Journal of Back and Musculoskeletal Rehabilitation - Volume 35, issue 6

Authors: Neumann, Anne | Hampel, Petra

Article Type: Research Article

Abstract: BACKGROUND: Psychological factors influence the development and persistence of chronic low back pain (CLBP) and may impair the psychosocial rehabilitation success. OBJECTIVE: To examine the effects of a combined pain competence and depression prevention training compared to the pain competence training alone and as well as the patients’ stages of pain on the long-term psychosocial rehabilitation success. METHODS: In this controlled multicentre study with cluster-block randomization, patients with CLBP in different stages of pain (I–III) received either pain competence training (control group, CG; n = 255) or combined …pain competence and depression prevention training (intervention group, IG; n = 271; per protocol). Depressive symptoms (primary outcome), anxiety, somatization, health status, and average pain intensity (secondary outcomes) were assessed up to 12 months of follow-up. Standardised questionnaires were used to record the outcomes, which were filled out by the patients themselves. Analyses after multiple imputation (N = 1225) were conducted to validate multi- and univariate analyses of variance. RESULTS: Patients in stage of pain I and II showed significant improvements in depressive symptoms, anxiety, mental health, and average pain intensity at the 12-month follow-up, irrespective from treatment condition. CONCLUSIONS: Multidisciplinary rehabilitation seems to be appropriate for patients with CLBP in stage of pain I and II. However, patients in stage of pain III need more psychological treatments to manage their mental comorbidities. Show more

Keywords: Low back pain, pain chronification, mental disorders, multidisciplinary rehabilitation, Mainz Pain Staging System

DOI: 10.3233/BMR-210221

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1257-1268, 2022

Authors: Alamam, Dalyah | Alhowimel, Ahmed | Alodaibi, Faris | Alsobayel, Hana

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a prevalent disorder and leading cause of disability worldwide. In Saudi Arabia, patients with LBP are dispensed with educational materials to supposedly facilitate their recuperation. OBJECTIVE: Appraise the suitability of educational materials provided for people with LBP in Saudi Arabia to determine whether they meet the needs of patients, inform self-management, and are consistent with clinical practice guidelines. METHODS: A qualitative data collection method was used, and content analyses were conducted to analyse data based on manifest content. Educational items in English and Arabic were collected from …relevant health providers in Saudi Arabia. RESULTS: Seventeen educational materials were sourced from: Ministry of Health hospitals (n = 10), military hospitals (n = 4), private hospitals (n = 2), and a multidisciplinary healthcare association (n = 1). Six identified sub-themes comprise: epidemiological/anatomical data about LBP (n = 6); causes/risk factors (n = 10); exercise (n = 14) and physical activity-related (n = 3) recommendations; treatment-related recommendations (n = 2); general health and lifestyle-related recommendations (n = 8); and postural and ergonomics-related recommendations (n = 13). A common theme emerged, that ‘the content of educational materials hindered reassurance and self-management for people with LBP.’ CONCLUSION: The reviewed educational materials fail to adequately report information that assure patients or inform their self-management among the Saudi population with LBP. Further, reviewed items are heavily influenced by the biomedical model of pain. Show more

Keywords: Low back pain, patient education, educational materials, content analysis, patient-centred care

DOI: 10.3233/BMR-210232

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1269-1276, 2022

Authors: Yazici, Alikemal | Yerlikaya, Tuba

Article Type: Research Article

Abstract: BACKGROUND: The relationship between the endurance of the lumbar paraspinal muscles and morphological changes needs to be clarified. In this context, the importance can be revealed of increasing the endurance level of the paraspinal muscles in the prevention and treatment of low back diseases. OBJECTIVE: The aim of this study was to examine the relationship between the clinical evaluation results of the cross-sectional area (CSA) and fat infiltration of the lumbar deep paraspinal muscles. METHODS: The study included 37 patients with mechanical low back pain (mechanical), 41 patients with lumbar hernia without root …compression (discopathy) and 36 healthy individuals as a control group. The functional status of the lumbar deep paraspinal muscles was evaluated clinically with muscle endurance tests. The fat infiltration and CSA of the muscles were evaluated on axial MRI sections at the L3-S1 level. RESULTS: The mean values of the prone bridge, Biering-Sorenson, and trunk flexion tests were seen to be highest in the control group and lowest in the discopathy group (p < 0.001). In all tests, the longest test period was obtained at < 10% fat infiltration and the shortest at > 50% fat infiltration. It was observed that as the amount of fat infiltration of the muscles increased, the test times were shortened. There was no significant relationship between the endurance level and the CSA of the groups. CONCLUSION: The study results demonstrated that the endurance of the paraspinal muscles is associated with the fat infiltration of the muscles. In patients with chronic low back pain, information about muscle morphology and degeneration can be obtained with simple endurance tests without the need for further measurements. On clinical examination, a weak endurance level of the paraspinal muscles indicates the presence of a low back problem and an increase in the amount of fat infiltration. Show more

Keywords: Paraspinal muscle endurance, low back pain, cross section area, fat infiltration

DOI: 10.3233/BMR-210241

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1277-1287, 2022

Authors: Sousa, Diego Santiago Freire | de Farias, Wevans Monthier | de Amorim Batista, Gabriel | de Oliveira, Valéria Mayaly Alves | Pirauá, André Luiz Torres | Beltrão, Natália Barros | Pitangui, Ana Carolina Rodarti | de Araújo, Rodrigo Cappato

Article Type: Research Article

Abstract: BACKGROUND: Scapular dyskinesis has been associated with shoulder dysfunctions, and changes in electromyographic (EMG) activity have been reported during the execution of some exercises. OBJECTIVE: To compare upper limb muscles EMG of asymptomatic subjects with and without scapular dyskinesis during bench-press and dumbbell fly exercise performed on different surface stability conditions. METHODS: Twenty-eight physically active men were allocated into two groups: Control group (n = 14) and Dyskinesis group (n = 14). The participants performed six repetitions lasting three seconds of the bench …press and dumbbell fly exercises with 50% of one-repetition maximum (1RM) on a bench and a Swiss ball. The EMG activity of the pectoralis major, serratus anterior, upper and lower trapezius, anterior deltoid, biceps and triceps muscles were recorded. RESULTS: No differences were found between groups, regardless of exercise or surface type. Inserting the unstable surface in the supine exercise promoted a slight increase in upper trapezius EMG activity for the control [4.32 (95% CI: 1.04 to 7.60)] and dyskinesis [3.30 (95% CI: 0.34 to 6.27)] groups. CONCLUSIONS: There is no difference in upper limb muscle EMG activity between subjects with and without scapular dyskinesis. In addition, inserting unstable surfaces did not modify EMG activity. Show more

Keywords: Electromyography, exercise therapy, scapula, shoulder

DOI: 10.3233/BMR-210243

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1289-1297, 2022

Authors: Gao, Shuai-Shuai | Capitán-Morales, Luis C. | Wang, Yan-Jun | Yao, Yong-Feng | Zhang, Ya-Hui | Verdera, Aurelio Borrás | Zhang, Wen-Ting

Article Type: Research Article

Abstract: BACKGROUND: Osteoporotic hip fractures have posed a significant burden to society, and more epidemiological data is required. OBJECTIVE: To compare the epidemiological differences of hip fracture patients in Spain and China. METHOD: This was a retrospective comparative study. Comparisons were made in terms of morbidity, demographic and anthropometric characteristics, length of stay, cost of hospitalization, and mortality by consulting the medical histories of osteoporotic hip fractures in two hospitals. The t test was used for measurement data, and the X 2 test was used for count …data. The difference is statistically significant when p < 0.05. RESULTS: A total of 757 patients were enrolled in this study, with 426 from Virgen Macarena University Hospital (HUVM) and 331 from Xi’an Daxing Hospital (XDH). The average age was 81.4 ± 9.26 and 76.0 ± 8.08 years; the proportion of women was 74.9% and 68.0%, respectively. The incidence of osteoporotic hip fractures in Seville residents over 50 years old was approximately 239 per 100,000 residents, compared to 158 per 100,000 residents in Xi’an. The timing of surgery in Spanish patients was significantly longer than in Chinese patients, 78.7 ± 48.2 vs. 60.7 ± 43.1 hours, p = 0.000. There were 81 deaths in Spain and 43 deaths in China during the one-year follow-up period (p = 0.026). CONCLUSIONS: In terms of incidence, demographics, surgical methods, and mortality, there are significant differences between hip fracture patients in Seville, Spain and Xi’an, China. Show more

Keywords: Epidemiology, hip fracture, osteoporosis, mortality

DOI: 10.3233/BMR-210245

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1299-1310, 2022

Authors: Yan, Zhi-Wei | Yang, Zhen | Yang, Jinghui | Chen, Ya-Feng | Zhang, Xue-Bin | Song, Cheng-Lin

Article Type: Research Article

Abstract: BACKGROUND: Non-specific low back pain (NS-LBP) is a serious public health problem. Tai Chi is promising in reducing the risk of falls and alleviating symptoms in this population. OBJECTIVE: To investigate the effect of Tai Chi on gait and dynamic balance in elderly women with NS-LBP. METHODS: 20 women (age > 65 yr.) with NS-LBP were randomly assigned to a Tai Chi group (n = 10) or a control group (n = 10). The Tai Chi group practiced Tai Chi …exercise 3 times a week for 6 weeks. Each session lasted 60 minutes. Pain, spatiotemporal gait features and dynamic balancing capacity were assessed at 0 and 6 weeks. RESULTS: Compared to the control group at 6 weeks, the Tai Chi group had a significant decrease in VAS (p = 0.027) and stride width (p = 0.019), significant improvement in gait velocity, stride length (p < 0.001). Regarding dynamic balance capacity, the Tai Chi group had significant improvements in anterior (Left: p = 0.001; Right: p = 0.038), postero-lateral (Left: p < 0.001; Right: p = 0.038), and postero-medial (Left: p = 0.015; Right: p = 0.018). CONCLUSION: 6-week Tai Chi can relieve pain and improve gait and dynamic balance in elderly women with NS-LBP, which suggests Tai Chi could be a promising rehabilitation intervention to reduce the risk of falls in this population. Show more

Keywords: Low back pain, Tai Ji, gait, postural balance, accidental falls

DOI: 10.3233/BMR-210247

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1311-1319, 2022

Authors: Eker, Amber | Kaymakamzade, Bahar | Diker, Sevda | Cumaogulları, Ozge | Yigitoglu, Pembe Hare

Article Type: Research Article

Abstract: BACKGROUND: Postural disorders are frequently observed in Parkinson’s disease (PD). The underlying mechanisms that cause postural disorders are not fully understood and the majority of these disorders have no response to antiparkinsonian treatments. These disabling conditions require further investigation to better understand the underlying mechanisms in order to develop effective treatments. OBJECTIVE: The aim of this study was to investigate the frequency of axial postural disorders in PD and to determine the associated clinical risk factors. METHODS: In this single-center clinical trial, the data of PD patients were reviewed retrospectively. The frequencies of …postural disorders were determined, and the demographic clinical characteristics of the patients were compared. RESULTS: The records of 127 patients with idiopathic PD were analyzed. Axial posture disorders were found in 42.6% of patients. Patients with axial posture disorders were older when the disease onset was detected, amongst these patients the condition was also longer lasting. The mean levodopa dose was higher in the patients with posture disorders. The initial symptom was bradykinesia and the Hoehn and Yahr’s score was ⩾ 3 in the majority of the patients with posture disorder. Additionally, constipation, hallucinations, postural instability, and falls were significantly more common in patients with posture disorders. CONCLUSION: Posture disorders were observed in nearly half of PD patients and were more frequently observed in patients with an advanced condition. In addition, our investigation has found that it is crucial to follow up with patients who present with bradykinesia for the development of postural disorder. Show more

Keywords: Axial, Parkinson’s disease, posture, posture disorders, treatment

DOI: 10.3233/BMR-210263

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1321-1328, 2022

Authors: Sencan, Savas | Sacaklidir, Rekib | Gunduz, Osman Hakan

Article Type: Research Article

Abstract: BACKGROUND: The Sciatica Frequency Index (SFI) and Sciatica Bothersomeness Index (SBI) are two separate indices scored for both the bothersomeness and frequency of radiating symptoms. There is no Turkish scale used specifically for sciatica. OBJECTIVE: We aimed to translate SBI and SBI in Turkish and investigate the reliability and validity of these indices. METHODS: A total of 80 patients with lumbar disc herniation (LDH) were prospectively included. Construct validity was assessed by comparing the SBI and SFI with subscales of Short Form 36 (SF-36), back and leg Numeric Rating Scale (NRS) and Roland …Morris Disability Questionnaire (RMDQ). Reliability was assessed by internal consistency (Cronbach’s alpha) and test-retest reliability. RESULTS: A weak correlation was found between SBI/SFI, back NRS and SF-36 subgroups while a moderate correlation was found between SBI/SFI, RMDQ and leg NRS. The SBI and SFI had high internal consistency measured by Cronbach’s alpha (0.76 and 0.73). Test-retest reliability of the SBI and SFI were 0.95 (95% CI: 0.92–0.97) and 0.95 (95% CI: 0.92–0.97) respectively, indicating excellent reliability. CONCLUSION: The Turkish versions of the SFI/SBI are a valid and reliable tool supporting their usability in patients with LDH-induced sciatica. Show more

Keywords: Lumbar region, sciatica, reliability and validity

DOI: 10.3233/BMR-210281

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1329-1335, 2022

Authors: Turan, Kayhan | Kara, Gokhan Kursat | Camurcu, Yalkin | Kizilay, Yusuf Onur | Uysal, Yunus | Sahin, Ecem | Aydinli, Ufuk

Article Type: Research Article

Abstract: BACKGROUND: To date, only one study assessed the spinal mobility and muscle strength of patients who were treated either with fusion or brace treatment. OBJECTIVE: The aim of this retrospective study was to evaluate the range of motion (ROM) and strength of the cervical and thoracic/lumbar spine in patients who underwent spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) in comparison to healthy individuals. METHODS: Patients (n = 28) who were treated surgically for AIS were included in the study. An age and gender matched control …group (n = 22) was included that consisted of healthy individuals. DAVID ® Lumbar/Thoracic Extension, Lumbar/Thoracic Rotation, and Cervical Extension/Lateral Flexion devices were used to measure cervical and lumbar/thoracic ROM as well as muscle strength. RESULTS: Significant differences were observed between groups in all ROM measurements except thoracic/lumbar sagittal flexion ROM measurement (p = 0.198). There were significant differences between groups in terms of muscle strength, except thoracic lumbar left rotation strength (p = 0.081). CONCLUSIONS: The findings of the current study demonstrated that cervical and thoracic/lumbar range of motion, as well as muscle strength, were significantly decreased in surgically treated adolescent idiopathic scoliosis patients compared to healthy counterparts. However, trunk (thoracic/lumbar) flexion range of motion and trunk left rotation muscle strength were not significantly different. Show more

Keywords: Adolescent idiopathic scoliosis, posterior instrumentation, range of motion, muscle strength, surgery

DOI: 10.3233/BMR-210303

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1337-1343, 2022

Authors: Kanaan, Saddam F. | Al-Karasneh, Mohammad Nofan | Almhdawi, Khader A. | Oteir, Alaa O. | Guimarães, Isabel | Al-Omari, Ali A. | Khraise, Hana’a

Article Type: Research Article

Abstract: BACKGROUND: The Low Back Pain Treatment Beliefs Questionnaire (LBP-TBQ) was developed to systematically measure patients’ preferences about common treatments for low back pain (LBP). However, the questionnaire is not available in the Arabic language. OBJECTIVE: To translate and cross-culturally adapt the LBP-TBQ to the Arabic language and assess its clinimetric properties. METHODS: The LBP-TBQ was translated into Arabic version according to published guidelines. In pilot testing, the face and content validity of the translated questionnaire was assessed. Two hundred and fifty patients with LBP completed the translated LBP-TBQ for five common LBP treatments. …In addition, a subgroup of 51 participants completed the questionnaire on two consecutive occasions to examine the test-retest reliability. RESULTS: Confirmatory factor analysis results showed that the Arabic version of LBP-TBQ has three factors: (1) “credibility”, (2) “effectiveness and fitness”, and (3) “concerns”, and this 3-factors model had the best fit for the data for all the five treatments. Cronbach’s α of the total items ranged from 0.812 to 0.899, while the sub-scores ranged from 0.557 to 0.837, indicating moderate to high internal consistency. The ICC ( 2 , 1 ) ranged from 0.626 to 0.909, which shows acceptable to good test-retest reliability. Correlation with other LBP questionnaires was < 0.3, demonstrating acceptable discriminant validity. Finally, the questionnaire showed acceptable criterion validity for all the subscales and the general questionnaire. CONCLUSIONS: The Arabic version of LBP-TBQ is reliable, valid, and appropriate to use in clinical and research settings. Show more

Keywords: Low back pain, beliefs, treatments, Arabic language, reliability, validity

DOI: 10.3233/BMR-210306

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 35, no. 6, pp. 1345-1355, 2022