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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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Elliott JM, Walton DM, Albin SR, Courtney DM, Siegmund GP, Carroll LJ, Weber KA, Smith AC. Biopsychosocial sequelae and recovery trajectories from whiplash injury following a motor vehicle collision. Spine J 2023; 23:1028-1036. [PMID: 36958668 PMCID: PMC10330498 DOI: 10.1016/j.spinee.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND CONTEXT Five out of 10 injured in a motor vehicle collision (MVC) will develop persistent pain and disability. It is unclear if prolonged symptoms are related to peritraumatic pain/disability, psychological distress, muscle fat, lower extremity weakness. PURPOSE To test if widespread muscle fat infiltration (MFI) was (1) unique to those with poor recovery, (2) present in the peritraumatic stage, (3) related to known risk factors. STUDY DESIGN/SETTING A cohort study, single-center academic hospital. PATIENT SAMPLES A total of 97 men and women (age 18-65) presenting to an urban academic emergency medicine department following MVC, but not requiring inpatient hospitalization. PRIMARY OUTCOME MEASURE Neck disability at 12-months. METHODS Participants underwent magnetic resonance imaging (MRI) to quantify neck and lower extremity MFI, completed questionnaires on pain/disability and psychological distress (< 1-week, 2-weeks, 3-, and 12-months) and underwent maximum volitional torque testing of their lower extremities (2-weeks, 3-, and 12-months). Percentage score on the Neck Disability Index at 12-months was used for a model of (1) Recovered (0%-8%), (2) Mild (10%-28%), and (3) Moderate/Severe (≥ 30%). This model was adjusted for BMI and age. RESULTS Significant differences for neck MFI were revealed, with the Recovered group having significantly lower neck MFI than the Mild and Moderate/Severe groups at all time points. The Mild group had significantly more leg MFI at 12-months (p=.02) than the Recovered group. There were no other significant differences at any other time point. Lower extremity torques revealed no group differences. The Traumatic Injury Distress Scale (TIDS) and MFI of the neck at 1-week postinjury significantly predicted NDI score at 12-months. CONCLUSIONS Higher neck MFI and distress may represent a risk factor though it is unclear whether this is a pre-existing phenotype or result of the trauma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02157038.
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Affiliation(s)
- J M Elliott
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, The Kolling Institute, 10 Westbourne St, St Leonards, New South Wales, 2065, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 N Michigan Ave, Chicago, IL 60611, USA.
| | - D M Walton
- Faculty of Health Sciences, School of Physical Therapy, Western University Canada Schulich School of Medicine and Dentistry, 1151 Richmond St, London, Ontario N6A 5C1, Canada; Department of Psychiatry, Western University Canada, 151 Richmond St, London, Ontario N6A 5C1, Canada
| | - S R Albin
- School of Physical Therapy, Regis University, 3333 Regis Boulevard Denver, CO 80221-1099, USA
| | - D M Courtney
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - G P Siegmund
- MEA Forensics, 11151 Horseshoe Way, Richmond, British Columbia V7A 4S5, Canada
| | - L J Carroll
- School of Public Health, University of Alberta, 11405 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada
| | - K A Weber
- Division of Pain Medicine, Stanford School of Medicine, 900 Blake Wilbur Dr, Palo Alto, CA 94304, USA
| | - A C Smith
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado, 12631 E 17th Ave, Aurora, CO 80045, USA
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Convolutional neural networks for the automatic segmentation of lumbar paraspinal muscles in people with low back pain. Sci Rep 2022; 12:13485. [PMID: 35931772 PMCID: PMC9355981 DOI: 10.1038/s41598-022-16710-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/14/2022] [Indexed: 12/03/2022] Open
Abstract
The size, shape, and composition of paraspinal muscles have been widely reported in disorders of the cervical and lumbar spine. Measures of size, shape, and composition have required time-consuming and rater-dependent manual segmentation techniques. Convolutional neural networks (CNNs) provide alternate timesaving, state-of-the-art performance measures, which could realise clinical translation. Here we trained a CNN for the automatic segmentation of lumbar paraspinal muscles and determined the impact of CNN architecture and training choices on segmentation performance. T2-weighted MRI axial images from 76 participants (46 female; age (SD): 45.6 (12.8) years) with low back pain were used to train CNN models to segment the multifidus, erector spinae, and psoas major muscles (left and right segmented separately). Using cross-validation, we compared 2D and 3D CNNs with and without data augmentation. Segmentation accuracy was compared between the models using the Sørensen-Dice index as the primary outcome measure. The effect of increasing network depth on segmentation accuracy was also investigated. Each model showed high segmentation accuracy (Sørensen-Dice index ≥ 0.885) and excellent reliability (ICC2,1 ≥ 0.941). Overall, across all muscles, 2D models performed better than 3D models (p = 0.012), and training without data augmentation outperformed training with data augmentation (p < 0.001). The 2D model trained without data augmentation demonstrated the highest average segmentation accuracy. Increasing network depth did not improve accuracy (p = 0.771). All trained CNN models demonstrated high accuracy and excellent reliability for segmenting lumbar paraspinal muscles. CNNs can be used to efficiently and accurately extract measures of paraspinal muscle health from MRI.
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Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. Spine J 2022; 22:660-676. [PMID: 34718177 DOI: 10.1016/j.spinee.2021.10.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have proposed that there is a relationship between low back pain (LBP) and morphology and composition of paraspinal muscles. However, results have been conflicting, especially regarding fatty infiltration of muscles. PURPOSE The primary goal of this study was to review and analyze results from imaging studies which investigated morphological and composition changes in the multifidus, erector spinae and psoas major muscles in people with LBP. STUDY DESIGN/SETTING Systematic review with meta-analysis. PATIENT SAMPLE A patient sample was not required OUTCOME MEASURES: This review did not have outcome measures. METHODS PubMed, Scopus, Web of Sciences, EMBASE and ProQuest were searched for eligible studies up to 31st July 2020 (all languages). A systematic search of electronic databases was conducted to identify studies investigating the association between the morphology and fat content of lumbar muscles in people with LBP compared with a (no LBP) control group. 13,795 articles were identified. Based on the screening for inclusion/ exclusion, 25 were included. The quality of the studies was evaluated using the Newcastle-Ottawa Scale. From the 25 articles, 20 were included in the meta-analysis. RESULTS Results showed that the total cross-sectional area of the multifidus was smaller in people with LBP (Standardized mean difference, SMD = -0.24, 95% CI = -0.5 to 0.03). Combined SMDs showed a medium effect of LBP on increasing multifidus muscle fat infiltration (SMD = 0.61, 95% CI = 0.30 to 0.91). There were no LBP related differences identified in the morphology or composition of the lumbar erector spine and psoas major muscles. CONCLUSIONS People with LBP were found to have somewhat smaller multifidus muscles with a significant amount of intramuscular fat infiltration. Varying sample size, age and BMI of participants, quality of studies and the procedures used to measure fat infiltration are possible reasons for inconsistencies in results of previous studies.
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Popovich JM. CORR Insights®: Cervical Paraspinal Muscle Fatty Degeneration Is Not Associated with Muscle Cross-sectional Area: Qualitative Assessment Is Preferable for Cervical Sarcopenia. Clin Orthop Relat Res 2021; 479:733-735. [PMID: 33724976 PMCID: PMC8083911 DOI: 10.1097/corr.0000000000001733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/18/2021] [Indexed: 01/31/2023]
Affiliation(s)
- John M Popovich
- J. M. Popovich Jr, Michigan State University, East Lansing, MI, USA
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Crawford RJ. Letter to Editor re: Shahidi et al Gene expression in lumbar spine muscle. Spine (Phila Pa 1976) 2020; 45:E972-E973. [PMID: 32675620 DOI: 10.1097/brs.0000000000003575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Dallaway A, Kite C, Griffen C, Duncan M, Tallis J, Renshaw D, Hattersley J. Age-related degeneration of the lumbar paravertebral muscles: Systematic review and three-level meta-regression. Exp Gerontol 2020; 133:110856. [PMID: 32006635 DOI: 10.1016/j.exger.2020.110856] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Morphological changes of the lumbar spine muscles are not well characterised with ageing. To further the understanding of age-related degeneration of the lumbar spine musculature, normative morphological changes that occur within the paravertebral muscles must first be established. METHODS A systematic review and meta-regressions were conducted adhering to PRISMA guidelines. Searches for published and unpublished data were completed in June 2019. RESULTS Searches returned 4781 articles. 34 articles were included in the quantitative analysis. Three-level meta-analyses showed age-related atrophy (r = -0.26; 95% CI: -0.33, -0.17) and fat infiltration (r = 0.39; 95% CI: 0.28, 0.50) in the lumbar paravertebral muscles. Degenerative changes were muscle-specific and men (r = -0.32; 95% CI: -0.61, 0.01) exhibited significantly greater muscle atrophy than women (r = -0.24; 95% CI: -0.47, 0.03). Imaging modality, specifically ultrasound, also influenced age-related muscle atrophy. Measurements taken across all lumbar levels revealed the greatest fat infiltration with ageing (r = 0.58, 95% CI: 0.35, 0.74). Moderators explained a large proportion of between-study variance in true effects for muscle atrophy (72.6%) and fat infiltration (79.8%) models. CONCLUSIONS Lumbar paravertebral muscles undergo age-related degeneration in healthy adults with muscle, lumbar level and sex-specific responses. Future studies should use high-resolution imaging modalities to quantify muscle atrophy and fat infiltration.
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Affiliation(s)
- A Dallaway
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, United Kingdom.
| | - C Kite
- School of Life and Health Sciences, Cell and Tissue Biomedical Research Group, Aston University, Aston Triangle, Birmingham B4 7ET, United Kingdom; Centre for Active Living, University Centre Shrewsbury, University of Chester, Guildhall, Frankwell Quay, Shrewsbury SY3 8HQ, United Kingdom
| | - C Griffen
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, United Kingdom
| | - M Duncan
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; School of Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom
| | - J Tallis
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; School of Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom
| | - D Renshaw
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom
| | - J Hattersley
- Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Science and Health Building, Whitefriars Street, Coventry University, Coventry CV1 2DS, United Kingdom; Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, United Kingdom
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Newman-Griffis D, Porcino J, Zirikly A, Thieu T, Camacho Maldonado J, Ho PS, Ding M, Chan L, Rasch E. Broadening horizons: the case for capturing function and the role of health informatics in its use. BMC Public Health 2019; 19:1288. [PMID: 31615472 PMCID: PMC6794808 DOI: 10.1186/s12889-019-7630-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual’s interaction with the world, including organismal concepts such as individual body structures, functions, and pathologies, as well as the outcomes of the individual’s interaction with their environment, referred to as activity and participation. Function, particularly activity and participation outcomes, is an important indicator of health at both the level of an individual and the population level, as it is highly correlated with quality of life and a critical component of identifying resource needs. Since it reflects the cumulative impact of health conditions on individuals and is not disease specific, its use as a health indicator helps to address major barriers to holistic, patient-centered care that result from multiple, and often competing, disease specific interventions. While the need for better information on function has been widely endorsed, this has not translated into its routine incorporation into modern health systems. Purpose We present the importance of capturing information on activity as a core component of modern health systems and identify specific steps and analytic methods that can be used to make it more available to utilize in improving patient care. We identify challenges in the use of activity and participation information, such as a lack of consistent documentation and diversity of data specificity and representation across providers, health systems, and national surveys. We describe how activity and participation information can be more effectively captured, and how health informatics methodologies, including natural language processing (NLP), can enable automatically locating, extracting, and organizing this information on a large scale, supporting standardization and utilization with minimal additional provider burden. We examine the analytic requirements and potential challenges of capturing this information with informatics, and describe how data-driven techniques can combine with common standards and documentation practices to make activity and participation information standardized and accessible for improving patient care. Recommendations We recommend four specific actions to improve the capture and analysis of activity and participation information throughout the continuum of care: (1) make activity and participation annotation standards and datasets available to the broader research community; (2) define common research problems in automatically processing activity and participation information; (3) develop robust, machine-readable ontologies for function that describe the components of activity and participation information and their relationships; and (4) establish standards for how and when to document activity and participation status during clinical encounters. We further provide specific short-term goals to make significant progress in each of these areas within a reasonable time frame.
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Affiliation(s)
- Denis Newman-Griffis
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA. .,Department of Computer Science and Engineering, The Ohio State University, 2015 Neil Avenue, DL 395, Columbus, OH, 43210, USA.
| | - Julia Porcino
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Ayah Zirikly
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Thanh Thieu
- Department of Computer Science, Oklahoma State University, 116-A MSCS, Stillwater, OK, 74078, USA
| | - Jonathan Camacho Maldonado
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Pei-Shu Ho
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Min Ding
- Information Technology Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD, 20899, USA
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Elizabeth Rasch
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
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Elliott JM, Parrish TB, Walton DM, Vassallo AJ, Fundaun J, Wasielewski M, Courtney DM. Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash? Am J Emerg Med 2019; 38:869-873. [PMID: 31285071 DOI: 10.1016/j.ajem.2019.06.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE There remains limited evidence for the clinical importance of most imaging findings in whiplash. However, it is possible the type and number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. The purpose is to interpret cervical spine pathologies in the context of known factors influencing recovery. MATERIALS AND METHODS This is a secondary analysis from a database of 97 acutely injured participants enrolled in a prospective inception cohort study. Thirty-eight participants underwent standard of care cervical spine CT in the emergency medicine department. All 38 participants were assessed at <1-week, 2-weeks, and 3-months post-injury and classified using percentage scores on the Neck Disability Index (recovered/mild (NDI of 0-28%) or moderate/severe (NDI ≥ 30%)). Between-group comparison of categorical variables (gender (male/female), presence of at least one CT finding (yes/no), and presence of ≥3 pathologies on CT (yes/no)) was conducted using 2-tailed Fisher's exact test. RESULTS Participants from both groups demonstrated at least one observable pathology. The group with persistent moderate/severe symptoms presented with significantly more pathology at baseline than those who later reported recovery or milder symptoms at 3-months post injury (p = 0.02). CONCLUSIONS This preliminary study, which needs replication in a larger cohort, provides foundation that the number of degenerative pathologies seen on initial post MVC CT may be associated with the subsequent clinical course of whiplash.
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Affiliation(s)
- James M Elliott
- The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia; Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - David M Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Amy J Vassallo
- The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia
| | - Joel Fundaun
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - D Mark Courtney
- Department of Emergency Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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