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Werthman AM, Jolley BD, Rivera A, Rusli MA. Emergency Department Management of Low Back Pain: A Comparative Review of Guidelines and Practices. Cureus 2024; 16:e53712. [PMID: 38455774 PMCID: PMC10919314 DOI: 10.7759/cureus.53712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
This narrative review examines the current best practices and guidelines for integrating pharmacologic interventions, imaging, and physiotherapy in the management of low back pain. The review also explores how patient factors such as age, sex, comorbidities, and prevalent pathologies/diagnoses influence the choice and effectiveness of these treatment approaches.
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Affiliation(s)
- Alec M Werthman
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
| | - Brayden D Jolley
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
| | - Andrew Rivera
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
| | - Melissa A Rusli
- Internal Medicine, Lakeland Regional Health Medical Center, Lakeland, USA
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102
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Paschali M, Lazaridou A, Sadora J, Papianou L, Garland EL, Zgierska AE, Edwards RR. Mindfulness-based Interventions for Chronic Low Back Pain: A Systematic Review and Meta-analysis. Clin J Pain 2024; 40:105-113. [PMID: 37942696 DOI: 10.1097/ajp.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the United States each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized. DESIGN Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs), pilot RCTs, and single-arm studies that explored the effectiveness of MBIs in CLBP. METHODS Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7. RESULTS Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included mindfulness meditation, mindfulness-based stress reduction, mindfulness-based cognitive therapy, mindfulness-oriented recovery enhancement, acceptance and commitment therapy, dialectical behavioral therapy, meditation-cognitive behavioral therapy, mindfulness-based care for chronic pain, self-compassion course, and loving-kindness course. Pain intensity scores were reported using a numerical rating scale (0 to 10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP. CONCLUSIONS MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data the high variability in study methodologies, small sample sizes, inclusion of studies with high risk of bias, and reliance on pre-post treatment differences with no attention to maintenance of effects. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.
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Affiliation(s)
- Myrella Paschali
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Asimina Lazaridou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
- Fielding Graduate University, Santa Barbara, CA
| | | | - Lauren Papianou
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development
- College of Social Work, University of Utah, Salt Lake City, UT
| | - Aleksandra E Zgierska
- Departments of Family and Community Medicine, Public Health Sciences, and Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Hershey, PA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital
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Clemens KS, Vang M, Colloca L, Sieg M, Vase L, Ruble A, Geers AL. The desire for side-effect information in pain treatment: an experimental analysis of contextual and individual difference factors. Pain 2024; 165:383-391. [PMID: 37975871 DOI: 10.1097/j.pain.0000000000003025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/19/2023] [Indexed: 11/19/2023]
Abstract
ABSTRACT Informing patients about potential side effects of pain treatment is a requirement that protects patients and aids decision making, but it increases the likelihood of unwanted nocebo side effects. If patients do not desire all side-effect information, it may be possible to ethically reduce nocebo effects through authorized concealment of side effects, whereby patients and clinicians engage in shared decision-making to regulate the disclosure of side-effect information. Currently, there is no experimental data clarifying the factors that causally influence desire for side-effect information in pain treatment. In 2 cross-sectional, between-subjects scenario experiments (experiment 1 N = 498, experiment 2 N = 501), 18 to 79-year-old community adults learned about a lower back pain treatment, and potential side-effect severity, frequency, and duration were manipulated. Individual differences in information avoidance were also recorded. In both experiments, participants reported high desire for side-effect information, but the desire was reduced when side effects were described as less severe, less frequent, and participants scored high in information avoidance. Results were not moderated by participants' level of contact with the health care system, chronic health condition, or clinical pain history. Additional analyses indicated that low side-effect severity and frequency lessen desire for side-effect information because these variables reduce belief that side-effect information will be needed in the future and lower feelings of anticipated regret. The experiments identify situational and individual-difference factors that decrease the desire for side-effect information and provide evidence on when and for whom it may be useful for physicians to engage in shared medical decision-making with the goal of reducing nocebo side effects.
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Affiliation(s)
- Kelly S Clemens
- Department of Psychology, Illinois State University, Normal, IL, United States
| | - Michael Vang
- Department of Psychology, University of Toledo, Toledo, OH, United States
| | - Luana Colloca
- Pain and Translational Symptom Science Department, and Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, MD, United States
| | - Mette Sieg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Abigail Ruble
- Department of Counselor Education, Capital University, Bexley, OH, United States
| | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, OH, United States
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104
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McNaughton DT, Roseen EJ, Downie A, Jenkins H, Øverås CK, Young JJ, Fink HA, Stone KL, Cawthon P, Hartvigsen J. Stressful life events and low back pain in older men: A cross-sectional and prospective analysis using data from the MrOS study. Eur J Pain 2024; 28:263-272. [PMID: 37632158 PMCID: PMC10841215 DOI: 10.1002/ejp.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/17/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Stressful life events, such as loss of a partner, loss of a pet or financial problems, are more common with increasing age and may impact the experience of pain. The aim of the current study is to determine the cross-sectional and prospective association between stressful life events and low back pain reporting in the Osteoporotic Fracture in Men Study, a cohort of older men aged ≥65 years. METHODS At a study visit (March 2005-May 2006), 5149 men reported whether they had experienced a stressful life event or low back pain in the prior 12 months. Following that visit, data on low back pain patients were gathered through triannual questionnaires every 4 months for 1 year. Multivariable logistic regression analyses estimated the association of stressful life events with recent past low back pain or future low back pain. RESULTS N = 2930, (57%) men reported at least one stressful life event. The presence of a stressful life event was associated with greater odds of any low back pain (OR = 1.42 [1.26-1.59]) and activity-limiting low back pain (OR = 1.74 [1.50-2.01]) in the same period and of any low back pain (OR = 1.56 [1.39-1.74]) and frequent low back pain (OR = 1.80 [1.55-2.08]) in the following year. CONCLUSION In this cohort of men, the presence of stressful life events increased the likelihood of reporting past and future low back pain. SIGNIFICANCE Stressful life events such as accident or illness to a partner are common in later life and may impact the experience of pain. We present cross-sectional and prospective data highlighting a consistent association between stressful life events and low back pain in older men. Further, there is evidence to suggest that this relationship is upregulated by an individual's living situation. This information may be used to strengthen a biopsychosocial perspective of an individual's pain experience.
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Affiliation(s)
- David T McNaughton
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Eric J Roseen
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Hazel Jenkins
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Cecilie K Øverås
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Justin J Young
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada
| | - Howard A Fink
- Geriatric Research Education and Clinical Center, Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
| | - Katie L Stone
- Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Peggy Cawthon
- Research Institute, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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105
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Manica P, Claudatus J, Pertile R, Ariani A, Fioravanti A. Efficacy of balneotherapy on pain, function, and sleep quality in patients with chronic low-back pain: a prospective observational study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02626-4. [PMID: 38285108 DOI: 10.1007/s00484-024-02626-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 01/30/2024]
Abstract
The aim of this prospective observational study was to evaluate the efficacy of a cycle of sulfate-arsenical-ferruginous mud bath therapy on pain, function, and sleep quality in patients with chronic low-back pain (CLBP). One hundred twenty-three patients treated at Levico Spa Center (Italy) with 12 daily local mud packs and generalized thermal baths were included in this experience. General medical assessments were performed before starting the therapy, at the end of the treatment, and 3 months later. Pain intensity and stiffness were measured by a 0 to 10 cm visual analogue scale (VAS); the range of mobility of the lumbar spine was evaluated using the Schober test and functional disability by the Roland-Morris Disability Questionnaire (RMDI). The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The VAS score for pain and stiffness showed a significant reduction (p < 0.0001) at the end of the treatment persisting for 3 months of follow-up. Similarly, a significant improvement was found for the Schober test and RMDQ. Finally, we showed a significant decrease of PSQI score at the end of the cycle of mud bath and at 3 months of follow-up. The Spearman analysis showed a significant positive correlation between the score of PSQI and VAS pain, VAS stiffness, and RMDQ. In conclusion, this preliminary study confirms the beneficial and long-term efficacy of balneotherapy on pain and function and, for the first one, shows the positive effect on quality of sleep in patients with CLBP treated with a cycle of mud bath therapy.
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Affiliation(s)
- Patrizia Manica
- Thermal Resort of Levico and Vetriolo, Levico Terme, Trento, Italy
| | | | - Riccardo Pertile
- Department of Clinical and Evaluative Epidemiology, Healthcare Trust of the Autonomous Province of Trento, APSS, Trento, Italy
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106
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Villalba-Meneses F, Guevara C, Lojan AB, Gualsaqui MG, Arias-Serrano I, Velásquez-López PA, Almeida-Galárraga D, Tirado-Espín A, Marín J, Marín JJ. Classification of the Pathological Range of Motion in Low Back Pain Using Wearable Sensors and Machine Learning. SENSORS (BASEL, SWITZERLAND) 2024; 24:831. [PMID: 38339548 PMCID: PMC10857033 DOI: 10.3390/s24030831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/14/2023] [Accepted: 01/23/2024] [Indexed: 02/12/2024]
Abstract
Low back pain (LBP) is a highly common musculoskeletal condition and the leading cause of work absenteeism. This project aims to develop a medical test to help healthcare professionals decide on and assign physical treatment for patients with nonspecific LBP. The design uses machine learning (ML) models based on the classification of motion capture (MoCap) data obtained from the range of motion (ROM) exercises among healthy and clinically diagnosed patients with LBP from Imbabura-Ecuador. The following seven ML algorithms were tested for evaluation and comparison: logistic regression, decision tree, random forest, support vector machine (SVM), k-nearest neighbor (KNN), multilayer perceptron (MLP), and gradient boosting algorithms. All ML techniques obtained an accuracy above 80%, and three models (SVM, random forest, and MLP) obtained an accuracy of >90%. SVM was found to be the best-performing algorithm. This article aims to improve the applicability of inertial MoCap in healthcare by making use of precise spatiotemporal measurements with a data-driven treatment approach to improve the quality of life of people with chronic LBP.
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Affiliation(s)
- Fernando Villalba-Meneses
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain; (J.M.); (J.J.M.)
- School of Biological Sciences and Engineering, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador; (A.B.L.); (M.G.G.); (I.A.-S.); (P.A.V.-L.); (D.A.-G.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain
| | - Cesar Guevara
- Centro de Investigación en Mecatrónica y Sistemas Interactivos—MIST, Universidad Tecnológica Indoamérica, Quito 170103, Ecuador;
| | - Alejandro B. Lojan
- School of Biological Sciences and Engineering, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador; (A.B.L.); (M.G.G.); (I.A.-S.); (P.A.V.-L.); (D.A.-G.)
| | - Mario G. Gualsaqui
- School of Biological Sciences and Engineering, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador; (A.B.L.); (M.G.G.); (I.A.-S.); (P.A.V.-L.); (D.A.-G.)
| | - Isaac Arias-Serrano
- School of Biological Sciences and Engineering, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador; (A.B.L.); (M.G.G.); (I.A.-S.); (P.A.V.-L.); (D.A.-G.)
| | - Paolo A. Velásquez-López
- School of Biological Sciences and Engineering, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador; (A.B.L.); (M.G.G.); (I.A.-S.); (P.A.V.-L.); (D.A.-G.)
| | - Diego Almeida-Galárraga
- School of Biological Sciences and Engineering, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador; (A.B.L.); (M.G.G.); (I.A.-S.); (P.A.V.-L.); (D.A.-G.)
| | - Andrés Tirado-Espín
- School of Mathematical and Computational Sciences, Yachay Tech University, Hacienda San José s/n, San Miguel de Urcuquí 100119, Ecuador;
| | - Javier Marín
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain; (J.M.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain
| | - José J. Marín
- IDERGO (Research and Development in Ergonomics), I3A (Instituto de Investigación en Ingeniería de Aragón), University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain; (J.M.); (J.J.M.)
- Department of Design and Manufacturing Engineering, University of Zaragoza, C/Mariano Esquillor s/n, 50018 Zaragoza, Spain
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107
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Hamdan A, Mosleh R. How does the general population approach their pain? A cross-sectional study in Palestine. SAGE Open Med 2024; 12:20503121231223442. [PMID: 38268944 PMCID: PMC10807350 DOI: 10.1177/20503121231223442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024] Open
Abstract
Background Pain perception and management vary across cultural contexts; yet, little is known about pain approaches in the general population of Palestine. Existing research lacks specific knowledge about how pain is coped with in this region. Objective To explore pain management among Palestine's general population, studying prevalence, characteristics, and sociodemographic influences. It aims to uncover treatment choices and understand cultural impacts on pain experiences, offering insights into Palestinian pain perception and coping strategies. Methods Convenience and snowball sampling methods were employed to collect data from 646 adults in Palestine. Participants' sociodemographic characteristics, pain experiences, and pain management strategies were examined. Descriptive statistics, chi-square tests, and binary logistic regression followed by multiple logistic regressions were used for data analysis. Results A significant portion of participants reported experiencing pain, with chronic pain being predominant. Pain prevalence varied across age groups, with higher rates in the elderly, followed by middle-aged and younger participants. Marital status and education level were linked to pain prevalence. Participants employed diverse pain management strategies, such as self-medication, physician visits, complementary medicine, and physical therapy. Age, gender, marital status, and education level influenced choices in pain management approaches. For instance, the elderly favored traditional medical interventions, while higher education levels were associated with reduced inclination toward conventional treatments. Conclusion This study underscores the complex interaction of sociodemographic factors, pain experiences, and treatment preferences in pain management. It emphasizes personalized strategies considering age, marital status, education, and gender. Integrating these aspects improves treatment and satisfaction. The findings empower healthcare providers to create precise strategies, enhancing patient experiences for better outcomes.
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Affiliation(s)
- Anas Hamdan
- Faculty of Medicine and Health Sciences, Department of Anesthesia and Resuscitation Technology, An-Najah National University, Nablus, Palestine
| | - Rami Mosleh
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, Palestine
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108
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Wallwork SB, Braithwaite FA, O'Keeffe M, Travers MJ, Summers SJ, Lange B, Hince DA, Costa LOP, Menezes Costa LDC, Chiera B, Moseley GL. The clinical course of acute, subacute and persistent low back pain: a systematic review and meta-analysis. CMAJ 2024; 196:E29-E46. [PMID: 38253366 PMCID: PMC10805138 DOI: 10.1503/cmaj.230542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Understanding the clinical course of low back pain is essential to informing treatment recommendations and patient stratification. Our aim was to update our previous systematic review and meta-analysis to gain a better understanding of the clinical course of acute, subacute and persistent low back pain. METHODS To update our 2012 systematic review and meta-analysis, we searched the Embase, MEDLINE and CINAHL databases from 2011 until January 2023, using our previous search strategy. We included prospective inception cohort studies if they reported on participants with acute (< 6 wk), subacute (6 to less than 12 wk) or persistent (12 to less than 52 wk) nonspecific low back pain at study entry. Primary outcome measures included pain and disability (0-100 scale). We assessed risk of bias of included studies using a modified tool and assessed the level of confidence in pooled estimates using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. We used a mixed model design to calculate pooled estimates (mean, 95% confidence interval [CI]) of pain and disability at 0, 6, 12, 26 and 52 weeks. We treated time in 2 ways: time since study entry (inception time uncorrected) and time since pain onset (inception time corrected). We transformed the latter by adding the mean inception time to the time of study entry. RESULTS We included 95 studies, with 60 separate cohorts in the systematic review (n = 17 974) and 47 cohorts (n = 9224) in the meta-analysis. Risk of bias of included studies was variable, with poor study attrition and follow-up, and most studies did not select participants as consecutive cases. For the acute pain cohort, the estimated mean pain score with inception time uncorrected was 56 (95% CI 49-62) at baseline, 26 (95% CI 21-31) at 6 weeks, 22 (95% CI 18-26) at 26 weeks and 21 (95% CI 17-25) at 52 weeks (moderate-certainty evidence). For the subacute pain cohort, the mean pain score was 63 (95% CI 55-71) at baseline, 29 (95% CI 22-37) at 6 weeks, 29 (95% CI 22-36) at 26 weeks and 31 (95% 23-39) at 52 weeks (moderate-certainty evidence). For the persistent pain cohort, the mean pain score was 56 (95% CI 37-74) at baseline, 48 (95% CI 32-64) at 6 weeks, 43 (95% CI 29-57) at 26 weeks and 40 (95% CI 27-54) at 52 weeks (very low-certainty evidence). The clinical course of disability was slightly more favourable than the clinical course of pain. INTERPRETATION Participants with acute and subacute low back pain had substantial improvements in levels of pain and disability within the first 6 weeks ( moderate-certainty evidence); however, participants with persistent low back pain had high levels of pain and disability with minimal improvements over time (very low-certainty evidence). Identifying and escalating care in individuals with subacute low back pain who are recovering slowly could be a focus of intervention to reduce the likelihood of transition into persistent low back pain. PROTOCOL REGISTRATION PROSPERO - CRD42020207442.
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Affiliation(s)
- Sarah B Wallwork
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Felicity A Braithwaite
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Mary O'Keeffe
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Mervyn J Travers
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Simon J Summers
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Belinda Lange
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Dana A Hince
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Leonardo O P Costa
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Luciola da C Menezes Costa
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - Belinda Chiera
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
| | - G Lorimer Moseley
- IIMPACT in Health (Wallwork, Braithwaite, Moseley), University of South Australia, Kaurna Country, Adelaide, Australia; Persistent Pain Research Group, Hopwood Centre for Neurobiology (Braithwaite), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia; Institute for Musculoskeletal Health (O'Keeffe), School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; School of Health Sciences and Physiotherapy (Travers), University of Notre Dame Australia, Fremantle, Australia; School of Biomedical Science (Summers), Queensland University of Technology, Queensland, Australia; Caring Futures Institute (Lange), College of Nursing and Health Sciences, Flinders University, Adelaide, Australia; Institute for Health Research (Hince), Faculty of Medicine, Nursing, Midwifery and Health Sciences, University of Notre Dame, Fremantle, Australia; Masters and Doctoral Programs in Physical Therapy (Costa, Menezes Costa), Universidade Cidade de São Paulo, São Paulo, Brazil; UniSA STEM (Chiera), University of South Australia, Kaurna Country, Adelaide, Australia
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Parvar SY, Mojgani P, Lankarani KB, Poursaeed F, Mohamadi Jahromi LS, Mishra V, Abbasi A, Shahabi S. Barriers and facilitators to reducing low-value care for the management of low back pain in Iran: a qualitative multi-professional study. BMC Public Health 2024; 24:204. [PMID: 38233835 PMCID: PMC10792884 DOI: 10.1186/s12889-023-17597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Low back pain (LBP) is a prevalent musculoskeletal disorder with a wide range of etiologies, ranging from self-limiting conditions to life-threatening diseases. Various modalities are available for the diagnosis and management of patients with LBP. However, many of these health services, known as low-value care (LVC), are unnecessary and impose undue financial costs on patients and health systems. The present study aimed to explore the perceptions of service providers regarding the facilitators and barriers to reducing LVC in the management of LBP in Iran. METHODS This qualitative descriptive study interviewed a total of 20 participants, including neurosurgeons, physiatrists, orthopedists, and physiotherapists, who were selected through purposive and snowball sampling strategies. The collected data were analyzed using the thematic content analysis approach. RESULTS Thirty-nine sub-themes, with 183 citations, were identified as barriers, and 31 sub-themes, with 120 citations, were defined as facilitators. Facilitators and barriers to reducing LVC for LBP, according to the interviewees, were categorized into five themes, including: (1) individual provider characteristics; (2) individual patient characteristics; (3) social context; (4) organizational context; and (5) economic and political context. The ten most commonly cited barriers included unrealistic tariffs, provider-induced demand, patient distrust, insufficient time allocation, a lack of insurance coverage, a lack of a comprehensive referral system, a lack of teamwork, cultural challenges, a lack of awareness, and defensive medicine. Barriers such as adherence to clinical guidelines, improving the referral system, improving the cultural status of patients, and facilitators such as strengthening teamwork, developing an appropriate provider-patient relationship, improving the cultural status of the public, motivating the patients, considering an individualized approach, establishing a desirable payment mechanism, and raising the medical tariffs were most repeatedly stated by participants. CONCLUSION This study has pointed out a great number of barriers and facilitators that shape the provision of LVC in the management of LBP in Iran. Therefore, it is essential for relevant stakeholders to consider these findings in order to de-implement LVC interventions in the process of LBP management.
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Affiliation(s)
- Seyedeh Yasamin Parvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology, Tehran, Iran
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of The Islamic Republic of Iran, Tehran, Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Poursaeed
- Transitional Doctor of Physical Therapy Program, College of Professional Studies, Northeastern University, Boston, USA
| | - Leila Sadat Mohamadi Jahromi
- Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, UAE
| | - Alireza Abbasi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
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110
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Ceulemans D, Moens M, Reneman M, Callens J, De Smedt A, Godderis L, Goudman L, Lavreysen O, Putman K, Van de Velde D. Biopsychosocial rehabilitation in the working population with chronic low back pain: a concept analysis. J Rehabil Med 2024; 56:jrm13454. [PMID: 38226563 PMCID: PMC10802789 DOI: 10.2340/jrm.v56.13454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/29/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVE To identify the essential attributes of biopsychosocial rehabilitation for chronic low back pain in the working population. DESIGN A concept analysis was conducted according to the 8-step method of Walker and Avant. This framework provides a clear concept and theoretical and operational definitions. METHODS Five databases were searched, followed by a systematic screening. Subsequently, attributes, illustrative cases, antecedents, consequences and empirical referents were formulated. RESULTS Of the 3793 studies identified, 42 unique references were included. Eleven attributes were identified: therapeutic exercise, psychological support, education, personalization, self-management, participation, follow-up, practice standard, goal-setting, social support, and dietary advice. Subsequently, illustrative cases were described. Antecedents, such as motivation, preparedness and a multidisciplinary team, were found, together with consequences such as decreased pain, less sick-leave and increased function and work status. Finally, examples of empirical referents were given. CONCLUSION This study identified the attributes that are necessary to develop biopsychosocial rehabilitation intervention programmes for chronic low back pain. The defined concept of biopsychosocial rehabilitation for chronic low back pain may serve as a solid base to further develop and apply interventions. Future research should focus on the objectification of biopsychosocial rehabilitation and conceptualization regarding how personalization is done.
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Affiliation(s)
- Dries Ceulemans
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium; STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium.
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Michiel Reneman
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jonas Callens
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Ann De Smedt
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Department of Physical Medicine and Rehabilitation, Universitair Ziekenhuis Brussel, Jette, Belgium
| | - Lode Godderis
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium; IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Jette, Belgium; Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Jette, Belgium; Department of Neurosurgery, Universitair Ziekenhuis Brussel, Jette, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium
| | - Olivia Lavreysen
- STIMULUS Research Group, Vrije Universiteit Brussel, Jette, Belgium; Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven (University of Leuven), Leuven, Belgium
| | - Koen Putman
- Interuniversity Centre for Health Economics Research (I-CHER), Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Healthcare Sciences, Department of Rehabilitation Sciences, Occupational Therapy Research Group, Ghent University, Ghent, Belgium
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Zhang Y, Liu L, Qi Y, Lou J, Chen Y, Liu C, Li H, Chang X, Hu Z, Li Y, Zhang Y, Feng C, Zhou Y, Zhai Y, Li C. Lactic acid promotes nucleus pulposus cell senescence and corresponding intervertebral disc degeneration via interacting with Akt. Cell Mol Life Sci 2024; 81:24. [PMID: 38212432 PMCID: PMC11071984 DOI: 10.1007/s00018-023-05094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
The accumulation of metabolites in the intervertebral disc is considered an important cause of intervertebral disc degeneration (IVDD). Lactic acid, which is a metabolite that is produced by cellular anaerobic glycolysis, has been proven to be closely associated with IVDD. However, little is known about the role of lactic acid in nucleus pulposus cells (NPCs) senescence and oxidative stress. The aim of this study was to investigate the effect of lactic acid on NPCs senescence and oxidative stress as well as the underlying mechanism. A puncture-induced disc degeneration (PIDD) model was established in rats. Metabolomics analysis revealed that lactic acid levels were significantly increased in degenerated intervertebral discs. Elimination of excessive lactic acid using a lactate oxidase (LOx)-overexpressing lentivirus alleviated the progression of IVDD. In vitro experiments showed that high concentrations of lactic acid could induce senescence and oxidative stress in NPCs. High-throughput RNA sequencing results and bioinformatic analysis demonstrated that the induction of NPCs senescence and oxidative stress by lactic acid may be related to the PI3K/Akt signaling pathway. Further study verified that high concentrations of lactic acid could induce NPCs senescence and oxidative stress by interacting with Akt and regulating its downstream Akt/p21/p27/cyclin D1 and Akt/Nrf2/HO-1 pathways. Utilizing molecular docking, site-directed mutation and microscale thermophoresis assays, we found that lactic acid could regulate Akt kinase activity by binding to the Lys39 and Leu52 residues in the PH domain of Akt. These results highlight the involvement of lactic acid in NPCs senescence and oxidative stress, and lactic acid may become a novel potential therapeutic target for the treatment of IVDD.
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Affiliation(s)
- Yuyao Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Libangxi Liu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
- Department of Orthopedics, General Hospital of Central Theater Command of PLA, Wuhan, 430000, China
| | - Yuhan Qi
- Institute of Basic Theory of Traditional Chinese Medicine, China Academy of Chinese Medical Science, Beijing, 100000, China
| | - Jinhui Lou
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Yuxuan Chen
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Chao Liu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Haiyin Li
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Xian Chang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Zhilei Hu
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Yueyang Li
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Yang Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China
| | - Yu Zhai
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China.
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Military Medical University, Chongqing, 400037, China.
- State Key Laboratory of Trauma, Burn and Combined Injury, Army Military Medical University, Chongqing, 400038, China.
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Almansour AH, Almutairi DS, Alaskar TM, Kalkatawi MS, Aljubair MF, Alotaibi RS, AlHarkan KS, Alqahtani HA, AlOmar RS. Prevalence of low back pain and disability among secondary school teacher in the eastern province of the Kingdom of Saudi Arabia: a cross-sectional analytical study. Front Public Health 2024; 12:1307845. [PMID: 38282762 PMCID: PMC10810998 DOI: 10.3389/fpubh.2024.1307845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Introduction Lower back pain is common worldwide and affects over 600,000 people annually, including teachers. The study aimed to investigate the prevalence of low back pain and disability among secondary school teachers in the Eastern Province of the Kingdom of Saudi Arabia. Materials and methods This cross-sectional study included secondary school teachers in the eastern province of Saudi Arabia. 34 schools were selected using a multistage stratified sampling approach. Teachers were allotted randomly and proportionally to each school. Data was collected by anonymous questionnaire having three elements: sociodemographic and health-related questions, the Standardized Nordic Questionnaire, and the Oswestry Low Back Pain Disability Questionnaire. The anthropometric data was also included. Both unadjusted and adjusted logistic regression analyses were performed. Results A total of 601 teachers participated in the study with 62.56% reported low back pain. The overall mean age was 40.31 ± 8.13 years. The male-to-female ratio was similar. Back pain was significantly higher among females than males (73.36 and 51.52%, respectively). Additionally, back pain will significantly increase when stress levels and the number of classes increases. A positive correlation was found between age with low back pain (p = 0.001).There was minimal disability in 64.63% of the 376 teachers who reported low back pain, moderate disability in 29.79%, and severe disability in 4.79%, and only three (0.8%) were considered crippled. Females were more frequently seen in moderate and crippled categories, and perceived stress levels generally increased mean disability scores. Age and female gender were revealed to be significant predictors of low back pain by logistic regression (adjusted odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02-1.07) and (adjusted OR = 2.11, 95% CI = 1.45-3.05), respectively. The number of classes per week was also a significant predictor. Conclusion This study adds to the epidemiological evidence that reveals a high prevalence of low back pain and disability among teachers. Identified risk factors in this study may also reinforce the importance of setting different interventions and preventive measures to reduce lower back pain risk.
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Affiliation(s)
- Abdulelah H. Almansour
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Danah S. Almutairi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Turki M. Alaskar
- Department of Occupational Medicine, Khobar Health Network, Eastern Health Cluster, Ministry of Health, Khobar, Saudi Arabia
| | - Mohannad S. Kalkatawi
- Department of Public Health, Health Sciences College Al-Leith, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Mohammed F. Aljubair
- Erada Complex and Mental Health, Eastern Health Cluster, Ministry of Health, Dammam, Saudi Arabia
| | - Rakan S. Alotaibi
- Department of Occupational Medicine, Ministry of Defense, Khobar, Saudi Arabia
| | - Khalid S. AlHarkan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hatem A. Alqahtani
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem S. AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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113
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Shamsi M, Mirzaei M, Hopayian K. A controlled clinical trial investigating the effects of stretching and compression exercises on electromyography of calf muscles in chronic LBP patients with a deep gluteal syndrome. BMC Sports Sci Med Rehabil 2024; 16:12. [PMID: 38200475 PMCID: PMC10782553 DOI: 10.1186/s13102-023-00802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/28/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND In deep gluteal syndrome (DGS), the piriformis muscle could impinge the sciatic nerve. The FAIR (flexion adduction internal rotation) test is a provocation test used to identify sciatic nerve irritation caused by this muscle. Compression and stretching exercises are usually prescribed to treat this syndrome. The aim of this study was to compare the effects of these two treatments on surface electromyography (sEMG) of the gastrocnemius and tibialis anterior in patients with low back pain (LBP) and DGS. MATERIALS AND METHODS Forty-five participants were allocated to three groups of stretching exercise, compression or control. In addition to 15 min of heat and 15 min of electrical nerve stimulation for pain relief, participants in the compression exercise (CE) group received self-compression exercise, those in the stretching exercise (SE) group received self-stretching exercise and those in the control group received no extra interventions. For the two intervention groups, three sets of two minutes of exercise with two minutes of rest in between were applied. The sEMG amplitude values of the gastrocnemius and tibialis anterior muscles of the affected buttock side of any one group while performing the FAIR test were compared to the others. Pain and disability were assessed and the changes were compared between the two groups. RESULTS After the intervention period, no group demonstrated a change in the sEMG of the gastrocnemius or tibialis anterior muscles (p > 0.05). There was no difference in the change in this variable between groups (Mean difference (95% CI) of gastrocnemius was ranged over= -4.04 to 7.72 (-19.44 to 23.14); p = 0.603); (Mean difference (95% CI) of tibialis anterior muscles was ranged from - 2.44 to -6.43 (-18.28 to 9.31); p = 0.550).; Pain and disability also decreased significantly in all three study groups (p < 0.05). However, only the disability of patients who performed stretching exercises improved compared to the compression exercise group (Mean difference (95% CI) = -12.62 (-20.41 to -4.38); p = 0.009). CONCLUSION Neither stretching nor compression exercises altered the sEMG of the gastrocnemius and tibialis anterior muscles in patients with DGS. Furthermore, performing stretching exercises improved disability compared to the other interventions. TRIAL REGISTRATION The trial was retrospectively registered in the Iranian Registry of Clinical Trials ( www.irct.ir ) on 10/01/2017 as IRCT201604178035N4. URL of the record: https://en.irct.ir/trial/8473 .
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Affiliation(s)
- MohammadBagher Shamsi
- Department of Physiotherapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Mirzaei
- Department of Physiotherapy, School of Rehabilitation Sciences, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Kevork Hopayian
- Centre for Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
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Kuchynsky K, Stevens P, Hite A, Xie W, Diop K, Tang S, Pietrzak M, Khan S, Walter B, Purmessur D. Transcriptional profiling of human cartilage endplate cells identifies novel genes and cell clusters underlying degenerated and non-degenerated phenotypes. Arthritis Res Ther 2024; 26:12. [PMID: 38173036 PMCID: PMC10763221 DOI: 10.1186/s13075-023-03220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/22/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Low back pain is a leading cause of disability worldwide and is frequently attributed to intervertebral disc (IVD) degeneration. Though the contributions of the adjacent cartilage endplates (CEP) to IVD degeneration are well documented, the phenotype and functions of the resident CEP cells are critically understudied. To better characterize CEP cell phenotype and possible mechanisms of CEP degeneration, bulk and single-cell RNA sequencing of non-degenerated and degenerated CEP cells were performed. METHODS Human lumbar CEP cells from degenerated (Thompson grade ≥ 4) and non-degenerated (Thompson grade ≤ 2) discs were expanded for bulk (N=4 non-degenerated, N=4 degenerated) and single-cell (N=1 non-degenerated, N=1 degenerated) RNA sequencing. Genes identified from bulk RNA sequencing were categorized by function and their expression in non-degenerated and degenerated CEP cells were compared. A PubMed literature review was also performed to determine which genes were previously identified and studied in the CEP, IVD, and other cartilaginous tissues. For single-cell RNA sequencing, different cell clusters were resolved using unsupervised clustering and functional annotation. Differential gene expression analysis and Gene Ontology, respectively, were used to compare gene expression and functional enrichment between cell clusters, as well as between non-degenerated and degenerated CEP samples. RESULTS Bulk RNA sequencing revealed 38 genes were significantly upregulated and 15 genes were significantly downregulated in degenerated CEP cells relative to non-degenerated cells (|fold change| ≥ 1.5). Of these, only 2 genes were previously studied in CEP cells, and 31 were previously studied in the IVD and other cartilaginous tissues. Single-cell RNA sequencing revealed 11 unique cell clusters, including multiple chondrocyte and progenitor subpopulations with distinct gene expression and functional profiles. Analysis of genes in the bulk RNA sequencing dataset showed that progenitor cell clusters from both samples were enriched in "non-degenerated" genes but not "degenerated" genes. For both bulk- and single-cell analyses, gene expression and pathway enrichment analyses highlighted several pathways that may regulate CEP degeneration, including transcriptional regulation, translational regulation, intracellular transport, and mitochondrial dysfunction. CONCLUSIONS This thorough analysis using RNA sequencing methods highlighted numerous differences between non-degenerated and degenerated CEP cells, the phenotypic heterogeneity of CEP cells, and several pathways of interest that may be relevant in CEP degeneration.
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Affiliation(s)
- Kyle Kuchynsky
- Department of Biomedical Engineering, The Ohio State University, 3016 Fontana Laboratories, 140 W. 19th Ave, Columbus, OH, 43210, USA
| | - Patrick Stevens
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Amy Hite
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - William Xie
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, OH, USA
| | - Khady Diop
- Department of Biomedical Engineering, The Ohio State University, 3016 Fontana Laboratories, 140 W. 19th Ave, Columbus, OH, 43210, USA
| | - Shirley Tang
- Department of Biomedical Engineering, The Ohio State University, 3016 Fontana Laboratories, 140 W. 19th Ave, Columbus, OH, 43210, USA
| | - Maciej Pietrzak
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
- The James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Safdar Khan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Benjamin Walter
- Department of Biomedical Engineering, The Ohio State University, 3016 Fontana Laboratories, 140 W. 19th Ave, Columbus, OH, 43210, USA
| | - Devina Purmessur
- Department of Biomedical Engineering, The Ohio State University, 3016 Fontana Laboratories, 140 W. 19th Ave, Columbus, OH, 43210, USA.
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Weerasekera A, Knight PC, Alshelh Z, Morrissey EJ, Kim M, Zhang Y, Napadow V, Anzolin A, Torrado-Carvajal A, Edwards RR, Ratai EM, Loggia ML. Thalamic neurometabolite alterations in chronic low back pain: a common phenomenon across musculoskeletal pain conditions? Pain 2024; 165:126-134. [PMID: 37578456 PMCID: PMC10841327 DOI: 10.1097/j.pain.0000000000003002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/14/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT Recently, we showed that patients with knee osteoarthritis (KOA) demonstrate alterations in the thalamic concentrations of several metabolites compared with healthy controls: higher myo-inositol (mIns), lower N-acetylaspartate (NAA), and lower choline (Cho). Here, we evaluated whether these metabolite alterations are specific to KOA or could also be observed in patients with a different musculoskeletal condition, such as chronic low back pain (cLBP). Thirty-six patients with cLBP and 20 healthy controls were scanned using 1 H-magnetic resonance spectroscopy (MRS) and a PRESS (Point RESolved Spectroscopy) sequence with voxel placement in the left thalamus. Compared with healthy controls, patients with cLBP demonstrated lower absolute concentrations of NAA ( P = 0.0005) and Cho ( P < 0.05) and higher absolute concentrations of mIns ( P = 0.01) when controlling for age, as predicted by our previous work in KOA. In contrast to our KOA study, mIns levels in this population did not significantly correlate with pain measures (eg, pain severity or duration). However, exploratory analyses revealed that NAA levels in patients were negatively correlated with the severity of sleep disturbance ( P < 0.01), which was higher in patients compared with healthy controls ( P < 0.001). Additionally, also in patients, both Cho and mIns levels were positively correlated with age ( P < 0.01 and P < 0.05, respectively). Altogether, these results suggest that thalamic metabolite changes may be common across etiologically different musculoskeletal chronic pain conditions, including cLBP and KOA, and may relate to symptoms often comorbid with chronic pain, such as sleep disturbance. The functional and clinical significance of these brain changes remains to be fully understood.
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Affiliation(s)
- Akila Weerasekera
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Paulina C. Knight
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Zeynab Alshelh
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Erin J. Morrissey
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Minhae Kim
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Yi Zhang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vitaly Napadow
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Alessandra Anzolin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Angel Torrado-Carvajal
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Robert R. Edwards
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eva-Maria Ratai
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Marco L. Loggia
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Knox PJ, Pugliese JM, Pohlig RT, Coyle PC, Sions JM, Hicks GE. A Clinical Measure of Trunk Neuromuscular Function Predicts Falling in Older Adults With Chronic Low Back Pain. J Geriatr Phys Ther 2024; 47:13-20. [PMID: 36827686 PMCID: PMC10447628 DOI: 10.1519/jpt.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Older adults with low back pain (LBP) are at risk for falling, but condition-specific mechanisms are unknown. Trunk neuromuscular function is critical for maintaining balance during mobility tasks and is often impaired in older adults with LBP. The purpose of this study was to assess whether aberrant lumbopelvic movements (or aberrant movements), a clinical index of trunk neuromuscular function, were associated with increased fall risk among older adults with chronic LBP over a 12-month follow-up period. METHODS This study analyzed data from a prospective cohort study of 250 community-dwelling older adults with chronic LBP. Participants were screened for 4 aberrant movements during 3 trials of forward flexion from a standing position: instability catch, painful arc, altered lumbopelvic rhythm, and Gower's sign. Aberrant movements were totaled to yield a summary score (ie, 0-4). Prospective falls were monitored via monthly fall calendars for 12 months. A generalized linear model with Poisson distribution and log link function was used to evaluate the association between aberrant movements and prospective fall risk. Age, sex, body mass index, LBP intensity, dynamic balance performance, prior falls, anxiolytic medication usage, and hip osteoarthritis characteristics were included as covariates in the model. RESULTS Baseline aberrant movements were independently associated with greater fall risk (risk ratio = 1.249, 95% CI = 1.047-1.491, P = .014); each 1-unit increase in aberrant movement score imparted a 24.9% increase in the risk of falling. CONCLUSIONS Aberrant movements increased the risk of falling among older adults with chronic LBP over a 1-year span.
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Affiliation(s)
- Patrick J. Knox
- Department of Physical Therapy, University of Delaware, Newark, DE
| | | | - Ryan T. Pohlig
- Department of Epidemiology, University of Delaware, Newark, DE
- Biostatistics Core, University of Delaware, Newark, DE
| | - Peter C. Coyle
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Jaclyn M. Sions
- Department of Physical Therapy, University of Delaware, Newark, DE
| | - Gregory E. Hicks
- Department of Physical Therapy, University of Delaware, Newark, DE
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Zhou D, Liu H, Zheng Z, Wu D. Design principles in mechanically adaptable biomaterials for repairing annulus fibrosus rupture: A review. Bioact Mater 2024; 31:422-439. [PMID: 37692911 PMCID: PMC10485601 DOI: 10.1016/j.bioactmat.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 09/12/2023] Open
Abstract
Annulus fibrosus (AF) plays a crucial role in the biomechanical loading of intervertebral disc (IVD). AF is difficult to self-heal when the annulus tears develop, because AF has a unique intricate structure and biologic milieu in vivo. Tissue engineering is promising for repairing AF rupture, but construction of suitable mechanical matching devices or scaffolds is still a grand challenge. To deeply know the varied forces involved in the movement of the native annulus is highly beneficial for designing biomimetic scaffolds to recreate the AF function. In this review, we overview six freedom degrees of forces and adhesion strength on AF tissue. Then, we summarize the mechanical modalities to simulate related forces on AF and to assess the characteristics of biomaterials. We finally outline some current advanced techniques to develop mechanically adaptable biomaterials for AF rupture repair.
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Affiliation(s)
- Dan Zhou
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Hongmei Liu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zhaomin Zheng
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
- Pain Research Center, Sun Yat-Sen University, Guangzhou 510080, China
| | - Decheng Wu
- Guangdong Provincial Key Laboratory of Advanced Biomaterials, Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
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Van Wesemael S, Bogaerts K, De Baets L, Goossens N, Vlemincx E, Amerijckx C, Sohail S, Matheve T, Janssens L. The association between pain-related psychological variables and postural control in low back pain: A systematic review and meta-analysis. Gait Posture 2024; 107:253-268. [PMID: 37925241 DOI: 10.1016/j.gaitpost.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/13/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Alterations in postural control have been found in individuals with low back pain (LBP), particularly during challenging postural tasks. Moreover, higher levels of negative pain-related psychological variables are associated with increased trunk muscle activity, reduced spinal movement, and worse maximal physical performance in individuals with LBP. RESEARCH QUESTION Are pain-related psychological variables associated with postural control during static bipedal standing tasks in individuals with LBP? METHODS A systematic review and meta-analysis were conducted. Pubmed, Web of Science, and PsycINFO were searched until March 2023. Studies were included if they evaluated postural control during static bipedal standing in individuals with LBP by measuring center of pressure (CoP) variables, and reported at least one pain-related psychological variable. Correlation coefficients between pain-related psychological variables and CoP variables were extracted. Study quality was assessed with the "Quality In Prognosis Studies" tool (QUIPS). Random-effect models were used to calculate pooled correlation coefficients for different postural tasks. Sub-analyses were performed for positional or dynamic CoP variables. Certainty of evidence was assessed with an adjusted "Grading of Recommendations, Assessment, Development, and Evaluations" tool (GRADE). The protocol was registered on PROSPERO (CRD42021241739). RESULTS Sixteen studies (n = 723 participants) were included. Pain-related fear (16 studies) and pain catastrophizing (three studies) were the only reported pain-related psychological variables. Both pain-related fear (-0.04 < pooled r < 0.14) and pain catastrophizing (0.28 < pooled r < 0.29) were weakly associated with CoP variables during different postural tasks. For all associations, the certainty of evidence was very low. SIGNIFICANCE Pain-related fear and pain catastrophizing are only weakly associated with postural control during static bipedal standing in individuals with LBP, regardless of postural task difficulty. Certainty of evidence is very low thus it is conceivable that future studies accounting for current study limitations might reveal different findings.
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Affiliation(s)
- Sofie Van Wesemael
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium.
| | - Katleen Bogaerts
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium; KU Leuven, Health Psychology, Faculty of Psychology and Educational Sciences, Tiensestraat 102, 3000 Leuven, Belgium
| | - Liesbet De Baets
- Vrije Universiteit Brussel, Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Pleinlaan 2, 1050 Brussels, Belgium
| | - Nina Goossens
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
| | - Elke Vlemincx
- KU Leuven, Health Psychology, Faculty of Psychology and Educational Sciences, Tiensestraat 102, 3000 Leuven, Belgium; Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam Movement Sciences Research Institute, Department of Health Sciences, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Charlotte Amerijckx
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
| | - Suniya Sohail
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium; Foundation University Islamabad, Department of Rehabilitation Sciences, Defence Avenue, Phase-I, DHA, 44000 Islamabad, Pakistan
| | - Thomas Matheve
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium; Ghent University, Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Lotte Janssens
- UHasselt, REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Agoralaan Gebouw A, 3590 Diepenbeek, Belgium
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Levy AS, Maddy K, Murray A, John DL, Kumar V, Urakov T. Transforaminal lumbar interbody fusion with placement of steerable banana cage: A single-center retrospective analysis of radiographic parameters of success. Radiography (Lond) 2024; 30:163-167. [PMID: 38035428 DOI: 10.1016/j.radi.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies. METHODS This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected. RESULTS 26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001). CONCLUSIONS TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels. IMPLICATIONS FOR PRACTICE As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection.
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Affiliation(s)
- A S Levy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - K Maddy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - A Murray
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - D L John
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - V Kumar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - T Urakov
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
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Struyf N, Vanwing T, Jacquet W, Ho-A-Tham N, Dankaerts W. What do we know about Indigenous Peoples with low back pain around the world? A topical review. Scand J Pain 2024; 24:sjpain-2023-0114. [PMID: 38497253 DOI: 10.1515/sjpain-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Low back pain (LBP) represents a worldwide burden with rising disability, especially in low- and middle-income countries. Indigenous Peoples are exposed to many risk factors for LBP and seem to have overall worse health and higher mortality compared to non-Indigenous. This article aims to provide a topical overview of LBP in Indigenous Peoples. METHODS A comprehensive search was done using the keywords "Indigenous" and "back pain." Secondly, a cross-reference search of the citations list of the included articles was conducted. RESULTS LBP is a prevalent, disabling health condition among Indigenous Peoples that impacts activities of daily living, emotional well-being, and cultural identity. Indigenous Peoples face numerous and unique barriers to obtain Western health care. LBP in Indigenous Peoples is partly iatrogenic and available health care lacks a culturally secure setting. In combination with racism and discrimination by health care providers, this leads to miscommunication, frustration, and poor outcome in Indigenous patients around the world. CONCLUSION Contextual considerations and interpretation of findings within the appropriate cultural context are needed in future research and treatment of LBP in Indigenous Peoples. However, our literature analysis exhibits disproportionate representation with the scarcity of studies of Indigenous Peoples of Asia and Africa. Addressing this gap in the literature could provide significant scientific value. Indigenous Peoples should not be forgotten in reducing the global burden for LBP.
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Affiliation(s)
- Niels Struyf
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
- Onderzoeksgroep Musculoskeletale Revalidatie, Tervuursevest 101 - Bus 1501, 3001 Leuven Belgium
| | - Tom Vanwing
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Wolfgang Jacquet
- Department of Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nancy Ho-A-Tham
- Department of Physiotherapy, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Wim Dankaerts
- Department of Rehabilitation Sciences, Research Group for Musculoskeletal Rehabilitation, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Kaltoft K, Nielsen JL, Andersen AMN, Falch-Joergensen AC. The relation between preterm birth and self-reported spinal pain in pre-adolescence-a study of 47,063 subjects from the Danish National Birth Cohort. Eur J Pediatr 2024; 183:203-211. [PMID: 37861793 PMCID: PMC10857978 DOI: 10.1007/s00431-023-05264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023]
Abstract
Repeated exposure to pain and stress in early life may cause alterations in pain sensitivity later in life. Children born preterm are often exposed to painful invasive procedures. This study aimed to explore the relationship between being born preterm and self-report of spinal pain in pre-adolescence. This prospective study was based on the Danish National Birth Cohort and consisted of 47,063 11-14-year-olds. Data from the Danish National Birth Cohort were linked with national registers through Statistics Denmark. Analyses were performed as multiple logistic regression models estimating odds ratios and 95% confidence intervals. Spinal pain (neck, mid back, and/or low back pain) was assessed using a subdivision of the Young Spine Questionnaire. Severe spinal pain was defined as having pain often or once in a while with an intensity of four to six on the Revised Faces Pain Scale. Inverse probability weighting was used to account for potential selection bias. Girls born very preterm (< 34 full weeks of gestation) were less likely to report spinal pain (OR: 0.60; 95% CI: 0.40-0.93) compared with those term-born. The associations were weaker when examining moderate to severe spinal pain and when examining the three spinal regions separately. None of these was statistically significant. CONCLUSION We found no associations for boys. In conclusion, this study indicates that girls born very preterm are seemingly less likely to have severe spinal pain in pre-adolescence than girls born at term. WHAT IS KNOWN • Spinal pain is one of the largest disease burdens globally, and the evidence regarding the etiology of spinal pain in children and adolescents is limited. • Repeated exposure to pain and stress in early life (i.e., being preterm) may cause alterations in pain sensitivity later in life. WHAT IS NEW • Girls born very preterm (< 34 full weeks of gestation) seem less likely to report severe spinal pain in pre-adolescence compared with girls born at full term. • There is no association between gestational age and later experience of spinal pain in pre-adolescent boys.
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Affiliation(s)
- Klara Kaltoft
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark
| | - Jane Lykke Nielsen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark
| | - Anne-Marie Nybo Andersen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark
| | - Anne Cathrine Falch-Joergensen
- Section of Epidemiology, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Oster Farimagsgade 5, bd. 24, DK-1014, Copenhagen K, Denmark.
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Oh J, Yeo J. Trends in the prescription of opioids and gabapentinoids in patients with failed back surgery syndrome in Korea: a population-based study. Korean J Pain 2024; 37:73-83. [PMID: 38130090 PMCID: PMC10764216 DOI: 10.3344/kjp.23246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
Background Failed back surgery syndrome (FBSS) is a chronic condition that is characterized by persistent back pain following one or more spinal surgeries. Pharmacological interventions, such as the use of opioids and gabapentinoids, are frequently used in the treatment of FBSS. However, prolonged and excessive use of these medications can lead to dependence and adverse effects. This study investigates trends in opioid and gabapentinoid prescriptions among patients with FBSS in Korea from 2016 to 2020. Methods Data from the Health Insurance and Review Agency were analyzed, and claims listing FBSS were selected for the study. Prescription patterns of opioids and gabapentinoids were classified based on the number of days prescribed per year. Results Of the 390,095 patients diagnosed with FBSS, 41.6% of the patients were prescribed gabapentinoids, and 42.0% of them were prescribed opioids, while 10.6% of the patients were classified as long-term gabapentinoid users, 11.4% as long-term opioid users, and 7.4% of the patients were found to have long-term prescriptions for both drugs. The proportion of patients who received both gabapentinoid and opioid prescriptions increased annually. The doses of opioids prescribed have also increased along with the increase in the number of patients receiving opioid prescriptions. Conclusions The prescription rates of opioids and gabapentinoids among patients with FBSS in Korea continue to increase steadily, posing potential risks of addiction and adverse effects. Further research is needed to better understand the actual status of addiction in patients with FBSS.
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Affiliation(s)
- Jinyoung Oh
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Kyunpook National University Chilgok Hospital, Daegu, Korea
| | - Jinseok Yeo
- Department of Anesthesiology and Pain Medicine, Kyungpook National University School of Medicine, Kyunpook National University Chilgok Hospital, Daegu, Korea
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Broadhurst PJ, Gibbons E, Knowles AE, Copson JE. Prevalence of Incidental Extraspinal Findings on MR Imaging of the Lumbar Spine in Adults: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2023; 45:113-118. [PMID: 38164532 PMCID: PMC10756571 DOI: 10.3174/ajnr.a8065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Low back pain is common worldwide. MR imaging may identify extraspinal findings that are not related to the proposed clinical question. The prevalence of extraspinal incidental findings and their clinical significance has not been well-established. PURPOSE This review aimed to evaluate the prevalence of extraspinal findings on MR imaging of the lumbar spine in adults and the prevalence of clinically significant incidental findings. DATA SOURCES A systematic search of MEDLINE and EMBASE was performed, including studies published before June 14, 2023. STUDY SELECTION Studies presenting a prevalence of extraspinal findings in patients 16 years of age or older were included. DATA ANALYSIS A random effects meta-analysis was used to generate composite prevalence measures of extraspinal findings, patients with extraspinal findings, and clinically significant findings. DATA SYNTHESIS Sixteen studies were included in this meta-analysis, with a total of 19,593 patients and 6,006 extraspinal incidental findings. The overall prevalence of extraspinal findings was 19.9% (95% CI, 11.1%-30.7%). Overall, 26.7% of patients had an extraspinal finding identified (95% CI, 14.8%-40.6%). The most common subgroup of extraspinal findings was genitourinary findings in males (27.1%; 95% CI, 25.6%-28.8%). Data from 8 studies demonstrated the prevalence of clinically significant findings at 5.4% (95% CI, 3.2%-8.1%). LIMITATIONS Retrospective populations with small numbers of participants in clinically relevant subgroups may result in heterogeneity and imprecision within composite outcome measures. CONCLUSIONS Extraspinal findings are common, detected in more than one-quarter of patients. Five percent of findings are clinically significant and may require further action.
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Affiliation(s)
- Philip J Broadhurst
- From the Department of Radiology (P.J.B.), Wythenshawe Hospital, Manchester, UK
| | - Eileen Gibbons
- Department of Medicine (E.G.), Salford Royal Hospital, Manchester, UK
| | - Amy E Knowles
- Barts Health London National Health Service Trust (A.E.K.), London, UK
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Scott-Young M, Nielsen D, Riar S. Fundamentals of Mechanobiology and Potential Applications in Spinal Fusion. Int J Spine Surg 2023; 17:S61-S74. [PMID: 38135446 PMCID: PMC10753328 DOI: 10.14444/8562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Mechanobiology can help optimize spinal fusion by providing insights into the mechanical environment required for bone healing and fusion. This includes understanding the optimal loading conditions, the mechanical properties of implanted materials, and the effects of mechanical stimuli on the cells involved in bone formation. The present article reviews the evidence for surface technologies and implant modification of spinal cages in enhancing spinal fusion. METHODS Databases used included Embase, MEDLINE, Springer, and Cochrane Library. Relevant articles were identified using specific keywords and search fields. Only systematic reviews, meta-analyses, review articles, and original research articles in English were included. Two researchers independently performed the search and selection process. A flowchart of the search strategy and study selection method is provided in the article. RESULTS The studies indicate that surface modification can significantly enhance osseointegration and interbody fusion by promoting cellular adhesion, proliferation, differentiation, and mineralization. Various surface modification techniques such as coating, etching, nanotopography, and functionalization achieve this. Similarly, implant material modification can improve implant stability, biocompatibility, and bioactivity, leading to better fusion outcomes. Mechanobiology plays a vital role in this process by influencing the cellular response to mechanical cues and promoting bone formation. CONCLUSIONS The studies reviewed indicate that surface technologies and implant material modification are promising approaches for improving the success of spinal cage fusion. Mechanobiology is critical in this process by influencing the cellular response to mechanical signals and promoting bone growth.
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Affiliation(s)
- Matthew Scott-Young
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Spine, Bond University, Gold Coast, Queensland, Australia
| | - David Nielsen
- Gold Coast Spine, Bond University, Gold Coast, Queensland, Australia
| | - Sukhman Riar
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Queensland, Australia
- Gold Coast Spine, Bond University, Gold Coast, Queensland, Australia
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Faulks CR, Biddau DT, Munday NR, McKenzie DP, Malham GM. Patient-specific spinal rods in adult spinal deformity surgery reduce proximal junctional failure: a review of patient outcomes and surgical technique in a prospective observational cohort. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:409-421. [PMID: 38196735 PMCID: PMC10772658 DOI: 10.21037/jss-23-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/22/2023] [Indexed: 01/11/2024]
Abstract
Background Spinal rods used for adult spinal deformity (ASD) correction are usually manufactured straight and bent manually during surgery. Pre-bent patient-specific spinal rods (PSSR) developed with software provide the surgeon with an intraoperative deformity correction consistent with the surgical plan. Our aim was to report clinical and radiological outcomes using PSSR. We investigated rates of junctional complications both proximally [kyphosis (PJK) and failure (PJF)] and distally [failure (DJF)]. Methods Prospective case series of 20 consecutive patients who underwent ≥4 level ASD surgery with PSSR at a single institution between January 2019 and December 2022. Preoperative, 6-week, 6-month, 12-month, 24-month, and final follow-ups assessed patient satisfaction (Ottawa decision regret questionnaire) and patient reported outcome measures (PROMs) [visual analogue scale (VAS; Back/Leg), Oswestry disability index (ODI), and 12-Item Short Form Survey (SF-12)]. Sagittal spinopelvic parameters [sagittal vertical axis (SVA), pelvic tilt (PT), and pelvic incidence and lumbar lordosis mismatch (PI-LL)] measured by serial EOS scans were performed preoperatively then compared to planned correction and postoperative measures. Interoperative cages (narrow/wide) were placed for interbody support. PJK risk score assessed likelihood of developing kyphosis. Serial computed tomography (CT) imaging assessed complication (fusion/subsidence). Results The mean age of the patients (75% female) was 71.9±6.9 years, and the mean follow-up was 25.2±8.6 [7-40] months. Preoperative mean PROMs showed statistically significant overall improvement (P<0.001) postoperatively to final follow-up. Four patients without wide footprint cages at L4/5 or L5/S1, suffered DJF and reported regret undergoing surgery. Statistically significant difference (P<0.001) between preoperative and surgical plan in SVA and PI-LL but not in PT (P=0.058). No statistically significant difference in surgical plan versus the postoperative SVA, PI-LL, and PT (due to difficulty achieving the surgical plan, and also to maintaining the correction). One patient suffered PJF. There was a mean proximal kyphotic angle (PKA) of 17.8±13.0 degrees and PJK risk score of 3.7±1.0 with 40% who experienced PJK. No rod breakages were observed. Conclusions In this series, PSSR improved PROMs and treated ASD. Sagittal parameters planned preoperatively correlated with postoperative correction. PJF was reduced, compared to the literature (35%), but PJK was observed over time. DJF occurred and was related to the absence of interbody cages at the lumbosacral junction and decisional regret.
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Affiliation(s)
- Charlie R. Faulks
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean T. Biddau
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Nigel R. Munday
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
| | - Dean P. McKenzie
- Research Development & Governance, Epworth HealthCare, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
| | - Gregory M. Malham
- Neuroscience Institute, Epworth HealthCare, Melbourne, VIC, Australia
- Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
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Tong MW, Tolpadi AA, Bhattacharjee R, Han M, Majumdar S, Pedoia V. Synthetic Knee MRI T 1p Maps as an Avenue for Clinical Translation of Quantitative Osteoarthritis Biomarkers. Bioengineering (Basel) 2023; 11:17. [PMID: 38247894 PMCID: PMC10812962 DOI: 10.3390/bioengineering11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
A 2D U-Net was trained to generate synthetic T1p maps from T2 maps for knee MRI to explore the feasibility of domain adaptation for enriching existing datasets and enabling rapid, reliable image reconstruction. The network was developed using 509 healthy contralateral and injured ipsilateral knee images from patients with ACL injuries and reconstruction surgeries acquired across three institutions. Network generalizability was evaluated on 343 knees acquired in a clinical setting and 46 knees from simultaneous bilateral acquisition in a research setting. The deep neural network synthesized high-fidelity reconstructions of T1p maps, preserving textures and local T1p elevation patterns in cartilage with a normalized mean square error of 2.4% and Pearson's correlation coefficient of 0.93. Analysis of reconstructed T1p maps within cartilage compartments revealed minimal bias (-0.10 ms), tight limits of agreement, and quantification error (5.7%) below the threshold for clinically significant change (6.42%) associated with osteoarthritis. In an out-of-distribution external test set, synthetic maps preserved T1p textures, but exhibited increased bias and wider limits of agreement. This study demonstrates the capability of image synthesis to reduce acquisition time, derive meaningful information from existing datasets, and suggest a pathway for standardizing T1p as a quantitative biomarker for osteoarthritis.
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Affiliation(s)
- Michelle W. Tong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
- Department of Bioengineering, University of California Berkeley, Berkeley, CA 94720, USA
| | - Aniket A. Tolpadi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
- Department of Bioengineering, University of California Berkeley, Berkeley, CA 94720, USA
| | - Rupsa Bhattacharjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
| | - Misung Han
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA (S.M.); (V.P.)
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Carraro A, Gilic B, Bertolo R, Albergoni A, Sarto F, Roklicer R, Sarto D. Lower back pain in young climbers: a retrospective cross-sectional study. Front Sports Act Living 2023; 5:1328811. [PMID: 38186399 PMCID: PMC10770867 DOI: 10.3389/fspor.2023.1328811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Objective The popularity of sport climbing has been growing since its inclusion in the Olympic Games program, which led to more people practicing it on recreational, amateur, and professional levels. Strenuous climbing training sessions and competitions might lead to frequent and serious musculoskeletal injuries and complaints among competitive climbers. This study aimed to investigate the prevalence of low back pain (LBP) and to explore the influence of various risk factors on LBP in adolescent climbers. Methods The sample included 180 competitive climbers (46.6% males) aged 13-19 years competing in under-16 (48.3%) or under-20 categories. Data collection was carried out using the Nordic Musculoskeletal Questionnaire (NMQ) and the Graded Chronic Pain Scale (GCPS). Results A total of 74.4% of the entire sample of participants (male = 75%; female = 74%) reported lower back complaints throughout the past twelve months, and only 15.5% during the last seven days. A major part of complaints was classified as low intensity-low disability (Grade I, 62.8%; male = 72.6%; female = 54.2%). Under-20 competitors reported a small but significantly higher percentage of almost all NMQ measures compared to under-16 athletes. Conclusions This study found a relatively high prevalence of LBP, although complaints were of limited severity and did not affect climbers' regular training practice. Moreover, climbers did not differ in LBP prevalence according to sex, while climbers from the older age group reported higher complaints and seeking medical attention than younger climbers. Future studies should prospectively monitor the influence of climbing on LBP in youth climbers.
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Affiliation(s)
- Attilio Carraro
- Faculty of Education, Free University of Bozen-Bolzano, Bozen, Italy
| | - Barbara Gilic
- Faculty of Kinesiology, University of Split, Split, Croatia
| | - Riccardo Bertolo
- Associazione Sportiva Dilettantistica Opera Verticale, Scorzè, Venezia, Italy
| | - Andrea Albergoni
- Faculty of Education, Free University of Bozen-Bolzano, Bozen, Italy
| | - Fabio Sarto
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Roberto Roklicer
- Faculty of Education, Free University of Bozen-Bolzano, Bozen, Italy
| | - Diego Sarto
- School of Human Movement Sciences, University of Padova, Padova, Italy
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van Amstel R, Noten K, Malone S, Vaes P. Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method ® and Exercise Therapy. Life (Basel) 2023; 14:7. [PMID: 38276256 PMCID: PMC10820544 DOI: 10.3390/life14010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The 4xT method is a protocolized practice in treating musculoskeletal disorders. The 4xT method consists of four components: Test (functional diagnostic test), Trigger (fascia tissue manipulations), Tape (elastic taping), and Train (exercise). There is a lack of clinical studies evaluating the treatment effects of the use of the 4xT method. METHODS A randomized controlled trial was conducted to compare the effectiveness of the 4xT method and exercise therapy-only in patients with chronic nonspecific low back pain. Based on a priori sample size calculation, fifty-one individuals with chronic nonspecific low back pain were randomly assigned to either the 4xT or exercise group. Both groups underwent a six-week rehabilitation program with two treatments per week. The primary outcomes were trunk flexion and extension mobility, trunk flexion, and extension mobility-dependent pain, and quality of life evaluated during a 6-week therapy period and after a 6-week therapy-off period. RESULTS Interaction effects were noted in all outcomes. The 4xT group showed significant improvements over time for trunk flexion and extension mobility, trunk flexion and extension mobility-dependent pain, and quality of life (p < 0.05), with no significant relapse post-therapy (except for extension mobility). The exercise group exhibited significant within-time changes in the quality of life, as measured with the VAS (p < 0.05), but not for EQ-5D-3L. CONCLUSIONS The results of this study demonstrate that the 4xT method stands out as a promising and impactful treatment option for chronic nonspecific low back pain individuals, as it demonstrated significant reductions in mobility-dependent pain, increased trunk mobility, and improved quality of life compared to exercise-only treatments.
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Affiliation(s)
- Robbert van Amstel
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, 1081 Amsterdam, The Netherlands
- Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands
| | - Karl Noten
- Fysio Science Department, Fysio Physics Groups, 3401 IJsselstein, The Netherlands
| | - Shaun Malone
- Department of Rehabilitation Sciences and Physiotherapy (MOVANT), University of Antwerp, Wilrijk, 2000 Antwerpen, Belgium
| | - Peter Vaes
- Faculty of Rehabilitation Science and Physical Therapy, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
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Diz JBM, Dutra MTP, Feijó IC, Sogno ALM, Silva FR, Carnevale GDEF, Moreira BDES, Silva CFM. LOW BACK PAIN ESTIMATES IN PROFESSIONAL SOCCER: A SYSTEMATIC REVIEW AND META-ANALYSIS. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e266012. [PMID: 38115872 PMCID: PMC10726716 DOI: 10.1590/1413-785220233105e266012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/22/2022] [Indexed: 12/21/2023]
Abstract
Objective To evaluate the epidemiological and clinical characteristics of low back pain (LBP) in adult professional soccer players. Methods Systematic review and meta-analysis. Results The review included 44 studies. The pooled prevalence of LBP during ≤ 1 season was 1% (95%CI = 0-4%) in men. The pooled point prevalence of LBP was 25% (95%CI = 16-36%) in men and 28% (95%CI = 20-37%) in women. The pooled past-year prevalence of LBP was 34% (95%CI = 24-44%) in men. The pooled lifetime prevalence of LBP was 32% (95%CI = 25-39%) in men and 50% (95%CI = 32-69%) in women. The pooled frequency of LBP/total number of injuries was 2% (95%CI = 1-3%) in men and 4% (95%CI = 2-5%) in women. The pooled incidence rate of LBP/1,000 player-hours of exposure was 0.30 (95%CI = 0.17- 0.53) in men and 0.32 (95%CI = 0.06 -1.87) in women. The recurrence of LBP ranged from 3% to 63% in men. The intensity of LBP ranged from 1.68 (2.39) to 4.87 (2.14) points on a 0-10 scale (minimum = 0 and maximum = 8 points). The severity of LBP (days absent from professional activities due to pain) ranged from 2 (0) to 10 (19) days (minimum = 1 and maximum = 28 days). Conclusion Adult elite soccer players have a substantial prevalence of LBP. The frequency and incidence of LBP (compared with other conditions and sports) seems to be low. Estimates of the recurrence, intensity, and severity of LBP are uncertain. Level of Evidence II, Systematic Review of Level II Studies.
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130
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Hunter R, Beattie M, O'Malley C, Gorely T. Mobile apps to self-manage chronic low back pain: A realist synthesis exploring what works, for whom and in what circumstances. PEC INNOVATION 2023; 3:100175. [PMID: 38213759 PMCID: PMC10782115 DOI: 10.1016/j.pecinn.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 01/13/2024]
Abstract
Objective Chronic low back pain places a significant burden on healthcare services and sufferers. Clinical guidelines state that it is a condition that requires self-management. This realist synthesis explores how a mobile app could help people to self-manage chronic low back pain. Method Six databases and several non-academic sources were searched. In addition, nineteen realist interviews were conducted with stakeholders. Sources were selected and appraised for relevancy, richness, and rigour. Data was coded with analytical memos making retroductive inferences. Causal explanations were presented in context-mechanism-outcome configurations to form three programme theories. Results Data from 57 sources was synthesised to create 16 context-mechanism-outcome configurations and presented as three refined programme theories. The findings suggest people need to feel believed before they will engage with a self-management app. For those who feel abandoned by the healthcare service, a self-management app for chronic low back pain can be a valuable source of ongoing support and reduce feelings of social isolation. Conclusion A self-management app, if introduced appropriately and as adjunct to care, can be an empowering tool to self-manage chronic low back pain. Innovation Using input from key stakeholders enhances our understanding of the hidden generative mechanisms underpinning a programme's success or failure.
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Affiliation(s)
- Rebecca Hunter
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Michelle Beattie
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Chris O'Malley
- Specialist Librarian (Learning and Information Services), University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Trish Gorely
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
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131
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Mohd Isa IL, Zulkiflee I, Ogaili RH, Mohd Yusoff NH, Sahruddin NN, Sapri SR, Mohd Ramli ES, Fauzi MB, Mokhtar SA. Three-dimensional hydrogel with human Wharton jelly-derived mesenchymal stem cells towards nucleus pulposus niche. Front Bioeng Biotechnol 2023; 11:1296531. [PMID: 38149172 PMCID: PMC10749916 DOI: 10.3389/fbioe.2023.1296531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023] Open
Abstract
Introduction: A regenerative strategy employing extracellular matrix (ECM)-based biomaterials and stem cells provide a better approach to mimicking the three-dimensional (3D) microenvironment of intervertebral disc for endogenous tissue regeneration. However, there is currently limited understanding regarding the human Wharton Jelly derived-mesenchymal stem cells (hWJ-MSCs) towards nucleus pulposus (NP)-like cells. Our study focused on the development of 3D bioengineered hydrogel based on the predominant ECM of native NP, including type II collagen (COLII) and hyaluronic acid (HA), which aims to tailor the needs of the microenvironment in NP. Methods: We have fabricated a 3D hydrogel using from COLII enriched with HA by varying the biomacromolecule concentration and characterised it for degradation, stability and swelling properties. The WJ-MSC was then encapsulated in the hydrogel system to guide the cell differentiation into NP-like cells. Results: We successfully fabricated COLII hydrogel (2 mg/ml) and HA 10 mg/ml at a weight ratio of HA and COLII at 1:9 and 4.5:9, and both hydrogels physically maintained their 3D sphere-shaped structure after complete gelation. The higher composition of HA in the hydrogel system indicated a higher water intake capacity in the hydrogel with a higher amount of HA. All hydrogels showed over 60% hydrolytic stability over a month. The hydrogel showed an increase in degradation on day 14. The hWJ-MSCs encapsulated in hydrogel showed a round morphology shape that was homogenously distributed within the hydrogel of both groups. The viability study indicated a higher cell growth of hWJ-MSCs encapsulated in all hydrogel groups until day 14. Discussion: Overall, our findings demonstrate that HA/COLII hydrogel provides an optimal swelling capacity, stability, degradability, and non-cytotoxic, thus mimics the NP microenvironment in guiding hWJ-MSCs towards NP phenotype, which is potentially used as an advanced cell delivery system for intervertebral disc regeneration.
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Affiliation(s)
- Isma Liza Mohd Isa
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Izzat Zulkiflee
- CÚRAM, SFI Research Centre for Medical Devices, University of Galway, Galway, Ireland
| | - Raed H. Ogaili
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nurul Huda Mohd Yusoff
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Natasya Nadia Sahruddin
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shaiful Ridzwan Sapri
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Elvy Suhana Mohd Ramli
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sabarul Afian Mokhtar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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132
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Rashed R, Kowalski K, Walton D, Niazigharemakhe A, Rushton A. Physical measures of physical functioning as prognostic factors to predict outcomes in low back pain: Protocol for a systematic review. PLoS One 2023; 18:e0295761. [PMID: 38079434 PMCID: PMC10712879 DOI: 10.1371/journal.pone.0295761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is a highly prevalent condition that substantially impairs individuals' physical functioning. This highlights the need for effective management strategies to improve patient outcomes. It is, therefore, crucial to have knowledge of physical functioning prognostic factors that can predict outcomes to facilitate the development of targeted treatment plans aiming to achieve better patient outcomes. There is no synthesis of evidence for physical functioning measures as prognostic factors in the LBP population. The objective of this systematic review is to synthesize evidence for physical measures of physical functioning as prognostic factors to predict outcomes in LBP. METHODS The protocol is registered in the International Prospective Register of Systematic Reviews and reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Prospective longitudinal observational studies investigating potential physical prognostic factors in LBP and/or low back-related leg pain population will be included, with no restriction on outcome. Searches will be performed in MEDLINE, EMBASE, Scopus, CINAHL databases, grey literature search using Open Grey System and ProQuest Dissertations and Theses, hand-searching journals, and reference lists of included studies. Two independent reviewers will evaluate the eligibility of studies, extract data, assess risk of bias and quality of evidence. Risk of bias will be assessed using the Quality in Prognostic Studies (QUIPS) tool. Adequacy of clinical, methodological, and statistical homogeneity among included studies will decide quantitative (meta-analysis) or qualitative analysis (narrative synthesis) focused on prognostic factors and strength of association with outcomes. Quality of cumulative evidence will be evaluated using a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE). DISCUSSION Information about prognostic factors can be used to predict outcomes in LBP. Accurate outcome prediction is essential for identifying high-risk patients that allows targeted allocation of healthcare resources, ultimately reducing the healthcare burden. REGISTRATION PROSPERO, CRD42023406796.
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Affiliation(s)
- Rameeza Rashed
- School of Physiotherapy, Western University, London, Ontario, Canada
| | - Katie Kowalski
- School of Physiotherapy, Western University, London, Ontario, Canada
| | - David Walton
- School of Physiotherapy, Western University, London, Ontario, Canada
| | | | - Alison Rushton
- School of Physiotherapy, Western University, London, Ontario, Canada
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Ta KNT, Bai CH, Chuang KJ. Prevention of Work Absence Due to Back Pain: A Network Meta-Analysis. Eur J Investig Health Psychol Educ 2023; 13:2891-2903. [PMID: 38131899 PMCID: PMC10871117 DOI: 10.3390/ejihpe13120200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
This paper reviewed the most effective strategies for preventing work absence due to back pain (BP) and BP episodes (the number of people reporting back pain). We searched randomized controlled trials (RCTs) of prevention strategies for BP from previous meta-analyses, PubMed, CENTRAL, and Embase and conducted a network meta-analysis. Thirteen RCTs (2033 participants) were included. Low- to high-quality evidence showed that exercise combined with ergonomics, education, back belts, and education combined with ergonomics did not prevent sickness absenteeism or BP episodes. There was moderate-quality evidence that exercise, especially resistance exercise, was the best prevention strategy to reduce the number of people reporting absenteeism due to BP (risk ratio [RR] = 0.10; 95% CI: 0.01 to 0.69). Moderate-quality evidence suggested that resistance and stretching exercises combined with education was the best prevention strategy to reduce pain (RR = 0.80; 95% CI: 0.67 to 0.96) and the number of absenteeism days for BP (standardized mean difference [SMD] = -0.39; 95% CI: -0.77 to -0.02). In conclusion, exercise, especially resistance and stretching exercises, and exercise combined with education were ranked as the best interventions to prevent sickness absenteeism and BP episodes.
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Affiliation(s)
- Kim-Ngan Thi Ta
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 235, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 235, Taiwan
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134
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Michalak M, Druszcz A, Miś M, Paprocka-Borowicz M, Rosińczuk J. Quality of Life, Disability Level, and Pain Intensity among Patients after Lumbar Disc Surgery: An Observational Three-Month Follow-Up Study. Healthcare (Basel) 2023; 11:3127. [PMID: 38132017 PMCID: PMC10742899 DOI: 10.3390/healthcare11243127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
The prevalence of intervertebral disc degeneration in the lumbar region resulting in low back pain is high. One of the treatment options is neurosurgery. Previous studies and systematic reviews demonstrate the need to identify factors that affect the health-related quality of life of patients undergoing surgery. This study aimed to analyze the sociodemographic and clinical factors that affect the quality of life of patients undergoing lumbar disc surgery. A group of 128 patients was assessed for eligibility and qualified by radiological examinations for lumbar disc surgery by a neurosurgeon in the outpatient clinic. Finally, 110 patients were studied and evaluated 24 h and 3 months after surgery. Health-related quality of life (36-Item Short Form Survey, SF-36), disability level (Oswestry Disability Index, ODI), and pain intensity (Visual Analogue Scale, VAS) were assessed. The mean pain intensity before surgery was 7.8 ± 2.3 pts and decreased significantly 24 h after surgery, with a mean score of 3.8 ± 2.4 pts (p = 0.0000). After three months, the increase in pain intensity was at 4.8 ± 2.4 pts, but the score was still significantly better than before surgery (p = 0.0024). The mean ODI score before surgery was 29.3 ± 8.4 pts (slight disability), and three months after surgery, there was an insignificant increase to a mean value of 31.5 ± 10.4 pts (p = 0.0834). There was a statistically significant increase in quality-of-life scores at three months after surgery in the following domains: physical functioning (8.7%; p = 0.0176), bodily pain (26.2%; p = 0.0000), vitality (5.8%; p = 0.0132) and mental health (6.2%; p = 0.0163), and a decrease in role limitations due to physical problems (3.8; p = 0.0013) and general health perception (6.7%; p = 0.0112). In conclusion, the surgical procedure plays an important role in improving the quality of life of patients operated on for intervertebral disc degeneration. It was effective in reducing the pain level, especially 24 h after surgery; however, surgery did not affect the disability level.
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Affiliation(s)
- Monika Michalak
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Adam Druszcz
- Department of Neurosurgery, Provincial Specialist Hospital in Legnica, 59-220 Legnica, Poland;
| | - Maciej Miś
- Department of Neurosurgery, Specialist Hospital in Walbrzych, 58-309 Walbrzych, Poland;
| | | | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland;
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135
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Barsa M, Filyk O. Erector spinae plane block versus local infiltration anaesthesia for transforaminal percutaneous endoscopic discectomy: A prospective randomised controlled trial. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:552-560. [PMID: 37666454 DOI: 10.1016/j.redare.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/20/2022] [Indexed: 09/06/2023]
Abstract
BACKGROUND Around 60%-80% of the population suffers from back pain, making it one of the most common health complaints. Transforaminal percutaneous endoscopic discectomy (TPED) is an effective treatment for low back pain that can be performed using different anaesthesia techniques. Our primary objective was to test the hypothesis that bilateral Erector spinae plane block (ESP) plus sedation is equally effective as traditional local infiltration anaesthesia plus sedation in TPED. MATERIALS AND METHODS Fifty-two patients undergoing TPED were randomly assigned to 2 groups: G1 - intravenous sedation with local infiltration anaesthesia; G2 - intravenous sedation with bilateral ESP. PRIMARY OUTCOME volume of fentanyl and propofol administered during surgery. SECONDARY OUTCOMES adverse events during sedation reported using the World Society of Intravenous Anaesthesia (SIVA) adverse sedation event tool, level of postoperative sedation measured on the Richmond Agitation-Sedation Scale (RASS), intensity of postoperative pain on a visual analogue scale (VAS), mechanical pain threshold (MPT) measured with von Frey monofilaments on both lower extremities, patient satisfaction with analgesia on 5-point Likert scale. RESULTS Volume of fentanyl, propofol, and level of postoperative sedation was significantly lower in G2 (p < 0.001). There was no difference between groups in intensity of pain, patient satisfaction with analgesia, and mechanical pain threshold after surgery. There were no adverse events in G2, but in G1 2 patients presented minimal risk descriptors, 5 presented minor risk descriptors, and 1 presented sentinel risk descriptors that required additional medication or rescue ventilation. CONCLUSIONS The ESP was equal to local infiltration anaesthesia in terms of intensity of pain, mechanical pain threshold after surgery, and patient satisfaction; however, ESP reduced the volume of intraoperative fentanyl and propofol, thereby reducing the adverse effects of sedation.
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Affiliation(s)
- M Barsa
- Anaesthesiologist at Communal Enterprise of Rivne region council "Yuri Semenyuk Rivne regional clinical hospital", Rivne, Ukraine; Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
| | - O Filyk
- Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
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Nowakowska-Lipiec K, Michnik R, Linek P, Myśliwiec A, Zadoń H, Gorwa J. Effect of strengthening and weakening of abdominal and dorsal muscles on lumbar spine loads in parents of disabled children. J Biomech 2023; 161:111864. [PMID: 37976939 DOI: 10.1016/j.jbiomech.2023.111864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
Pain in the lower part of the back is one of the most common chronic illnesses globally. This work aimed to determine the impact of the reinforcement of particular groups of abdominal and dorsal muscles on the loads exerted on the lumbar section of the spine in 30 mothers of children with motor disabilities. An optical Ariel Performance Analysis System recorded and processed the kinematics data of everyday activities. Tests investigating the effects of the strengthening or weakening of abdominal and dorsal muscles on loading in the lumbar section of the spine utilized the AnyBody Modelling System. Input data for the simulations included mean values of body positions, while the effects of strengthening or weakening of muscles were simulated in the muscle forces model by introducing different values for muscle physiological cross-sectional area (PCSA). Simulations used decreasing or increasing PCSA values of abdominal muscles and the erector spinae. The analysis involved component and resultant force values on the lumbosacral joint (L5-S1) of the spine and intra-abdominal pressure values. The highest reduction of the resultant reaction value in L5-S1 was observed in the simulations that increased the PCSA of the transverse abdominal (TrA). Indeed, a double increase in the TrA cross-section caused a reduction of the resultant reaction in L5-S1 by 30% and the anterior-posterior and proximal-distal forces by approximately 20-30%. Increased PCSA of the erector spinae exerted higher loads on the spine. These results indicate that strengthening weakened abdominal muscles, particularly TrA, in parents of children with motor disabilities reduces lower spinal loads during daily activities.
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Affiliation(s)
- Katarzyna Nowakowska-Lipiec
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland.
| | - Robert Michnik
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Paweł Linek
- Institute of Physiotherapy and Health Sciences, Musculoskeletal Elastography and Ultrasonography Laboratory, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Andrzej Myśliwiec
- Institute of Physiotherapy and Health Sciences, Laboratory of Physiotherapy and Physioprevention, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Hanna Zadoń
- Department of Biomechatronics, Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
| | - Joanna Gorwa
- Department of Biomechanics, Faculty of Sport Sciences, Poznan University of Physical Education, Poznań, Poland
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137
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Anheyer D, Cramer H. [Yoga as an intervention for chronic pain]. Schmerz 2023; 37:426-430. [PMID: 37380760 DOI: 10.1007/s00482-023-00733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 06/30/2023]
Abstract
The use of yoga, especially as an intervention for chronic pain, is increasing worldwide. Available data on chronic low back pain, within limits also for chronic neck pain and certain types of headache, show statistically significant positive effects related to pain intensity and pain-related impairments. The data provide evidence that yoga is at least equal in efficacy and safety to other exercise interventions as well as individualized physical therapy. The dose of the intervention seems to be of secondary importance, but the establishment of a long-term independent practice after initial supervision seems to be essential; however, for other pain disorders there is still a need for research.
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Affiliation(s)
- Dennis Anheyer
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Osianderstr. 5, 72076, Tübingen, Deutschland
- Bosch Health Campus, Stuttgart, Deutschland
- Lehrstuhl für Forschungsmethodik und Statistik in der Psychologie, Department für Psychologie und Psychotherapie, Universität Witten/Herdecke, Witten, Deutschland
| | - Holger Cramer
- Institut für Allgemeinmedizin und Interprofessionelle Versorgung, Universitätsklinikum Tübingen, Osianderstr. 5, 72076, Tübingen, Deutschland.
- Bosch Health Campus, Stuttgart, Deutschland.
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138
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Mitchaï PM, Mapinduzi J, Verbrugghe J, Michiels S, Janssens L, Kossi O, Bonnechère B, Timmermans A. Mobile technologies for rehabilitation in non-specific spinal disorders: a systematic review of the efficacy and potential for implementation in low- and middle-income countries. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4077-4100. [PMID: 37794182 DOI: 10.1007/s00586-023-07964-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/22/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE The aim of this systematic review was primarily to identify the types of mHealth technologies for the rehabilitation of non-specific spinal disorders, second to evaluate their efficacy, and finally to determine their applicability in LMICs. METHODS Three databases (Scopus, PubMed, and Web of Science) were searched for randomized controlled trials and clinical trials from January 2012 until December 2022. Studies were found eligible when using mHealth technologies for the rehabilitation of non-specific spinal disorders. To evaluate efficacy, the primary outcome was pain intensity, and the secondary outcomes were disability and quality of life. To evaluate the applicability in LMICs, information about financial and geographical accessibility, offline usability, and languages was extracted. RESULTS Fifteen studies were included comprising 1828 participants who suffer from non-specific low back pain (86.05%) and non-specific neck pain (13.95%). Fourteen distinct smartphone-based interventions and two sensor system interventions were found, with a duration ranging from four weeks to six months. All mHealth interventions demonstrated efficacy for the improvement of pain, disability and quality of life in non-specific spinal disorders, particularly low back pain. Five of the evaluated smartphone applications were free of charge accessible and had language features that could be adapted for use in LMICs. CONCLUSION mHealth interventions can be used and integrated into the conventional treatment of non-specific spinal disorders in rehabilitation. They have demonstrated efficacy and could be implemented in LMICs with minor adaptations to overcome language barriers and the absolute necessity of the internet.
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Affiliation(s)
- Pénielle Mahutchegnon Mitchaï
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, 03 BP 10, Parakou, Benin
| | - Jean Mapinduzi
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- Department of Physiotherapy, National Institute of Public Health, University of Bujumbura, Bujumbura, Burundi
| | - Jonas Verbrugghe
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Sarah Michiels
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Lotte Janssens
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
| | - Oyéné Kossi
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium.
- ENATSE, National School of Public Health and Epidemiology, University of Parakou, 03 BP 10, Parakou, Benin.
- Unit of Neurology and NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin.
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
| | - Annick Timmermans
- REVAL, Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
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Kenawy HM, Nuñez MI, Morales X, Lisiewski LE, Burt KG, Kim MKM, Campos L, Kiridly N, Hung CT, Chahine NO. Sex differences in the biomechanical and biochemical responses of caudal rat intervertebral discs to injury. JOR Spine 2023; 6:e1299. [PMID: 38156061 PMCID: PMC10751974 DOI: 10.1002/jsp2.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/26/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023] Open
Abstract
Background Intervertebral disc degeneration (IDD) is a major cause of low back pain (LBP) worldwide. Sexual dimorphism, or sex-based differences, appear to exist in the severity of LBP. However, it is unknown if there are sex-based differences in the inflammatory, biomechanical, biochemical, and histological responses of intervertebral discs (IVDs). Methods Caudal (Coccygeal/Co) bone-disc-bone motion segments were isolated from multiple spinal levels (Co8 to Co14) of male and female Sprague-Dawley rats. Changes in motion segment biomechanics and extracellular matrix (ECM) biochemistry (glycosaminoglycan [GAG], collagen [COL], water, and DNA content) were evaluated at baseline and in response to chemical insult (lipopolysaccharide [LPS]) or puncture injury ex vivo. We also investigated the contributions of Toll-like receptor (TLR4) signaling on responses to LPS or puncture injury ex vivo, using a small molecule TLR4 inhibitor, TAK-242. Results Findings indicate that IVD motion segments from female donors had greater nitric oxide (NO) release in LPS groups compared to male donors. HMGB1 release was increased in punctured discs, but not LPS injured discs, with no sex effect. Although both male and female discs exhibited reductions in dynamic moduli in response to LPS and puncture injuries, dynamic moduli from female donors were higher than male donors across all groups. In uninjured (baseline) samples, a significant sex effect was observed in nucleus pulposus (NP) DNA and water content. Female annulus fibrosus (AF) also had higher DNA, GAG, and COL content (normalized by dry weight), but lower water content than male AF. Additional injury- and sex-dependent effects were observed in AF GAG/DNA and COL/DNA content. Finally, TAK-242 improved the dynamic modulus of female but not male punctured discs. Conclusions Our findings demonstrate that there are differences in rat IVD motion segments based on sex, and that the response to injury in inflammatory, biomechanical, biochemical, and histological outcomes also exhibit sex differences. TLR4 inhibition protected against loss of mechanical integrity of puncture-injured IVD motion segments, with differences responses based on donor sex.
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Affiliation(s)
- Hagar M. Kenawy
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - María I. Nuñez
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Xóchitl Morales
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | | | - Kevin G. Burt
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
| | - Min Kyu M. Kim
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Leonardo Campos
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nadia Kiridly
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Clark T. Hung
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Nadeen O. Chahine
- Department of Biomedical EngineeringColumbia UniversityNew YorkNew YorkUSA
- Department of Orthopedic SurgeryColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Abhinav K, Jadhav D, Agrawal AK, Agrawal R, Agrawal A. Postoperative Evaluation of Pain and Disability in Patients Undergoing Spinal Discectomy. Cureus 2023; 15:e49963. [PMID: 38179379 PMCID: PMC10765259 DOI: 10.7759/cureus.49963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A spinal discectomy surgery (SDS) is a common surgical procedure performed to treat lumbosacral radiculopathy. AIM To evaluate postoperative patterns of pain and disability in patients undergoing spinal discectomy. METHODS AND MATERIALS This investigation was a retrospective longitudinal review of prospective information gathered from 543 enrolled patients for lumbar radiculoplasty. The study participants were divided into two categories: Category 1 (SDS) comprising patients of lumbar radiculoplasty managed with SDS (n=270) and Category 2 (non-SDS) comprising patients of lumbar radiculoplasty managed with therapy other than SDS (n=273). It included study participants taking medication for pain control including opioids and non-opioids and physiotherapy for strengthening lower back muscles. At baseline, three months, 12 months, and 24 months after surgery, patient-reported information was gathered. Leg pain magnitude, back pain magnitude, and pain-related impairment were the key outcome metrics of interest. RESULTS The mean postoperative visual analog scale (VAS) score for leg pain at three-month follow-up was 4.3±1.2 in study participants in SDS and 8.1±1.3 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 12-month follow-up was 2.8±1.1 in study participants in SDS and 7.9±1.5 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). The mean postoperative VAS score at 24-month follow-up was 1.7±1.2 in study participants in SDS and 7.1±1.1 in the non-SDS category. The VAS score was lower in the SDS category showing greater reduction in postoperative pain with statistically meaningful results (p<0.001). CONCLUSION It was observed that after discectomy, patients suffering from lumbar radiculopathy have significant pain and disability recovery. According to these results, only a small percentage of individuals exhibit negative results at the level of impairment.
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Affiliation(s)
- Kumar Abhinav
- Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Dikpal Jadhav
- Department of Neurosurgery, King Edward Memorial (KEM) Hospital, Mumbai, IND
| | - Arun Kumar Agrawal
- Department of Neurosurgery, Patna Medical College and Hospital, Patna, IND
| | - Rama Agrawal
- Department of Physiology, Patna Medical College and Hospital, Patna, IND
| | - Ankita Agrawal
- Department of Conservative Dentistry and Endodontics, Buddha Institute of Dental Sciences and Hospital, Patna, IND
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Vigdal ØN, Storheim K, Killingmo RM, Rysstad T, Pripp AH, van der Gaag W, Chiarotto A, Koes B, Grotle M. External validation and updating of prognostic prediction models for nonrecovery among older adults seeking primary care for back pain. Pain 2023; 164:2759-2768. [PMID: 37490100 DOI: 10.1097/j.pain.0000000000002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/23/2023] [Indexed: 07/26/2023]
Abstract
ABSTRACT Prognostic prediction models for 3 different definitions of nonrecovery were developed in the Back Complaints in the Elders study in the Netherlands. The models' performance was good (optimism-adjusted area under receiver operating characteristics [AUC] curve ≥0.77, R2 ≥0.3). This study aimed to assess the external validity of the 3 prognostic prediction models in the Norwegian Back Complaints in the Elders study. We conducted a prospective cohort study, including 452 patients aged ≥55 years, seeking primary care for a new episode of back pain. Nonrecovery was defined for 2 outcomes, combining 6- and 12-month follow-up data: Persistent back pain (≥3/10 on numeric rating scale) and persistent disability (≥4/24 on Roland-Morris Disability Questionnaire). We could not assess the third model (self-reported nonrecovery) because of substantial missing data (>50%). The models consisted of biopsychosocial prognostic factors. First, we assessed Nagelkerke R2 , discrimination (AUC) and calibration (calibration-in-the-large [CITL], slope, and calibration plot). Step 2 was to recalibrate the models based on CITL and slope. Step 3 was to reestimate the model coefficients and assess if this improved performance. The back pain model demonstrated acceptable discrimination (AUC 0.74, 95% confidence interval: 0.69-0.79), and R2 was 0.23. The disability model demonstrated excellent discrimination (AUC 0.81, 95% confidence interval: 0.76-0.85), and R2 was 0.35. Both models had poor calibration (CITL <0, slope <1). Recalibration yielded acceptable calibration for both models, according to the calibration plots. Step 3 did not improve performance substantially. The recalibrated models may need further external validation, and the models' clinical impact should be assessed.
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Affiliation(s)
- Ørjan Nesse Vigdal
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Rikke Munk Killingmo
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Tarjei Rysstad
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Are Hugo Pripp
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Wendelien van der Gaag
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Center for Muscle and Health, University of Southern Denmark, Odense, Denmark
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Faculty of Health Science, OsloMet-Oslo Metropolitan University, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
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Sun L, Yan H, Zhang Y. Magnetic resonance spectroscopy (MRS) of multifidus muscle metabolites in chronic low back pain (CLBP). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4397-4404. [PMID: 37721604 DOI: 10.1007/s00586-023-07933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE The purpose of the study was to investigate several potential imaging biomarkers of CLBP that may be useful for diagnosis and treatment efficacy evaluation. Proton magnetic resonance spectroscopy (1H-MRS) was used to detect the content and ratio of creatine (Cr), choline (Cho), and lipid (Lip) in the multifidus muscle (Mm) in patients with CLBP and to test for relationships between these metabolites and pain severity and duration. METHODS Sixty patients with CLBP (experimental group) and sixty-nine asymptomatic volunteers (control group) underwent routine diagnostic magnetic resonance imaging of the lumbar spine. 1H-MRS was acquired with single-voxel MR spectroscopy. The MRS region of interest for measuring Cho, Cr, and Lip concentrations was determined at the L4/5 multifidus muscle (Mm), bilaterally. The contents and ratios of Cr, Cho, and Lip in bilateral and ipsilateral-to-pain (or matched control side) Mm were obtained, and the integral ratios of different metabolites obtained by using Cr as an internal reference were statistically analyzed. RESULTS There were no significant within-group differences in the contents and ratios of Lip, Cr, Cho, Lip/Cr, and Cho/Cr between the left and right Mm of the healthy control group (p > 0.05) or the CLBP group (p > 0.05). The CLBP group showed a much higher Lip and Lip/Cr ratio in the bilateral Mm compared to the healthy control group (p < 0.05) but there were no between-group differences in Cr, Cho, or the Cho/Cr ratio (p > 0.05). The severity of CLBP was correlated with Lip (p < 0.05). CONCLUSION Using 1H-MRS, we demonstrated higher Lip and Lip/Cr ratios in the Mm of patients with CLBP, compared to asymptomatic controls. Mm Lip was correlated with CLBP intensity. An increase in Lip in the Mm may be a characteristic finding in CLBP and may offer a useful prognostic marker for guiding rehabilitation strategies.
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Affiliation(s)
- Limeng Sun
- Department of Radiology, The Traditional Chinese Medicine Hospital of Taian, No. 58 Dongyue Street, Taian District, Taian, 271000, Shandong Province, China
| | - Hu Yan
- Department of Spine Surgery, The Traditional Chinese Medicine Hospital of Taian, No. 58 Dongyue Street, Taian District, Taian, 271000, Shandong Province, China.
| | - Ye Zhang
- Department of Radiology, Taian Maternal and Child Health Hospital, No. 386 Longtan Road, Gaoxin District, Taian, 27100, Shandong Province, China
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143
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Cetik RM, Latalski M, Yazici M. Management of low back pain accompanying sagittal plane pathologies in children: Spondylolysis/spondylolisthesis and Scheuermann's disease. J Child Orthop 2023; 17:535-547. [PMID: 38050599 PMCID: PMC10693848 DOI: 10.1177/18632521231215873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Background Low back pain in childhood was underappreciated for a long time, but recent studies report higher prevalences, up to 70%. Two of the common causes are spondylolyis/spondylolisthesis and Scheuermann's disease. These disorders are relevant in a way they both cause significant back pain, and may disrupt the sagittal spinal balance. Purpose To present the current evidence on the diagnosis, natural history and treatment of these disorders with a special focus on sagittal spinal alignment. Methods This study is conducted as a literature review. Results and Conclusions Spondylolysis and low-grade spondylolisthesis have a benign course and are typically treated conservatively. When pars repair is indicated, pedicle screw-based techniques achieve more than 90% fusion with acceptable complication rates. High-grade spondylolisthesis, however, is frequently progressive. Surgical treatment involves fusion, which can be done in situ or after reduction. Reduction is useful for "unbalanced" patients to acquire sagittal spinopelvic balance, and it is important to distinguish these patients. Despite lowering the risk for pseudoarthrosis, reduction brings a risk for neurologic complications. With re-operation rates as high as 40%, these patients definitely require careful preoperative planning. Scheuermann's disease generally causes back pain in addition to cosmetic discomfort during adolescence. If the kyphosis is lower than 60°, symptoms typically resolve into adulthood with conservative measures only. However, it must be kept in mind that these patients may experience problems with physical performance and have a lower quality of life even when the problem seems to have "resolved". Severe kyphosis and intractable back pain are the most frequently referred surgical indications, and surgery typically involves fusion. Proper utilization of osteotomies and proper selection of the upper and lower fusion levels are of utmost importance to prevent complications in these patients.
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Affiliation(s)
- Riza Mert Cetik
- Department of Orthopedics and Traumatology, Pursaklar State Hospital, Ankara, Turkey
| | - Michał Latalski
- Children’s Orthopedics Department, Medical University of Lublin, Lublin, Poland
| | - Muharrem Yazici
- Department of Orthopedics and Traumatology, Hacettepe University Hospitals, Ankara, Turkey
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144
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Cimerman M, Kacin A. Reproducibility and content validity of the Slovenian version of the STarT Back Screening Tool for chronicity risk assessment in patients with low back pain. Int J Rehabil Res 2023; 46:350-354. [PMID: 37906074 DOI: 10.1097/mrr.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Chronic pain is the most common cause of impaired work ability and thus represents a significant social and economic burden. STarT Back Screening Tool (SBT) is the most often used screening tool for rapid identification and classification of patients for their risk of development of chronic low back pain, which is valid and reliable in the original English version and translation into other languages. The aim of the present study was to translate the SBT into Slovenian and to evaluate its content validity and reliability. We translated the SBT from English into Slovenian and back according to the standard protocol. We tested its metric properties on a group of patients with low back pain aged 18 to 65 years. The reliability of the reassessment was calculated using the ICC and specific agreement, while the content validity of the questionnaire was determined using the ceiling and floor effect. Of the 42 patients who participated in the study, 42.9% were at low risk, 33.3% were at moderate risk, and 23.8% were at high risk of developing chronic pain, according to the SBT. The ICC for the entire sample was 0.96 (95% CI 0.92-0.98). The Slovenian translation of the SBT showed excellent specific agreement between the initial and repeat assessments: 91.4% for the low-risk group, 85.7% for the moderate-risk group, and 95.2% for the high-risk group. In addition, it showed good content validity, as no ceiling or floor effects were detected. The Slovenian translation of the questionnaire is suitable for clinical use.
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Affiliation(s)
- Marinka Cimerman
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana
| | - Alan Kacin
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana
- Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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145
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Rigoard P, Ounajim A, Moens M, Goudman L, Roulaud M, Lorgeoux B, Baron S, Nivole K, Many M, Lampert L, David R, Billot M. Should we Oppose or Combine Waveforms for Spinal Cord Stimulation in PSPS-T2 Patients? A Prospective Randomized Crossover Trial (MULTIWAVE Study). THE JOURNAL OF PAIN 2023; 24:2319-2339. [PMID: 37473903 DOI: 10.1016/j.jpain.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/16/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
Refractory persistent spinal pain syndrome after surgery (PSPS-T2) can be successfully addressed by spinal cord stimulation (SCS). While conventional stimulation generates paresthesia, recent systems enable the delivery of paresthesia-free stimulation. Studies have claimed non-inferiority/superiority of selected paresthesia-free stimulation compared with paresthesia-based stimulation, but the comparative efficacy between different waveforms still needs to be determined in a given patient. We designed a randomized controlled 3-month crossover trial to compare pain relief of paresthesia-based stimulation versus high frequency versus burst in 28 PSPS-T2 patients implanted with multiwave SCS systems. Our secondary objectives were to determine the efficacy of these 3 waveforms on pain surface, quality of life, functional capacity, psychological distress, and validated composite multidimensional clinical response index to provide holistic comparisons at 3-, 6-, 9-, and 15-month post-randomization. The preferred stimulation modality was documented during the follow-up periods. No difference between the waveforms was observed in this study (P = .08). SCS led to significant pain relief, quality of life improvement, improvement of multidimensional clinical response index, and of all other clinical outcomes at all follow-up visits. Forty-four percent of the patients chose to keep the paresthesia-based stimulation modality after the 15-month follow-up period. By giving the possibility to switch and/or to combine several waveforms, the overall rate of SCS responders further increased with 25%. In this study, high frequency or burst do not appear superior to paresthesia-based stimulation, wherefore paresthesia-based stimulation should still be considered as a valid option. However, combining paresthesia-based stimulation with paresthesia-free stimulation, through personalized multiwave therapy, might significantly improve SCS responses. PERSPECTIVE: This article assesses clinical SCS efficacy on pain relief, by comparing paresthesia-based stimulation and paresthesia-free stimulation (including high frequency and burst) modalities in patient presenting with PSPS-T2. Switching and/or combining waveforms contribute to increasing the global SCS responders rate.
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Affiliation(s)
- Philippe Rigoard
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Neuro-Spine & Neuromodulation, Poitiers University Hospital, Poitiers, France; Pprime Institute UPR 3346, CNRS, ISAE-ENSMA, University of Poitiers, Chasseneuil-du-Poitou, France
| | - Amine Ounajim
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Maarten Moens
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Lisa Goudman
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Brussels, Belgium; STIMULUS research group, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Manuel Roulaud
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Bertille Lorgeoux
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Sandrine Baron
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Kévin Nivole
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Mathilde Many
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Lucie Lampert
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - Romain David
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France; Department of Physical and Rehabilitation Medicine Unit, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Maxime Billot
- PRISMATICS Lab (Predictive Research in Spine/Neuromodulation Management and Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
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146
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Haddas R, Botros M, D'Agostino CR, Jablonski J, Ramirez G, Vasalos K, Thirukumaran C, Rubery PT. The effect of a workplace wellness program on disability, function and pain in healthcare providers workers with low back pain-outcomes of 3040 academic health center employees. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4405-4419. [PMID: 37875680 DOI: 10.1007/s00586-023-07971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/16/2023] [Accepted: 09/22/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE (1) Identification of musculoskeletal risk factors for healthcare providers suffering low back pain (LBP) and the creation of risk profiles for those individuals and (2) analyze the impact of a workplace wellness program on healthcare providers who suffer from low back pain. METHODS A total of 3040 employees at an academic healthcare center underwent a computer-adaptive survey of health-related quality of life (HRQOL), biometric tests, and a disability and functional movement assessment as part of the workplace wellness program (WWP). Clinical interventions with a rehabilitation specialist were offered to employees identified as at risk for low back pain. Data collected were analyzed using descriptive methods and multivariable regressions to address the study objectives. RESULTS Of the 3040 healthcare providers enrolled in this study, 77% identified with non-specific LBP with greater weakness, numbness, reduced flexibility, and physical activity. The major predictive risk factors for LBP were Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference score, PROMIS fatigue, previous work injury, flexibility, numbness, PROMIS social function, level of education, and BMI. Healthcare providers with LBP who completed the WWP improved in most dimensions of HRQOL and disability and functional outcomes. CONCLUSIONS A high proportion of healthcare providers suffer from LBP as a result of the nature of their work. Disability and functional outcomes measurements and PROMIS results quantitatively assess healthcare providers with LBP. Organizations can develop injury mitigation programs to target employees at high risk of LBP using the risk factors we identify. Completion of the WWP was associated with improvements in disability, HRQOL and functional measures.
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Affiliation(s)
- Ram Haddas
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA.
| | - Mina Botros
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Charles R D'Agostino
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Justin Jablonski
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Gabriel Ramirez
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Kostantinos Vasalos
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
| | - Paul T Rubery
- Department of Orthopaedics, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY, 14642, USA
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147
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Potaczek T, Jasiewicz B. How back pain influences daily activities and quality of life: Incidence of back pain related to age. J Child Orthop 2023; 17:505-511. [PMID: 38050592 PMCID: PMC10693836 DOI: 10.1177/18632521231215855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 12/06/2023] Open
Abstract
Low back pain is a prevalent global musculoskeletal issue, with a lifetime prevalence ranging from 49% to 70% in adults. Traditionally associated with adults, recent field surveys indicate comparable prevalence rates in children and adolescents, challenging earlier assumptions. Non-specific low back pain, where the source cannot be identified through diagnostic imaging, accounts for about 80%-90% of cases. Studies have shown that over 80% of adolescents with low back pain exhibit no underlying pathology. The prevalence of low back pain in younger populations varies widely, influenced by study methodology, age, and pain types. Research suggests that back pain prevalence in adolescents increases with age, with a shift in attitudes considering it is not necessarily indicative of specific issues. Level of evidence: level V.
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Affiliation(s)
- Tomasz Potaczek
- Department of Orthopaedics and Rehabilitation, Jagiellonian University Medical College, Zakopane, Poland
| | - Barbara Jasiewicz
- Department of Orthopaedics and Rehabilitation, Jagiellonian University Medical College, Zakopane, Poland
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148
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Tieppo Francio V, Westerhaus BD, Carayannopoulos AG, Sayed D. Multifidus dysfunction and restorative neurostimulation: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1341-1354. [PMID: 37439698 PMCID: PMC10690869 DOI: 10.1093/pm/pnad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Chronic low back pain (CLBP) is multifactorial in nature, with recent research highlighting the role of multifidus dysfunction in a subset of nonspecific CLBP. This review aimed to provide a foundational reference that elucidates the pathophysiological cascade of multifidus dysfunction, how it contrasts with other CLBP etiologies and the role of restorative neurostimulation. METHODS A scoping review of the literature. RESULTS In total, 194 articles were included, and findings were presented to highlight emerging principles related to multifidus dysfunction and restorative neurostimulation. Multifidus dysfunction is diagnosed by a history of mechanical, axial, nociceptive CLBP and exam demonstrating functional lumbar instability, which differs from other structural etiologies. Diagnostic images may be used to grade multifidus atrophy and assess other structural pathologies. While various treatments exist for CLBP, restorative neurostimulation distinguishes itself from traditional neurostimulation in a way that treats a different etiology, targets a different anatomical site, and has a distinctive mechanism of action. CONCLUSIONS Multifidus dysfunction has been proposed to result from loss of neuromuscular control, which may manifest clinically as muscle inhibition resulting in altered movement patterns. Over time, this cycle may result in potential atrophy, degeneration and CLBP. Restorative neurostimulation, a novel implantable neurostimulator system, stimulates the efferent lumbar medial branch nerve to elicit repetitive multifidus contractions. This intervention aims to interrupt the cycle of dysfunction and normalize multifidus activity incrementally, potentially restoring neuromuscular control. Restorative neurostimulation has been shown to reduce pain and disability in CLBP, improve quality of life and reduce health care expenditures.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Physical Medicine & Rehabilitation, The University of Kansas Medical Center, Kansas City, KS 66160, United States
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
| | - Benjamin D Westerhaus
- Cantor Spine Institute at the Paley Orthopedic & Spine Institute, West Palm Beach, FL 33407, United States
| | - Alexios G Carayannopoulos
- Department of Neurosurgery and Neurology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS 66160, United States
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149
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Marins EF, Caputo EL, Krüger VL, Junior DM, Scaglioni FG, Del Vecchio FB, Primo TT, Alberton CL. Effectiveness of m-health-based core strengthening exercise and health education for public safety workers with chronic non-specific low back pain: study protocol for a superiority randomized controlled trial (SAFEBACK). Trials 2023; 24:780. [PMID: 38041180 PMCID: PMC10693081 DOI: 10.1186/s13063-023-07833-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Low back pain (LBP) is the leading cause of years lived with disability worldwide. Public safety workers are highly exposed to physically demanding activities and inappropriate postures, increasing the risk of experiencing LBP. Smartphone app-based self-managed interventions may be an alternative for chronic non-specific LBP (CNSLBP) treatment. This study aims to evaluate the effectiveness of a smartphone app-based self-managed exercise program plus health education, compared to a health education program alone, on neuromuscular and perceptual outcomes in police officers and firefighters with CNSLBP. METHODS This is a parallel, two-armed, blinded evaluator randomized clinical trial. Police officers and firefighters (from public safety institutions in the Rio Grande do Sul state, Brazil) will be randomly assigned to a m-health self-managed exercise program (twice a week) plus health education or health education alone. Self-management exercise program components are mobility and core resistance exercises, available on the app. Follow-ups will be conducted post-treatment (8 weeks) and 16 weeks after randomization. The co-primary outcomes will be pain intensity and disability post-treatment (8 weeks). Secondary outcomes will be biopsychosocial factors related to CNSLBP. DISCUSSION We hypothesize that the effects of a smartphone app-based self-managed exercise program on co-primary and secondary outcomes will be superior, compared to the health education only in public safety workers with CNSLBP. TRIAL REGISTRATION The study was prospectively registered at ClinicalTrials.gov (NCT05481996. Registered on August 01, 2022).
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Affiliation(s)
- Eduardo F Marins
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil.
| | - Eduardo L Caputo
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
| | - Vitor L Krüger
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
| | - Dirceu M Junior
- Postgraduate Program in Computing, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, Rio Grande Do Sul, 96010-610, Brazil
| | - Fabrício G Scaglioni
- Postgraduate Program in Computing, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, Rio Grande Do Sul, 96010-610, Brazil
| | - Fabricio B Del Vecchio
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
| | - Tiago T Primo
- Postgraduate Program in Computing, Universidade Federal de Pelotas, Rua Gomes Carneiro, 1, Pelotas, Rio Grande Do Sul, 96010-610, Brazil
| | - Cristine L Alberton
- Postgraduate Program in Physical Education, Universidade Federal de Pelotas, Physical Education School, Rua Luiz de Camões 625, Pelotas, Rio Grande Do Sul, 96055-630, Brazil
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150
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Lotz JC, Ropella G, Anderson P, Yang Q, Hedderich MA, Bailey J, Hunt CA. An exploration of knowledge-organizing technologies to advance transdisciplinary back pain research. JOR Spine 2023; 6:e1300. [PMID: 38156063 PMCID: PMC10751978 DOI: 10.1002/jsp2.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/02/2023] [Accepted: 10/29/2023] [Indexed: 12/30/2023] Open
Abstract
Chronic low back pain (LBP) is influenced by a broad spectrum of patient-specific factors as codified in domains of the biopsychosocial model (BSM). Operationalizing the BSM into research and clinical care is challenging because most investigators work in silos that concentrate on only one or two BSM domains. Furthermore, the expanding, multidisciplinary nature of BSM research creates practical limitations as to how individual investigators integrate current data into their processes of generating impactful hypotheses. The rapidly advancing field of artificial intelligence (AI) is providing new tools for organizing knowledge, but the practical aspects for how AI may advance LBP research and clinical are beginning to be explored. The goals of the work presented here are to: (1) explore the current capabilities of knowledge integration technologies (large language models (LLM), similarity graphs (SGs), and knowledge graphs (KGs)) to synthesize biomedical literature and depict multimodal relationships reflected in the BSM, and; (2) highlight limitations, implementation details, and future areas of research to improve performance. We demonstrate preliminary evidence that LLMs, like GPT-3, may be useful in helping scientists analyze and distinguish cLBP publications across multiple BSM domains and determine the degree to which the literature supports or contradicts emergent hypotheses. We show that SG representations and KGs enable exploring LBP's literature in novel ways, possibly providing, trans-disciplinary perspectives or insights that are currently difficult, if not infeasible to achieve. The SG approach is automated, simple, and inexpensive to execute, and thereby may be useful for early-phase literature and narrative explorations beyond one's areas of expertise. Likewise, we show that KGs can be constructed using automated pipelines, queried to provide semantic information, and analyzed to explore trans-domain linkages. The examples presented support the feasibility for LBP-tailored AI protocols to organize knowledge and support developing and refining trans-domain hypotheses.
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Affiliation(s)
- Jeffrey C. Lotz
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | | | - Paul Anderson
- Department of Computer Science & Software EngineeringCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Qian Yang
- Department of Information ScienceCornell UniversityIthacaNew YorkUSA
| | | | - Jeannie Bailey
- Department of Orthopaedic SurgeryUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
| | - C. Anthony Hunt
- Department of Bioengineering & Therapeutic SciencesUniversity of California at San FranciscoSan FranciscoCaliforniaUSA
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