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

Authors: Do, Junghwa | Lim, Woo-Taek | Kim, Dae Yul | Ko, Eun Jae | Ko, Myoung-Hwan | Kim, Geon Woo | Kim, Ji Hye | Kim, SooBin | Kim, Hwal

Article Type: Research Article

Abstract: BACKGROUND: Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments. OBJECTIVE: To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke. METHODS: A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with …a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2 max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose). RESULTS: RAGT significantly improved VO2 max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers. CONCLUSION: RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation. Show more

Keywords: Cerebrovascular accident, robotics, high-intensity interval training, rehabilitation

DOI: 10.3233/BMR-230385

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1309-1319, 2024

Authors: Ortiz, Ralph | Motyka, Thomas | Petterson, Stephanie | Krystofiak, Jason

Article Type: Research Article

Abstract: BACKGROUND: Sustained acoustic medicine (SAM) is a noninvasive long-term treatment that provides essential mechanical and thermal stimulus to accelerate soft tissue healing, alleviate pain, and improve physical activity. SAM increases localized deep tissue temperature, blood flow, cellular proliferation, migration, and nutrition exchange, resulting in reduced inflammation and an increased rate of tissue regeneration. OBJECTIVE: To assess the efficacy of SAM treatment of discogenic back pain in the lower spinal column to reduce pain, improve quality of life, and lower pharmacotherapy use. METHODS: Sixty-five subjects with chronic low back pain were randomly assigned to …SAM (N = 33) or placebo (N = 32) groups. Subjects self-applied SAM device bilaterality on the lower lumbar region for 4 hours daily for 8 weeks and completed daily pain diaries before, during, and after treatment. Subjects recorded pain reduction using a numeric rating scale (NRS), medication use, and physical activity using the Global Rating of Change (GROC) and Oswestry Disability Index (ODI). RESULTS: SAM treatment significantly reduced chronic lower back pain from baseline relative to placebo treatment (p < 0.0001). SAM treated subjects reported significantly lower back pain at 4 weeks, with the highest pain reduction (- 2.58 points NRS, p < 0.0001) reported at 8 weeks. Similar trends were observed in improved physical activity (3.48 GROC, p < 0.0001, 69–88% ODI, p < 0.0001) and 22.5% (15.2 morphine milligram equivalent) reduction in the use of opioid medication from baseline to 8 weeks. CONCLUSION: Daily, home-use SAM treatment significantly improves the clinical symptoms of chronic lower back pain, improves physical mobility, and reduces daily medication use. SAM treatment is well-tolerated by patients and may be considered a safe, non-invasive treatment option for chronic discogenic, lower back pain. Show more

Keywords: Low back pain, low-intensity continuous ultrasound, ultrasound therapy, sustained acoustic medicine, mechanotransduction, herniated discs, chronic pain, durable medical equipment

DOI: 10.3233/BMR-230402

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1321-1332, 2024

Authors: Alzahrani, Abdullah | Alshehri, Mansour Abdullah | Alzahrani, Hosam

Article Type: Research Article

Abstract: BACKGROUND: Physiotherapists must identify potential red flags that may impede recovery and function in individuals with low back pain (LBP) or put them at risk. OBJECTIVES: This study aimed to (1) investigate physiotherapists’ awareness and use of red flags for individuals with LBP in Saudi Arabia and (2) identify factors associated with their awareness and use of LBP red flags. METHODS: This cross-sectional study collected data using an anonymous online questionnaire (February–July 2023). It included physiotherapists working in private/public hospitals in Saudi Arabia. The questionnaire asked about the participants’ characteristics, their awareness of …LBP red flags, and their use of red flags for LBP assessment. RESULTS: A total of 643 participating physiotherapists (26.2 ± 3.8 years), 63.8% of whom were females, completed the survey. Most participants (94.4%) had adequate awareness of LBP red flags, and more than half (61%) had good utilization of red flags when assessing individuals with LBP. There was a positive correlation between the physiotherapists’ awareness and use of LBP red flags. CONCLUSION: The majority of the participating physiotherapists in Saudi Arabia were aware of LBP red flags, and many reported to have good use of red flags in clinical practice when assessing and managing individuals with LBP. Show more

Keywords: Low back pain, red flags, physiotherapists, awareness, cross-sectional

DOI: 10.3233/BMR-230410

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1333-1343, 2024

Authors: Koca, Tuba Tülay | Berk, Ejder | Özel, Elif | Yılmaz, Ahmet Said | Ertürk, Zeynel

Article Type: Research Article

Abstract: BACKGROUND: Sarcopenia and frailty may develop at varying rates depending on the metabolic, structural, and functional changes in the muscle structure after stroke. OBJECTIVE: To evaluate the prevalence of sarcopenia and frailty in patients with stroke and affecting clinical parameters. METHODS: This was a cross-sectional and analytical study. Twenty-six (49.1%) women and 27 men (50.9%) with stroke with an average age of 60.2 ± 10.3 (median = 62) years were included in the study. To evaluate physical performance, balance, and mobility, we used the 4-meter walk test …(4-MWT), timed up and go test, chair sit and stand test, and the Berg Balance Scale (BBS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. The SARC-F scale was used for sarcopenia. RESULTS: The average stroke duration was 21.6 ± 18.2 months. Prefrailty was present in 14 (26.4%) patients, frailty was present in 34 (64.2%) patients, and two (3.8%) patients were normal. Sarcopenia was detected in 28 (52.8%) patients. According to handgrip strength, the prevalence of low muscle strength was 17% (n = 9). In the sarcopenic group, female sex (p = 0.005) was more frequent, 4-MWT was longer (p = 0.003), chair stand test results were lower (p < 0.001), the clinical frailty scale (CFS) was higher (p < 0.001), fall risk was higher compared with the BBS (p < 0.001), there was lower HG strength (p = 0.009), lower malnutrition scores (PNI, prognostic nutritional index, p < 0.001), and lower lymphocyte counts (p = 0.037). EAT-10 scores and dysphagia presence (p = 0.026), the presence of malnutrition (p < 0.021) and Nottingham Health Profile score (p < 0.001) were higher in the sarcopenic group. CONCLUSION: Sarcopenia and frailty frequently develop in patients with chronic stroke, with low lymphocyte counts, physical performance, muscle strength, and mobility and balance scores, and it is associated with poor prognostic factors including high disease severity, dysphagia, malnutrition, risk of falling, and poor quality of life. Show more

Keywords: Stroke, sarcopenia, frailty

DOI: 10.3233/BMR-230423

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1345-1354, 2024

Authors: Zhang, Nannan | Chen, Jianmin | Wang, Zhiyong | Ni, Jun

Article Type: Research Article

Abstract: BACKGROUND: After undergoing fibula-free flap harvest, patients may experience complications such as ankle instability. It remains unclear whether these patients have deficits of proprioception, and the recovery process is also uncertain. OBJECTIVE: This study aimed to objectively evaluate proprioception on the donor and normal side of surgical patients during long-term follow-up using the Pro-kin system. METHODS: This study enrolled 36 patients who underwent reconstruction of the head and neck using osseous free flaps harvested from the fibula. Each patient underwent pre-operative evaluations and was subsequently evaluated at postoperative months 1, 3, 6, and …12. The study assessed the proprioceptive evaluation of the lower limbs, muscle function, range of motion of the ankle, and donor side complications. RESULTS: On the donor side, the average trace error (ATE) at postoperative month 1 was significantly higher than pre-operation, postoperative months 6 and 12 (P < 0.05). The test execution time (TTE) at postoperative month 1 was significantly increased by 9.875s compared to the pre-operative levels (P = 0.012, 95% confidence interval [CI] 4: 1.877–17.873) and by 11.583s compared to postoperative month 12 (P = 0.007, 95% CI: 2.858–20.309). The reduction in range of motion of ankle dorsiflexion was most pronounced at postoperative month 1, exhibiting an 11.25∘ decrease compared to pre-operative levels (P < 0.001, 95% CI: 6.304–16.16). Although the range of motion of ankle dorsiflexion gradually improved over time at postoperative months 3, 6, and 12, it remained lower than pre-operative levels (P < 0.05). CONCLUSION: The study revealed that the patients exhibited proprioceptive disturbances in both lower limbs at postoperative month 1. The proprioceptive function gradually improved over time, with a gradual decrease in donor site complications. Show more

Keywords: Fibula-free flap harvest, proprioception, pro-kin system, ankle instability, rehabilitation

DOI: 10.3233/BMR-230436

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1355-1362, 2024

Authors: Ewertowska, Paulina | Formella, Oskar | Poniatowski, Łukasz | Zielińska, Afrodyta | Krzysztofik, Michał | Czaprowski, Dariusz

Article Type: Research Article

Abstract: BACKGROUND: Whole-body vibration (WBV) is being used in rehabilitation and sport. Studies confirm its positive impact on muscle strength and power or regulating muscle hypertension. However, there are some uncertainties regarding its influence on postural stability. This issue seems particularly interesting in the case of individuals with generalized joint hypermobility (GJH), for whom proprioceptive training and muscle strengthening exercises are recommended while techniques that decrease muscle tension are not advised. OBJECTIVE: The aim of the study was to evaluate the acute effect of WBV on postural stability in adults with GJH. METHODS: 60 …participants were categorized into the groups: 1) hypermobility with vibration (GJH+ WBV), 2) hypermobility without vibration (GJH–WBV), 3) control group with vibration (CTRL+ WBV), 4) control group without vibration (CTRL–WBV). The first and the third group completed WBV (frequency: 15 Hz and 30 Hz, amplitude 3 mm, 3 × 3 min). The second and fourth groups participated only in measurement sessions. GJH was assessed using the Beighton test. Postural stability was measured as the overall stability index (OSI) on the Biodex Balance System on the stable and unstable platform with open and closed eyes. Measurements were taken before and after WBV for two weeks. RESULTS: At a frequency of 15 Hz, a significant time effect was observed for measurements Before and After in CTRL–WBV on the stable platform with open eyes (p = 0.012) and on the unstable platform with closed eyes (p = 0.000) for the GJH+ WBV and CTRL+ WBV groups. There were no significant interactions (p > 0.05) between factors. At a frequency of 30 Hz, there was a significant time effect Before and After (p = 0.047) on the stable platform with open eyes, but no interaction was found between factors (p = 0.835). CONCLUSION: There is no positive acute effect of WBV on postural stability in adults with and without GJH. Show more

Keywords: Joint instability, vibration, postural control, balance

DOI: 10.3233/BMR-240004

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1363-1371, 2024

Authors: Koca, Tuba Tülay | Özer, Alev

Article Type: Research Article

Abstract: BACKGROUND: During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations. OBJECTIVE: To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy. METHODS: The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using …the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia. RESULTS: The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n = 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2 , and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p = 0.49), gestational week (p = 0.75), and gravida (p = 0.81) were similar. BMI (p = 0.038) and ODI scores (p < 0.001) were higher in the group with LBP. CONCLUSION: LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend. Show more

Keywords: Lumbopelvic pain, disability, exercise, pregnancy

DOI: 10.3233/BMR-240006

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1373-1380, 2024

Authors: Li, Mengshi | Shi, Qiongfang | Che, Xinle | Du, Xingyan | Wang, Dongming | Song, Yufeng

Article Type: Research Article

Abstract: BACKGROUND: Patients who underwent total knee arthroplasty (TKA) often experience muscle loss due to pain and limited mobility. Nutritional supplementation and rehabilitation may positively affect the decline in muscle function. OBJECTIVE: The purpose of this study is to evaluate whether whey protein intervention, in addition to conventional rehabilitation training, is beneficial in improving muscle function and quality of life in patients after TKA. METHODS: 72 patients who met the criteria were selected for this randomized controlled study. For the experimental group, whey protein was used as a daily supplement for 12 weeks, while …the control group was given a placebo, during which both groups received conventional rehabilitation training. Muscle strength and each of the secondary observables needed to be measured and statistically analyzed preoperatively and at 4, 8, and 12 weeks post-intervention. RESULTS: In total, 62 subjects completed the study: 32 in the experimental group and 30 in the control group. Both groups showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference after 12 weeks of treatment. Compared to the control group, patients in the experimental group showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference (p = 0.001, p = 0.002, p = 0.001, p = 0.001, p = 0.001, respectively) after 12 weeks of treatment. CONCLUSION: The 12-week intervention of whey protein nutritional supplement showed significant improvement in muscle mass and function among post-TKA patients besides aiding with conventional rehabilitation exercise. Show more

Keywords: Nutritional supplementation, isometric muscle strength, rehabilitation

DOI: 10.3233/BMR-240013

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1381-1390, 2024

Authors: Nakata, Akimi | Osuka, Satoshi | Ishida, Tomoya | Saito, Yuki | Koshino, Yuta | Samukawa, Mina | Kasahara, Satoshi | Tohyama, Harukazu

Article Type: Research Article

Abstract: BACKGROUND: Lumbopelvic movement patterns during prone hip extension has been proposed as a clinical screening method for trunk muscle dysfunction in patients with chronic low back pain (CLBP). However, correlations between trunk muscle onset and pelvic kinematics have not been investigated. OBJECTIVE: To examine the correlation between trunk muscle onset and pelvic kinematics during prone hip extension in participants with CLBP. METHODS: Fifteen patients with CLBP and 15 healthy individuals participated. We evaluated the muscle activities of the lumbar multifidus, the longissimus, and the semitendinosus via electromyogram and the displacement angles of the …pelvic tilt, oblique and rotation. RESULTS: The onset of the multifidus at the ipsilateral side of hip extension was significantly delayed in the patients with CLBP compared to the control group (P < 0.001). The onset of the ipsilateral multifidus in the control group was significantly correlated with increased anterior pelvic tilt angle (P = 0.019, r = 0.597), whereas no significant correlation was observed in the CLBP group (P = 0.810, r = - 0.068). CONCLUSION: The results suggest that pelvic kinematics during prone hip extension does not predict the delayed trunk muscle onset in patients with CLBP. Show more

Keywords: Biomechanics, electromyography, pelvis, paraspinal muscles, rehabilitation

DOI: 10.3233/BMR-240028

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1391-1400, 2024

Authors: Shahidzadeh, Azadeh | Toopchizadeh, Vahideh | Shahidzadeh, Arezoo | Farshbaf-Khalili, Azizeh | Salekzamani, Yaghoub

Article Type: Research Article

Abstract: BACKGROUND: Choosing appropriate complementary methods, such as exercise, along with taping methods may be effective in treating patients with kyphosis. OBJECTIVE: The present study aimed to examine the effect of different tape tensions/directions combined with corrective exercises on the degree of postural kyphosis in adolescents. METHODS: In this randomized controlled trial, 54 adolescents with postural kyphosis were assigned into three groups: No taping (control), I-shaped taping technique with 10% stretching force (Kinesiotape I), and I-shaped taping using facilitation technique with 40% stretching force (Kinesiotape II). Both groups in Kinesiotaping also received a V-shaped …tape (10% stretching force). All participants received a similar comprehensive corrective exercise. Patients received the allocated interventions for 6 weeks and visited every two weeks at the clinic. Measurements were done using a flexible ruler, kyphometer, and photogrammetry. RESULTS: Between-group analyses revealed no significant differences between the study groups following the interventions (p > 0.05). However, the within-group analyses according to flexible ruler, Kyphometer, and Photogrammetry measurements indicated that exercise alone (control) [p = 0.011, p = 0.056, and p = 0.005, respectively], Kinesiotape I – exercise [p = 0.001, p = 0.002, p = 0.013, and respectively], as well as Kinesiotape II – exercise [p < 0.001, p < 0.001, and p < 0.001, respectively] significantly decreased the postural kyphosis degree except exercise alone using Kyphometer measurement. No adverse events were observed during the study. CONCLUSION: The findings of photogrammetry, flexible rulers, and photogrammetry similarly indicated that the corrective exercises with or without tape tension/directions significantly decreased the postural kyphosis degree in adolescents. Show more

Keywords: Athletic tape, exercise therapy, kyphosis, adolescent, randomized controlled trials

DOI: 10.3233/BMR-240040

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 5, pp. 1401-1415, 2024