Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 6

Authors: Oxfeldt, Martin | Tegner, Heidi | Björklund, Martin | Christensen, Jan

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is the leading cause of disability and an increasing sick leave in Denmark. Psychosocial risk factors have been linked to the development of LBP-related disability and work-absenteeism. The short form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-sf) was developed to screen for psychosocial risk factors and assess the risk of long-term disability and work-absenteeism. OBJECTIVE: To translate and cross-culturally adapt ÖMPSQ-sf into Danish and evaluate test-retest reliability with relative and absolute reliability and internal consistency in LBP-patients in a secondary setting. METHODS: A six-step translation and cross-culturally adaptation process …was used. Forty-four patients with subacute and chronic LBP were recruited at an outpatient clinic. RESULTS: Test-retest reliability (n = 37) was found to be excellent (ICC2.1 = 0.92), Internal Consistency (n = 44) was adequate (Cronbach’s alpha = 0.72). Absolute reliability included Standard Error of Measurement (SEM = 3.97 points), 95% Limits of Agreement (95% LOA = 0.08, - 15.90–15.74), and Smallest Detectable Change (SDC = 10.87 points). CONCLUSION: The Danish ÖMPSQ-sf showed acceptable measurements properties in subacute and chronic LBP-patients. Further research is needed to assess other measurement properties of the ÖMPSQ-sf, in relation to validity, responsiveness, and the predictive ability before application in research or clinical practice. Show more

Keywords: Low back pain, Örebro questionnaire, reliability, psychosocial risk factors, disability, work absenteeism

DOI: 10.3233/BMR-230363

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1529-1536, 2024

Authors: Cobanoglu, Gamze | Guzel, Nevin A. | Ecemis, Zeynep Berfu | Demirkan, M. Yusuf

Article Type: Research Article

Abstract: BACKGROUND: The Band Pull-Apart (BPA) exercise is used to strengthen the periscapular muscles. It was recently stated that the lower extremity and trunk movements should be included in the shoulder rehabilitation programs to optimize an effective energy transfer throughout the kinetic chain. OBJECTIVE: The aim of this study is to investigate the effects of kinetic chain based BPA exercise on the muscle activations of the sternocleidomasteideous (SCM) and the trapezius muscles in individuals with and without forward head posture (FHP). METHODS: Eighteen individuals with FHP and 18 individuals without FHP were included. Photographic …measurements were made to identify individuals with FHP. The muscle activations of SCM, Upper Trapezius (UT), Middle Trapezius (MT), and Lower Trapezius (LT) were measured with surface EMG. BPA exercise was performed in the standing, unipedal standing, squat, unipedal squat, and Bulgarian split squat (BSS). RESULTS: There was no Group × Exercise interaction for the SCM, UT, MT, LT muscle activations, or for the UT/MT and UT/LT ratios (p > 0.05). While there was a difference in the activation of all muscles between individuals with and without FHP (p < 0.05), both ratios were similar (p > 0.05). There was a statistically significant difference between exercises for SCM, MT, and LT muscle activations (p < 0.000 for these muscles), UT/MT (p < 0.000) and UT/LT ratios (p = 0.004). SCM muscle activation in squat was lower than activation in standing (Mean Difference (MD) = 2.5% Maximal Voluntary Isometric Contractions (MVIC); p = 0.004) and in unipedal standing (MD = 2.1% MVIC; p = 0.002). MT muscle activation in squat was higher than activation in standing (MD = 9.7% MVIC), unipedal standing (MD = 7.8% MVIC), unipedal squat (MD = 6.9% MVIC) and BSS (MD = 9.4% MVIC; p < 0.000 for these positions). LT muscle activation in the squat was higher than activation in the standing (MD = 8.5% MVIC) and unipedal squat (MD = 8.1% MVIC; p < 0.004 for these positions). UT/MT ratio in the squat was lower than standing (MD = 0.3), unipedal standing (MD = 0.2) and BSS (MD = 0.3; p < 0.000 for these positions). UT/LT ratio in squat was lower than unipedal squat (MD = 0.5) and BSS (MD = 0.6; p = 0.002; for these positions). CONCLUSION: Performing the BPA exercise in the squat position is suggested in cases where lower SCM and UT muscle activation, lower UT/MT, and UT/LT ratios and higher MT and LT muscle activations are needed for individuals with and without FHP. Show more

Keywords: Shoulder, superficial back muscles, electromyography, exercise therapy, posture

DOI: 10.3233/BMR-230397

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1537-1549, 2024

Authors: Shin, Sun-Shil | Yoo, Won-Gyu

Article Type: Research Article

Abstract: BACKGROUND: Trunk rotation is important in many sporting activities The thoracic spine has reciprocal relationships with the lumbar and pelvic spines, such that reduced flexibility in the lumbar or thoracic spine can lead to abnormal patterns of trunk movement and pain. However, few studies have investigated the relative trunk rotation mobilities of the thorax, lumbar, and pelvis. OBJECTIVE: To compare thoracic, lumbar, and pelvic rotation angles during the lumbar-locked rotation test between hyper and normal thoracic rotation groups. METHODS: Thirty-two young, active participants were enrolled in this study. After the attachment of inertial …measurement units at the T1, T7, T12, L3, and S2 levels, the participants were required to stand in a comfortable upright posture for 5 s to allow postural measurements before performing the lumbar-locked rotation test. The participants were then divided into hyper thoracic rotation and normal thoracic rotation groups based on T1 angle measurements obtained during the lumbar-locked rotation test. RESULTS: The hyper thoracic rotation group had significantly higher thoracic rotation angles on both the right (p < 0.05) and left (p < 0.05) sides compared with the normal thoracic rotation group. Furthermore, we observed flat lumbar lordosis in the hyper thoracic rotation group compared with the normal thoracic rotation group, particularly in the lower lumbar region in standing posture. CONCLUSION: Our data suggest that evaluations of thoracic mobility should consider relative thoracic, lumbar, and pelvic motions, rather than the T1 angle alone. This study provides a basis for health professionals to evaluate movement dysfunctions associated with thoracic hypermobility. Show more

Keywords: Flat lumbar, lumbar-locked rotation test, relative movement, thoracic hypermobility

DOI: 10.3233/BMR-230404

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1551-1559, 2024

Authors: Mikkonen, Jani | Luomajoki, Hannu | Airaksinen, Olavi | Goubert, Liesbet | Pratscher, Steven | Leinonen, Ville

Article Type: Research Article

Abstract: BACKGROUND: Exercise is a first-line treatment for chronic non-specific low back pain (CNSLBP). Exercise combined with specific breathing techniques have the potential to improve multifactorial outcomes. No previous studies, however, have compared outcomes between identical exercises with or without a specific breathing protocol in a uniform clinical study setting. OBJECTIVES: 1) To investigate the feasibility of combining synchronized breathing with movement control exercises and evaluate eligibility criteria, randomization procedures, and dropout rates. 2) To study the preliminary efficacy of the interventions on multifactorial outcome measures. METHODS: Thirty subjects with CNSLBP were randomized into …two groups. Both groups had four contact clinic visits where they received personalized home movement control exercises to practice over two months. The experimental group included a movement control exercise intervention combined with synchronized breathing techniques. Trial registration number: NCT05268822. RESULTS: Feasibility was demonstrated by meeting the recruitment goal of 30 subjects within the pre-specified timeframe with enrolment rate of 24.8% (30/121). Synchronized breathing techniques were successfully adhered by participants. Home exercise adherence was nearly identical between the groups without any adverse events. Preliminary efficacy findings on pain intensity, disability, and self-efficacy in the experimental group exceeded the minimal clinically important difference. No such findings were observed in any outcome measures within the control group. Overall, multifactorial differences were consistent because nine out of eleven outcome measures showed greater improvements for the experimental group. CONCLUSION: The synchronized breathing with movement control exercises protocol was feasible and may be more beneficial for improving multifactorial outcomes compared to identical exercises alone. Results suggested progression to a full-scale trial. Show more

Keywords: Chronic musculoskeletal pain, feasibility, breathing exercises, specific breathing technique, motor control exercises, yoga, pilates

DOI: 10.3233/BMR-230413

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1561-1571, 2024

Authors: Lu, Yang | Li, Yalei | Wang, Jingru | Zhao, Feng | Zhu, Chaohua | Wang, Hui | Ji, Xiaoli | Zhang, Haijing | Ping, Ya

Article Type: Research Article

Abstract: BACKGROUND: The knee joint anatomical structure is susceptible to external forces, which can lead to functional break down, profoundly affecting the quality of life and daily functioning of individuals. OBJECTIVE: To investigate the effects of continuous nursing intervention on walking function, quality of life, and treatment satisfaction in patients undergoing unicondylar knee replacement. METHODS: This prospective study included 90 patients who underwent unicondylar knee arthroplasty due to unicondylar osteoarthritis. Participants were divided into two groups based on their nursing methods: the control group (n = 45) and the observation …group (n = 45). RESULTS: Three months post-intervention, the observation group demonstrated significant improvements in knee joint range of motion, Hospital for Special Surgery Knee Score score, and Lysholm knee joint score compared to the control group (P < 0.05). The observation group also had a shorter completion time for the Timed Up and Go test and significantly higher SF-36 scores (P < 0.05 for both). Additionally, Knee Injury and Osteoarthritis Outcome Score scores in the observation group were significantly higher after three months of intervention (P < 0.05). And the observation group reported higher satisfaction rates and lower dissatisfaction rates compared to the control group (P < 0.05). CONCLUSION: Early postoperative rehabilitation guidance, regular reviews, and rehabilitation exercise guidance result in better rehabilitation outcomes, enhanced knee joint function, improved walking ability, and overall quality of life for patients undergoing unicondylar knee replacement. Show more

Keywords: Nursing, arthroplasty, replacement, knee, quality of life

DOI: 10.3233/BMR-230414

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1573-1580, 2024

Authors: Kondo, Yu | Higuchi, Daisuke | Miki, Takahiro | Watanabe, Yuta | Takebayashi, Tsuneo

Article Type: Research Article

Abstract: BACKGROUND: There is a paucity of data on physical activity and its effects in patients after cervical spine surgery. OBJECTIVE: This study aimed to examine the association between physical activity and disability in patients after cervical spine surgery while also considering age, sex, pain, and central sensitization (CS)-related symptoms. METHODS: Participants included individuals with a cervical degenerative condition who had undergone surgery. Neck disability index, physical activity frequency, numerical rating scale for pain intensity, and short form of the CS inventory were recorded more than 1 year postoperatively. The linear mixed model was …performed to examine the association between physical activity and disability. RESULTS: The responses of 145 participants were analyzed. The linear mixed model results showed that the stretching and light-intensity exercise frequency (β = - 0.14, p = 0.039) was independently associated with disability, adjusted for age, sex, pain, and CS-related symptoms. Conversely, other physical activities, such as walking and muscle strength exercises, were not associated with a disability. CONCLUSION: The findings emphasize the importance of performing regular physical activity, regardless of pain and CS-related symptoms. Show more

Keywords: Degenerative cervical disease, disability, physical activity, pain

DOI: 10.3233/BMR-230428

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1581-1589, 2024

Authors: Xie, Xing-Wen | Wang, Chun-Xiao | Zhao, Yong-Li | Luo, Yong-Sheng | Wang, Zhong-Hua | Liu, Jing | Li, Hui | Li, Ding-Peng

Article Type: Research Article

Abstract: BACKGROUND: In China, Tongluo-Qutong rubber plaster (TQRP) is commonly used for cervical spondylotic radiculopathy, but lacks high-quality trials. OBJECTIVE: This study aimed to conduct a multicenter, open-label, parallel-group, randomized controlled trial in China to investigate the practical efficacy and safety of TQRP in the treatment of CSR. METHODS: A total of 240 patients diagnosed with CSR were recruited for the investigation from multiple hospitals in Gansu province, China. The patients were randomly assigned to either an experimental or a control group. The experimental group received treatment with TQRP, whereas the control group was …administered a diclofenac sodium patch (DSP) for a maximum duration of 21 days. The visual analogue scale (VAS) score for pain, the proportion of patients experiencing 50% or more pain relief, the neck disability index (NDI), changes as per the Eaton trial, and recurrence during the follow-up period were evaluated for both groups. The safety and adverse events associated with the concurrent drug therapy were also evaluated. RESULTS: At each time point, the mean VAS and NDI scores of both groups demonstrated a downward trend. The experimental group exhibited a greater decline in VAS score at each time point compared to the control group (P < 0.01). In the Eaton trial, both the percentage of patients experiencing pain relief of 50% or more and the number of abnormal results exhibited improvement. However, the outcomes in the 21 ± 3d experimental group were significantly superior to those in the control group (P < 0.01). During the follow-up period, the recurrence events in the experimental group were reduced compared to the control group. The difference between the two groups was statistically significant (P < 0.05). The incidence of adverse reactions was 1.74% for TQRP and 3.54% for DSP. CONCLUSION: TQRP is effective and safe in the treatment of CSR. Show more

Keywords: Cervical spondylotic radiculopathy, Chinese traditional medicine, TQRP, rubber plaster

DOI: 10.3233/BMR-230431

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1591-1599, 2024

Authors: Son, Aria | Johnson, James | Leachman, Jennifer | Bloyder, Joseph | Brant, Jeannine M.

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is a significant source of disability and decreased quality of life. The Self-Natural Posture Exercise (SNPE) intervention can be used effectively in many cases, but feasibility and impact has not been fully explored. OBJECTIVE: The current study explores the feasibility and efficacy of face-to-face (FtF) and virtual (Vir) SNPE programs on chronic low back pain. METHODS: This is a randomized single-blinded waitlist control study with 10 participants in the FtF group (age 45.8 ± 2.89) and 9 in the Vir group (age 52.2 ± …2.3). Participants had low to moderate low back pain for > 3 months. Those who would eventually become the Vir group served initially as a waitlist control (Con) group. The FtF group received 12 weeks of in-person exercise training sessions conducted and the Vir group received weekly recorded training videos created by and featuring the same instructor. Measured outcomes included feasibility assessed by rate of retention and rate of attendance, level of low back pain (Oswestry Disability Index, Visual Analogue Scale), quality of life (36-Item Short Form Health Survey 1.0), muscular pressure pain threshold, and muscle tone. Analysis was done via repeated measures ANOVA and Wilcoxon tests. RESULTS: Rates of retention were 80% in the FtF group and 78% in the Vir group. Attendance rates were 88% in the FtF group and 60% in the Vir group. ODI, VAS, and some SF-36 domains improved in both the FtF and Vir groups. Overall, the FtF group improved in more domains and by a larger degree than the Vir group and both groups improved relative to Con. CONCLUSION: A 12-week SNPE program, done virtually or in person, shows promise in improving ODI, VAS, and some SF-36 domains. FtF appears to be more effective. Future studies would benefit from sampling a larger and more diverse population. Show more

Keywords: Chronic low back pain, rehabilitation, tele-rehabilitation, self-natural posture exercise, physical therapy

DOI: 10.3233/BMR-230441

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1601-1616, 2024

Authors: Zengi, Hakan | Safran, Elif Esma | Şevgin, Ömer

Article Type: Research Article

Abstract: BACKGROUND: Clinical research on the management and rehabilitation of work-related upper spinal pain in bus drivers is sparse, indicating a gap in knowledge and treatment strategies. This highlights the growing need for innovative approaches to rehabilitation programs in this area. OBJECTIVE: To examine the effects of kinesio taping (KT) on pain, functionality, and work performance in bus drivers experiencing neck pain. METHODS: The study involved 44 participants who were randomised into two different groups: the exercise group (n = 22) and the kinesio tape group (n = …22), with participants in both groups undertaking exercise interventions. Evaluations were made before and after 6 weeks of treatment. At the end of the 6-week, the participants’ ROM, pain evaluations and functional scales were evaluated with disability, and work functionality. RESULTS: Neck pain severity decreased in both groups (p < 0.001 for each value), but there was no difference between the groups (p : 0.071). When disability scores were evaluated, improvement was noted in both groups (p : 0.001 for each value), but no statistically significant difference was found (p : 0.754). When the improvements in ROM values before and after the treatment were examined, the difference between the groups was recorded only in the neck extension ROM value (p : 0.011). Significant improvement was noted in all sub-steps of job performance in both groups (p < 0.05). CONCLUSION: KT added to ergonomic training and home exercise programmes is effective in controlling work-related musculoskeletal pain in drivers with neck pain. However, the addition of KT to exercise therapy was found to be no more effective than exercise therapy alone in improving pain control, functionality and work performance. Show more

Keywords: Ergonomics, muscle stretching exercises, occupational diseases

DOI: 10.3233/BMR-240001

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1617-1630, 2024

Authors: Kim, Jun-Hee

Article Type: Research Article

Abstract: BACKGROUND: Low back pain (LBP) is one of the most frequently occurring musculoskeletal disorders, and factors such as lifestyle as well as individual characteristics are associated with LBP. OBJECTIVE: The purpose of this study was to develop and compare efficient low back pain prediction models using easily obtainable demographic and lifestyle factors. METHODS: Data from adult men and women aged 50 years or older collected from the Korean National Health and Nutrition Examination Survey (KNHANES) were used. The dataset included 22 predictor variables, including demographic, physical activity, occupational, and lifestyle factors. Four machine …learning algorithms, including XGBoost, LGBM, CatBoost, and RandomForest, were used to develop predictive models. RESULTS: All models achieved an accuracy greater than 0.8, with the LGBM model outperforming the others with an accuracy of 0.830. The CatBoost model had the highest sensitivity (0.804), while the LGBM model showed the highest specificity (0.884) and F1-Score (0.821). Feature importance analysis revealed that EQ-5D was the most critical variable across all models. CONCLUSION: In this study, an efficient LBP prediction model was developed using easily accessible variables. Using this model, it may be helpful to identify the risk of LBP in advance or establish prevention strategies in subjects who have difficulty accessing medical facilities. Show more

Keywords: Chronic pain, artificial intelligence, risk assessment, health surveys, physical activity, quality of life

DOI: 10.3233/BMR-240059

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1631-1640, 2024

Authors: Zhang, Yan | Zhou, Xiuling | Zhu, Yulan | He, Kai | Li, Xueqi | Chen, Hao | Cheng, Yi | Ding, Hong

Article Type: Research Article

Abstract: BACKGROUND: Morphological changes in the abdominal wall muscle in diastasis recti abdominis (DRA) patients with low back pain (LBP) symptoms and whether there is a wider interrectus distance (IRD) remain unclear. OBJECTIVE: The aim of this study was to determine the correlation between DRA severity and LBP and the morphological differences in abdominal wall muscles between patients who presented with symptoms of LBP and those who were asymptomatic. METHODS: A total of 57 postpartum DRA patients were enrolled, including 21 without LBP, 36 with LBP, and 30 healthy nulliparous women. The numerical rating …scale (NRS) was used to evaluate the degree of LBP. The IRD and muscle thickness of the abdominal muscles were measured via an ultrasonography device at the end of a natural breathing cycle. RESULTS: The abdominal muscles of the rectus abdominis (RA), external oblique muscle (EO), and transversus abdominis (TrA) in the DRA patients were significantly thinner than those in the control group (p < 0.05), whereas the difference in the internal oblique muscle (IO) was not significant (p > 0.05). There were no statistically significant differences in abdominal muscle thickness or the IRD regardless of whether the patients with DRA had LBP symptoms, with similar findings between the NRS score and DRA severity (P > 0.05). CONCLUSION: In DRA patients within one year postpartum, no significant difference was found in the severity of DRA or abdominal muscles, regardless of whether they were complicated by LBP symptoms. Shortening the IRD alone may not be beneficial for improving LBP symptoms in DRA patients. The relationship between DRA and LBP and the role of the abdominal muscles in postpartum LBP should be interpreted with caution. Show more

Keywords: Diastasis recti abdominis, low back pain, abdominal wall muscles, ultrasound, interrectus distance

DOI: 10.3233/BMR-240074

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1641-1647, 2024

Authors: Ijaz, Madiha | Ahmad, Sajid Rashid | Akram, Muhammad

Article Type: Research Article

Abstract: BACKGROUND: The construction of buildings is risky for workers’ musculoskeleton. OBJECTIVE: This study aims to calculate the significance of risk associated with work-related musculoskeletal disorders. METHOD: 600 workers from 20 construction sites were surveyed using the Nordic Musculoskeletal Questionnaire (modified) and their performance was assessed at seven construction-tasks using RULA and REBA sheets. SPSS v. 26 and R programming were used for statistical analysis. RESULTS: The mean value of workers’ age was 28.4381 years, with 8.8205 working months/year and 65USDs monthly earnings. Maximum reporting of body discomfort was by workers …of window/door framing. Workers’ BMI (35–44 kg/m2 ) and break duration (< 15 minutes) prompted neck pain with OR 7.79 (95% CI 1.135-53.587) and OR 1.179 (95%CI 0.231–6.014) respectively. Bagging was dangerous for the ankle with OR 9.881 (95% CI 5.140–18.994), and window/door framing for feet with OR 2.057 (95% CI 1.196–3.539). The mean value of the RULA grand score ranged from 5.89 (lowest for ‘leveling’) to 9.25 (highest for ‘demolishing’), and the REBA sheet between 8–11 for all seven studied work-stages. CONCLUSION: Workers’ upper and lower limbs are affected by the work-stages they perform and the social lifestyle they live in. These findings from 600 workers are sufficient to be generalized for intervention. Show more

Keywords: Work-related musculoskeletal disorders, construction buildings, socioeconomic plights, upper extremity deformities, arthrogryposis, lower extremity deformities, multiplex congenital

DOI: 10.3233/BMR-240078

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1649-1661, 2024

Authors: Shi, Chencui | Zou, Qiangdong | Wei, Hong

Article Type: Research Article

Abstract: BACKGROUND: During pregnancy, structural and functional changes usually occur in the body, which has various consequences, including lower back pain (LBP) and hypothyroidism. One of the risk factors for these problems is physical inactivity. OBJECTIVE: This study aimed to investigate the association of back pain and physical inactivity, weight gain, and hypothyroidism in pregnant women. METHODS: In this cohort study, 420 pregnant women (26.333 ± 5.820 years old) were included. At first, participants answered this question: “Do you have any plans for pregnancy in the next month?” If the answer …was yes, further evaluations were performed. The physical activity and pain intensity were measured by the International Physical Activity Questionnaire Short Form (IPAQ-S) and Visual Analogue Scale. Serum TSH was measured by automated chemiluminescence and commercial kits. Measurements were conducted before, the first, second, and third trimester of pregnancy. RESULTS: Women reporting LBP were less engaged in physical activities and weight gained in the second and third trimesters of pregnancy was significantly higher than pregnant women without LBP (p < 0.05). TSH level and weight gained in pregnant women with low physical activity level was significantly higher than pregnant women with moderate and high physical activity (p < 0.05) (without significant difference in TSH and BMI). The physical inactivity (before: OR: 1.11 95% CI: 0.89 to 1.22; first trimester: OR: 1.09 95% CI: 1.02 to 1.59; second trimester: OR: 0.92 95% CI: 0.87 to 1.31; third trimester: OR: 1.12 95% CI: 1.02 to 1.39), TSH (OR: 0.85 95% CI: 0.57 to 1.29), and weight gain (second trimester: OR: 0.87 95% CI: 0.92 to 1.59; third trimester: OR: 1.44 95% CI: 1.02 to 1.98; p < 0.05) did predict increased pain intensity. CONCLUSION: Using health-oriented approaches to increase physical activity and normalize thyroid function and weight gain during pregnancy can have beneficial effects on LBP. Show more

Keywords: Musculoskeletal disorders, pregnancy, sedentary, thyroid

DOI: 10.3233/BMR-240086

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1663-1671, 2024

Authors: Huang, Shiming | Wang, Qiang | Chen, Daohua | Zhan, Peng | Chen, Dongfeng

Article Type: Research Article

Abstract: BACKGROUND: Advanced knee osteoarthritis (KOA) impacts both knees, resulting in pain, deformity, and substantial restrictions in joint mobility. OBJECTIVE: This study aims to examine the effectiveness of combining arthroscopic debridement with functional exercise in treating advanced KOA. METHODS: A total of 296 patients diagnosed with advanced KOA were divided into two groups: the observation group (n = 152) received arthroscopic debridement combined with functional exercise, while the control group (n = 144) underwent arthroscopic debridement only. The study compared and observed the outcomes between …the two groups. RESULTS: There were no significant differences in knee joint function, inflammation level, and oxidative stress between the two groups before treatment (P > 0.05). Following treatment for six months, the observation group exhibited significantly lower visual analog scale (VAS) score, tissue inhibitors of metalloproteinase-1 (TIMP-1), tumor necrosis factor-alpha (TNF-α ), interleukin-1 (IL-1), matrix metalloproteinase-3 (MMP-3), and malondialdehyde (MDA) levels compared to the control group (P < 0.05). Meanwhile, the observation group showed significantly higher levels of Lysholm score, hospital for special surgery (HSS) score, range of motion (ROM) of knee, peak torque (PT) and total work (TW) for knee extension and flexion, superoxide dismutase (SOD), total antioxidant capacity (T-AOC), and glutathione (GSH) compared to the control group (P < 0.05). Besides, the effective treatment rate in the observation group was notably higher than that in the control group (80.92% vs. 69.44%, P < 0.05). CONCLUSION: The combination of arthroscopic debridement with functional exercise is an effective treatment for advanced KOA. This approach not only enhances the function and strength of knee joint and reduces inflammatory response but also boosts the body’s antioxidant capacity. The treatment exhibits encouraging outcomes and warrants broad implementation. Show more

Keywords: Arthroscopic debridement, Functional exercise, Advanced knee osteoarthritis, Therapeutic effects, Retrospective observation

DOI: 10.3233/BMR-240106

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1673-1683, 2024

Authors: Tapajčiková, Táňa | Líška, Dávid | Slapšinskaitė Dackevičienė, Agnė | Skladaný, L’ubomír

Article Type: Research Article

Abstract: BACKGROUND: Individuals diagnosed with liver cirrhosis typically experience a variety of symptoms. Decompensation, a critical stage in the disease’s progression, is characterized by the emergence of prominent clinical signs. These signs typically include ascites, bleeding tendencies, hepatic encephalopathy, and jaundice. Furthermore, it is noteworthy that regions in the sensorimotor cortex responsible for practical and gnostic functions are closely situated within the parieto-occipital part of the cortex. Liver cirrhosis may also have an impact on this aspect of human motor function. OBJECTIVES: The main objective of the study is to compare the gnostic function and stereognostic function …in individuals with liver cirrhosis and those in a healthy population. METHODS: The patients included in our registry, known as RH7, were enrolled in our study. The first group consisted of 74 liver cirrhosis patients (including 25 women and 49 men). The control group consisted of a 63 healthy population (including 23 women and 40 and men). Both groups underwent both the Petrie and kinaesthesia tests. RESULTS: The results of the Petrie test, which compared healthy participants with those with liver cirrhosis, indicate that the healthy population achieved a significant difference in both right and left upper limb compared to those with liver cirrhosis patients (p < 0.05). The healthy population showed a significant difference compared to liver cirrhosis patients in the kinesthesia test (p < 0.05), except for the second attempt with the left upper limb (p = 0.267). According to the LFI, there was no significant difference in either upper limb during both the initial and second attempts of Petrie test (p > 0.05). CONCLUSION: Patients with liver cirrhosis exhibited significantly poorer gnostic functions compared to the healthy population. This condition also leads to notable impairments in motor functions, affecting both the precision and coordination of movements. Despite these deficits, frailty alone does not appear to be an indicator of worsened gnostic or stereognostic functions. Therefore, while liver cirrhosis has a clear negative impact on motor and cognitive abilities, the presence of frailty does not necessarily exacerbate these specific cognitive deficits. This distinction is crucial for clinical assessments and interventions targeting motor and cognitive rehabilitation in patients with liver cirrhosis. Show more

Keywords: Liver cirrhosis, gnostic and stereognostic function, frailty, rehabilitation

DOI: 10.3233/BMR-240114

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1685-1694, 2024

Authors: Depreli, Ozde | Angin, Ender

Article Type: Research Article

Abstract: BACKGROUND: The hand is the most frequently used part of the body during daily life activities. Any musculoskeletal problem that may occur in the hand can lead to loss of function. OBJECTIVE: This study examined the relationship between the wrist and elbow position adapted during smartphone use, pain and discomfort, smartphone addiction, and hand function. METHODS: Pain and discomfort were evaluated with the visual analog scale, wrist and elbow angle during phone use were evaluated with a universal goniometer, smartphone addiction was evaluated with the Smartphone Addiction Scale-Short Version, and functional status of …the hand was evaluated with the Michigan Hand Outcomes Questionnaire. RESULTS: A total of 120 university students (female: n = 60), with an average age of 22.71 ± 2.7 years, were included in this cross-sectional study. A relationship was found between the angle of the wrist and elbow during smartphone use and pain/discomfort (r = 0.692, p = 0.001), smartphone addiction (r = 0.575, p = 0.001), and hand function parameters (r = 0.20–0.55, p ⩽ 0.05). CONCLUSION: Due to the increased use of smartphones in today’s environment, a preventive program should be developed in which texting for extended periods is avoided, along with frequent breaks to rest the hands, and stretching exercises for the upper extremities during rest. Show more

Keywords: Students, hand joints, elbow joints, visual analog pain scale

DOI: 10.3233/BMR-240154

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1695-1704, 2024

Authors: Yilmaz, Kamil | Sert, Ozlem Akkoyun | Unuvar, Bayram Sonmez | Gercek, Hasan

Article Type: Research Article

Abstract: BACKGROUND: Chronic pain can affect body perception at the central level by causing the somatosensory cortex to rearrange. Additionally, cervical afferent abnormalities in individuals with neck pain can impair proprioceptive sensitivity, potentially leading to alterations in body alignment and biomechanics. Nevertheless, there are insufficient studies exploring these notions. OBJECTIVE: The main objective of this study was to compare the head posture and neck proprioceptive sense of individuals with chronic neck pain and healthy controls. METHODS: Utilizing a cross-sectional study, a total of 76 volunteers comprising 38 individuals with neck pain and 38 matched …healthy controls participated in the study. Head posture and cervical joint position sense were measured using a Cervical Range of Motion Deluxe (CROM) device. Firstly, the deviation angles of the head in three planes were evaluated, then the Head Repositioning Accuracy (HRA) test was performed to determine the joint position error. Visual Analogue Scale (VAS) was used to determine the severity of pain in individuals with neck pain. RESULTS: The deviation angles of the head in all three planes were significantly lower in the healthy control group (p < 0.05). Joint position error values were significantly higher in all directions (flexion-extension, right-left lateral flexion, and rotation) in the neck pain group (p < 0.001). CONCLUSION: The findings show that the proprioceptive sensation of the cervical region in individuals with neck pain was adversely affected, with changes were observed in the head posture. NOTE: The abstract of this study was presented as a verbal declaration at the International Congress of Health Sciences-ICHES-IDU 2020 that was held in İzmir on 20–21 June 2020. Show more

Keywords: Neck pain, position sense, posture, proprioception, proprioceptive disorders

DOI: 10.3233/BMR-240155

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1705-1713, 2024

Authors: Haklıgil, Gizem Vaiz | Oksüz, Sevim | Angın, Ender

Article Type: Research Article

Abstract: BACKGROUND: Although guidelines and systematic reviews recommend the use of exercise in the treatment of chronic pain and neck pain, there are no clear recommendations for conservative treatments frequently used in clinics. The effect of supporting clinical Pilates exercises with passive physiotherapy methods on biopsychosocial status is still unknown. OBJECTIVE: The objective was to investigate the effects of conventional treatment (CT) in addition to clinical Pilates on pain levels, physical condition, functional status, and psychosocial status in individuals with chronic neck pain. METHODS: Fifty women were randomly divided into 2 groups, the clinical Pilates …group (Pilates, n = 25), and the group receiving CT in addition to clinical Pilates (Pilates-CT, n = 25). Both groups received treatment 3 days a week for 6 weeks. The CT program involved the implementation of hot pack (HP) application, Transcutaneous Electrical Nerve Stimulation (TENS), and therapeutic ultrasound (US) to the cervical area. RESULTS: CT in addition to Pilates was more effective in reducing the Visual Analog Scale (at rest and during activity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, NeckPix Scale, Hospital Anxiety and Depression Scale-depression, and Cognitive Exercise Therapy Approach–Biopsychosocial questionnaire scores (p < 0.05) and in increasing the degree of change in the extension range of motion (ROM) and cervical flexor endurance values and scores in the energy parameter of Short Form-36 (p < 0.05). CONCLUSION: CT provided in addition to Pilates was more effective in reducing pain levels, disability, fear of movement, depression levels, and negative biopsychosocial status and improving extension ROM and cervical flexor endurance, neck awareness, and the energy/vitality parameter of quality of life in individuals with chronic neck pain. Show more

Keywords: Chronic pain, exercise, physical therapy modalities, endurance, core stability, rehabilitation

DOI: 10.3233/BMR-240170

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1715-1727, 2024

Authors: Longo, Umile Giuseppe | de Sire, Alessandro | De Salvatore, Sergio | Zollo, Giuliano | Di Matteo, Vincenzo | Corradini, Alessandra | Ceccaroli, Alice | Ammendolia, Valerio | Calabrese, Giovanni | D’Hooghe, Pieter

Article Type: Research Article

Abstract: BACKGROUND: Glenohumeral degenerative joint disease may affect up to 20% of the population. There are several classification systems of this disease in the scientific literature. OBJECTIVE: The aim of this study is to determine the reliability and reproducibility of glenohumeral osteoarthritis classification systems. METHODS: We assessed glenohumeral plain radiographs performed in a University Hospital. These radiographs were graded into nine radiological classification systems by two observers on two evaluations. Patients who have performed CT/MRI scan were staged according to the Walch classification. The intra-observer and inter-observer reliability of the classification schemes were determined …by using Cohen’s weighted kappa coefficient. RESULTS: A total of 752 patients were included in the study (52.4% females and 47.6% males), mean aged 66.2 ± 16.3 years. The intra-observer and inter-observer reliabilities were 0.543 (observer 1), 0.630 (observer 2), and 0.760 (inter-observer) for the Weinstein grading system; 0.661, 0.706, and 0.761 for the Guyette grading system; 0.575, 0.679 and 0.704 for the Kellgren and Lawrence classification; 0.817, 0.816 e 0.871 for the Samilson and Prieto classification; 0.791, 0.811 and 0.847 for the Allain modification; 0.797, 0.842 and 0.860 for the Gerber modification; 0.773, 0.827 and 0.828 for the Buscayret modification; 0.584, 0.648 and 0.755 for the Hawkins and Angelo classification; 0.661, 0.749 and 0.764 for the Rosenberg classification. Intra-observer reliability for MRI was 0.757 (observer 1) and 0.675 (observer 2), while intra-observer reliability for CT was 0.811 (observer 1) and 0.653 (observer 2). Inter-observer reliabilities were 0.790 for MRI and 0.673 for CT. CONCLUSION: The classification systems according to Weinstein, Guyette, Hawkins and Angelo, Rosenberg and the modifications of the Samilson and Prieto classification according to Allain, Gerber and Buscayret showed a comparable reliability with the commonly used glenohumeral osteoarthritis grading systems, Samilson and Prieto and Kellgren and Lawrence. Thus, they are recommended for clinical and especially scientific purposes. Show more

Keywords: Shoulder, glenohumeral osteoarthritis, radiological classifications, Walch classification, CT/MRI scan

DOI: 10.3233/BMR-240187

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1729-1739, 2024

Authors: Fatima, Sahar | Asif, Mohammad Musa | Zaheer, Anna | Arslan, Syed Asadullah | Qurat-Ul-Ain, Asifa | Farooq, Ayesha Ahmad

Article Type: Research Article

Abstract: BACKGROUND: The Avoidance Endurance Questionnaire (AEQ) successfully measures the fear-avoidance and endurance-related responses to chronic pain. OBJECTIVE: The objective of this study was to translate, cross-culturally adapt AEQ into Urdu and assess the reliability and validity of the Urdu version. METHOD: For the translation and cross-cultural adaptation process, the Beaton Guidelines were followed. A total of 103 participants responded to the Urdu version of the AEQ SF-12, Pain Catastrophizing Scale (PCS) and Numeric Pain Rating Scale (NPRS) at baseline and after 48 hours. The test-retest reliability was assessed using the intraclass correlation coefficient …(ICC). Cronbach’s alpha was used to measure internal consistency. To measure validity, Pearson’s correlation between the subscales of AEQ-Urdu and other outcome measures (SF-12, PCS and NPRS scores) were used (p < 0.05). RESULTS: The mean age of the total 103 participants was 32.7 ± 10.90 among which 45 (43.6%) were male and 58 (56.3%) were female. The pre-final version of the translated AEQ was tested on 40 Urdu speaking participants and no major changes were made. The Cronbach’s alpha for all subscales of the AEQ-Urdu ranged from 0.848–0.990. AEQ-U showed an excellent test-retest reliability with the ICC ranging from 0.775–0.996. The majority of the subscales of AEQ showed significant (p < 0.05) positive correlation with pain scales (PCS and NPRS) and negative correlation with the domains of SF-12. CONCLUSION: The AEQ-U has reliable and valid construct validity, good internal consistency, and test-retest reliability, indicating that it has adequate psychometric features and can be a useful tool for evaluating pain responses in patients with chronic musculoskeletal pain. Show more

Keywords: AEQ, chronic pain, NPRS, PCS, validity, reliability

DOI: 10.3233/BMR-240197

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1741-1748, 2024

Authors: Sahin, Tülay | Sacaklidir, Rekib | Sancar, Mert | Öztürk, Ekim Can

Article Type: Research Article

Abstract: BACKGROUND: Human assumed central sensitization (HACS) is a potential pathophysiological mechanism underlying a group of musculoskeletal disorders. HACS may negatively influence the outcomes of surgical or interventional procedures. OBJECTIVE: The present study aimed to investigate the impact of HACS on treatment outcomes of transforaminal epidural steroid injection (TFESI). METHODS: Patients who received fluoroscopy-guided single-level lumbosacral TFESI between January 2020 and January 2021 were included in the study. The patients were divided into two groups with respect to the existence of HACS. Patients were assessed before the procedure, at the third week, and at …the third month after the procedure. The presence of HACS was investigated by central sensitization inventory (CSI). The Numerical Rating Scale (NRS), Oswestry Disability Index (ODI), and Beck Depression Inventory (BDI) were used for patient assessment. RESULTS: A total of 65 patients were included in the study. Thirty-one of the patients had HACS. There was no difference between the groups in terms of demographic data. Significant improvement in NRS was found at 3rd week and 3rd month compared to the baseline. BDI and ODI scores were also significantly reduced at the end of 3 months (p < 0.001). NRS scores at all time points were significantly lower in patients without HACS (p < 0.05). CONCLUSION: The presence of HACS has a negative effect on pain scores, disability, and mental state in patients undergoing TFESI. Show more

Keywords: Lumbar disc herniation, epidural injections, central sensitization, central sensitization inventory

DOI: 10.3233/BMR-240231

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 6, pp. 1749-1755, 2024