Journal of Back and Musculoskeletal Rehabilitation - Volume 36, issue 5

Authors: Soer, Remko

Article Type: Research Article

DOI: 10.3233/BMR-235003

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 993-994, 2023

Authors: Adenis, Nicolas | Gosselin, Kévin | Stetsenko, Nikolaï | Thevenon, André

Article Type: Review Article

Abstract: BACKGROUND: Patient education is a recommended treatment strategy for persistent low back pain (PLBP). Pain neuroscience education (PNE) is an emerging concept with boundaries still unclear. OBJECTIVE: To clarify the PNE concept and identify its key characteristics in PLBP management. METHODS: A systematic search was conducted using the following databases: Pubmed, ScienceDirect, Google Scholar, Cochrane, and Pedro. Inclusion criteria: publications in English or French on pain neuroscience education and chronic low back pain, educational books cited in white literature. Three reviewers independently selected eligible studies for final inclusion. Numerical analysis and narrative synthesis …were carried out from the extracted data. RESULTS: From 919 identified publications, 54 were selected. Ten educational resources were added. PNE refers to a theoretical framework, a specific educational intervention, and an overall care approach. It is characterized by the intention to help the patient reconceptualize their PLBP from a tissue injury marker to a protective, neurobiological perspective, and then to increase adherence to biopsychosocial rehabilitation and normalize cognitive-behavioral responses. Pain sciences concepts are presented with an optimization of learning strategies. CONCLUSION: PNE stands out from other educational and cognitive behavioral approaches through its objective of changing the pain concept. Show more

Keywords: Low back pain, chronic pain, neurosciences, education

DOI: 10.3233/BMR-220370

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 995-1010, 2023

Authors: Cai, Peng | Wei, Xijun | Wang, Wanyu | Cai, Canxin | Li, Hai

Article Type: Review Article

Abstract: BACKGROUND: Osteoarthritis is one of the leading causes of global disability and pain. OBJECTIVE: To investigate whether High-Intensity Laser therapy has superior pain-relieving effects in individuals with symptomatic knee osteoarthritis. METHODS: Searches were conducted using CENTRAL, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and related reference lists with language limed to English. Clinical trials investigating the effectiveness of High-Intensity Laser therapy compared to other laser therapies, conventional therapies or exercises on knee osteoarthritis pain were included. The screening and selection of studies, data extraction, and methodological quality assessment were performed by two independent …researchers. Studies were quantitatively integrated using the Review Manager Software and qualitative analysis using the criteria recommended by the Cochrane Collaboration. RESULTS: Nine studies meeting the eligibility criteria were identified, among which only one study was identified as excellent methodology quality, six was marked as good quality, and the remaining two studies were regarded as fair or poor quality. All studies reported positive effects of High-Intensity Laser therapy on knee osteoarthritis pain. Two studies (136 people) gave indication that there was moderate evidence that High-Intensity Laser therapy could be a promising new possibility in pain relief among patients with knee osteoarthritis compared with sham laser therapy in a short-term treatment (MD, - 2.04, 95% CI, - 2.12 to - 1.96; Z = 51.01, P < 0.01). Four studies (160 people) showed that High-Intensity Laser therapy could be an effective modality on treating pain compared to conventional physiotherapies in decreasing visual analog scale score (MD, - 0.98, 95% CI, - 1.19 to - 0.76; Z = 9.02, P < 0.01). Three studies (123 people) demonstrated that High-Intensity Laser therapy combined with exercises was more effective than placebo laser or lower-intensity laser combined with exercises in alleviating pain in patients with knee osteoarthritis (MD, - 1.54, 95% CI, - 1.84 to - 1.24; Z = 10.06, P < 0.01). CONCLUSION: High-Intensity Laser therapy could be a promising and recommended modality in alleviating knee osteoarthritis pain, especially when it was implemented in combination with exercises. Show more

Keywords: Laser therapy, knee osteoarthritis, pain, rehabilitation

DOI: 10.3233/BMR-220228

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1011-1021, 2023

Authors: Dong, Xueping | Zhao, Yikun | Zhao, Zhen | Fang, Jiajin | Zhang, Xintao

Article Type: Review Article

Abstract: BACKGROUND: Marathon running is an extreme sport with a distance of about 42 kilometers. Its relationship to high-sensitivity cardiac troponin (hs-cTn) remains controversial. OBJECTIVE: As the gold standard for detecting myocardial injury, the trends of hs-cTn before and after a marathon were investigated and analyzed. METHODS: A literature search was conducted in PubMed, EMBASE, and Cochrane Library databases by combing the keywords marathon and troponin, and studies regarding high-sensitivity cardiac troponin I (hs-cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations before and after marathon running (not for half-marathon and ultra-marathon) were included. “Quality …Assessment Tool for Before-After (Pre-Post) Studies With No Control Group” were used to assess the risk of bias. Statistical analysis was performed using Review Manager, presenting data as mean values and 95% confidence intervals (CIs). Sensitivity analysis and subgroup analysis were performed if there was high heterogeneity among studies based on I 2 statistic. RESULTS: A total of 13 studies involving 824 marathoners were included in this systematic review and meta-analysis. Both hs-cTnI (MD 68.79 ng/L, [95% CI 53.22, 84.37], p < 0.001) and hs-cTnT (MD 42.91 ng/L, [95% CI 30.39, 55.43], p < 0.001) were elevated after running a marathon, but the concentration of hs-cTnT returned to baseline after 72 to 96 h post-race (MD 0.11 ng/L, [95% CI - 1.30, 1.52], p = 0.88). The results of subgroup analysis demonstrated that the 99th percentile upper reference limit of hs-cTnT might be the source of heterogeneity. CONCLUSION: The concentrations of hs-cTnI and hs-cTnT were increased after marathon running, but the change of hs-cTnT is usually not seen as irreversible myocardial injury. Show more

Keywords: Marathon running, troponin, myocardium

DOI: 10.3233/BMR-220352

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1023-1031, 2023

Authors: Fakontis, Christos | Iakovidis, Paris | Lytras, Dimitrios | Kasimis, Konstantinos | Koutras, Georgios | Ntinou, Stefania Rafailia | Kottaras, Anastasios | Chatziprodromidou, Ioanna P. | Chatzikonstantinou, Paraskevi | Apostolou, Thomas

Article Type: Review Article

Abstract: BACKGROUND: Physical therapists use dry needling (DN) and percutaneous needle electrolysis (PNE) to treat musculoskeletal pain. OBJECTIVE: To investigate the efficacy of PNE vs. DN in the treatment of musculoskeletal pain. METHODS: This systematic review and meta-analysis was based on the PICOS and PRISMA protocols. The PubMed, PEDro, Cochrane Library, SCOPUS, and Google Scholar databases were searched for randomized clinical trials measuring pain intensity in various musculoskeletal syndromes using PNE and DN. Pain outcome measures were the visual analog scale or the numerical pain rating scale. Risk of bias was assessed according to …Cochrane guidelines and quality of evidence was reported using the Grading of Recommendations Assessment, Development, and Evaluation approach (GRADE). Standardized mean differences were calculated using random effects models. RESULTS: The meta-analysis of the six included studies showed that the overall effect of PNE vs. DN for pain reduction was statistically significant at - 0.74 (95% confidence interval [CI], - 1.34 to - 0.14) with a large effect size (SMD = - 0.41; 95% CI, - 0.75 to - 0.08), albeit clinically insignificant in the short, medium, and long term. Risk of bias was generally low with moderate-level evidence due to the overall effect heterogeneity and the small sample. CONCLUSIONS: Moderate-quality evidence showed that PNE is slightly more effective than DN in reducing pain. However, because the results were not clinically significant, we cannot recommend the application of PNE over DN. More high-quality studies comparing the two interventions are needed to draw firm conclusions. Show more

Keywords: Physical therapy modalities, pain management, rehabilitation, meta-analysis as topic

DOI: 10.3233/BMR-220408

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1033-1046, 2023

Authors: Tuncer, Aysenur | Kastal, Eren | Tuncer, Abidin Hakan | Yazıcıoğlu, İffet

Article Type: Research Article

Abstract: BACKGROUND: Sleep bruxism has been associated with temporomandibular dysfunction, pain, fatigue, and poor sleep quality. OBJECTIVE: The aim of this study was to determine the gender and age distribution of sleep and oral habits of children with sleep bruxism and to examine the effect of a sleep hygiene and physiotherapy program. METHODS: In this cross-sectional study, 82 children aged 6–13 years with sleep bruxism were initially screened between March 2020 and June 2021, from which 37 of them voluntarily attended an 8-week sleep hygiene and physiotherapy program. Evaluations were made using a Visual …Analogue Scale (VAS), the Children’s Sleep Habits Questionnaire (CSHQ), and the Oral Habits Questionnaire (OHQ) at the beginning and at the end of the 8-week program. RESULTS: Statistically significant differences were determined between the 6–9 years and 10–13-year age groups in respect of the sleep habits subcategories of resistance to bedtime (p = 0.001), sleep anxiety (p = 0.043), parasomnia (p = 0.040), and sleep respiratory disorder (p = 0.041). Following the 8-week treatment program, a significant reduction was obtained in the VAS value (p < 0.05), CSHQ subcategories of resistance to bedtime (p = 0.001), sleep duration (p = 0.008), parasomnia (p = 0.000), and in the OHQ score (p = 0.000). CONCLUSION: There was no relationship between sleep bruxism and gender, but a relationship was found with age. The rate of bruxism was seen to decrease with an increase in age. It was determined that oral, sleep habits, and bruxism are closely related, and the rates at which bruxism is seen are affected by the oral habits. Sleep hygiene and physiotherapy have been effective in children with sleep bruxism. Show more

Keywords: Child, bruxism, therapy, sleep, habits

DOI: 10.3233/BMR-220235

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1047-1059, 2023

Authors: Erden, Ender | Turk, Ayla Cagliyan | Erden, Ebru | Dag, Zuhal

Article Type: Research Article

Abstract: BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and also affects the musculoskeletal system. OBJECTIVE: This study was conducted to investigate the musculoskeletal symptoms, type of pain and effect on quality of life in patients presenting with pain after COVID-19. METHODS: This prospective, descriptive study included 97 patients aged 18 years or older who were diagnosed with COVID-19 based on a positive polymerase chain reaction test result, with or without musculoskeletal pain prior to COVID-19 infection. Patients who applied to the post-COVID-19 outpatient …clinic with the complaint of pain at least 1 month and maximum 1 year after the diagnosis of COVID-19 were included. Patients’ demographic characteristics and musculoskeletal examination findings were evaluated. The patients were examined, and the questionnaire forms were completed. The pain was assessed using the visual analog scale (VAS), the Douleur-Neuropathique-4 (DN-4) questionnaire, while the quality of life was assessed using the Short Form-36 (SF-36) survey. Patients were divided into groups in terms of gender, age, body mass index. Shapiro-Wilk’s test, the independent samples t-test and the Mann-Whitney U test were used for statistical analyses. RESULTS: The mean age of the patients was 46.5 ± 13.5 years, 30 of them were male. Pain increased in patients with pre-COVID-19 arthralgia and myalgia (p < 0.001). Post-COVID-19 VAS was significantly higher than pre-COVID-19 VAS (7 ± 1.2 vs. 3.2 ± 1.9, p < 0.05). Pre-COVID-19 patients with myalgia had significantly worse SF-36 physical function, social function, pain, general health perception (p < 0.05). The mean scores of females in the SF-36 physical function, pain were significantly worse than males (p < 0.05). According to DN-4, 41 (42.3%) patients had neuropathic pain. There was moderate negative correlation between VAS, DN-4 and SF-36 (p < 0.05). CONCLUSIONS: Arthralgia, myalgia, and neuropathic pain, all of which negatively affect the quality of life, are often observed in the patients infected with COVID-19. Show more

Keywords: COVID-19, arthralgia, myalgia, neuropathic pain, short form-36

DOI: 10.3233/BMR-220297

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1061-1074, 2023

Authors: Cai, Congcong | Gazali, Nurul Adliah | Lau, Hilary Xinyi | Tan, Marilyn Boon Cheng | Othman, Erlly Irma | Chan, Cynthia Si Qing | Lim, Edwin Choon Wyn

Article Type: Research Article

Abstract: BACKGROUND: Previous literature suggests that transversus abdominis (TrA) activation is diminished in chronic low back pain (cLBP) subjects compared to healthy subjects in less-functional positions. However, few studies have investigated the effects of upright functional movement on TrA activation in cLBP individuals. OBJECTIVE: This pilot study aimed to compare TrA activation characteristics in healthy and cLBP subjects during the movement of double leg standing (DLS) to single leg standing (SLS) and to a 30 ∘ single leg quarter squat (QSLS). METHODS: TrA activation was determined by the percentage change …in TrA thickness from DLS to SLS and DLS to QSLS. TrA thickness was measured in 14 healthy and 14 cLBP participants using ultrasound imaging with a probe holder at 20 mm and 30 mm from the fascia conjunction point. RESULTS: At both measurement points (20 and 30 mm), there were no significant main effects of body sides, lower limb movements and the interactions between them on TrA activations between the healthy and cLBP participants even after covariates were adjusted for (all p > 0.05). CONCLUSIONS: Results from this study suggest the evaluation of TrA activation during upright functional movements as part of an assessment for cLBP management may not be suggested. Show more

Keywords: Low back pain, abdominal muscles, ultrasonography, physical functional performance

DOI: 10.3233/BMR-220120

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1075-1086, 2023

Authors: Jiang, Chuanjie | Yang, Yongjun | Yu, Jianlin | Zhou, Jiping | Lin, Haipeng | Duan, Xiuyang | Li, Jinjian

Article Type: Research Article

Abstract: BACKGROUND: In cervicothoracic junction, the use of strong fixation device such as pedicle screw placement is often needed. OBJECTIVE: The current study aimed to evaluate the accuracy and safety of pedicle screw placement using stress conduction analysis in the clinical application. METHODS: We retrospectively collected patients who underwent pedicle screw internal fixation in cervicothoracic junction. Patients were divided into conventional nail placement (Group A) and modified pedicle screw implantation under guidance of stress analysis (Group B) according to the methods of pedicle screw placement. The accuracy of pedicle screw placement was assessed by …computed tomography (CT) examination, and the success rate was calculated. RESULTS: A total of 80 patients who underwent pedicle screw internal fixation in cervicothoracic junction were included. There were no obvious differences in baseline characteristics between two groups. The success rate of total screw placement, cervical spine screw placement and upper thoracic spine screw placement in Group B was higher than those in Group A (P < 0.001, P = 0.005, P = 0.008). Additionally, Heary Grade I in the Group B was higher than Group A (P = 0.001). CONCLUSION: Stress analysis-guided technique can increase the accuracy of pedicle screw placement. Importantly, it meets the requirements of internal fixation of the cervicothoracic junction. Show more

Keywords: Pedicle screw fixation, stress analysis, cervicothoracic junction, freehand nail placement

DOI: 10.3233/BMR-220154

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1087-1094, 2023

Authors: Yin, Jianshi | Zhang, Yongzhao | Zhao, Xiangmei | Yan, Han | Liu, Jun | Chang, Xiaohui | Wang, Junsheng

Article Type: Research Article

Abstract: BACKGROUND: In recent years, percutaneous kyphoplasty (PKP) has been increasingly used in clinical settings. OBJECTIVE: In this study, we aimed to determine the analgesic effect of intravertebral lidocaine injections in PKP. METHODS: A total of 60 patients who were treated with PKP were enrolled in this study. Lidocaine hydrochloride was chosen as the medication for the experimental group. Patients were randomly assigned into three groups using a double-blind study design: In group A (20 cases), no drugs were injected into the vertebral body during surgery; group B (20 cases) received intravertebral injection of …normal saline; and in group C (20 cases), lidocaine hydrochloride was administered into the vertebral body during surgery. The age of patients, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected were compared across the three groups. A pain visual analog scale (VAS) was used to assess pain suffered by the patients before, during, and 24 hours after the surgery. RESULTS: Age, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected did not differ significantly among the three groups (P > 0.05). The differences in VAS scores 24 hours before and after surgery were not statistically significant (P > 0.05). Group C had lower intraoperative VAS scores than groups A and B, and the difference was statistically significant (P < 0.01). There was no statistically significant difference between group A and group B (P > 0.05). CONCLUSION: Intravertebral injections of lidocaine during PKP can successfully reduce intraoperative pain. Show more

Keywords: Compression fracture, intravertebral, lidocaine, PKP, the elderly

DOI: 10.3233/BMR-220174

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 36, no. 5, pp. 1095-1100, 2023