Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 5

Authors: Mistry, Dillan | Gokulakrishnan, Dhikshitha | Ampat, George

Article Type: Editorial

DOI: 10.3233/BMR-245004

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1099-1101, 2024

Authors: de Sire, Alessandro | Marotta, Nicola | Prestifilippo, Emanuele | Zito, Roberta | Bartalotta, Isabella | Lippi, Lorenzo | Mezian, Kamal | Vecchio, Michele | Invernizzi, Marco | Ammendolia, Antonio

Article Type: Review Article

Abstract: BACKGROUND: Fibromyalgia is a debilitating condition marked by persistent pain and reduced functionality. Various therapeutic methods have been suggested to alleviate symptoms in individuals with fibromyalgia, yet the impact of diverse rehabilitation strategies remains unclear. OBJECTIVE: This systematic review and meta-analysis aimed at assessing the efficacy of rehabilitation interventions in improving functioning in fibromyalgia patients. METHODS: We conducted a comprehensive literature search of multiple international databases (PubMed, Scopus, and Web of Science) from their inception until November 22nd , 2023. We identified 23 randomized controlled trials (RCTs) assessing multiple rehabilitation strategies. The primary …outcome was the Fibromyalgia Impact Questionnaire (FIQ). Study quality was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). The study protocol was registered in PROSPERO (CRD42020197666). RESULTS: Our meta-analysis rehabilitation interventions significantly reduce FIQ scores (MD = - 11.74, 95% CI: - 16.88 to - 6.59, p < 0.0001). Notably, the subgroup analysis showed that different rehabilitation modalities seem to induce different therapeutic responses. CONCLUSIONS: Rehabilitation strategies hold promise in addressing the functional impairments and improving the overall well-being of individuals with fibromyalgia. The study underscores the need for further research to determine the optimal rehabilitation approach and its potential impact on the multilevel disability characterizing patients with fibromyalgia. Show more

Keywords: Fibromyalgia, rehabilitation, pain management, physical therapy, functioning

DOI: 10.3233/BMR-230382

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1103-1129, 2024

Authors: Chang, Min Cheol | Choo, Yoo Jin | Denis, Isabelle | Mares, Christopher | Majdalani, Carl | Yang, Seoyon

Article Type: Review Article

Abstract: BACKGROUND: Low back pain and sciatica caused by herniated lumbar discs (HLDs) are common complaints among patients visiting pain clinics. Among the various therapeutic methods, intradiscal ozone injections have emerged as an effective alternative or additional treatment option for HLDs. OBJECTIVE: This meta-analysis aimed to investigate the effectiveness of intradiscal ozone injections in the treatment of HLDs. METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published until January 25, 2024. We included studies that investigated the efficacy of intradiscal ozone injections in patients with HLDs. We evaluated …the methodological quality of individual studies using the Cochrane Collaboration tool. RESULTS: At ⩾ 6 months after treatment, the therapeutic effect of intradiscal ozone injections in patients with HLDs was greater than that of steroid injections (treatment success rate, 6 months: odds ratio = 3.95, 95% confidence interval [CI] [2.44, 6.39], P < 0.01) or conventional medications (changes in the Visual Analog Scale [VAS], 6 months: standardized mean difference [SMD] = 1.65, 95% CI [1.08, 2.22], P < 0.01; 12 months: SMD = 1.52, 95% CI [0.96, 2.08], P < 0.01) but similar to that of microdiscectomy (changes in VAS, 18 months: SMD = - 0.05, 95% CI [- 0.67, 0.57], P = 0.87). At < 6 months after treatment, the reduction in the VAS score after intradiscal ozone injections was higher than that after steroid injections (changes in VAS, 1 month: SMD = 2.53, 95% CI [1.84, 3.21], P < 0.01). CONCLUSION: Intradiscal ozone injections may be a useful therapeutic tool in patients with HLDs. Compared with other conventional treatment methods such as steroid injections and oral medications, intradiscal ozone injection has great long-term (⩾ 6 months) effectiveness. Show more

Keywords: Injections, pain management, intervertebral disc displacement, low back pain, pain, meta-analysis

DOI: 10.3233/BMR-240024

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1131-1139, 2024

Authors: Rossini, Bianca | Anstruther, Meagan | Fortin, Maryse

Article Type: Research Article

Abstract: BACKGROUND: Student circus artists put constant stress on their back. However, the presence of low back pain (LBP) and related disability in this population remains unclear. OBJECTIVES: To 1) examine LBP history in circus artists and compare related disability scores using the Oswestry Disability Index (ODI) and the Athlete Disability Index (ADI), and 2) examine the correlation between LBP-related disability scores, pain intensity and pain catastrophizing. METHODS: Thirty-three circus students completed an online survey on demographics, training history, and LBP. Participants reporting LBP filled the ODI, ADI, numerical pain rating scale (NPRS), and …Pain Catastrophizing Scale (PCS). Descriptive statistics and Pearson’s correlation coefficients were used to assess the correlations between the ODI, ADI, NPRS, and PCS. RESULTS: There was a significant positive correlation between the ODI and ADI (r = 0.77, p < 0.001) and between the NPRS and ADI (r = 0.52, p = 0.03), but no correlation between NPRS and ODI. While the PCS scores were significantly correlated with the NPRS ((r = 0.71; p < 0.001) and the ADI (r = 0.51; p = 0.032), no correlation was observed between the PCS and ODI scores (p = 0.088). Based on the ODI scores, 94.44% of the artists reporting LBP were classified with mild disability, 5.56% moderate, and 0% severe disability as compared to 66.67%, 27.78% and 5.55% with the ADI, respectively. CONCLUSION: Our study highlights the potential of the ADI as an effective tool for assessing LBP-related disability in circus artists, supported by a strong correlation with the NPRS. Show more

Keywords: Circus artists, low back pain, oswestry disabilty index, athletes disability index

DOI: 10.3233/BMR-230213

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1141-1150, 2024

Authors: Masoudi, Mona | Ehsani, Fatemeh | Hedayati, Rozita | Ramezani, Mona | Jaberzadeh, Shapour

Article Type: Research Article

Abstract: BACKGROUND: Impairment in both the motor and cognitive aspects of postural control is a critical issue in patients with chronic low back pain (CLBP) who experience high pain anxiety (HPA). OBJECTIVE: This study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on postural control during cognitive postural tasks in CLBP patients with HPA. METHODS: This study included 66 patients randomly assigned to three groups: DLPFC a-tDCS, DLPFC c-tDCS, and sham tDCS. All groups received 20 minutes of tDCS, but …the stimulation was gradually turned off in the sham group. Postural stability indices were assessed using the Biodex Balance System. RESULTS: Both the a-tDCS and c-tDCS groups showed a significant reduction in most postural stability indices at static and dynamic levels after the interventions (immediately, 24 hours, and one-week follow-up) during the cognitive postural task (P < 0.01). Additionally, there was a significant improvement in postural balance in the a-tDCS and c-tDCS groups compared to the sham tDCS group (P < 0.01). Furthermore, the a-tDCS group showed significantly greater improvement than the c-tDCS group (P < 0.01). CONCLUSION: Based on the results, both a-tDCS and c-tDCS over the DLPFC had positive effects on postural control during cognitive postural tasks in CLBP patients with HPA. Show more

Keywords: Chronic low back pain, pain-related anxiety, cathodal transcranial direct current stimulation, anodal transcranial direct current stimulation, dorsolateral prefrontal cortex, postural stability

DOI: 10.3233/BMR-230229

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1151-1161, 2024

Authors: Tseng, Shiuan-Yu | Tseng, Chin-Yen | Ko, Chung-Po | Chang, Yu-Kang | Lai, Chung-Liang | Wang, Chun-Hou

Article Type: Research Article

Abstract: BACKGROUND: Aerobic exercise is closely associated with the vital functions of patients with scoliosis. Infrared thermography (IRT) has been increasingly applied in physiological measurements in recent years. OBJECTIVE: This observational study aimed to use IRT to examine the back body surface temperatures of patients with idiopathic scoliosis during aerobic exercise. METHODS: Forty-two participants who completed a pre-test were divided into a scoliotic group and a non-scoliotic group. Both groups completed a 30-minute cycling exercise, during which their back body temperature was measured using IRT, and the root-mean-square of the back electromyography value after …30 minutes of aerobic exercise was analyzed. RESULTS: The back body temperature decreased significantly after 30 minutes of exercise in the non-scoliotic group. In contrast, the back body temperature (at the trapezius and quadratus lumborum muscles) was asymmetric or increased after exercise in the scoliotic group. CONCLUSIONS: These findings suggest that when patients with scoliosis exercise, their back body temperature should be assessed thoroughly to prevent adverse physiological reactions potentially caused by back body temperature imbalances as well as the potential health problems caused by poor heat dissipation. In addition, such observations can be useful in the early screening of scoliosis. Show more

Keywords: Bicycling, electromyography, spine

DOI: 10.3233/BMR-230234

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1163-1169, 2024

Authors: Moreno-Mateo, Fernando | Maniega, Silvia Santiago | Peris, Almudena Llorente | Ramajo, Rubén Hernádez | González, David César Noriega

Article Type: Research Article

Abstract: BACKGROUND: During the last two decades, there has been a growing interest in spinal sagittal alignment. Most published studies have focused on the role of spinopelvic parameters in patients with adult spinal deformity or in those with previous spinal fusion. OBJECTIVE: The aim of this study was to explore possible association between disability related to back pain and spinopelvic parameters in the absence of coronal deformity or previous spinal surgery. METHODS: In the setting of a larger study involving patients with low back pain (LBP), those without previous surgery or spinal deformity in …the coronal plane were selected. A total of 52 patients (mean age 59 years, range 21–86, 23 men and 29 women) were found. The visual analogic scale (VAS) and Oswestry Disability Index questionnaire (ODI) were recorded. Surgimap software was used to measure the sagittal vertical axis (SVA), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), and lumbar lordosis (LL). Statistical analysis was performed with SPSS Statistics software. Pearson or Spearman correlation were the test of choice depending on the specific variables. RESULTS: A statistically significant association was found between SVA and ODI (r 0.59, p < 0.03). Increased pelvic tilt was also associated with more severe disability related to back pain (r 0.48, p < 0.03). PI-LL mismatch showed moderate association with disability and severity of back pain, although this association did not reach statistical significance (r 0.52, p < 0.08). CONCLUSION: Our findings suggest that sagittal misalignment may be related with more severe disability and back pain in patients with minor or null deformity in the coronal plane. Show more

Keywords: Spinopelvic parameters, sagittal alignment, back pain

DOI: 10.3233/BMR-230242

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1171-1176, 2024

Authors: Di Gesù, Marco | Alito, Angelo | Borzelli, Daniele | Romeo, Domenico | Bonomolo, Fabio | Calafiore, Dario | de Sire, Alessandro

Article Type: Research Article

Abstract: BACKGROUND: Ultrasound-guided galvanic electrolysis technique (USGET) is an innovative mini-invasive intervention with the potential to optimise outcomes in the treatment of Achille’s tendinopathy (AT). OBJECTIVE: The aim of this pilot study is to evaluate the efficacy of adding USGET to conventional eccentric exercise treatment in patients with chronic AT. METHODS: Inclusion criteria were patients with unilateral non-insertional AT, pain lasting > 3 months, aged 25–60 years. Patients were randomised in two groups receiving the same physiotherapy treatment (2 sessions per week for 8 weeks). In addition, the experimental group received three USGET stimulations, one …every 15 days. Outcome measures were assessment of Achilles tendinopathy severity using the Victorian Institute of Sport Assessment-Achilles (VISA-A) and pain intensity using the Visual Analogue Scale (VAS). Assessment points occurred at the onset of treatment (T0), its conclusion (T1), and subsequent follow-ups at one (T2) and two months (T3). RESULTS: Out of the 52 patients who met the study inclusion criteria, two participants withdrew from the study, resulting in a total of 50 subjects who completed the research. None of the parameters showed a different distribution at T1 (p > 0.337). At T2, there was a statistical difference in VISA-A (p = 0.010) and its subscales and VAS (p = 0.002) in the USGET group. At T3, both groups improved with a statistical difference observed in VISA-A (p < 0.001) and its subscales Pain (p = 0.004), Function (p = 0.003) and Sport (p = 0.002), but the EG patients showed a greater improvement. No adverse events were reported. CONCLUSION: The effect of USGET combined with eccentric exercise appears to be a safe and effective technique for achieving pain relief and functional recovery in the medium term, supporting the integrated use of USGET as a rehabilitative treatment option for patients with chronic AT. Show more

Keywords: Achilles tendon, exercise therapy, interventional ultrasound, physical and rehabilitation medicine, tendinopathies

DOI: 10.3233/BMR-230255

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1177-1188, 2024

Authors: Zhang, Bin | Zeng, Jiahao | Zhang, Jiayi | Song, Keyan | Kuang, Liang | Wu, Xiangbo | Zhao, Guang | Shang, Huijuan | Ni, Zhenhong | Chen, Lin

Article Type: Review Article

Abstract: BACKGROUND: Ultrasound has a long history as a diagnostic and therapeutic tool. Low-intensity pulsed ultrasound (LIPUS), whose intensity is below 300 mW/cm2 , has been widely used in orthopedic rehabilitation treatment. However, the detailed bioeffects and underlying mechanisms of LIPUS treatment need to be explored. OBJECTIVE: To make a comprehensive view of the field, bibliometric and visualization analysis was used to reveal the global research trends of LIPUS in orthopedics and rehabilitation treatment between 1994 and 2023. METHODS: All literature data on LIPUS were retrieved from the Web of Science Core Collection database. …VOSviewer and CiteSpace were applied for the bibliometric and visualization analysis. RESULTS: A total of 760 publications were included. The distribution of publications generally showed an unstable rising trend. China had the highest number of publications (28.0%), and Chong Qing Medical University was the organization with the highest number of publications (5.8%). Ultrasound in Medicine and Biology had the highest number of publications (8.8%), while BMJ-British Medical Journal had the highest impact factor among the retrieved journals. Ling Qin from the Chinese University of Hong Kong was the most active researcher. Our overlay visualization map showed that the keywords such as pain, knee osteoarthritis, apoptosis, chondrocytes, cartilage, and autophagy, which link to osteoarthritis, have becoming the new research trends and hotspots. CONCLUSION: LIPUS is a popular and increasingly important area of orthopedic rehabilitation, and collaboration of authors from different countries should be further strengthened. Predictably, clinical application of LIPUS on chronic inflammation-related diseases and regenerative medicine, and in-depth biological mechanisms are the orientations of LIPUS in orthopedic rehabilitation treatment. Show more

Keywords: LIPUS, bone, fracture, cartilage, rehabilitation research

DOI: 10.3233/BMR-230273

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1189-1203, 2024

Authors: Jung, Do Hun | Lee, Sang-Eok | Park, Dougho | Lee, Jang Woo

Article Type: Research Article

Abstract: BACKGROUND: An electrodiagnostic evaluation is conducted to diagnose carpal tunnel syndrome (CTS) and evaluate its severity. OBJECTIVE: This study proposes a revised approach for classifying the severity of electrophysiological findings for patients with CTS. METHODS: This retrospective cross-sectional study included patients with CTS confirmed through electrodiagnostic evaluations. Based on the Stevens’ classification, the patients were divided into three groups (mild/moderate/severe). A new intermediate group was defined to identify patients with normal motor nerve conduction studies and abnormal electromyographic results. CTS pain was evaluated using a numeric rate scale. Physical examinations and sonographic evaluation …were performed to detect anatomical abnormalities. RESULTS: Overall, 1,069 CTS hands of 850 CTS patients were included. The mean age was 57.9 ± 10.8 years, and 336 (39.5%) were men. There were 522 (48.8%) mild cases; 281 (26.3%) moderate cases; and 266 (24.9%) severe cases. In the severe group, 49 cases were reclassified into the intermediate group. The median cross-sectional area in the intermediate group significantly differed from that in the severe group. However, the pain score significantly differed from that of the moderate group. CONCLUSION: The intermediate CTS group showed clinical features that were intermediate to those of the moderate and severe CTS groups. Show more

Keywords: Nerve compression syndromes, classification, neurophysiology, ultrasonography

DOI: 10.3233/BMR-230275

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1205-1212, 2024