Journal of Back and Musculoskeletal Rehabilitation - Volume 32, issue 2

Authors: Em, Serda | Karakoc, Mehmet | Sariyildiz, Mustafa Akif | Bozkurt, Mehtap | Aydin, Abdulkadir | Cevik, Remzi | Nas, Kemal

Article Type: Research Article

Abstract: BACKGROUND: Diseases causing disabilities lead to sexual dysfunction. However, studies that evaluate sexual functions in patients with traumatic lower limb amputations (LLA) are limited and controversial. OBJECTIVE: The objective is to evaluate sexual functions in male patients with LLA and to identify factors that might contribute to sexual dysfunction. The hypothesis is that male patients with LLA would experience worse sexual and emotional functioning and consequently emotional impairment that consequently influenced the sexual function. METHODS: Sixty men with traumatic LLA and 60 healthy men were assessed according to the International Index of Erectile Function …(IIEF) scoring system. Emotional state was assessed by the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), and the quality of life by the Short Form-36 Health Survey (SF-36). RESULTS: Patients had significantly lower scores in the IIEF total score and subscores in comparison with the controls. Intercourse satisfaction scores were significantly higher (p < 0.05) in patients with trans-tibial amputation than in those with trans-femoral amputation. BDI and BAI scores negatively correlated with erectile function, sexual desire, intercourse satisfaction, overall satisfaction and total IIEF scores. The mental and physical scores of SF-36 significantly correlated with some of the sub scores and IIEF total scores. The power of statistical analysis for study population was 100% according to the given effect size (α = 0.01). CONCLUSION: The present study suggests that the LLA leads to impairments in the sexual function and quality of life in male patients. Also, sexual dysfunction in patients is strongly associated with emotional state, pain, level of amputation and quality of life. Show more

Keywords: Amputation, lower extremity, sexuality, emotional state, quality of life

DOI: 10.3233/BMR-170873

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 277-285, 2019

Authors: Toprak, M. | Erden, M.

Article Type: Research Article

Abstract: BACKGROUND: Nocturnal shoulder pain could play an essential role in frozen shoulder (FS) and can lead to disturbed sleep, anxiety, depression and reduced quality of life (QoL). OBJECTIVE: The aim of this study was to examine anxiety, depression, sleep quality and quality of life in patients with FS and compare these to healthy controls. METHODS: We prospectively evaluated 148 participants (76 FS patients and 72 healthy controls). We obtained Visual Analogue Scale (VAS) pain score, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life Scale …short form (WHOQoL-BREF). RESULTS: FS patients had significantly higher scores for VAS and BAI (p < 0.001) than the control group. There was no significant difference between the BDI scores of the groups (p = 0.067). The WHOQoL-BREF scale of the physical, mental and environmental fields were significantly lower in the FS group (p < 0.001). FS patients had significantly lower sleep efficiency, and sleep disorders in terms of PSQI section scores (p < 0.001). CONCLUSION: Our study demonstrated that there is a high prevalence and close relationships of pain, anxiety and sleep disturbance in patients with FS. Adding a psychiatric evaluation to the treatment of patients with FS may be beneficial. Show more

Keywords: Frozen shoulder, sleep quality, pain, anxiety, depression, quality of life

DOI: 10.3233/BMR-171010

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 287-291, 2019

Authors: Mitchell, Ulrike H. | Hurrell, Jennifer

Article Type: Research Article

Abstract: BACKGROUND : Between 2005 and 2015 significant changes in the clinical decision making paradigm for the treatment of spinal instability occurred. This was largely motivated by a clinical prediction rule (CPR) derivation study that was developed to specifically identify patients with low back pain who are more likely to respond positively to lumbar stabilization exercises. OBJECTIVE : This is a narrative literature review on the recent advances physiotherapy has made in the treatment of clinical spinal instability. METHODS: Literature discussing the conservative treatment of lumbar spinal instability published from 2005–2015 was identified with electronic searches …of PubMed (MEDLINE) Advanced search, Web of Science, BIOSIS Previews, MEDLINE (EBSCO), SportDISCUS (EBSCO), CINAHL (EBSCO), PEDro, Scopus and Cochrane and reviewed. RESULTS : Five systematic reviews, 2 with meta-analyses, and 1 systematic review on the quality of systematic reviews were found. There seems to be some benefit from specific stabilization exercise programs in regards to pain reduction, but they might not be more effective than other forms of exercise. The currently existing CPR for stabilization exercises is not far enough developed to use in clinical practice and is not validated as of yet. CONCLUSION : Stabilization exercises seem to decrease chronic low back pain, although it is not clear that this pain has to be caused by clinical spinal instability. Caution should be exercised when using CPRs in the clinic; they are not meant to be strict treatment guidelines, but rather a tool that helps facilitate clinical decision-making. Show more

Keywords: Stability, CPR, spine, lumbar, systematic review

DOI: 10.3233/BMR-181239

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 293-298, 2019

Authors: Park, So Hyun | Lee, Yun-Seob | Cheon, Song Hee | Yong, Min-Sik | Lee, Daehwan | Lee, Eun-Ju

Article Type: Research Article

Abstract: BACKGROUND: Many practitioners recommend step-up and step-down exercises to increase muscle strength in the lower extremities. However, decreased stability of the hip joint and imbalanced muscle activities can alter limb biomechanics during these movements. OBJECTIVE: This study investigated muscle imbalance between the medial and lateral muscle components and between the proximal and distal muscle components by expressing the proportions of muscle activation in the step-up and step-down positions. METHODS: Nineteen subjects participated in the study. Activity of the vastus medialis oblique, vastus lateralis, semitendinosus, biceps femoris, adductor, gluteus medius, and gluteus maximus was …assessed. RESULTS: The semitendinosus-biceps femoris ratio was higher in the step-down position than in the step-up position. The adductor-gluteus medius, adductor-vastus lateralis, and adductor-biceps ratios were higher in the step-up position than in the step-down position. The gluteus maximus-biceps ratio was greater in the step-down position than in the step-up position. In the hip joint, internal rotation was significantly greater in the step-up position. CONCLUSIONS: The transverse angle of the hip joint has a greater effect on the medial-lateral balance of the muscles surrounding the hip joint. Muscle activation in the medial hamstring is greater in the step-down position; in the adductor, muscle activation is greater in the step-up position. The step-down position is more appropriate for those with proximal weakness, as it can promote muscle activation in the gluteus maximus while maintaining biceps femoris activation. Show more

Keywords: Hip joint, muscle activities, step-up, step-down

DOI: 10.3233/BMR-160779

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 299-303, 2019

Authors: Dernek, Bahar | Kesiktas, Fatma Nur

Article Type: Research Article

Abstract: BACKGROUND: Osteoarthritis (OA) is a chronic disease most often occurring in knee joints, leading to pain of varying severity and deterioration in daily living activities. OBJECTIVE: To compare efficacy of platelet-rich-plasma (PRP) versus PRP in combination with ozone gas injection in patients with early stage knee OA. METHODS: Retrospective data of patients who received PRP alone (n = 45) or combined treatment (PRP + ozone, n = 35) injection was analyzed. Patients were evaluated using the visual analogue scale (VAS) …and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. RESULTS: In both PRP alone and combined treatment groups, post-treatment VAS and WOMAC scores at month 1, month 3, and month 6 showed a significant reduction compared to pre-treatment scores (p < 0.001). Physical function and total WOMAC scores as well as VAS scores at post-treatment month 3 were significantly lower in the combined treatment group compared to the PRP alone group. Moreover, in the combined treatment group, VAS scores on Day 10 and hyper-inflammation at the injection site was significantly lower than the PRP alone group. CONCLUSION: In general, similar efficacy was observed between treatment with PRP alone and treatment with PRP in combination with ozone. However, patients receiving ozone treatment are less likely to experience post-injection pain and are more likely to recover faster when compared to patients receiving PRP treatment alone. Show more

Keywords: Platelet-rich-plasma, ozone, knee, osteoarthritis

DOI: 10.3233/BMR-181301

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 305-311, 2019

Authors: Kim, Seon-Chil | Lee, Byoung-Kwon | Kim, Chang-Yong

Article Type: Research Article

Abstract: BACKGROUND: The Republic of Korea has become the most rapidly aging society and is anticipated to enter the post-aged society in 2026. As the population ages, demand for senior-friendly products has gradually increased. Under the demands for these circumstances, usability evaluation aimed to make these products more competitive in terms of quality has been perceived as a critical means. In particular, ergonomically wrong-designed products could prove fatal to elderly people. OBJECTIVE: The purpose of the study is to develop qualitative usability evaluation criteria of communication service robot, one of the senior-friendly products, for elderly people. …METHODS: To develop the usability testing criteria of a communication service robot for elderly people. The following was carried out: product selection, selection of target product, development of leading indicators, correction by experts, and preliminary evaluation according to the scenario and development of core indicators. For this, a draft questionnaire was developed for the elderly at around age 60. After small group tests and interviews, the experts modified the initial draft to the usability evaluation criteria of communication service robot for elderly people. RESULTS: Development indicators include four subscales: safety, controllability, efficiency, and satisfaction. All the subscales passed the reliability criteria by four groups of elderly people, divided by gender and the familiarity witth smart move devices. CONCLUSIONS: Development indicators cover a wider area of user experiences of the communication service robot and are a good measurement tool to help both the users and developers of the service robot for elderly people. Show more

Keywords: Communication service robot, elderly people, senior-friendly products, usability evaluation, user

DOI: 10.3233/BMR-169655

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 313-319, 2019

Authors: Simsek, Ibrahim Engin | Elvan, Ata | Selmani, Metin | Cakiroglu, Mehmet Alphan | Kirmizi, Muge | Bayraktar, Burcin Akcay | Angin, Salih

Article Type: Research Article

Abstract: BACKGROUND: In the relevant literature generalized hypermobility syndrome (GHS) has been shown to alter the kinetic and kinematic patterns of the human movement system. Although GHS affects the general body biomechanics of individuals, the body of knowledge in plantar pressure distribution in GHS is far from sufficient. OBJECTIVE: The aim of this study was to determine whether individuals with joint hypermobility syndrome have abnormal plantar pressure distribution during normal gait compared to healthy individuals. METHODS: A total of 37 participants (mean age: 22.16 ± 2.58 years) diagnosed with GHS and …37 aged-matched participants (mean age: 23.35 ± 2.85 years) without GHS were included in the study. Dynamic plantar pressure distribution was obtained as each participant walked in barefoot at a self-selected pace over EMED-m system (Novel GmbH, Munich, Germany). Correlations between hypermobility score (HS) (Beighton score) and plantar pressure variables, and between group differences in peak pressure (PP), pressure-time integral (PTI), average pressure (AP) and maximum force (MxF) were computed for 10 regions under the sole. RESULTS: HS was significantly correlated with peak pressure under the mid-foot (MF) (r = 0.24, p = 0.043), 5 th metatarsal head (MH5) (r = 0.33, p = 0.001), big toe (BT) (r = 0.44, p < 0.001), and second toe (ST) (r = 0.38, p = 0.001). A similar trend was observed for pressure-time integrals under hindfoot (HF) (r = 0.24, p = 0.04), MF (r = 0.30, p = 0.009), MH5 (r = 0.25, p = 0.033), BT (r = 0.37, p = 0.001) and ST (r = 0.34, p = 0.003). The only significant MxF detected was under the ST (r = 0.23, p = 0.048), and AP was determined to be significantly higher as HS increases indicated by APs under MH5 (r = 0.24, p = 0.042), BT (r = 0.32, p = 0.005) and ST (r = 0.40, p < 0.001). Peak pressure values under HF were significantly higher in the hypermobile group (p = 0.023), MH5 (p = 0.001), BT (p < 0.001) and ST (p = 0.003). AP and PTI were also found to be significantly higher in the hypermobile group under MH5 (p = 0.009), BT (p = 0.037), and ST (p = 0.003). MxF was higher only under MF5 (p = 0.029) and SF (p = 0.041) in the hypermobile group. CONCLUSION: The forefoot regions received a higher load in GHS during gait. This could be useful in clinical evaluation of the foot in GHS, preventing potential injuries of lower extremity, and also in processes related to decision making for foot orthotics and/or rehabilitation protocols. Show more

Keywords: Joint hypermobility syndrome, plantar pressure, gait, pedobarography

DOI: 10.3233/BMR-170973

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 321-327, 2019

Authors: Huang, Zhi-Fa | Lin, Bing-Quan | Torsha, Tahsin Tarik | Dilshad, Sabil | Yang, De-Sheng | Xiao, Jun

Article Type: Research Article

Abstract: BACKGROUND: Piriformis syndrome (PS) is an entrapment of the sciatic nerve by the piriformis muscle, or myofascial pain from the piriformis muscle. OBJECTIVE: The aim of this study was to investigate the effectiveness of Mannitol plus Vitamins B regime in the management of PS. METHODS: Twenty two patients were included in this study and received 250 ml of mannitol 20% intravenous infusion for 5 days + Vitamins B (vitamin B 1 10 mg + vitamin B 2 10 mg …+ vitamin B 12 50 μ g PO) for 6 weeks. Clinical outcomes were assessed systematically by clinical tests (tenderness, FAIR test, Beatty’s, Freiberg’s and Pace’s maneuver), Numeric Rating Scale (NRS), Likert Analogue Scale (LAS), and MR examination. RESULTS: The clinical evaluations showed a significant reduction (p < 0.05) of tenderness, FAIR test, Beatty’s maneuver, Freiberg’s maneuver and Pace’s maneuver when compared with baseline evaluation during the 3rd and 6th month follow-ups. A statistically significant improvement of pain was measured by NRS at resting (p < 0.001), at night (p < 0.001) and during activities (p < 0.001) and LAS with prolonged sitting (p < 0.001), standing (p < 0.001) and lying (p < 0.001). Concomitantly, swelling of SN revealed a significant reduction (p = 0.003) from 86.4% to 18.2%. CONCLUSIONS: Mannitol plus Vitamins B is effective in the management of piriformis syndrome and it could be an alternative regime in treating PS. Show more

Keywords: Mannitol, Vitamins B, management, piriformis syndrome

DOI: 10.3233/BMR-170983

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 329-337, 2019

Authors: Cisowska-Adamiak, Małgorzata | Mackiewicz-Milewska, Magdalena | Szymkuć-Bukowska, Iwona | Hagner, Wojciech | Beuth, Wojciech

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) affects most people at least once in their lives. OBJECTIVE: To evaluate the efficacy of ultrasound therapy (UD) in patients with LBP receiving two different treatment dosages. METHODS: The study design was a randomized prospective study. Patients were subjected to UD for two weeks. All persons in the study were evaluated at the Outpatient Rehabilitation Clinic at the Antoni Jurasz University Hospital in Bydgoszcz, Poland. Inclusion criteria were lumbosacral pain lasting more than 8 weeks, signs of osteoarthritis on imaging studies, and ages30–65 years. Exclusion criteria were radicular pain, …nonmechanical causes of pain, contraindications for UD, or the patient received other LBP therapy during the study. The Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RM), and Visual Analog Scale (VAS) were used to evaluate the results. RESULTS: For both groups, the ODI scores were significantly reduced by 13.7% and 8.84%, the RM scores decreased by 3.37 points and 3.59 points, and pain remissions on the VAS scale were 20.28 mm and 16.31 mm (p < 0.05). CONCLUSION: UD decreased patients’ disability levels and pain intensity. However, effective ultrasound parameters must be determined because of the wide dosage variations. Show more

Keywords: Low back pain, ultrasound therapy, disability level, pain

DOI: 10.3233/BMR-170926

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 339-343, 2019

Authors: Giesche, Florian | Krause, Frieder | Niederer, Daniel | Wilke, Jan | Engeroff, Tobias | Vogt, Lutz | Banzer, Winfried

Article Type: Research Article

Abstract: BACKGROUND: Low back pain patients have been suggested to exhibit dysfunctional spinal movement patterns. However, there is a lack of clinically applicable but valid and reliable assessment tools, helping to discriminate normal and pathologically altered movement. OBJECTIVE: We aimed to examine whether kinematic parameters determined with an ultrasound-based motion analysis and thereof derived chromokinegraphical angle-time matrices (CATMAs) are able to discriminate between non-symptomatic and symptomatic movement behaviour in individuals with non-specific chronic (CLBP), specific low back pain (SLBP), and controls. METHODS: Thoracic and lumbar spine range of motion (ROM [ ∘ …]); angular velocity (V [ ∘ /sec]) and side-to-side differences [%] during a lateral flexion movement were assessed in 17 healthy participants, 16 individuals with CLBP and 11 SLBP patients. CATMAs ratings of two investigators (6-item Likert scale) were dichotomised, classifying the observed movement as physiological or non-physiological. Intrarater and interrater reliability were estimated using kappa statistics and Cronbach’s Alpha. T-tests and a ROC analysis to determine optimal cut-offs for the separation of the collectives as well as contingency tables for selectivity of the cut-offs (motor outcomes) were calculated. RESULTS: CATMA ratings displayed partly moderate to good (rater B; i.e. CLBP vs. controls) and partly insufficient discriminant validity (rater A). Due to this, inter-rater reliability was poor (k = 0.061 to 0.135), while intra-rater-reliability was moderate to good for both raters (k = 0.329 to 0.625) except for SLBP vs. controls (rater A; k = - 0.18). Regarding kinematics, group differences occurred neither in ROM nor in V (p > 0.05), but in terms of the relative side comparison between CLBP and controls (p < 0.05). ROC analysis (CLBP vs. controls) revealed an optimal cut-off at side asymmetries of 16.9% (ROM) and 28.9% (V). Between SLBP patients and controls, no significant differences were observed neither in terms of the absolute values nor the relative side differences of both kinematic variables. CONCLUSIONS: Side asymmetries of V and ROM may be used to differentiate between controls and individuals with CLBP. CATMAs appear to be of limited diagnostic value for the identification of pathological spine movement. Show more

Keywords: MiSpEx, low back pain, movement behaviour, side asymmetries, ultrasonic optometry

DOI: 10.3233/BMR-181203

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 345-353, 2019

Authors: Cho, Jang Hyuk | Jung, Sung Hwa | Yang, Shi Mo | Park, Hyun

Article Type: Case Report

Abstract: BACKGROUND AND OBJECTIVE: Calcific tendinitis is commonly found in the rotator cuff; however, it is very rare in the long biceps tendon (LBT). Furthermore, calcific tendinitis involving the LBT in the hemiplegic shoulder after a stroke has not been previously reported. MATERIALS AND METHOD: We present a case of a 63-year-old man who suffers from a stroke and atypical calcific tendinitis involving the LBT as a rare cause of hemiplegic shoulder pain. The patient had experienced intractable pain in the right hemiplegic shoulder for more than 6 months with a waxing and waning course. Marked tenderness …to palpation was present at the biceps tendon adjacent to the bicipital groove. Ultrasound (US) and computed tomography revealed a long, blade-shaped, circumscribed, cloudy and irregular dense calcific deposit in the LBT site, distal to the bicipital groove. The patient underwent US-guided corticosteroid injection at the posterior intra-articular joint. The symptoms failed to resolve; we injected an additional corticosteroid into the biceps tendon sheath adjacent to the calcific deposit. This procedure provided satisfactory relief, and follow-up US revealed mild diminution of the calcification through absorption. CONCLUSION: This is the first report on atypical calcific tendinitis involving the LBT causing hemiplegic shoulder pain after a stroke. Show more

Keywords: Calcific tendinitis, long biceps tendon, hemiplegic shoulder pain

DOI: 10.3233/BMR-171037

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 355-359, 2019

Authors: Maselli, Filippo | Testa, Marco

Article Type: Case Report

Abstract: INTRODUCTION: Running is one of the most common sports practices in the world due to the beneficial impact on the health, despite the relatively high risk of getting injuries. In fact, running is one of the most common sports capable to induce overuse injuries of the lower back and leg. In previous studies, the symptoms in the lower limb have been attributed to lumbosacral degenerative pathology. When the symptoms are unclear, they must be studied with great attention by carrying out an accurate process of screening and differential diagnosis. MATERIALS AND METHODS: A 42-year-old non-competitive male …runner who complained of left leg pain was referred to a physiotherapist. He reported a continuous, deep, sharp, shooting pain of the left leg. The symptoms began one year earlier. Symptoms worsened during prolonged driving and long distance running. The patient had been previously diagnosed with lumbar radicular irradiation in the leg by a general practitioner. Initial management, in another physical therapy outpatient setting, was without any improvement. RESULTS: After surgical excision, symptoms gradually regressed shortly and the patient was referred to a physiotherapist in order to fully recover and restore work and running activities. CONCLUSION: This case report describes the history, assessment and treatment of a runner with a rare cause of leg pain. After surgery excision, treatment focused on education and loading the tissues over many weeks through a graded program of loaded exercises and running retraining. Show more

Keywords: Schwannoma, differential diagnosis, running

DOI: 10.3233/BMR-181164

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 32, no. 2, pp. 361-365, 2019