Journal of Back and Musculoskeletal Rehabilitation - Volume 37, issue 4

Authors: de Sire, Alessandro | Ferrillo, Martina

Article Type: Editorial

DOI: 10.3233/BMR-245003

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 817-819, 2024

Authors: Arias-Vázquez, Pedro Iván | Guzzardo, Mauro Nicolás | Guzzardo, Duilio Román | Castillo-Avila, Rosa Giannina | Tovilla-Zárate, Carlos Alfonso | Ake Montiel, Miguel Angel Nazul

Article Type: Research Article

Abstract: BACKGROUND: Corticosteroid injections are frequently used in the short-term treatment of musculoskeletal pain, but their use is controversial as repeated exposures to corticosteroids can lead to deleterious effects on musculoskeletal tissue. Ozone injections have been proposed as a possible treatment for musculoskeletal pain; however, their effectiveness has not been compared with corticosteroids. OBJECTIVE: To evaluate the effectiveness of ozone injections for reducing pain in individuals with musculoskeletal pain in comparison with corticosteroid injections through a meta-analysis. METHODS: An online systematic search was performed using electronic databases up to September 2023. We searched for studies …that compared corticosteroid injections with ozone injections in the treatment of musculoskeletal pain of diverse origins. RESULTS: Eleven studies were included comprising a total of 534 individuals. In the overall pooled analysis, a pain reduction in favor of corticosteroid injections was found in the short term (d = 0.31, 95% CI 0.01 to 0.60, p (z) 0.04, I2 = 32%). In the medium term, no significant differences were found in reducing pain between groups (d = - 0.17, 95% CI - 0.42 to 0.07, p (z) 0.15, I2 = 0%). CONCLUSIONS: Our results suggest that corticosteroids injections are more effective in reducing musculoskeletal pain in the short term, but equally effective in the medium term when compared with ozone injections. Nonetheless, better-quality clinical trials are necessary to corroborate these results. Show more

Keywords: Musculoskeletal diseases, osteoarthritis, tendinopathy, nerve compression syndromes

DOI: 10.3233/BMR-230173

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 821-838, 2024

Authors: Cheng, Jinling | Han, Dongmiao | Qu, Jiayang | Liu, Zicai | Huang, Ying

Article Type: Review Article

Abstract: BACKGROUND: With lifestyle changes, the prevalence of flatfoot is increasing year by year, with a prevalence of 29%. Flatfoot will lead to an inevitable injury and reduce the quality of life. Short foot exercises can enhance the strength of the intrinsic muscles of the foot and improve the symptoms of flatfoot. However, there is controversy regarding its specific efficacy. OBJECTIVE: This meta-analysis quantitatively evaluates the effect of short foot training on patients with flatfeet and provides evidence to inform the clinical approach to short foot training in patients with flat feet. METHODS: A …total of eight databases were searched, including CNKI, WANFANG, VIP, and CBM in Chinese and PubMed, Cochrane, Web of Science, and Embase in English. The timeframe for searching the literature was March 2023 for each database build. English database search terms and search formulas were: (flat foot OR talipes valgus OR talipes calcaneovalgus) AND (short foot exercises OR physical therapy OR neurophysiotherapy). RESULTS: The current pooled results show no significant difference in the improvement of the navicular drop test and foot posture index with short foot exercises compared to controls; only short foot exercises greater than 6 w showed a significant improvement in the navicular drop test, and sensitivity analysis showed a significant improvement in the foot posture index with short foot exercises. CONCLUSION: This systematic review and meta-analysis showed that short foot exercises need a larger sample size to find their effect on improving flat feet; the duration of the intervention is a factor. As most studies are currently unclear whether the participants were patients with flat feet or asymptomatic individuals with flat feet the disease syndrome in patients with flatfoot may also be a factor. Show more

Keywords: Pes planus, flexible flatfoot, exercises

DOI: 10.3233/BMR-230226

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 839-851, 2024

Authors: Lippi, Lorenzo | de Sire, Alessandro | Turco, Alessio | Santi, Roberto Mario | Polverelli, Marco | Ammendolia, Antonio | Follenzi, Antonia | Invernizzi, Marco

Article Type: Review Article

Abstract: BACKGROUND: Hemophilic arthropathy is a detrimental condition that crucially affects functional outcomes in hemophilic patients. In recent years, due to the advances in systemic therapies, growing attention has been raised in the rehabilitation field in order to improve functional outcomes of hemophilic patients. However, the optimal rehabilitation modalities in these patients are far from being fully characterized. OBJECTIVE: The present study aimed to assess the effects of different rehabilitation interventions on physical functioning and health-related quality of life of hemophilic arthropathic patients. METHODS: The review followed the Preferred Reporting Items for Systematic Reviews and …Meta-analyses (PRISMA) statement. Five databases were systematically searched for randomized controlled trials (RCTs) published until June 22nd, 2023. The selection criteria included adult patients with hemophilia A and B receiving rehabilitation interventions. The outcomes were muscle strength, physical function, pain intensity, physical performance, and health-related quality of life. RESULTS: Out of 1,743 identified records, 17 studies were included in the qualitative synthesis. Rehabilitation interventions were categorized into exercise intervention, fascial therapy, and multimodal intervention. The findings suggested positive outcomes in terms of muscle modifications, range of motion improvements, joint health enhancements, pain intensity reduction, and quality of life improvements. More in detail, meta-analyses showed significant improvements in pain intensity [ES: - 1.10 cm (- 1.37, - 0.82), p < 0.00001], joint health [ES: - 1.10 (- 1.38, - 0.82), p < 0.00001], In accordance, exercise interventions showed significant benefits in terms of joint health [ES: - 2.54 (- 3.25, - 1.83), p < 0.00001)] and quality of life [ES: 1.17 (0.48, 1.86), p < 0.0000)]. CONCLUSION: Rehabilitation interventions have a positive impact on functional outcomes and health-related quality of life of hemophilic arthropathic patients. Further studies are needed to better elucidate the role of a comprehensive intervention combining different rehabilitation approaches to treat hemophilic arthropathy. Show more

Keywords: Hemophilia, rehabilitation, fascial therapy, physical exercise, muscle, hemophilic arthropathy

DOI: 10.3233/BMR-230320

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 853-870, 2024

Authors: Berduszek, Redmar J. | Reneman, Michiel F. | Dekker, Rienk | van der Sluis, Corry K.

Article Type: Research Article

Abstract: BACKGROUND: The shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Patient Rated Wrist/Hand Evaluation (PRWHE) are commonly used questionnaires to assess patient-reported hand function. Information about the measurement properties of the Dutch versions is scarce. OBJECTIVE: To gain insight into the measurement properties of the Dutch language versions of the QuickDASH and the PRWHE in patients with (non)specific complaints of the hand, wrist, forearm and elbow. METHODS: Internal consistency, construct validity, test-retest reliability, responsiveness, and floor and ceiling effects were assessed according to COnsensus-based Standards for the selection …of health Measurement INstruments (COSMIN) recommendations. RESULTS: Questionnaires were filled out by 132 patients. Internal consistency of QuickDASH (Cronbach’s α = 0.92) and PRWHE (Cronbach’s α = 0.97) was high. Predefined hypotheses for construct validity were not confirmed for 75% for both QuickDASH and PRWHE (accordance with 62% of predefined hypotheses for both questionnaires). Test-retest reliability of QuickDASH (ICC = 0.90) and PRWHE (ICC = 0.87) was good. Both QuickDASH (AUC = 0.84) and PRWHE (AUC = 0.80) showed good responsiveness. No floor or ceiling effects were present. CONCLUSIONS: Measurement properties of the Dutch language versions of the QuickDASH and the PRWHE, applied to patients with (non)specific complaints of the hand, wrist, forearm and elbow, were very similar. Test-retest reliability and responsiveness were good for both QuickDASH and PRWHE. Construct validity could not be demonstrated sufficiently. Show more

Keywords: Hand, upper extremity, patient reported outcome measures, pain measurement, disability evaluation, psychometrics

DOI: 10.3233/BMR-230225

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 871-881, 2024

Authors: Miçooğulları, Mehmet | Yüksel, İnci | Angın, Salih

Article Type: Research Article

Abstract: BACKGROUND: Cranio-cervico-mandibular (CCM) malalignment is associated with forward head posture (FHP) and temporomandibular joint (TMJ) disorders and affects masticatory muscles. OBJECTIVE: This randomized, double-blind controlled trial aimed to compare the efficacy of scapula-thoracic (ST) exercises on temporomandibular and cervical joint position sense and postural stability in individuals with CCM malalignment. METHODS: Fourty-nine participants with CCM malalignment were randomly assigned to the ST exercise group (STEG, n = 24) or the control group (CG, n = 25). STEG included progressive strengthening, proprioceptive, and stabilization …exercises. All participants were assessed before treatment, at the end of the 8th week treatment period and at the 12th week post-treatment follow-up. Cranio-vertebral angle measurement, Fonseca’s Questionnaire, Helkimo Clinical Dysfunction Index, TMJ position test, cervical joint position error test and postural stability assessment were used. RESULTS: The TMJ and cervical joint position sense, total sway degree, area gap percentage, sway velocity and antero-posterior body sway results showed significant improvement in the STEG compared to the CG (p < 0.05), however medio-lateral body sway did not differ between groups (p > 0.05). CONCLUSIONS: Postural stability, TMJ and cervical joint position sense appear to be affected in individuals with CCM malalignment. Our results showed that an exercise program including ST stabilization, proprioception and strengthening of the scapular muscles may be effective in the management of CCM malalignment and will allow clinicians to plan holistic treatment. Show more

Keywords: Temporomandibular joint disorders, exercise therapy, proprioception, posture

DOI: 10.3233/BMR-230323

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 883-896, 2024

Authors: Ylinen, Jari | Pasanen, Tero | Heinonen, Ari | Kivistö, Heikki | Kautiainen, Hannu | Multanen, Juhani

Article Type: Research Article

Abstract: BACKGROUND: Weakness and atrophy in trunk muscles have been associated with chronic low back pain (CLBP). OBJECTIVE: This study aimed to identify isometric exercises resulting the highest trunk muscle activity for individuals with and without CLBP. METHODS: Fourteen males with CLBP and 15 healthy age-matched healthy subjects were recruited for this study. Muscle activity during maximal voluntary isometric contraction (MVIC) was measured for a comparative reference with surface electromyography (sEMG) from six trunk muscles. Thereafter maximum EMG amplitude values were measured during eleven trunk stability exercises. The maximal EMG activity in each exercise …relative to the MVICs was analyzed using generalizing estimating equations (GEE) models with the unstructured correlation structure. RESULTS: The GEE models showed statistically significant differences in muscle activity between exercises within both groups (p < 0.001), with no significant differences between groups (p > 0.05). The highest muscle activity was achieved with the hip flexion machine for multifidus, side pull with a resistance band for lumbar extensors, side and single-arm cable pull exercises for thoracic extensors, rotary plank and the hip flexion machine for abdominal. CONCLUSION: This study found five isometric trunk exercises that exhibited highest muscle activity depending on muscle tested, with no significant difference between individuals with and without CLBP. Show more

Keywords: Electromyography, force measurement, isometric strength, resistance exercise, gym machine

DOI: 10.3233/BMR-230043

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 897-908, 2024

Authors: Zheng, Patricia | Ewing, Susan | Tang, Angelina | Black, Dennis | Hue, Trisha | Lotz, Jeffrey | Peterson, Thomas | Torres-Espin, Abel | O’Neill, Conor

Article Type: Research Article

Abstract: BACKGROUND: Tools, such as the STarTBack Screening Tool (SBT), have been developed to identify risks of progressing to chronic disability in low back pain (LBP) patients in the primary care population. However, less is known about predictors of change in function after treatment in the specialty care population. OBJECTIVE: We pursued a retrospective observational cohort study involving LBP patients seen in a multidisciplinary specialty clinic to assess which features can predict change in function at follow-up. METHODS: The SBT was administered at initial visit, and a variety of patient characteristics were available in …the chart including the presence of chronic overlapping pain conditions (COPCs). Patient Reported Outcomes Measurement Information System-10 (PROMIS-10) global physical health (PH) and global mental health (MH) were measured at baseline and at pragmatic time points during follow-up. Linear regression was used to estimate adjusted associations between available features and changes in PROMIS scores. RESULTS: 241 patients were followed for a mean of 17.0 ± 7.5 months. Mean baseline pain was 6.7 (SD 2.1), PROMIS-10 global MH score was 44.8 (SD 9.3), and PH score was 39.4 (SD 8.6). 29.7% were low-risk on the SBT, 41.8% were medium-risk, and 28.5% were high-risk. Mean change in MH and PH scores from baseline to the follow-up questionnaire were 0.86 (SD 8.11) and 2.39 (SD 7.52), respectively. Compared to low-risk patients, high-risk patients had a mean 4.35 points greater improvement in their MH score (p = 0.004) and a mean 3.54 points greater improvement in PH score (p = 0.006). Fewer COPCs also predicted greater improvement in MH and PH. CONCLUSIONS: SBT and the presence of COPC, which can be assessed at initial presentation to a specialty clinic, can predict change in PROMIS following treatment. Effort is needed to identify other factors that can help predict change in function after treatment in the specialty care setting. Show more

Keywords: Non-surgical spine care, precision medicine, specialty clinic, low back pain

DOI: 10.3233/BMR-230067

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 909-920, 2024

Authors: Hou, Xiaofei | Hu, Hailiang | Kong, Chao | Zhang, Sitao | Wang, Wei | Lu, Shibao

Article Type: Research Article

Abstract: BACKGROUND: The factors affecting lumbar spinal function in patients with degenerative lumbar spinal stenosis (DLSS) are still unclear. OBJECTIVE: This study explored psoas major muscle morphology in patients with DLSS and its association with their functional status. METHODS: A retrospective study was conducted on 288 patients with DLSS and 260 control subjects. Psoas major muscle evaluation included three morphometric parameters at the L3/4 disc level: psoas major index (PMI), muscle attenuation, and psoas major morphological changes (MPM). The association between psoas major morphology and functional status was assessed using the Oswestry disability index (ODI). …RESULTS: Both female and male patients with DLSS had a higher PMI and lower muscle attenuation. PMI and muscle attenuation were inversely correlated with age in the DLSS group. After multivariable analyses, the PMI and psoas major muscle attenuation were positively correlated with patients’ functional status. CONCLUSION: The PMI and muscle attenuation were positively correlated with functional status in patients with DLSS. These findings have important implications for physiotherapy programs of postoperative rehabilitation and conservative management of DLSS. Show more

Keywords: Degenerative lumbar spinal stenosis, psoas major muscle, morphology, functional status, oswestry disability index

DOI: 10.3233/BMR-230138

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 921-928, 2024

Authors: de Sire, Alessandro | Lippi, Lorenzo | Calafiore, Dario | Marotta, Nicola | Mezian, Kamal | Chiaramonte, Rita | Cisari, Carlo | Vecchio, Michele | Ammendolia, Antonio | Invernizzi, Marco

Article Type: Research Article

Abstract: BACKGROUND: Vertebral fragility fractures (VFFs) commonly result from low bone mass and microarchitecture deterioration of bone tissue. spinal orthoses are common non-pharmacological options for managing vertebral fracture pain. However, the effects of spinal orthoses on pain, physical functioning, and quality of life (QoL) are still debated. OBJECTIVE: This survey aimed to investigate the patients-reported outcomes of a dynamic spinal orthosis prescribed in the routine clinical practice of VFFs management. METHODS: This multi-center national-wide prospective cohort study assessed older patients (aged > 60 years) diagnosed with acute VFFs and prescribed with a …dynamic spinal orthosis (Spinfast® ). A survey questionnaire was realized and included sections on patient characterization, osteoporosis characterization, spinal orthosis, clinical outcomes, pain medications, and osteoporosis medications. The questionnaire was administered at baseline and after three months. A total of 68 patients completed the questionnaire at three months. Most patients had one or two VFFs and were treated with pain medications and osteoporosis medications. Compliance and tolerability of the spinal orthosis were assessed, and clinical outcomes such as pain intensity, physical functioning, and QoL were measured. RESULTS: The results showed no significant differences in outcomes between age subgroups. Italian physical medicine and rehabilitation physicians were commonly involved in the management of VFFs patients. Sixty-six patients completed the questionnaire. The results showed that pain intensity, physical functioning and QoL improved after three months of spinal orthosis wearing (p < 0.0001). CONCLUSION: The correct management of VFFs is mandatory to improve pain and reduce disability, and our findings suggested a positive role of dynamic spinal orthosis to improve the comprehensive management of VFFs patients. However, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF. Show more

Keywords: Osteoporosis, rehabilitation, spinal orthoses, spine, vertebral fractures

DOI: 10.3233/BMR-230177

Citation: Journal of Back and Musculoskeletal Rehabilitation, vol. 37, no. 4, pp. 929-941, 2024