public health concern affecting 70–85% of the world's population. There is paucity of published data on the prevalence, disability and risk factors for lower back pain among health workers in Uganda. Objective: To determine the frequency rate (note that is it implicit that frequency is a rate like incidence so including rate seems redundant here. This is bounded by zero and infinity. In contrast, prevalence is bounded by 0 and 1 and is thus a proportion not a rate) of lower back pain and its associated risks amongst health professionals in the Arua District of Uganda. Methods: Cross-sectional descriptive study of 245 consecutive participants conducted during February-April 2020. We stratified risks as individual or work related and analyzed the data using IBM SPSS version 25. Chi-square was used to measure the significance of association between categorical variables at 95% confidence interval, regarding a p ≤ 0.05 as significant. Results: The mean age of participants was 40.87 years ± 8.74 (SD), with female predominance (69.8%). Majority were either general nurses or midwives (64.9%) and more than half had practiced for over 6–10 years. The frequency rate of lower back pain was 39.6% (n = 97). Individual factors associated with LBP were; cigarette smoking (X2 = 33.040; P ≤ 0.001), alcohol consumption (X2 = 13.581; P ≤ 0.001), age (X2 = 14.717; P = 0.002), and female gender (X2 = 4.802; P = 0.028). The work related factors significantly associated with lower back pain were: being a nurse/midwife (X2 = 9.829; P = 0.007), working in the outpatient department (X2 = 49.752; P ≤ 0.001), bending (X2 = 43.912; P ≤ 0.001), lifting (X2 = 33.279; P < 0.001), over standing (X2 = 40.096; P ≤ 0.001), being in awkward positions (X2 = 15.607; P= < 0.001), and pushing patients (X2 = 21.999; P ≤ 0.001). Conclusion: The frequency rate of low back pain was high amongst health workers and its main associated individual and work related factors could have been prevented. Health workers should strike a balance between caring for their personal back-health and meeting clients' needs while manually handling patients. Ergonomic structuring, job organization, back health care courses and use of assistive equipment could reduce such occupational hazards in our low resourced settings.
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Affiliation(s)
- Michael Aleku
- Faculty of Clinical Medicine and Dentistry, Kampala International University, Kampala, Uganda
| | - Kevin Nelson
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Anne Abio
- Injury Epidemiology and Prevention (IEP) Research Group, Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland.,Heidelberg Institute of Global Health, Heidelberg, Germany
| | | | - Herman Lule
- Department of Surgery, Directorate of Research and Innovations, Kampala International University, Kampala, Uganda
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Gevers-Montoro C, Murray KJ, Santamaría B, Dominguez-Vera G, Álvarez-Galovich L, Vindigni D, Azari MF, Ortega de Mues A, Castro-Mendez A. Combined Chiropractic and Podiatric Treatment for Chronic Low Back Pain Concomitant With a Unilateral Pronated Foot: Protocol for a Multicenter Pilot Randomized Controlled Trial. J Chiropr Med 2021; 20:177-182. [DOI: 10.1016/j.jcm.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
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The prevalence and risk factors of chronic low back pain among adults in KwaZulu-Natal, South Africa: an observational cross-sectional hospital-based study. BMC Musculoskelet Disord 2021; 22:955. [PMID: 34781916 PMCID: PMC8591969 DOI: 10.1186/s12891-021-04790-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background Globally, chronic low back pain (CLBP) is the leading cause of disability associated with economic costs. However, it has received little attention in low-and-middle-income countries. This study estimated the prevalence and risk factors of CLBP among adults presenting at selected hospitals in KwaZulu-Natal. Methodology This cross-sectional study was conducted among adults aged ≥18 years who attended the selected hospitals in KwaZulu-Natal during the study period. A self-administered questionnaire was used to collect data on socio-demographic, work-related factors, and information about CLBP. The SPSS version 24.0 (IBM SPSS Inc) was used for data analysis. Descriptive statistics were used for demographic characteristics of participants. CLBP risk factors were assessed using multivariate logistic regression analysis. A p-value of ≤0.05 was deemed statistically significant. Results A total of 678 adults participated in this study. The overall prevalence of CLBP was 18.1% (95% CI: 15.3 – 21.3) with females having a higher prevalence than males, 19.8% (95% CI: 16.0 – 24.1) and 15.85% (95% CI: 11.8 – 20.6), respectively. Using multivariate regression analysis, the following risk factors were identified: overweight (aOR: 3.7, 95% CI: 1.1 – 12.3, p = 0.032), no formal education (aOR: 6.1, 95% CI: 2.1 – 18.1, p = 0.001), lack of regular physical exercises (aOR: 2.2, 95% CI: 1.0 – 4.8, p = 0.044), smoking 1 to 10 (aOR: 4.5, 95% CI: 2.0 – 10.2, p < 0.001) and more than 11 cigarettes per day (aOR: 25.3, 95% CI: 10.4 – 61.2, p < 0.001), occasional and frequent consumption of alcohol, aOR: 2.5, 95% CI: 1.1 – 5.9, p < 0.001 and aOR: 11.3, 95% CI: 4.9 – 25.8, p < 0.001, respectively, a sedentary lifestyle (aOR: 31.8, 95% CI: 11.2 – 90.2, p < 0.001), manual work (aOR: 26.2, 95% CI: 10.1 – 68.4, p < 0.001) and a stooped sitting posture (aOR: 6.0, 95% CI: 2.0 – 17.6, p = 0.001). Conclusion This study concluded that the prevalence of CLBP in KwaZulu-Natal is higher than in other regions, and that it is predicted by a lack of formal education, overweight, lack of regular physical exercises, smoking, alcohol consumption, sedentary lifestyle, manual work, and a stooped posture. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04790-9.
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Dong L, Dong B. miR-489-3p overexpression inhibits lipopolysaccharide-induced nucleus pulposus cell apoptosis, inflammation and extracellular matrix degradation via targeting Toll-like receptor 4. Exp Ther Med 2021; 22:1323. [PMID: 34630677 PMCID: PMC8495590 DOI: 10.3892/etm.2021.10758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is a common disease with a high morbidity rate, which results in a significant deterioration in the quality of life of patients. MicroRNAs (miRNAs/miRs) are a class of endogenous small non-coding RNAs that influence target genes and serve critical roles in numerous biological processes. However, the role of miR-489-3p in lumbar disc degeneration is yet to be elucidated. In the present study, human NP cells were treated with 10 ng/ml lipopolysaccharide (LPS) for 24 h to investigate the role of miR-489-3p in IDD in an in vitro model. Reverse transcription-quantitative (RT-q)PCR was performed to determine the expression levels of miR-489-3p. Then, the TargetScan database was used to predict the potential binding sites between miR-489-3p and Toll-like receptor (TLR)4, and a dual-luciferase reporter assay was performed to verify the findings. Subsequently, RT-qPCR and western blotting were used to analyze the expression levels of TLR4. In addition, human nucleus pulposus (NP) cells were transfected with a miR-489-3p mimic and TLR4 overexpression plasmid to study the effects of miR-489-3p on LPS-induced human NP cells. Cell apoptosis and cell viability were also determined using flow cytometry and MTT assays, respectively. Finally, ELISAs were performed to analyze the levels of inflammatory factors. The expression levels of miR-489-3p were discovered to be downregulated in LPS-treated human NP cells. In addition, TLR4 was revealed to be a direct target gene of miR-489-3p, and its expression levels were upregulated in LPS-treated human NP cells. miR-489-3p was found to inhibit the LPS-induced decreases in cell viability and increases in apoptosis, and the concentration of inflammatory cytokines. Furthermore, miR-489-3p suppressed the LPS-induced decreases in extracellular matrix deposition via decreasing the expression levels of aggrecan and collagen type II in human NP cells. Finally, the results revealed that miR-489-3p inhibited the LPS-induced activation of the NF-κB signaling pathway in human NP cells. Conversely, all of the effects of miR-489-3p on LPS-induced human NP cells were reversed by the TLR4 overexpression plasmid. These findings suggested that miR-489-3p may represent a novel therapeutic target for the treatment of IDD.
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Affiliation(s)
- Ling Dong
- Department of Rehabilitation Medicine, Guizhou Orthopedics Hospital, Guiyang, Guizhou 550000, P.R. China
| | - Bo Dong
- Pain Rehabilitation Department of TCM Orthopedic Center, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi 710054, P.R. China
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Michalsen A, Jeitler M, Kessler CS, Steckhan N, Robens S, Ostermann T, Kandil FI, Stankewitz J, Berger B, Jung S, Kröz M, Büssing A. Yoga, Eurythmy Therapy and Standard Physiotherapy (YES-Trial) for Patients With Chronic Non-specific Low Back Pain: A Three-Armed Randomized Controlled Trial. THE JOURNAL OF PAIN 2021; 22:1233-1245. [PMID: 33892154 DOI: 10.1016/j.jpain.2021.03.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
We aimed to evaluate the effects of yoga and eurythmy therapy compared to conventional physiotherapy exercises in patients with chronic low back pain. In a three-armed, multicentre, randomized controlled trial, patients with chronic low back pain were treated for 8 weeks in group sessions (75 minutes once per week). Primary outcome was patients' physical disability (measured by RMDQ) from baseline to week 8. Secondary outcome variables were pain intensity and pain-related bothersomeness (VAS), health-related quality of life (SF-12) and life satisfaction (BMLSS). Outcomes were assessed at baseline, after the intervention at 8 weeks and at a 16-week follow up. Data of 274 participants were used for statistical analyses. There were no significant differences between the three groups for the primary and all secondary outcomes. In all groups, RMDQ decreased comparably at 8 weeks, but did not reach clinical meaningfulness. Pain intensity and pain-related bothersomeness decreased, while quality of life increased in all 3 groups. In explorative general linear models for the SF-12's mental health component participants in the eurythmy arm benefitted significantly more compared to physiotherapy and yoga. Furthermore, within-group analyses showed improvements of SF-12 mental score for yoga and eurythmy therapy only. All interventions were safe. Clinical Trials Register: DRKS-ID: DRKS00004651 Perspective: This article presents the results of a multicentre three-armed randomized controlled trial on the clinical effects of three 8-week programs in patients with chronic low back pain. Compared to the 'gold standard' of conventional physiotherapeutic exercises, eurythmy therapy and yoga therapy lead to comparable symptomatic improvements in patients with chronic low back pain. However, the within-group effect sizes were small to moderate and did not reach clinical meaningfulness on patients' physical disability (RMDQ).
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Affiliation(s)
- Andreas Michalsen
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany.
| | - Michael Jeitler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Christian S Kessler
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Nico Steckhan
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Department of Internal and Integrative Medicine, Immanuel Hospital Berlin, Germany
| | - Sibylle Robens
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Germany
| | - Thomas Ostermann
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Germany
| | - Farid I Kandil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin
| | | | - Bettina Berger
- Institute of Integrative Medicine, Witten/Herdecke University, Germany
| | - Sonny Jung
- Institute of Integrative Medicine, Witten/Herdecke University, Germany
| | - Matthias Kröz
- Research Institute Havelhöhe (FIH), Berlin, Germany; Institute of Integrative Medicine, Witten/Herdecke University, Germany; Department of Research and Sleep Medicine Arlesheim Hospital, Arlesheim, Switzerland
| | - Arndt Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Germany
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Stoyanova-Piroth G, Milanov I, Stambolieva K. Translation, adaptation and validation of the Bulgarian version of the King's Parkinson's Disease Pain Scale. BMC Neurol 2021; 21:357. [PMID: 34525961 PMCID: PMC8442462 DOI: 10.1186/s12883-021-02392-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of the present study was to translate and cross-culturally adapt the King’s Parkinson’s Disease Pain Scale (KPPS) into Bulgarian and to investigate its psychometric properties in order to provide a validated Parkinson’s disease-specific pain instrument in Bulgarian language (KPPS-BG). Methods Translation into Bulgarian and a cultural adaptation were performed to obtain KPPS-BG. A total of 162 patients with idiopathic Parkinson’s disease were screened for pain using the complementary to the KPPS questionnaire – King’s Parkinson’s Disease Pain Questionnaire (KPPQ). KPPS-BG domain and total scores were calculated and internal consistency, construct validity and test-retest reliability were examined for 129 patients having one or more positive items in the KPPQ-BG. Results 79.6 % of the patients reported one or more types of pain. The most common type was musculoskeletal pain (83.7 %), followed by nocturnal pain (55.0 %), fluctuation-related pain (50.1 %), radicular pain (43.4 %), chronic pain (31.0 %), discoloration, edema/swelling (27.1 %) and, oro-facial pain (14.3 %). Mean KPPS-BG total score was 21.1 ± 17.3 SD. KPPS-BG showed a good reliability (Cronbach’s alpha 0.75). The test-retest reliability of the KPPS-BG was high and the intraclass correlation coefficient was 0.92, demonstrating а good repeatability. KPPS-BG total score was higher in patients with postural instability gait difficulty motor subtype, compared to tremor-dominant or indeterminate subtype. Significant positive correlations were found between KPPS-BG total score and modified H&Y, Movement Disorders Society Unified Parkinson’s Disease Rating Scale part III. Conclusions The KPPS-BG constitutes a reliable, comprehensive and useful tool for pain assessment in native Bulgarian patients with Parkinson’s disease.
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Affiliation(s)
- Galina Stoyanova-Piroth
- St. Naum Hospital of Neurology and Psychiatry, Medical University, 1, Louben Roussev str., 1113, Sofia, Bulgaria.
| | - Ivan Milanov
- St. Naum Hospital of Neurology and Psychiatry, Medical University, 1, Louben Roussev str., 1113, Sofia, Bulgaria
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Melatonin Inhibits Annulus Fibrosus Cell Senescence through Regulating the ROS/NF- κB Pathway in an Inflammatory Environment. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3456321. [PMID: 34458366 PMCID: PMC8387178 DOI: 10.1155/2021/3456321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/28/2021] [Indexed: 01/31/2023]
Abstract
Inflammation response is an important reason for disc cell senescence during disc degeneration. Recently, melatonin is suggested to protect against disc degeneration. However, the effects of melatonin on annulus fibrosus (AF) cell senescence are not fully studied. The main purpose of this study was to investigate the effects of melatonin on AF cell senescence in an inflammatory environment and the underlying mechanism. Rat disc AF cells were cultured in a medium with tumor necrosis factor-α (TNF-α). Melatonin was added along with the medium to observe its protective effects. Compared with the control AF cells, TNF-α significantly declined cell proliferation potency and telomerase activity, elevated senescence-associated β-galactosidase (SA-β-Gal) activity, upregulated protein expression of senescence markers (p16 and p53), and increased reactive oxygen species (ROS) content and activity of the NF-κB pathway. However, when the TNF-α-treated AF cells were incubated with melatonin, ROS content and activity of the NF-κB pathway were decreased, and those parameters reflecting cell senescence indicated that AF cell senescence was also partly alleviated. Together, melatonin suppresses AF cell senescence through regulating the ROS/NF-κB pathway in an inflammatory environment. This study sheds a new light that melatonin may be promising to retard inflammation-caused disc degeneration.
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Chen F, Wu T, Bai C, Guo S, Huang W, Pan Y, Zhang H, Wu D, Fu Q, Chen Q, Li X, Li L. Serum apolipoprotein B/apolipoprotein A1 ratio in relation to intervertebral disk herniation: a cross-sectional frequency-matched case-control study. Lipids Health Dis 2021; 20:79. [PMID: 34325707 PMCID: PMC8320064 DOI: 10.1186/s12944-021-01502-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/12/2021] [Indexed: 12/04/2022] Open
Abstract
Study design This was a cross-sectional frequency-matched case–control study. Background and aim The serum lipid profile of lipoprotein(a) [Lp(a)] level and apolipoprotein B/apolipoprotein A1 ratio (Apo B/Apo A1) ratio were found to be more representative for serum lipid level and were recognized as the independent risk factors for various diseases. Although the blood levels of total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were found to be associated with symptomatic intervertebral disk herniation (IDH), no studies to date have evaluated the association of Apo AI, Apo B, Lp(a), and Apo B/Apo AI levels with symptomatic IDH. This study aimed to assess the link between blood lipid levels and symptomatic IDH. Method The study included 1839 Chinese patients. Of these, 918 patients were diagnosed with IDH and enrolled in the experimental group. A control group of 921 patients underwent a physical examination during the same period. The serum lipid levels of TC, TG, LDL-C, HDL-C, Lp(a), Apo B, and Apo B/Apo AI were examined and analyzed. The control group comprised randomly selected patients who met the baseline levels of the aforementioned lipid molecules. Results Patients with IDH exhibited significantly higher TC, TG, LDL, Apo B, and Lp(a) levels than controls. The percentage of high TC, high TG, high LDL, high Apo B, and high Lp(a) were obviously higher in the IDH group than in the control group. However, hyperlipidemia had no relationship with the degenerated segment of the IDH (P = 0.201). The odds ratio (OR) for the incidence of IDH with elevated levels of LDL-C, TC, TG, Lp(a), Apo B, and Apo B/Apo AI was 1.583, 1.74, 1.62, 1.58, 1.49, and 1.39, respectively. The correlation analysis revealed the correlation between elevated LDL-C, TC, TG, Apo B, Lp(a), and incidence of IDH was significant (R2LDL = 0.017; R2TC = 0.004; R2TG = 0.015; R2Apo B = 0.004; R2Lp(a) = 0.021) (P < 0.05). Conclusion This study suggested that elevated levels of serum TC, TG, LDL, Apo B, Lp(a), and Apo B/Apo AI were associated with a higher risk of IDH. This study provided useful information to identify a population that might be at risk of developing IDH based on elevated lipid levels.
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Affiliation(s)
- Fei Chen
- Department of Cardiovascular, Pingxiang Hospital of Southern Medical University, Pingxiang, Jiangxi Province, 337055, China
| | - Tongde Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Chong Bai
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Song Guo
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Wenjun Huang
- Department of Cardiovascular, Pingxiang Hospital of Southern Medical University, Pingxiang, Jiangxi Province, 337055, China
| | - Yaqin Pan
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Huiying Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Desheng Wu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China
| | - Qiang Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China
| | - Qi Chen
- Department of Cardiovascular, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, Jiangxi Province, People's Republic of China.
| | - Xinhua Li
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China. .,Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, People's Republic of China.
| | - Lijun Li
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 JiMo Road, Shanghai, 200120, People's Republic of China.
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Ahlhelm F, Rotzinger R, Heesen M, Gebhard H, Omidi R. [Spinal ozone therapy]. Radiologe 2021; 61:736-741. [PMID: 34244811 PMCID: PMC8328893 DOI: 10.1007/s00117-021-00878-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/16/2022]
Abstract
Klinisches/methodisches Problem Technische Fortschritte auf dem Gebiet der spinalen interventionellen Neuroradiologie ermöglichen es, eine breite Palette an gezielten, minimal-invasiven Behandlungsoptionen einschließlich der spinalen Ozontherapie beim Rückenschmerz anzuwenden. Dieser Beitrag gibt eine Übersicht der biochemischen, molekularen, immunologischen und pharmazeutischen Mechanismen sowie Applikationstechniken der gezielten Ozontherapie. Radiologische Standardverfahren Zum Einsatz kommen die Computertomographie (CT) sowie konventionelle Röntgenaufnahmen (Durchleuchtung). Leistungsfähigkeit Die CT-gesteuerten Interventionen (epidural, periradikuläre, Facettengelenk und intradiskal) haben den höchsten Stellenwert und haben sich historisch durchgesetzt. Durchleuchtungsgesteuerte Verfahren können ebenfalls eingesetzt werden. Schlussfolgerung Die Ozontherapie liefert vielversprechende Ergebnisse. Der Beitrag soll dazu dienen, Informationen über die Grundlagen dieser Technik(en) zu vermitteln.
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Affiliation(s)
- F Ahlhelm
- Abteilung Neuroradiologie, Zentrum für Bildgebung, Kantonsspital Baden AG, Baden, Schweiz
| | - R Rotzinger
- Abteilung Neuroradiologie, Zentrum für Bildgebung, Kantonsspital Baden AG, Baden, Schweiz
| | - M Heesen
- Abteilung Anästhesie und Intensivmedizin, Kantonsspital Baden AG, Baden, Schweiz
| | - H Gebhard
- Klinik für Traumatologie, Universitätsspital Zürich ZH, Zürich, Schweiz.,Abteilung Wirbelsäulenchirurgie, Kantonsspital Baselland BL, Baselland, Schweiz
| | - R Omidi
- Abteilung Neuroradiologie, Zentrum für Bildgebung, Kantonsspital Baden AG, Baden, Schweiz.
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Marugán-Rubio D, Chicharro JL, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, Rodríguez-Sanz D, Vicente-Campos D, Dávila-Sánchez GJ, Calvo-Lobo C. Concurrent Validity and Reliability of Manual Versus Specific Device Transcostal Measurements for Breathing Diaphragm Thickness by Ultrasonography in Lumbopelvic Pain Athletes. SENSORS 2021; 21:s21134329. [PMID: 34202716 PMCID: PMC8272009 DOI: 10.3390/s21134329] [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] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The use of rehabilitative ultrasound imaging (RUSI) to evaluate diaphragm thickness during breathing in athletes who suffer from non-specific lumbopelvic pain presents some measurement errors. The purpose of this study was to evaluate intra- and inter-sessions, intra- and inter-rater reliabilities, and concurrent validity of diaphragm thickness measurements during breathing using transcostal RUSI with a novel thoracic orthotic device that was used to fix the US probe versus those measurements obtained using manual fixation. A total of 37 athletes with non-specific lumbopelvic pain were recruited. Intra- (same examiner) and inter-rater (two examiners) and intra- (same day) and inter-session (alternate days) reliabilities were analyzed. All measurements were obtained after manual probe fixation and after positioning the thoracic orthotic device to fix the US probe in order to correctly correlate both measurement methods. Both left and right hemi-diaphragm thickness measurements were performed by transcostal RUSI at maximum inspiration, expiration, and the difference between the two parameters during relaxed breathing. Intra-class correlation coefficients (ICC), standard errors of measurement (SEM), minimum detectable changes (MCD), systematic errors, and correlations (r) were assessed. Orthotic device probe fixation showed excellent reliability (ICC = 0.852-0.996, SEM = 0.0002-0.054, and MDC = 0.002-0.072), and most measurements did not show significant systematic errors (p > 0.05). Despite manual probe fixation with a reliability ranging from good to excellent (ICC = 0.714-0.997, SEM = 0.003-0.023, and MDC = 0.008-0.064 cm), several significant systematic measurement errors (p < 0.05) were found. Most significant correlations between both orthotic device and manual probe fixation methods were moderate (r = 0.486-0.718; p < 0.05). Bland-Altman plots indicated adequate agreement between both measurement methods according to the agreement limits. The proposed novel thoracic orthotic device may allow ultrasound probe fixation to provide valid and reliable transcostal RUSI measurements of diaphragmatic thickness during relaxed breathing thus reducing some measurement errors and avoiding systematic measurement errors. It may be advisable to measure diaphragm thickness and facilitate visual biofeedback with respect to diaphragm re-education during normal breathing in athletes with non-specific lumbopelvic pain.
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Affiliation(s)
- Daniel Marugán-Rubio
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
| | - Jose L. Chicharro
- Grupo FEBIO, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
| | | | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
| | - Davinia Vicente-Campos
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223 Madrid, Spain
- Correspondence:
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040 Madrid, Spain; (D.M.-R.); (R.B.-d.-B.-V.); (D.R.-S.); (C.C.-L.)
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Huang Q, Lu X, He T, Du J, Zhang P. Psychological effects of traditional Chinese mind-body exercises for low back pain: A protocol for meta-analysis. Medicine (Baltimore) 2021; 100:e25605. [PMID: 34087820 PMCID: PMC8183743 DOI: 10.1097/md.0000000000025605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Several studies reported that traditional Chinese mind-body exercises showed beneficial effects on improving anxiety and depression of patients with low back pain (LBP) in recent years. However, the effects of traditional Chinese mind-body exercises on improving psychological disorders of patients with LBP remain controversial. Most previous reviews only focused on the effects of traditional Chinese mind-body exercises for LBP on pain and dysfunction. Therefore, the present systematic review and meta-analysis will be conducted to evaluate the evidence on psychological effects of traditional Chinese mind-body exercises for LBP. METHODS AND ANALYSIS The electronic databases (PubMed, Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, China Knowledge Resource Integrated Database, and Wanfang Data) will be searched. The search will include all documents from their inception to February 2021. The Physiotherapy Evidence Database scale will be used for quality assessment of eligible studies. Risk of bias of eligible studies will also be assessed by Cochrane tool. The meta-analysis will be conducted using the Review Manager Version 5.3 software. The Higgins I2 statistic will be performed to examine for heterogeneity. The subgroup analysis will be conducted based on different types of traditional Chinese mind-body exercises, different intervention time, and different outcomes. Quality of evidence will be assessed using the Grades of Recommendation, Assessment, Development and Evaluation. ETHICS AND DISSEMINATION No ethical statement will be required for the performance of this review and meta-analysis. The results of this review will be published in an international peer-reviewed journal. INPLASY REGISTRATION NUMBER INPLASY202130075.
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Affiliation(s)
- Qian Huang
- Department of Acupunctue and Tuina, Lianyungang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Lianyungang
| | - Xiaonian Lu
- Department of Dermatology, Huashan Hospital, Fudan University
| | - Tianxiang He
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai
| | - Juan Du
- Department of Dermatology, Huashan Hospital, Fudan University
| | - Peiguo Zhang
- Department of Pain, Zibo Central Hospital, Zibo, China
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Schega L, Kaps B, Broscheid KC, Bielitzki R, Behrens M, Meiler K, Drange S, Franke J. Effects of a multimodal exercise intervention on physical and cognitive functions in patients with chronic low back pain (MultiMove): study protocol for a randomized controlled trial. BMC Geriatr 2021; 21:151. [PMID: 33653286 PMCID: PMC7923646 DOI: 10.1186/s12877-021-02093-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a common medical condition in adults over the age of 50. It is associated with severe disability, ranging from physical impairments to psychosocial distress. Since current treatments provide only small to moderate short-term effects, alternative interventions are required, whereby guidelines recommended multimodal approaches. Dancing can be considered as an inherently multimodal approach, as it requires a combination of physical and cognitive functions. Furthermore, it has already been applied effectively in neurorehabilitation. Therefore, it seems promising to merge a dance-therapeutic component together with motor-cognitive, strength and flexibility exercises in a novel multimodal treatment (MultiMove) to target the impaired everyday mobility and cognition of CLBP patients. The aim of this study is to analyse specific physical, cognitive and psychosocial effects of MultiMove in CLBP patients. METHODS A prospective, two-arm, single-blinded, randomized controlled trial will be conducted with an estimated sample size of 100 CLBP patients, assigned to either the MultiMove group or a control group. The intervention group will receive MultiMove twice a week for 60 min each over a period of 12 weeks. The primary outcome will be the mobility and function of the lower extremities assessed by the Timed Up-and-Go Test. Secondary outcomes comprise further physical and physiological functions (e.g. gait variability and haemodynamic response in the prefrontal cortex during motor-cognitive dual tasks), subjective health state (e.g. disability in daily life), executive functions (e.g. cognitive flexibility) and psychosocial aspects (e.g. kinesiophobia). Measures will be taken at baseline, after the intervention and at a 12-week follow-up. It is assumed that MultiMove improves the mentioned outcome parameters. DISCUSSION The combined assessment of changes in physical and cognitive functions as well as neuropsychological aspects in response to MultiMove will allow a better understanding of the motor-cognitive adaptations induced by multimodal exercises in CLBP patients. The specific conclusions will lead to recommendations for the conservative treatment approach in this clinically relevant patient group. TRIAL REGISTRATION German Clinical Trial Register (ID: DRKS00021696 / 10.07.2020), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021696.
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Affiliation(s)
- Lutz Schega
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Britta Kaps
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany.
| | - Kim-Charline Broscheid
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Robert Bielitzki
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Martin Behrens
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Zschokkestraße 32, 39104, Magdeburg, Germany
| | - Katharina Meiler
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130, Magdeburg, Germany
| | - Steffen Drange
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130, Magdeburg, Germany
| | - Jörg Franke
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Birkenallee 34, 39130, Magdeburg, Germany
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Kozinc Ž, Baltrusch S, Houdijk H, Šarabon N. Short-Term Effects of a Passive Spinal Exoskeleton on Functional Performance, Discomfort and User Satisfaction in Patients with Low Back Pain. JOURNAL OF OCCUPATIONAL REHABILITATION 2021; 31:142-152. [PMID: 32356222 DOI: 10.1007/s10926-020-09899-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Low back pain (LBP) remains a major worldwide healthcare issue. Recently, spinal exoskeletons were proposed as a potentially useful solution for LBP prevention and vocational reintegration for people who perform heavy load lifting, repetitive movements or work in prolonged static postures. The purpose of this study was to investigate how patients with LBP respond to the novel passive SPEXOR exoskeleton regarding functional performance, discomfort and general user impression. Methods Fourteen patients, with low to moderate LBP (2-7 on a 0-10 scale), performed 12 functional tasks with and without the exoskeleton. In addition to objective performance measures, participants subjectively assessed the level of local low back discomfort, task difficulty and general discomfort on a 0-10 visual analogue scales. Results The SPEXOR exoskeleton had favourable effects on performance and local discomfort during prolonged static forward bending. Minor reductions in performance were observed for sit-stand and ladder climbing tasks. The discomfort associated with the exoskeleton was generally low to moderate (median < 4), except for the 6-min walk test (median = 4.5), which is likely due to the weight of the device and obstruction of upper limb movement. The general impressions were mostly positive, with good adjustability, low interference with the movement and moderate support reported by the participants. Conclusion The SPEXOR exoskeleton is potentially useful for LBP prevention or management, however, further improvements are needed to provide higher levels support during heavy load lifting.
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Affiliation(s)
- Žiga Kozinc
- Department of Health Study, Andrej Marusic Institute, University of Primorska, Koper, Slovenia
- Department of Kinesiology and Physiotherapy, Faculty of Health Sciences, University of Primorska, Koper, Slovenia
| | - Saskia Baltrusch
- Research and Development, Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands
- Amsterdam Movement Sciences, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Han Houdijk
- Research and Development, Rehabilitation Centre Heliomare, Wijk aan Zee, The Netherlands
- Amsterdam Movement Sciences, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nejc Šarabon
- Department of Kinesiology and Physiotherapy, Faculty of Health Sciences, University of Primorska, Koper, Slovenia.
- Laboratory for Motor Control and Motor Behaviour, S2P, Science To Practice, Ltd., Ljubljana, Slovenia.
- Faculty of Health Sciences, University of Primorska, Polje 42, 6310, Izola, Slovenia.
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Ultrasound-guided periradicular oxygen-ozone injections as a treatment option for low back pain associated with sciatica. INTERNATIONAL ORTHOPAEDICS 2021; 45:1239-1246. [PMID: 33629173 DOI: 10.1007/s00264-021-04975-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/02/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The social impact and economic burden of low back pain are well known among the medical community. A novel therapeutic approach is represented by oxygen-ozone therapy, whose anti-inflammatory effects could be especially useful in patients with herniated discs. The most common administration is through a palpation-guided injection technique, although the use of ultrasound guidance could allow a more precise delivery of the therapeutic substance close to the nerve root. AIM OF THE STUDY To describe the clinical outcomes following US-guided periradicular injection of oxygen-ozone as a treatment option for low back pain associated to sciatica in patients affected by symptomatic L5-S1 disc herniation. CONCLUSION Ultrasound-guided periradicular injection of oxygen-ozone in L5-S1 herniation is a safe and effective minimally invasive treatment, able to improve both low back and radiating pain.
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Lucia K, Nulis S, Tkatschenko D, Kuckuck A, Vajkoczy P, Bayerl S. Spinal Cord Stimulation: A Reasonable Alternative Treatment in Patients With Symptomatic Adult Scoliosis for Whom Surgical Therapy Is Not Suitable? A Pilot Study. Neuromodulation 2021; 24:1370-1376. [PMID: 33560562 DOI: 10.1111/ner.13351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION In adult scoliosis, dorsal instrumentation and fusion can provide significant improvement of pain and disability scores (Owestry Index); however, complication rates of up to 39% have been reported. As such, recent attempts have been made at expanding the surgical spectrum to include less invasive techniques in patients such as neuromodulation, specifically spinal cord stimulation (SCS). We therefore aimed to evaluate its use in a larger cohort of adult scoliosis patients in the form of a pilot study. MATERIALS AND METHODS We analyzed prospectively collected data from 18 adult scoliosis patients receiving SCS treatment in our institution between February 2019 and May 2020. Clinical follow-up was performed at 3, 6, and 12 months following implantation of an epidural SCS System. Patients reported numeric rating scale (NRS) values for the categories of lower back pain (LBP) and regional pain (RP) both at rest and in motion. Further, SF-36, ADS-K, PSQI, and ODI forms were completed. The study was approved by the institutional Ethics Committee (EA2/093/13). RESULTS Initial preoperative NRS of LBP at rest was significantly reduced following SCS at three (45% reduction, p = 0.005) and six (43% reduction, p = 0.009) months follow-up. LBP in motion was also reduced at three (27% reduction, p = 0.002) and six (33% reduction vs. preoperative, p = 0.005) months. RP at rest was reduced at three (38% reduction, p = 0.003) and six (37% reduction, p = 0.007) and in movement at three (29% reduction, 0.006) and six (32% reduction, p = 0.011). Loss of thoracic kyphosis and increased pelvic incidence were associated with worse NRS response to SCS stimulation at six months follow-up. DISCUSSION In overweight, older adults for whom the risks of corrective surgery must be carefully considered, neuromodulation can significantly reduce LBP as well as regional pain in the first six months following implantation. These findings may provide a reasonable alternative in patients not willing or eligible to undergo extensive corrective surgery.
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Affiliation(s)
- Kristin Lucia
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Stefan Nulis
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Dimitri Tkatschenko
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Anja Kuckuck
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Simon Bayerl
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
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Xu H, Qi G, Li K, Yang K, Luo D, Cai Z. Impact of NF-κB pathway on the intervertebral disc inflammation and degeneration induced by over-mechanical stretching stress. JOURNAL OF INFLAMMATION-LONDON 2021; 18:6. [PMID: 33531032 PMCID: PMC7851949 DOI: 10.1186/s12950-021-00273-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/22/2021] [Indexed: 12/21/2022]
Abstract
Background Intervertebral disk degeneration (IVDD) contributes to low back pain. Increased cell apoptosis and inflammation, decreased extracellular matrix are associated with IVDD. Nuclear factor-kappa B (NF-κB) signaling pathway and inflammatory cytokines are implicated in the pathophysiology of IVDD. Methods In present study, we established a mechanical stretching stress-stimulated nucleus pulposus (NP) cell model. We knocked down NF-κB p65 by siRNA transfection to inhibit NF-κB and evaluated the effects of NF-κB inhibition on intervertebral disk degeneration. We applied the mechanical stretching stress on NP cells and inhibited NF-κB by siRNA, then evaluated the expression of inflammatory cytokines, matrix metalloproteinase (MMP), aggrecan, collagen II, and monitored viability and apoptosis of NP cells. Results Mechanical stretching stress induced the expression of TNF-α, IL-1β, NF-κB, MMP-3 and MMP-13, while inhibited the production of aggrecan and collagen II in NP cells. Mechanical stretching stress decreased the cell viability and induced apoptosis in NP cells. Inhibition of NF-κB by siRNA suppressed the production of TNF-α, IL-1β, NF-κB, MMP-3 and MMP-13, while upregulated the expression of aggrecan and collagen II in NP cells. Conclusions Inhibition of NF-κB by knocking down p65 suppressed over-mechanical stretching stress-induced cell apoptosis and promoted viability in NP cell. Inhibition of NF-κB suppressed inflammation and degeneration of NP cells in IVDD.
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Affiliation(s)
- Hui Xu
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Guobao Qi
- Department of Spinal Surgery, Dongying People's Hospital, No. 317, Nanyi Road, 257091, Dongying, Shandong, China
| | - Kunpeng Li
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Keshi Yang
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Dawei Luo
- Department of Spinal Surgery, Liaocheng People's Hospital, No. 67, Dongchang Xilu Road, 252000, Liaocheng, Shandong, China
| | - Zhongxu Cai
- Department of Spinal Surgery, Dongying People's Hospital, No. 317, Nanyi Road, 257091, Dongying, Shandong, China.
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Binch ALA, Ratcliffe LPD, Milani AH, Saunders BR, Armes SP, Hoyland JA. Site-Directed Differentiation of Human Adipose-Derived Mesenchymal Stem Cells to Nucleus Pulposus Cells Using an Injectable Hydroxyl-Functional Diblock Copolymer Worm Gel. Biomacromolecules 2021; 22:837-845. [PMID: 33470795 DOI: 10.1021/acs.biomac.0c01556] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Adipose-derived mesenchymal stem cells (ASCs) have been identified for their promising therapeutic potential to regenerate and repopulate the degenerate intervertebral disk (IVD), which is a major cause of lower back pain. The optimal cell delivery system remains elusive but encapsulation of cells within scaffolds is likely to offer a decisive advantage over the delivery of cells in solution by ensuring successful retention within the tissue. Herein, we evaluate the use of a fully synthetic, thermoresponsive poly(glycerol monomethacrylate)-poly(2-hydroxypropyl methacrylate) (PGMA-PHPMA) diblock copolymer worm gel that mimics the structure of hydrophilic glycosaminoglycans. The objective was to use this gel to direct differentiation of human ASCs toward a nucleus pulposus (NP) phenotype, with or without the addition of discogenic growth factors TGFβ or GDF6. Accordingly, human ASCs were incorporated into a cold, free-flowing aqueous dispersion of the diblock copolymer, gelation induced by warming to 37 °C and cell culture was conducted for 14 days with or without such growth factors to assess the expression of characteristic NP markers compared to those produced when using collagen gels. In principle, the shear-thinning nature of the biocompatible worm gel enables encapsulated human ASCs to be injected into the IVD using a 21G needle. Moreover, we find significantly higher gene expression levels of ACAN, SOX-9, KRT8, and KR18 for ASCs encapsulated within worm gels compared to collagen scaffolds, regardless of the growth factors employed. In summary, such wholly synthetic worm gels offer considerable potential as an injectable cell delivery scaffold for the treatment of degenerate disk disease by promoting the transition of ASCs toward an NP-phenotype.
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Affiliation(s)
- Abbie L A Binch
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, U.K
| | - Liam P D Ratcliffe
- Department of Chemistry, University of Sheffield Brook Hill, Sheffield S3 7HF, South Yorkshire, U.K
| | - Amir H Milani
- Department of Materials, University of Manchester, Manchester M13 9PL, U.K
| | - Brian R Saunders
- Department of Materials, University of Manchester, Manchester M13 9PL, U.K
| | - Steven P Armes
- Department of Chemistry, University of Sheffield Brook Hill, Sheffield S3 7HF, South Yorkshire, U.K
| | - Judith A Hoyland
- Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester M13 9PL, U.K.,NIHR Manchester Biomedical Research Centre, Central Manchester Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, U.K
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Kamali A, Ziadlou R, Lang G, Pfannkuche J, Cui S, Li Z, Richards RG, Alini M, Grad S. Small molecule-based treatment approaches for intervertebral disc degeneration: Current options and future directions. Theranostics 2021; 11:27-47. [PMID: 33391459 PMCID: PMC7681102 DOI: 10.7150/thno.48987] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023] Open
Abstract
Low back pain (LBP) is a major reason for disability, and symptomatic intervertebral disc (IVD) degeneration (IDD) contributes to roughly 40% of all LBP cases. Current treatment modalities for IDD include conservative and surgical strategies. Unfortunately, there is a significant number of patients in which conventional therapies fail with the result that these patients remain suffering from chronic pain and disability. Furthermore, none of the current therapies successfully address the underlying biological problem - the symptomatic degenerated disc. Both spinal fusion as well as total disc replacement devices reduce spinal motion and are associated with adjacent segment disease. Thus, there is an unmet need for novel and stage-adjusted therapies to combat IDD. Several new treatment options aiming to regenerate the IVD are currently under investigation. The most common approaches include tissue engineering, growth factor therapy, gene therapy, and cell-based treatments according to the stage of degeneration. Recently, the regenerative activity of small molecules (low molecular weight organic compounds with less than 900 daltons) on IDD was demonstrated. However, small molecule-based therapy in IDD is still in its infancy due to limited knowledge about the mechanisms that control different cell signaling pathways of IVD homeostasis. Small molecules can act as anti-inflammatory, anti-apoptotic, anti-oxidative, and anabolic agents, which can prevent further degeneration of disc cells and enhance their regeneration. This review pursues to give a comprehensive overview of small molecules, focusing on low molecular weight organic compounds, and their potential utilization in patients with IDD based on recent in vitro, in vivo, and pre-clinical studies.
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Affiliation(s)
- Amir Kamali
- AO Research Institute Davos, Davos, Switzerland
| | - Reihane Ziadlou
- AO Research Institute Davos, Davos, Switzerland
- Department of Biomedical Engineering, Medical Faculty of the University of Basel, Basel, CH
| | - Gernot Lang
- Department of Orthopaedic and Trauma Surgery, University Medical Center Freiburg, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | | | - Shangbin Cui
- AO Research Institute Davos, Davos, Switzerland
- The first affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhen Li
- AO Research Institute Davos, Davos, Switzerland
| | | | - Mauro Alini
- AO Research Institute Davos, Davos, Switzerland
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Xu P, Guan J, Chen Y, Xiao H, Yang T, Sun H, Wu N, Zhang C, Mao Y. Stiffness of photocrosslinkable gelatin hydrogel influences nucleus pulposus cell propertiesin vitro. J Cell Mol Med 2020; 25:880-891. [PMID: 33289319 PMCID: PMC7812302 DOI: 10.1111/jcmm.16141] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
Abstract
A key early sign of degenerative disc disease (DDD) is the loss of nucleus pulposus (NP) cells (NPCs). Accordingly, NPC transplantation is a treatment strategy for intervertebral disc (IVD) degeneration. However, in advanced DDD, due to structural damage of the IVD and scaffold mechanical properties, the transplanted cells are less viable and secrete less extracellular matrix, and thus, are unable to efficiently promote NP regeneration. In this study, we evaluated the encapsulation of NPCs in a photosensitive hydrogel made of collagen hydrolysate gelatin and methacrylate (GelMA) to improve NP regeneration. By adjusting the concentration of GelMA, we prepared hydrogels with different mechanical properties. After examining the mechanical properties, cell compatibility and tissue engineering indices of the GelMA-based hydrogels, we determined the optimal hydrogel concentration of the NPC-encapsulating GelMA hydrogel for NP regeneration as 5%. NPCs effectively combined with GelMA and proliferated. As the concentration of the GelMA hydrogel increased, the survival, proliferation and matrix deposition of the encapsulated NPCs gradually decreased, which is the opposite of NPCs grown on the surface of the hydrogel. The controllability of the GelMA hydrogels suggests that these NPC-encapsulating hydrogels are promising candidates to aid in NP tissue engineering and repairing endogenous NPCs.
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Affiliation(s)
- Panpan Xu
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Jingjing Guan
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Yu Chen
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,School of Life Sciences, Bengbu Medical College, Bengbu, China.,Department of Plastic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Hui Xiao
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Tianhao Yang
- School of Life Sciences, Bengbu Medical College, Bengbu, China
| | - Hengheng Sun
- School of Life Sciences, Bengbu Medical College, Bengbu, China
| | - Nan Wu
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China
| | - Changchun Zhang
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China
| | - Yingji Mao
- Department of Orthopaedics, First Affiliated Hospital, Bengbu Medical College, Bengbu, China.,Anhui Province Key Laboratory of Tissue Transplantation, Bengbu Medical College, Bengbu, China.,School of Life Sciences, Bengbu Medical College, Bengbu, China
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Meloncelli S, Germani G, Urti I, Divizia M, Rosciano M, Puntillo F, Paladini A, Varrassi G. Endoscopic radiofrequency facet joint treatment in patients with low back pain: technique and long-term results. A prospective cohort study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20958979. [PMID: 33294037 PMCID: PMC7708704 DOI: 10.1177/1759720x20958979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
Aims: The aim of the study was to evaluate the efficacy of endoscopic rhizotomy
(ER) for denervation of lumbar facet joints in patients with chronic low
back pain (LBP) due to facet joint syndrome (FJS). Methods: A total of 50 consecutive patients suffering from chronic LBP due to facet
joints were screened to be treated with ER. The patients participating in
the study had a 2-year follow up. Numeric Rating Scale (NRS) and Oswestry
Disability Index (ODI) were assessed in the preoperative and postoperative
period. To evaluate secondary endpoints, patients were divided into groups.
One group included the patients previously treated with percutaneous
radiofrequency (RF). The other group comprised patients at their first
interventional treatment. We also compared patients dividing them by age and
by number of joints treated, trying to elucidate if these parameters could
be predictive of effectiveness of the procedure. Results: All patients had a reduction in NRS and an improvement in ODI. NRS was
reduced significantly after 1 month and remained the same until the end of
the study. ODI was significantly improved from T1 (1 month after surgery) up
to T7 (end of the study). The improvements did not differ whether already
treated with percutaneous rhizotomy or not. Patients less than 60 years or
with 1–2 joints treated had better improvement compared with the others. Conclusion: The results obtained demonstrate that ER for denervation of the facet joint
is an effective treatment in patients with chronic LBP, with consistent and
stable results at 2-year follow up. The technique has a rapid learning curve
and no major complications occurred. Moreover, the previous percutaneous RF
treatment had no influence on the results obtained with endoscopic
technique. There is evidence that best results are obtained in younger
patients and/or in patients with 1–2 joints treated. Lay summary Low-back pain has facet joints inflammation or degeneration as pain generator
in 20–40% of cases. Nervous lesion of the dorsal ramus innervating the facet
joints has been shown as an efficacious treatment to obtain good analgesia.
Percutaneous techniques have provided short term results for several
reasons. This research aimed to see whether endoscopic denervation, which
guarantees a more precise approach to anatomical structure, would result in
more durable results. The study conducted on 40 patients has made it clear
that this approach gives significant analgesia for at least 2 years, which
was the time of patient follow up.
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Affiliation(s)
| | | | | | | | | | - Filomena Puntillo
- Department of Emergency and Organ Transplants, University "Aldo Moro" of Bari, Bari, Puglia, Italy
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Pires D, Cruz E, Canhão H, Nunes C. Minimum important change values for pain and disability: which is the best to identify a meaningful response in patients with chronic nonspecific low back pain? Physiother Theory Pract 2020; 38:1499-1507. [PMID: 33249981 DOI: 10.1080/09593985.2020.1843210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To examine the association between different minimum important change (MIC) values for pain and disability and a successful response in global perception of improvement in patients with chronic nonspecific low back pain (CNLBP). METHODS A prospective cohort study was conducted. At baseline, all participants completed a sociodemographic and clinical questionnaire, the Numeric Pain Rating Scale and the Quebec Back Pain Disability Scale (QBPDS). After a physiotherapy program, the Global Perceived Effect Scale (GPES) was completed together with pain and disability measures. The association of the different literature MIC values for pain and disability with a successful response on the GPES was analyzed using logistic regression models. The discrimination power, sensitivity, specificity and predictive values were computed. RESULTS A total of 183 patients with CNLBP participated in this study. A reduction of 30% on the QBPDS (OR = 7.8; area under the curve = 0.73; sensitivity = 0.72; specificity = 0.76) most accurately identified patients who perceived a global improvement on the GPES. Composite criteria using both pain and disability MIC values presented high odds ratios and specificity values, but failed to identify patients who perceived a meaningful improvement. CONCLUSION A 30% reduction on the QBPDS is recommended to identify patients with CNLBP who achieve a clinical improvement with physiotherapy treatment.
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Affiliation(s)
- Diogo Pires
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Eduardo Cruz
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal.,Department of Physical Therapy, School of Health Care, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - Helena Canhão
- Comprehensive Health Research Center (CHRC), Lisboa, Portugal.,Cedoc, EpiDoC Unit, NOVA Medical School, Nova University of Lisbon, Lisboa, Portugal.,Department of Rheumatology, CHULC-Hospital Curry Cabral, Lisboa, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Center (CHRC), Lisboa, Portugal
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47
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Kong L, Zhou X, Huang Q, Zhu Q, Zheng Y, Tang C, Li JX, Fang M. The effects of shoes and insoles for low back pain: a systematic review and meta-analysis of randomized controlled trials. Res Sports Med 2020; 28:572-587. [PMID: 32954802 DOI: 10.1080/15438627.2020.1798238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this review was to examine the effects of shoes and insoles on low back pain (LBP). Seven electronic databases were searched from their inception to May 2020. The methodological quality of the 14 included studies was assessed by PEDro scale. Quality of evidence was assessed using GRADE. Moderate evidence on the disability questionnaire score (SMD, 0.52; 95% CI, 0.28 to 0.77; P < 0.001) and pain score (SMD, 0.61; 95% CI, 0.36 to 0.85; P < 0.001) of the custom-made orthotics for chronic LBP compared with no orthotics/insoles intervention was found. Meta-analysis results also showed moderate evidence on the disability questionnaire score (SMD, 0.44; 95% CI, 0.05 to 0.82; P =0.03) in patients who wore unstable shoes compared with regular shoes. Pain and life quality scores showed low-quality evidence of unstable shoes for chronic LBP. Custom-made orthotics and unstable shoes can be recommended to patients as a management option of chronic LBP.
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Affiliation(s)
- Lingjun Kong
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China.,Institute of Tuina, Shanghai Institute of Traditional Chinese Medicine , Shanghai, China
| | - Xin Zhou
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China
| | - Qian Huang
- Department of Acupuncture and Tuina, Lianyungang Hospital of Traditional Chinese Medicine , Lianyungang, China
| | - Qingguang Zhu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China.,Institute of Tuina, Shanghai Institute of Traditional Chinese Medicine , Shanghai, China
| | - Yu Zheng
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China
| | - Cheng Tang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China
| | - Jing Xian Li
- School of Human Kinetics, University of Ottawa , Ottawa, Canada
| | - Min Fang
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine , Shanghai, China.,Institute of Tuina, Shanghai Institute of Traditional Chinese Medicine , Shanghai, China.,College of Acupuncture and Tuina, Shanghai University of Traditional Chinese Medicine , Shanghai, China
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Zhao Z, Zheng J, Ye Y, Zhao K, Wang R, Wang R. MicroRNA‑25‑3p regulates human nucleus pulposus cell proliferation and apoptosis in intervertebral disc degeneration by targeting Bim. Mol Med Rep 2020; 22:3621-3628. [PMID: 32901887 PMCID: PMC7533515 DOI: 10.3892/mmr.2020.11483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/25/2020] [Indexed: 12/22/2022] Open
Abstract
Intervertebral disc degeneration (IDD) is a degenerative disease of the spine originating from the intervertebral disc. MicroRNAs (miRNAs or miRs) are a group of endogenous small non‑coding RNAs that act on target genes and play a critical role in numerous biological processes. However, the underlying mechanism of miR‑25‑3p in IDD remains unclear. Therefore, the present study aimed to explore the role of miR‑25‑3p in the pathogenesis of IDD. The results demonstrated that miR‑25‑3p was downregulated in rat degenerative nucleus pulposus (NP) cells and that Bcl‑2 interacting mediator of cell death (Bim) was a direct target of miR‑25‑3p. Next, to investigate the effect of miR‑25‑3p on normal NP cell proliferation and apoptosis, NP cells were transfected with an miR‑25‑3p inhibitor, a negative control of miR‑25‑3p inhibitor, miR‑25‑3p inhibitor + control‑small interference RNA (siRNA) or miR‑25‑3p inhibitor + Bim‑siRNA for 48 h and cell proliferation and apoptosis were then analyzed. The results demonstrated that the miR‑25‑3p inhibitor could decrease NP cell proliferation and induce cell apoptosis, and these effects were reversed by Bim‑siRNA. In addition, an in vitro cell model of IDD was established by subjecting NP cells to 10 ng/ml interleukin (IL)‑1β for 24 h. Further experiments suggested that IL‑1β treatment induced a reduction in NP cell proliferation and an increase in cell apoptosis, which were prevented by the miR‑25‑3p mimic. All the effects of miR‑25‑3p mimic on IL‑1β‑treated NP cells were significantly reversed by Bim upregulation. These findings suggested that miR‑25‑3p may be a novel therapeutic target for IDD prevention.
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Affiliation(s)
- Zhifang Zhao
- Department of Orthopedics, No. 903 Hospital of People's Liberation Army, Hangzhou, Zhejiang 310013, P.R. China
| | - Jie Zheng
- Department of Orthopedics, No. 903 Hospital of People's Liberation Army, Hangzhou, Zhejiang 310013, P.R. China
| | - Youchen Ye
- Department of Orthopedics, No. 903 Hospital of People's Liberation Army, Hangzhou, Zhejiang 310013, P.R. China
| | - Kefeng Zhao
- Department of Orthopedics, No. 903 Hospital of People's Liberation Army, Hangzhou, Zhejiang 310013, P.R. China
| | - Ruozhang Wang
- Department of Orthopedics, No. 903 Hospital of People's Liberation Army, Hangzhou, Zhejiang 310013, P.R. China
| | - Ran Wang
- Department of Orthopedics, No. 903 Hospital of People's Liberation Army, Hangzhou, Zhejiang 310013, P.R. China
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The Economic and Social Burden of Low Back Pain in Spain: A National Assessment of the Economic and Social Impact of Low Back Pain in Spain. Spine (Phila Pa 1976) 2020; 45:E1026-E1032. [PMID: 32706566 DOI: 10.1097/brs.0000000000003476] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Economic evaluation of the costs of low back pain (LBP) in Spain from a societal perspective, including direct and indirect costs, based on a national representative sample of the general population, the National Health Survey of 2017 (NHS 2017). OBJECTIVE To estimate the costs attributable to LBP in Spain. SUMMARY OF BACKGROUND DATA LBP has a high prevalence and is associated with lower quality of life, functional status, and increased use of health services. Studies that assess the socio-economic burden of LBP from a general population perspective have not been published yet in Spain. METHODS Data from NHS 2017 were used. Direct costs (consultations-general practitioner, specialist and emergency departments-, diagnostic tests, hospitalizations, physiotherapy, psychologist, and medication consumption) and indirect costs (absenteeism and presenteeism) were assessed. Multivariate models were obtained to determine the independent attributable effect of LBP in each variable. Costs were determined through existing regional healthcare services public data. RESULTS Prevalence of LBP was 17.1% for men and 24.5% for women, and increased with age, low educational status, higher body mass index, and was associated with less physical activity, and lower self-perceived health. Multivariate analysis demonstrated that LBP was independently associated with a significant increase both in the utilization of all health services and on work day losses. Attributable costs of LBP were 8945.6 million euros, of which 74.5% implied indirect costs, representing overall 0.68% of Spanish Gross Domestic Product. CONCLUSION Spain is paying a heavy price for LBP, mostly associated with its significant impact on absenteeism and presenteeism, as well as a noteworthy effect on excess health services utilization. These findings underscore the need to address this considerable public health and social problem through interventions that address widely LBP and that have demonstrated to be cost-effective. LEVEL OF EVIDENCE 3.
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50
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Al-Hadidi F, Bsisu I, Haddad B, AlRyalat SA, Shaban M, Matani N, Dehidi S, Khater Y, Shahrouri R, Al Muzayen T, Al Hawamdeh H. The prevalence of low back pain among female hospital staff at childbearing age. PeerJ 2020; 8:e9199. [PMID: 32607279 PMCID: PMC7315438 DOI: 10.7717/peerj.9199] [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] [Received: 09/20/2019] [Accepted: 04/24/2020] [Indexed: 12/03/2022] Open
Abstract
Background Low back pain (LBP) is considered the most common work-related musculoskeletal disorder among female healthcare workers. The aim of this study is to compare the prevalence of LBP and non-ergonomic risk factors between female nurses, office workers, and patient transporters, and the effect of pain on job performance. Methods Based on semi-structured interviews, we conducted a cross-sectional study on Jordanian female hospital workers between January and July, 2017. Results We included 209 participants with a mean age of 35.57 ± 8 years from four Jordanian medical centers. Nurses have significantly higher frequency of LBP (82.5%; p = 0.05) compared to both office workers (67.5%) and patient transporters (68.6%). The mean difference in pain score using Visual Analogue Scale (VAS) after treatment varied significantly (p = 0.003), since it was 28.2 (±35.4) for office workers, compared to 22.8 (±26.5) for nurses and 6.5 (±33.7) for patient transporters. A higher frequency of nurses reported that LBP affected their job performance (64.9%; p = 0.013), and 43.3% of them reported having previous sick leaves due to LBP (p = 0.008). Conclusions LBP is common among female hospital workers, with significantly higher prevalence among female nurses when compared to other female hospital staff.
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Affiliation(s)
- Fadi Al-Hadidi
- Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Isam Bsisu
- Department of Anesthesia and Intensive Care, School of Medicine, University of Jordan, Amman, Jordan
| | - Bassem Haddad
- Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Mamoun Shaban
- Department of General Surgery, School of Medicine, University of Jordan, Amman, Jordan
| | - Nada Matani
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Sondos Dehidi
- School of Medicine, University of Jordan, Amman, Jordan
| | | | | | | | - Hashem Al Hawamdeh
- Department of Special Surgery, School of Medicine, University of Jordan, Amman, Jordan
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