Effects of kinesiology taping and core stability exercise on clinical variables in patients with non-specific chronic low back pain: A randomized controlled trial

OBJECTIVE

Properly-designed exercises and use of different physiotherapeutic modalities have been shown to be useful in the management of patients with non-specific chronic low back pain (NSCLBP). This research examined the effects of Kinesiology taping (KT) and Core-stabilization exercises (CSE) on pain intensity, lumbar range of motion, functional disability, depression, anxiety, sleep disturbance and Kinesiophobia in patients with NSCLBP.

DESIGN

Randomized controlled trial.

SETTINGS

Two tertiary health facilities.

PARTICIPANTS

Thirty-five patients (28 males and 7 females) with NSCLBP were allocated into three groups (KT + CSE, CSE and KT only).

MAIN OUTCOME MEASURE

Pain intensity, functional disability, psychological status, sleep disturbance, kinesiophobia and lumbar range of motion (LROM) were assessed.

RESULTS

The results revealed reduction in pain intensity, improved functional ability, psychological status (Depression and Anxiety), kinesiophobia, decreased sleep disturbance and increased LROM (P < 0.001) within each of the groups post-intervention.

CONCLUSION

All participants had improved clinical outcomes. However, KT + CSE group had better result in all the clinical outcomes.

CLINICAL TRIAL REGISTRY NUMBER

PACTR201807604459572.

Effect of a 10-Week Aquatic Exercise Training Program on Gross Motor Function in Children With Spastic Cerebral Palsy

Introduction. Cerebral palsy (CP) is caused by an injury to the developing brain, and abnormal gross motor function is a hallmark of CP. Properly structured exercises on land have been reported to be effective in improving functional performance in children with CP while only few have been documented on aquatic therapy. Objective. To investigate the effect of a 10-week aquatic exercise training program on gross motor function in children with spastic CP. Methods. Thirty participants aged 1 to 12 years were randomized into the experimental and control groups. Both groups received manual passive stretching and functional training exercises, depending on their level of motor impairment, either in water (temperature 28°C to 32°C) or on land. Each exercise training session lasted for about 1 hour 40 minutes, twice per week for 10 weeks in both groups. Measurement of gross motor function was done using Gross Motor Function Measure (GMFM-88) at baseline and after 4 weeks, 8 weeks, and 10 weeks of intervention. Both groups were compared for differences in change in gross motor function using Mann-Whitney U test. The level of significance was set at P < .05. Results. Only the experimental group showed significant improvement (P < .05) in all dimensions of gross motor function except for walking, running, and jumping (P = .112). Statistically significant difference (P < .05) was found between both groups for all dimensions of gross motor function after 10 weeks of intervention. Conclusion. Aquatic exercise training program is effective in the functional rehabilitation of children with spastic CP.

Prevalence and Impact of Work-Related Musculoskeletal Disorders on Job Performance of Call Center Operators in Nigeria

Background:

Work-related musculoskeletal disorders (WMSDs) have been documented among various occupational groups in Nigeria. However, there is limited data on the prevalence of WMSDs among call center operators (CCOs).

Objective:

To determine the prevalence of WMSDs among CCOs in Nigeria and to explore the extent to which these discomforts impact the daily work activities of the respondents.

Methods:

374 respondents who were randomly selected from 4 telecommunication companies in Lagos State, Nigeria, participated in this study. They were asked to complete a pretested questionnaire designed to capture the prevalence, impact and associated risk factors of WMSDs among CCOs.

Results:

42% and 65.2% of respondents experienced at least one WMSDs in the past 7 days, and 12 months, respectively. Women and CCOs who received calls with hand-held phones rather than headsets reported more discomforts during both 7 days and 12 months periods. Neck, shoulder, upper back, and lower back were the most affected areas during past 7 days and 12 months. Discomforts in the neck, low back, and knees prevented most of the respondents from performing their daily work.

Conclusion:

WMSDs have a serious impact on the daily job activities of the CCOs in Nigeria.

Impact of Computer Related Posture on the Occurrence of Musculoskeletal Discomfort among Secondary School Students in Lagos, Nigeria

BACKGROUND

Computers have become an essential part of life particularly in industrially advanced countries of the world. Children now have greater accessibility to computers both at school and at home. Recent studies suggest that with this increased exposure, there are associated musculoskeletal disorders (MSDs) in both school-aged children and adults.

OBJECTIVES

To assess the posture assumed by secondary school students during computer use and its impact on the occurrence and severity of reported musculoskeletal discomforts.

METHODS

Posture assumed during normal computer class, occurrence of discomforts, body parts involved and the intensity of discomforts were evaluated in 235 school aged children using Rapid Upper Limb Assessment (RULA) scale, Body Discomfort Chart (BDC) and Visual Analogue Scale (VAS) before and after normal computer class. Inferential statistics of t-test and chi-square were used to determine significance difference between variables, with level of significant set at p < 0.05.

RESULTS

None of the participants demonstrated acceptable posture. Computer use produced significant discomforts on the neck, shoulder and low back. There was a significant relationship between participants height and posture assumed. Two hundred and eleven (89.8%) participants reported discomforts/pain during the use of computer. Weight and height were contributory factors to the occurrence of musculoskeletal discomfort/pain (p < 0.05) in some of the body parts studied.

CONCLUSION

Musculoskeletal discomfort was found to be a problem among the school-aged children during computer use. Weight and height were implicated as factors that influenced the form of posture and the nature of the reported discomfort. Creating awareness about the knowledge of ergonomics and safety for promotion of good posture was therefore recommended.

Characterisation of physiotherapy needs in a rural community in South Eastern Nigeria

BACKGROUND

The majority of the populace in Nigeria resides in rural areas, where there is difficulty in accessing rehabilitation services. Rural dwellers are often poor and marginalized, and have been reported to have a high level of disability and functional dependence. They may therefore be in need of rehabilitation.

OBJECTIVE

To assess and characterize physiotherapy needs in a rural community of South Eastern Nigeria.

METHODS

A total of 400 individuals participated in this population-based cross-sectional study which included 'household members' aged 0-5 years and 12 years and above, involving 12 randomly selected villages from Nkanu West Local Government of South Eastern Nigeria. Distribution of the questionnaire was done by hand on a one-on-one basis, using the interviewer style. Information on infants and children was obtained from the heads of the households.

RESULTS

One hundred and ninety six (49.0%) reported ambulatory problems; the problem were mostly associated with the spine 75 (18.8%), multiple joints 51(12.8%) and lower limbs 43 (10.8%) respectively. The highest developmental deficit was reported at three years 6 (18.7%).

CONCLUSION

There is need to provide affordable community based rehabilitation (physiotherapy) outfits in this community.

Back school: the development of a Nigerian urban model

BACKGROUND

Back Schools are health education and behaviour modifying programmes for care of the back and prevention of back injuries, usually available as video documentary. They are often developed with consideration for the environment and the practices of the people they serve. Although back schools are available in many parts of the world, none has been developed for the Nigerian environment.

OBJECTIVE

To develop a back school model for the Nigerian urban setting.

METHODS

The Nigerian Back School (NBS) was developed from two existing video documentaries and series of focus group discussions. The focus group discussions suggested how to adapt these documentaries to the Nigerian environment and cultural practices. A hand book containing illustrations on wrong and correct postures was also developed.

RESULTS

The NBS comprises 30-minute video documentary and a 24-page handbook. The first part of the video documentary provides information on the epidemiology and causes of back pain, structures and functions of the back while the second and third parts consist of demonstrations of wrong and correct resting and working postures assumed during everyday life activities and simple exercises for the prevention or alleviation of back pain or its recurrence respectively. The NBS handbook consists of illustrations on wrong and correct postures assumed at rest and during activity of daily living

CONCLUSION

A back school (video documentary and handbook) with considerations for the Nigerian urban environment and the peoples' practices was made available.

Treatment of sports injuries referred for physiotherapy at a national sports medicine centre in Nigeria: a retrospective study

BACKGROUND

Physiotherapists are important members of the sports medicine team and are involved in the prevention and management of injured athletes right from the acute stage of injury to the stage of rehabilitation. However, the type of treatments rendered to injured athletes and level of physiotherapy utilisation in terms of injury referrals for physiotherapy in sports medicine in Nigeria is not fully known.

OBJECTIVE

To find out the extent of referral of sports injuries for physiotherapy and types of treatments rendered to injured athletes referred for physiotherapy at the National Sports Medicine Centre (NSMC), Lagos, South-West, Nigeria.

METHODS

All case files at the general records unit from January 1995 to December 2002 were investigated. Information on athlete's sport, body part treated and physiotherapy modalities used between January 1997 and December 2002 were also extracted from the treatment register at the physiotherapy department of the sports medicine centre.

RESULTS

A total of 171 sports related injuries were reported at the general records unit of the NSMC, with a male to female ratio of 2:1. Of this number, 121 (70.8%) were referred for physiotherapy with strain (n = 57, 33.3%) constituting the majority of physiotherapy referrals. At the physiotherapy department, the knee (n = 43, 30.1%) and the thigh (n = 33, 25.4%) were the most treated body parts. Track and field events (n = 48, 36.9%) recorded the highest number of injuries treated. Exercise therapy (n = 81, 25.5%) was the most frequently used modality, followed closely by transcutenous electrical nerve stimulation therapy (n = 73, 20.3%).

CONCLUSION

The frequency of referral of sports injuries for physiotherapy at the NSMC was high. Exercise therapy was the most frequently used treatment modality and injuries affecting the lower limbs were mostly treated. Emphasis should therefore be laid on prevention of lower limb injuries.

Gender variation of bilateral Q-angle in young adult Nigerians

BACKGROUND

The quadriceps femoris angle (Q-angle) is an important indicator of biomechanical function in the lower extremities. It is a quantitative measurement of patella position in respect to the lower extremity alignment.

OBJECTIVE

This study was designed to determine gender variation of bilateral Q-angle values in young adults and also to check for symmetry in individual participants.

METHODS

A total of 800 participants (400 males and 400 females), who were recruited consecutively participated in the study. They had no history of knee pain or musculoskeletal disorders and no obvious limb length discrepancy. Their ages ranged from 18 to 30 years. They were selected using a non-probability sample of convenience. The Q-angle was measured bilaterally using the universal goniometer with the participants in the erect weight bearing position. The data were analyzed using the independent t - test at 95% confidence interval.

RESULTS

The Q-angle valves in the male participants were 14.7 degrees +/- 2.1 for left and 13.0 degrees +/- 1.7 for right lower limbs respectively, while in the female participants, Q-angle values were 16.8 degrees +/- 1.3 and 15.3 degrees +/- 1.0 for left and right lower limbs respectively. Female participants had significantly higher Q-angle values than their male counterparts. The left lower limb recorded a significantly higher Q-angle value in both males and females than right lower limb (p < 0.05).

CONCLUSION

Q-angle is bilaterally asymmetric in an individual and higher in female, hence Q-angle measurement should always be bilateral, irrespective of whether one or both knees are involved.

Knowledge and perception of physiotherapy by final year medical students of a Nigerian university

BACKGROUND

It has been shown that multidisciplinary interactions have become a feature of the changing medical education system. It is not clear to what extent medical students have been integrated into this newer model, more especially at the College of Medicine of the University of Lagos (CMUL), AIM: To assess the level of knowledge and perception of physiotherapy by the final year medical students of CMUL about physiotherapy.

MATERIAL AND METHODS

Ninety eight final year medical students of CMUL participated in the study. They were required to complete a standard 22 item closed-ended questionnaire which was self administered. Data were presented as mean +/- standard deviation; Inferential statistics of chi-square and t-tests were used to compare differences between variables.

RESULTS

The respondents displayed above average knowledge of physiotherapy as the mean scores obtained for knowledge of physiotherapy were 20.25 +/- 4.50 and 18.77 +/- 4.60 for males and females respectively. They also showed a fair perception towards physiotherapy as the mean scores obtained were 32.70 +/- 7.20 and 34.33 +/- 7.30 for males and females respectively. However there was a significant gender difference in the medical students' knowledge of physiotherapy (p < 0.05).

CONCLUSION

The sampled final year medical students of CMUL had a good knowledge and fair perception of physiotherapy. Their main source of knowledge was classroom lectures. The need for further education of medical students with particular emphasis on clinical interaction was identified. It is hereby suggested that interprofessional courses and communication should be given greater attention during medical training.

Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain

BACKGROUND

Transcutaneous electrical nerve stimulation (TENS) was introduced more than 30 years ago as a therapeutic adjunct to the pharmacological management of pain. However, despite widespread use, its effectiveness in chronic low-back pain (LBP) is still controversial.

OBJECTIVES

To determine whether TENS is more effective than placebo for the management of chronic LBP.

SEARCH STRATEGY

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PEDro and CINAHL were searched up to July 19, 2007.

SELECTION CRITERIA

Only randomized controlled clinical trials (RCTs) comparing TENS to placebo in patients with chronic LBP were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the trials, assessed their methodological quality and extracted relevant data. If quantitative meta-analysis was not possible, a qualitative synthesis was performed, taking into consideration 5 levels of evidence as recommended by the Cochrane Collaboration Back Review Group.

MAIN RESULTS

Four high-quality RCTs (585 patients) met the selection criteria. Clinical heterogeneity prevented the use of meta-analysis. Therefore, a qualitative synthesis was completed. There was conflicting evidence about whether TENS was beneficial in reducing back pain intensity and consistent evidence in two trials (410 patients) that it did not improve back-specific functional status. There was moderate evidence that work status and the use of medical services did not change with treatment. Conflicting results were obtained from two studies regarding generic health status, with one study showing no improvement on the modified Sickness Impact Profile and another study showing significant improvements on several, but not all subsections of the SF-36 questionnaire. Multiple physical outcome measures lacked statistically significant improvement relative to placebo. In general, patients treated with acupuncture-like TENS responded similarly to those treated with conventional TENS. However, in two of the trials, an inadequate stimulation intensity was used for acupuncture-like TENS, given that muscle twitching was not induced. Optimal treatment schedules could not be reliably determined based on the available data. Adverse effects included minor skin irritation at the site of electrode placement.

AUTHORS' CONCLUSIONS

At this time, the evidence from the small number of placebo-controlled trials does not support the use of TENS in the routine management of chronic LBP. Further research is encouraged.

Balance, gait and fear of falling in the elderly--a pilot study in community-based rehabilitation homes

BACKGROUND

Falls represent a major threat to health status and independence in the elderly, causing pain and cessation of physical activities, whether due to fear of falling, declining mobility or balance.

OBJECTIVE

To evaluate falls, vis-à-vis balance, gait and fear of falling, in the elderly living in Community-Based Rehabilitation Homes.

METHODS

Two Community-Based Rehabilitation Homes were randomly picked and 85 apparently healthy elderly (Males 44, Females 41), aged between 65 and 90 years, volunteered to participate in this study. The level of gait and balance of the participants was assessed using Tinetti Performance Oriented Mobility Assessment (TPOMA) scale while the fear of falling was assessed using the Activities Specific Balance Confidence (ABC) scale. The occurrence of falls in the elderly was also recorded. Data were analyzed using descriptive statistics and inferential statistic of chi-square to see the effect of gender.

RESULTS

There was a significant difference between the physical characteristics of the male and female participants. Falls and fears of falls were prevalent. The frequency of falls increased with age. Chi-square test showed that the frequency of falls was significantly (p<0.05) higher in the females than males.

CONCLUSION

Falls are significant causative factors of pain and avoidable disability. Their prevention in the elderly should be a major concern in our environment.

Characteristics of back pain among commercial drivers and motorcyclists in Lagos, Nigeria

BACKGROUND

Studies have shown that there is a relationship between back pain and long hours of driving among commercial motor drivers (CMDs). It has also been reported that a high number of CMDs suffer from low back pain (LBP) with loss of working hours. However, little is known about the prevalence of back pain among the motorcyclists particularly the commercial motorcyclists (CMCs).

OBJECTIVE

To determine and compare the prevalence of back pain among CMDs and CMCs in Lagos state.

METHODS

A structured questionnaire was administered to 400 each of CMDs and CMCs. The questionnaire contained four sections of30 items. The respondents were requested to provide information on age, sex, working hour/day, associated back pain and location, pain severity and knowledge of preventive measures. Five hundred and ninety nine returned copies of the questionnaire were analyzed using descriptive statistics.

RESULTS

The prevalence of back pain was 193 (64.5%) and 180 (60%) among the CMDs and CMCs respectively. One hundred and seventy eight (59.3%) and 129 (43%) of those who reported back pain among the CMDs and CMCs, complained of LBP. The occurrence of upper back/neck pain was higher in the CMCs {41 (13.7%)} than the CMDs {5 (1.7%)}. Very few respondents {21 (7%) CMDs, and 4 (1.3%) CMCs} were aware of backpain preventive measures and none of the CMCs had formal ergonomics instructions at workplace.

CONCLUSION

Back pain was a common phenomenon among CMDs and CMCs; while LBP was more prevalent among CMDs, upper back/neck pain was more prevalent among CMCs. Practically, the result of this study can help in preventing occupational injury associated with driving/riding with emphases on good sitting posture.

Effect of sodium salicylate iontophoresis in the management of hip pain in patients with sickle cell disease

BACKGROUND

Iotophoresis is a means of delivering drugs across the skin for the management of a variety of conditions, most often for localized inflammation and pain. It is becoming popular as an alternative to oral and injection delivery system because it is non-invasive, non-traumatic, and painless and also because of its specific delivery system.

OBJECTIVE

The objective of this study was to determine the effectiveness of sodium salicylate iontophoresis in the management of hip pain in patient with sickle cell disorders (SCD).

METHOD

The participants for this study were 20 patients with SCD, their ages ranged from 15-30 years. They were randomly assigned into two groups of 10 (study and control groups. All the participants were given conventional physiotherapy and their regular medications. In addition sodium salicylate iontophoresis was giving to the affected hip of the participants in the study group using a galvanic current machine. Pain intensity and range of motion at the hip joint were assessed at the beginning and after 10 treatment sessions. Data were analyzed using Mann Whitney U test and paired t-test for the visual analogue scale and goniometric values respectively.

RESULT

The results showed that there was a statistically significant reduction in pain intensity only in the participants in the study group (p<0.05), there was also a statistically significant improvement in the hip range of motion of the participants in the study group (p<0.05).

CONCLUSION

It was concluded that sodium salicylate iontophoresis was effective in the management of hip pain in patients with SCD. It is therefore recommended for routine use for patients with SCD on admission with severe pain.

Insoles for prevention and treatment of back pain

BACKGROUND

There is lack of theoretical and clinical knowledge of the use of insoles for prevention or treatment of back pain. The high incidence of back pain and the popularity of shoe insoles call for a systematic review of this practice.

OBJECTIVES

To determine the effectiveness of shoe insoles in the prevention and treatment of non-specific back pain compared to placebo, no intervention, or other interventions.

SEARCH STRATEGY

We searched the following databases: The Cochrane Back Group Trials Register and The Cochrane Central Register of Controlled Trials (CENTRAL) to March 2005, and MEDLINE, EMBASE, and CINAHL to February 2007; reviewed reference lists in review articles, guidelines and in the included trials; conducted citation tracking; contacted individuals with expertise in this domain.

SELECTION CRITERIA

We included randomized controlled trials that examined the use of customized or non-customized insoles, for the prevention or treatment of back pain, compared to placebo, no intervention or other interventions. Study outcomes had to include at least one of the following: self-reported incidence or physician diagnosis of back pain; pain intensity; duration of back pain; absenteeism; functional status. Studies of insoles designed to treat limb length inequality were excluded.

DATA COLLECTION AND ANALYSIS

One review author conducted the searches and blinded the retrieved references for authors, institution and journal. Two review authors independently selected the relevant articles. Two different review authors independently assessed the methodological quality and clinical relevance and extracted the data from each trial using a standardized form.

MAIN RESULTS

Six randomized controlled trials met inclusion criteria: Three examined prevention of back pain (2061 participants) and three examined mixed populations (256 participants) without being clear whether they were aimed at primary or secondary prevention or treatment. No treatment trials were found. There is strong evidence that the use of insoles does not prevent back pain. There is limited evidence that insoles alleviate back pain or adversely shift the pain to the lower extremities.

LIMITATIONS

This review largely reflects limitations of the literature, including low quality studies with heterogeneous interventions and outcome measures, poor blinding and poor reporting.

AUTHORS' CONCLUSIONS

There is strong evidence that insoles are not effective for the prevention of back pain. The current evidence on insoles as treatment for low-back pain does not allow any conclusions.High quality trials are required for stronger conclusions.

Nigerian back school model: development and effect on industrial workers' knowledge of back pain and back care

Back schools are health education programmes on back pain. Many back schools have been developed for different populations since 1969 when the first one was developed in Sweden, but none for the Nigerian setting. The need to develop a back school that would be appropriate for the Nigerian environment was therefore identified. As a step towards its development, this preliminary study was carried out to determine the effect of a back school model (BSM) on some Nigerian industrial workers' knowledge of low back pain and back care. The subjects were 110 workers of a soap industry in Lagos, Nigeria. Apre-test, post-test quasi-experimental design was used. The BSM consisted of two 45 minute teaching sessions on structure and functions of the back, epidemiology and causes of back pain, correct postures and demonstration of exercises that may prevent/alleviate back pain. Data on demographic information, low back pain (LBP) experience, knowledge of back structure and back care were collected using a questionnaire with closed ended questions, which was completed before, immediately after and 8-weeks after BSM administration. The results showed that the subjects' mean knowledge score increased significantly from an initial value of 16.1 + 5.3 to 24.0 + 5.6 (p < 0.05) immediately after and 23.1 + 3.9 (p < 0.05) 8 weeks after BSM administration. Educational attainment had no influence on subjects' knowledge scores before or 8 weeks after BSM administration. Reported experience of LBP and duration on the job had no significant influence on subjects' knowledge scores before, immediately or 8-weeks following BSM administration. It was concluded that the BSM was effective in improving the workers' knowledge of LBP and back care. We believe that this findingjustifies the effort to develop the Nigerian model of back school.