1
|
Quirk DA, Chung J, Applegate M, Cherin JM, Dalton DM, Awad LN, Walsh CJ. Evaluating adaptiveness of an active back exosuit for dynamic lifting and maximum range of motion. ERGONOMICS 2024; 67:660-673. [PMID: 37482538 PMCID: PMC10803634 DOI: 10.1080/00140139.2023.2240044] [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: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023]
Abstract
Back exosuits deliver mechanical assistance to reduce the risk of back injury, however, minimising restriction is critical for adoption. We developed the adaptive impedance controller to minimise restriction while maintaining assistance by modulating impedance based on the user's movement direction and nonlinear sine curves. The objective of this study was to compare active assistance, delivered by a back exosuit via our adaptive impedance controller, to three levels of assistance from passive elastics. Fifteen participants completed five experimental blocks (4 exosuits and 1 no-suit) consisting of a maximum flexion and a constrained lifting task. While a higher stiffness elastic reduced back extensor muscle activity by 13%, it restricted maximum range of motion (RoM) by 13°. The adaptive impedance approach did not restrict RoM while reducing back extensor muscle activity by 15%, when lifting. This study highlights an adaptive impedance approach might improve usability by circumventing the assistance-restriction trade-off inherent to passive approaches.Practitioner summary: This study demonstrates a soft active exosuit that delivers assistance with an adaptive impedance approach can provide reductions in overall back muscle activity without the impacts of restricted range of motion or perception of restriction and discomfort.
Collapse
Affiliation(s)
- D. Adam Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Megan Applegate
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
| | - Diane M. Dalton
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Lou N. Awad
- College of Health & Rehabilitation Sciences: Sargent College, Boston University, Boston, MA
| | - Conor J. Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA
| |
Collapse
|
2
|
Daniels AH, Park AM, Lee DJ, Daher M, Diebo BG, Carayannopoulos A. Impact of Sacroiliac Belt Utilization on Balance in Patients with Low Back Pain. Orthop Rev (Pavia) 2024; 16:116960. [PMID: 38699080 PMCID: PMC11062887 DOI: 10.52965/001c.116960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024] Open
Abstract
Background Low back pain (LBP) is a common problem which can affect balance and, in turn, increase fall risk. The aim of this investigation was to evaluate the impact of a Sacroiliac Belt (SB) on balance and stability in patients with LBP. Methods Subjects with LBP and without LBP ("Asymptomatic") were enrolled. Baseline balance was assessed using the Berg Balance Scale. In a counterbalanced crossover design, LBP and Asymptomatic subjects were randomized to one of two groups: 1) start with wearing the SB (Serola Biomechanics, Inc.) followed by not wearing the SB or 2) start without wearing the SB followed by wearing the SB. For subjects in both groups, dynamic balance was then assessed using the Star Excursion Balance Test (SEBT) with each leg planted. Results Baseline balance was worse in LBP subjects (Berg 51/56) than Asymptomatic subjects (Berg 56/56) (p<0.01). SB significantly improved SEBT performance in LBP subjects regardless of which leg was planted (p<0.01). SB positively impacted Asymptomatic subjects' SEBT performance with the left leg planted (p=0.0002). Conclusion The Serola Sacroiliac Belt positively impacted dynamic balance for subjects with low back pain. Further research is needed to examine additional interventions and outcomes related to balance in patients with back pain, and to elucidate the mechanisms behind improvements in balance related to sacroiliac belt utilization.
Collapse
Affiliation(s)
- Alan H Daniels
- Warren Alpert Medical School Brown University
- Division of Spine Surgery, Department of Orthopaedic Surgery Rhode Island Hospital
| | | | | | | | - Bassel G Diebo
- Warren Alpert Medical School Brown University
- Division of Spine Surgery, Department of Orthopaedic Surgery Rhode Island Hospital
| | | |
Collapse
|
3
|
Banks JJ, Quirk DA, Chung J, Cherin JM, Walsh CJ, Anderson DE. The effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading during squat and stoop lifts. ERGONOMICS 2024:1-14. [PMID: 38389220 DOI: 10.1080/00140139.2024.2320355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Back support exosuits aim to reduce tissue demands and thereby risk of injury and pain. However, biomechanical analyses of soft active exosuit designs have been limited. The objective of this study was to evaluate the effect of a soft active back support exosuit on trunk motion and thoracolumbar spine loading in participants performing stoop and squat lifts of 6 and 10 kg crates, using participant-specific musculoskeletal models. The exosuit did not change overall trunk motion but affected lumbo-pelvic motion slightly, and reduced peak compressive and shear vertebral loads at some levels, although shear increased slightly at others. This study indicates that soft active exosuits have limited kinematic effects during lifting, and can reduce spinal loading depending on the vertebral level. These results support the hypothesis that a soft exosuit can assist without limiting trunk movement or negatively impacting skeletal loading and have implications for future design and ergonomic intervention efforts.
Collapse
Affiliation(s)
- Jacob J Banks
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| | - David A Quirk
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jinwon Chung
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Jason M Cherin
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Dennis E Anderson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Orthopedic Surgery, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Ganesh GS, Khan AR, Khan A. A survey of Indian physiotherapists' clinical practice patterns and adherence to clinical guidelines in the management of patients with acute low back pain. Musculoskeletal Care 2023; 21:478-490. [PMID: 36444875 DOI: 10.1002/msc.1720] [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: 10/28/2022] [Revised: 11/17/2022] [Accepted: 11/19/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Clinical practice guidelines (CPG) exist for the management of non-specific low back pain (LBP). The objective of this study is to evaluate if Indian physiotherapists' follow CPGs when treating patients with acute LBP. METHODS A cross-sectional survey using an online questionnaire was used to collect demographic information, views, and opinion about acute LBP and CPGs, and management strategies of a clinical vignette presenting a patient with acute LBP. RESULTS Responses from 328 physiotherapists were included in this study. Eighty-one percent of respondents indicated familiarity with CPGs for LBP and 75.3% (n = 328) respondents indicated that their intervention choices aligned with guidelines to at least some extent. Participants with post-graduate and doctoral degrees were more accustomed to CPGs than those with bachelor's degrees (p < 0.01). There were significant differences in clinical practice (p < 0.01) between therapists who expressed familiarity with guidelines and those who were not, as well as those with and without post-graduate and doctoral degrees. CONCLUSION In general, the study showed adherence to guidelines; however, there were areas that did not align with established evidence, especially referral for radiology and use of electrical modalities.
Collapse
Affiliation(s)
- G Shankar Ganesh
- Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Lucknow, Uttar Pradesh, India
| | | | | |
Collapse
|
5
|
Bai J, Hua A, Weng D, Wang N, Wang J. Effects of non-extensible lumbar belts on static and dynamic postural stability. BMC Musculoskelet Disord 2023; 24:362. [PMID: 37158940 PMCID: PMC10165835 DOI: 10.1186/s12891-023-06476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Previous studies have found that increased intra-abdominal pressure helps to reduce spinal loading and improve spine stability. Non-extensible lumbar belts (NEBs) could elevate intra-abdominal pressure and augment spinal stability. NEBs have been used in the healthcare field to help reduce pain and improve spine function for people with low back pain. However, the effect of NEBs on static and dynamic postural stability is not clear. METHODS This study aimed to investigate whether NEBs affect static and dynamic postural stability. Twenty-eight healthy male subjects were recruited to finish four static postural stability tasks and two dynamic postural stability tests. Center of pressure (COP) values during 30 s of quiet standing, dynamic postural stability index (DPSI) and Y balance test (YBT) score with and without NEBs were analyzed. RESULTS NEBs had no significant effect in all COP variables in the static postural tasks. The results of a repeated measure two-way ANOVA indicated the NEBs significantly improved the dynamic postural stability in YBT score and DPSI (F (1,27) = 5.506, p = .027, [Formula: see text] and F (1,27) = 83.94, p = .000, [Formula: see text] respectively). CONCLUSIONS The study results indicate that non-extensible belts improve dynamic stability in healthy male participants, with potential implications for rehabilitation and performance enhancement programs.
Collapse
Affiliation(s)
- Jingyuan Bai
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China
| | - Anke Hua
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China
| | - Dongkai Weng
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China
| | - Nan Wang
- Hangzhou Weizhen Health Technology Co., Ltd., 310058, Hangzhou, China
| | - Jian Wang
- Department of Sports Science, College of Education, Zhejiang University, Hangzhou, 310058, China.
- Center for Psychological Sciences, Zhejiang University, Hangzhou, 310058, China.
| |
Collapse
|
6
|
Fercho J, Krakowiak M, Yuser R, Szmuda T, Zieliński P, Szarek D, Pettersson SD, Miękisiak G. Evaluation of Movement Restriction of Spinal Orthoses Using Inertial Measurement Units. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16515. [PMID: 36554395 PMCID: PMC9779723 DOI: 10.3390/ijerph192416515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Despite the frequent use of orthopedic braces or spine stabilizers in diseases such as kyphosis, lordosis, and scoliosis, as well as in the case of injuries and rehabilitation after surgeries, there is no clear evidence of their proper stabilization of the spine while carrying out daily activities. This study sought to assess the spine's mobility while wearing three different orthopedic braces while performing basic tasks. Ten healthy subjects were enrolled. Three Inertial Measurement Units (IMUs) were attached superficially along the spine at approximate levels: cervical (C7), between thoracic (T8) and lumbar (L3), and sacrum. The angle between sensors was monitored to provide data on the sagittal profile. In addition, the displacement of the spine's longitudinal axis was measured (rotation). There are three types of orthopedic braces: the semi-rigid Hohmann corset, the Jewett brace, and the Thoracolumbar Fixed Spinal Orthosis (TLSO). Four tasks were monitored: standing, sitting, walking, and picking up an item from the floor with one hand. All braces provided a similar level of stability in both the sagittal plane and rotational axis while lifting an object. On the other hand, while walking and sitting, the TLSO was the only orthosis providing a statistically significant rigidity in the sagittal plane. When performing a more voluntary task, the measured rigidity of softer braces was significantly increased when compared with more involuntary tasks. A certain degree of motion restriction with spinal orthoses may come from the feedback pressure, which stimulates paraspinal muscles to contract and thus increases the overall rigidity of the trunk.
Collapse
Affiliation(s)
- Justyna Fercho
- Neurosurgery Department, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Michał Krakowiak
- Neurosurgery Department, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Rami Yuser
- Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Tomasz Szmuda
- Neurosurgery Department, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Piotr Zieliński
- Neurosurgery Department, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | - Dariusz Szarek
- Department of Neurosurgery, Marciniak’s Hospital, 54-049 Wrocław, Poland
| | - Samuel D. Pettersson
- Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk, 80-214 Gdańsk, Poland
| | | |
Collapse
|
7
|
Swathi S, P. S, Neelam S. Nonspecific low back pain in sedentary workers: A narrative review. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i5.1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A sedentary lifestyle is a risk factor, significantly increasing the incidence of low back pain (LBP). Higher levels of sedentary lifestyle were witnessed in the workers who spent the greatest amount of their time in sitting positions in the workplace and during free time. The incidence and prevalence of low back pain in sedentary workers were 14-37% and 34-62%. Noticeably, the people with low back pain had higher productivity loss. It specifies more research is required to help individuals with back pain to stay in their work. The main intention of this study briefly reviews the risk factors, associated adaptations, and Interventions in physical therapy for preventing and managing nonspecific low back pain in sedentary workers. To do this review, Information was gathered from the offline library resources and online electronic search databases (Scopus, COCHRANE, PUBMED). The keywords used were low back pain, sedentary workers, risk factors, adaptations, exercise therapy, and sedentary lifestyle. The prognosis and management of low back pain were greatly influenced by several risk factors related to physical, psychological, and occupational factors. During the transition of low back pain from acute to chronic stages, adaptations in various domains like psychological, behavioral, and neuromuscular changes are seen. Exercise therapy itself or in addition to other therapeutic approaches is successful in preventing and treatment of nonspecific low back pain in sedentary workforces. By identifying associated risk factors, and changes adapted by individual patients, Therapists can design proper exercise therapeutic approaches that will provide more effective interventions.
Collapse
|
8
|
The Effect of Lumbar Belts with Different Extensibilities on Kinematic, Kinetic, and Muscle Activity of Sit-to-Stand Motions in Patients with Nonspecific Low Back Pain. J Pers Med 2022; 12:jpm12101678. [PMID: 36294817 PMCID: PMC9605222 DOI: 10.3390/jpm12101678] [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: 09/19/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
Although lumbar belts can be used for the treatment and prevention of low back pain, the role of the lumbar belt remains unclear without clear guidelines. This study aimed to investigate the effect of lumbar belts with different extensibilities on the kinematics, kinetics, and muscle activity of sit-to-stand motions in terms of motor control in patients with nonspecific low back pain. A total of 30 subjects participated in the study: 15 patients with nonspecific low back pain and 15 healthy adults. Participants performed the sit-to-stand motion in random order of three conditions: no lumbar belt, wearing an extensible lumbar belt, and wearing a non-extensible lumbar belt. The sit-to-stand motion's kinematic, kinetic, and muscle activity variables in each condition were measured using a three-dimensional motion analysis device, force plate, and surface electromyography. An interaction effect was found for the time taken, anterior pelvic tilt angle, and muscle activity of the vastus lateralis and biceps femoris. The two lumbar belts with different extensibilities had a positive effect on motor control in patients with nonspecific low back pain. Therefore, both types of extensible lumbar belts can be useful in the sit-to-stand motion, which is an important functional activity for patients with nonspecific low back pain.
Collapse
|
9
|
Veiskarami M, Aminian G, Bahramizadeh M, Gholami M, Ebrahimzadeh F, Arazpour M. The Efficacy of "Anatomical Posture Control Orthosis" on the Activity of Erector spinae Muscle, Risk of Falling, Balance Confidence, and Walking Speed in Osteoporotic Hyperkyphotic Subjects. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:798-805. [PMID: 36246024 PMCID: PMC9527421 DOI: 10.22038/abjs.2021.53771.2678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 09/25/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Osteoporosis is a silent and asymptomatic disease that leads to thoracic hyperkyphosis, which can interfere with the normal function of the paraspinal musculature and balance control. There is no evidence regarding the effect of the anatomical posture control (APC) orthosis in older people with osteoporotic thoracic hyperkyphosis. This study aimed to examine the effects of this novel orthosis on the electromyography (EMG) of the erector spinae (ES) and balance control in this group of patients. METHODS In total, 22 elderly osteoporotic subjects with thoracic hyperkyphosis were enrolled in this study. The participants used the orthosis for 4 weeks. The clinical balance assessment scales assessing fall risk and surface EMG (sEMG) signals were recorded from the erector spinae muscles bilaterally before and after the use of orthosis. The marginal model was used with the generalized estimating equation analysis for investigating the effect of this orthosis on the sEMG of the paraspinal muscles and the balance control in this longitudinal study. RESULTS The normalized root mean square of sEMG of the lumbar and thoracic ES muscles reduced significantly (P<0.05), and significant improvement was observed (P<0.05) in the balance control test when the participants used this new-designed orthosis (P<0.05). CONCLUSION APC orthosis can decrease the activity of ES muscles during static standing and improve the static and dynamic balance in the hyperkyphotic osteoporotic subjects.
Collapse
Affiliation(s)
- Masoumeh Veiskarami
- Lorestan University of Medical Sciences, School of Alleid Medichal Sciences, Lorestan, Iran
| | - Gholamreza Aminian
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehrdad Gholami
- Lorestan University of Medical Sciences, School of Alleid Medichal Sciences, Lorestan, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics and Epidemiology, University of Medical Sciences, Lorestan, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
10
|
Lee DJ, Ahmed SA, Tang OY, Yang DS, Alsoof D, McDonald CL, Eltorai AE, Daniels AH. Comparative Effectiveness of Sacroiliac Belt versus Lumbar Orthosis Utilization on Nonspecific Low Back Pain: a Crossover Randomized Clinical Trial. Orthop Rev (Pavia) 2022; 14:37471. [DOI: 10.52965/001c.37471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Back braces are commonly utilized in the management of low back pain (LBP). Objective The aim of this study is to evaluate (1) user satisfaction with a sacroiliac belt versus a lumbar orthosis and (2) the effect of a sacroiliac belt versus a lumbar orthosis on pain, functional disability status, and analgesic use for subjects with subacute or chronic non-specific LBP. Methods This is a prospective randomized crossover study. For the two-week study period, control group subjects wore the Horizon 627 Lumbar Brace (“lumbar orthosis”) during the first week and the Serola Sacroiliac Belt (“sacroiliac belt”) during the second week; experimental group subjects wore the sacroiliac belt during the first week and the lumbar orthosis during the second week. User satisfaction (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 [QUEST 2.0] score), functional disability status (Oswestry Disability Index [ODI]), pain, and analgesic use were recorded. Results Overall, the sacroiliac belt demonstrated significantly higher user satisfaction than the Horizon brace (QUEST Score = 20.31 vs. 16.17, p = 0.0375) for the entire study period. Significant negative correlations were identified between user satisfaction and functional disability (t = -4.71, p < 0.0001), pain magnitude (t = -6.81, p < 0.0001) as well as pain frequency (t = -6.66, p < 0.0001). Conclusion In this prospective randomized crossover study, subject satisfaction was associated with improvements in functional disability, pain magnitude and pain frequency. The sacroiliac belt demonstrated significantly higher user satisfaction and similar effectiveness compared to the lumbar orthosis.
Collapse
Affiliation(s)
- David J. Lee
- The Warren Alpert Medical School of Brown University
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Landauer F, Trieb K. An Indication-Based Concept for Stepwise Spinal Orthosis in Low Back Pain According to the Current Literature. J Clin Med 2022; 11:jcm11030510. [PMID: 35159962 PMCID: PMC8837009 DOI: 10.3390/jcm11030510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 02/07/2023] Open
Abstract
Background: The current literature is not conclusive for spinal orthosis treatment in low back pain. Therefore, two questions have to be answered: Does the current literature support the indication of spinal orthosis treatment in low back pain? Which treatment concept can be derived from the result? Method: The 30 highest-rated literature citations (PubMed: best match, 30 December 2021) dealing with low back pain and spine orthosis were included in the study. Excluded were all articles related to Kinesio Taping, scoliosis, physical exercise, or dealing with side effects and unrelated to treatment effect. Thus, the literature list refers only to “low back pain and spine orthoses”. These articles were analyzed according to the PRISMA criteria and divided according to “specific diagnosis”, when the cause of pain was explained (group A), or when “specific diagnosis is not given” (group B). The articles were also distinguished by the information about the orthosis. Articles with biomechanical information about the function of the orthoses were called “diagnosis-based orthosis” (group C). All other articles were part of the group “unspecific orthotic treatment” (group D). The results were compared to each other in terms of effectiveness. According to anatomical causes, a concept of orthosis selection depending on diagnosis of low back pain for clinical practice was developed. The risk of bias lies in the choice of the MESH terms. The synthesis of the results was a clinical treatment concept based on findings from the current literature. Results: The literature citations with 1749 patients and 2160 citations of literature were processed; 21 prospective clinical or biomechanical studies and 9 review articles were included. The combination of literature citations according to “specific diagnosis” (group A) and “diagnosis based orthosis” (group C) was very likely to lead to a therapeutic effect (seven articles). No positive effect could be found in four articles, all dealing with postoperative treatment. When “specific diagnosis is not given” (group B) and combined with “unspecific orthotic treatment” (group D), therapy remained without measurable effect (15 articles). An effect was described in four articles (three biomechanical studies and one postoperative study). In review articles, according to specific diagnosis, only one article dealt with fractures and another with stenosis. In all review articles where specific diagnosis was not given, no effect with spine orthoses could be found. Using this knowledge, we created a clinical treatment concept. The structure was based on diagnosis and standardized orthoses. According to pain location and pathology (muscle, intervertebral disc, bone, statics, postoperative) the orthoses were classified to anatomical extent and the mechanical limitation (bandage, bodice, corset, orthosis with shoulder straps and erecting orthosis). Conclusion: The effectiveness of spinal orthoses could not be deduced from the current literature. The most serious limitation was the inconsistency of the complaint and the imprecise designation of the orthoses. Interpretation: Articles with a precise allocation of the complaint and a description of the orthosis showed a positive effect. The treatment concept presented here is intended to provide a basis for answering the question concerning the effectiveness of spinal orthoses as an accompanying treatment option in low back pain.
Collapse
Affiliation(s)
- Franz Landauer
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
- Correspondence:
| | - Klemens Trieb
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria;
- Computed Tomography Research Group, University of Applied Sciences Upper Austria, 4600 Wels, Austria
| |
Collapse
|
12
|
Im SC, Cho HY, Lee JH, Kim K. Analysis of the Effect of Wearing Extensible and Non-Extensible Lumbar Belts on Biomechanical Factors of the Sit-to-Stand Movement and Pain-Related Psychological Factors Affecting Office Workers with Low Back Pain. Healthcare (Basel) 2021; 9:healthcare9111601. [PMID: 34828646 PMCID: PMC8624328 DOI: 10.3390/healthcare9111601] [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: 10/18/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022] Open
Abstract
This study aimed to investigate the effects of wearing extensible and non-extensible lumbar belt (LB) on biomechanical factors of the sit-to-stand (STD) movement and pain-related psychological factors affecting office workers with low back pain. Among 30 office workers, 15 with low back pain (LBP) were assigned to the experimental group and 15 healthy adults were assigned to the control group. The participants performed STD movement in random order of three different conditions: without LB (Condition 1), with extensible LB (Condition 2), and with non-extensible LB (Condition 3). Biomechanical variables of STD movement in each condition were measured using a three-dimensional motion analysis system and force plate. Pain-related psychological factors were measured only in the experimental group. Among the biomechanical factors of STD movement, an interaction effect was found in the maximum anterior pelvic tilt angle and total-phase range of motion of the trunk (p < 0.05). Pain intensity, pain-related anxiety, and pain catastrophizing were decreased in the conditions with lumbar belts (Conditions 2 and 3) compared to the condition without LB (Condition 1) (p < 0.05). Extensible and non-extensible lumbar belts engender biomechanically beneficial effects during STD movement in both office workers with LBP and healthy office workers. Further, pain intensity, pain-related anxiety, and pain catastrophizing were decreased in office workers with LBP. Therefore, both types of extensible lumbar belts may be helpful in the daily life of patients with LBP and office workers.
Collapse
Affiliation(s)
- Sang-Cheol Im
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Korea; (S.-C.I.); (H.-Y.C.)
| | - Ho-Young Cho
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Korea; (S.-C.I.); (H.-Y.C.)
| | - Jae-Hong Lee
- Department of Physical Therapy, Daegu Health College, Daegu 41453, Korea;
| | - Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University, Gyeongsan 38453, Korea; (S.-C.I.); (H.-Y.C.)
- Correspondence: ; Tel.: +82-53-850-4351
| |
Collapse
|
13
|
Price JW. Osteopathic model of the development and prevention of occupational musculoskeletal disorders. J Osteopath Med 2021; 121:287-305. [PMID: 33635956 DOI: 10.1515/jom-2020-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Context The direct and indirect costs of work-related musculoskeletal disorders are significant. Prevention is the most effective way to control these costs. To do that, we must understand how these disorders develop. Objectives To use the five models of osteopathic care to illustrate how cellular processes and neural reflexes interact to create work-related musculoskeletal pathology and to provide evidence-informed musculoskeletal injury and disability prevention recommendations. Methods A literature review of electronic databases (Google Scholar, PubMed, OVID, Cochrane Central Register of Controlled Trials, PEDro, and OSTMED.DR) from inception to October 16, 2019 and hand-search of publication references was performed for systematic reviews, cohort studies, case-control studies, and randomized controlled trials. The search terms reflected topics related to occupational injury and injury prevention, and included supplementary laboratory studies and narrative reviews related to the biological aspects of musculoskeletal injury. The eligible studies contained the following criteria: (1) the population of working age; (2) exposures to known risk factors, musculoskeletal disorders, and psychosocial factors; (3) written in English; (4) full text papers published in peer-reviewed journals; and (5) systematic review, cohort study, case-control study, and randomized controlled trial methodology. Studies were excluded if they included outcomes of productivity and costs only or outcomes that were assessed through qualitative methods only. Results The literature search resulted in 1,074 citations; 26 clinical studies and 14 systematic reviews were used in this review. A comprehensive workplace musculoskeletal disorder prevention program should match demands to capacity, correct dysfunctional movement patterns, and limit tissue vulnerability (biomechanical-structural model); restore alpha-gamma balance, tonic-phasic synergistic function, and autonomic balance (neurological model); maximize physiologic reserve (metabolic-energy model) component of a prevention program; optimize respiration and circulation (respiratory-circulatory model); and address cognitive distortions (behavioral-biopsychosocial model). Conclusions The presented osteopathic model of the development and prevention of work-related musculoskeletal disorders suggests that a combination of preventive interventions will be more effective than any single preventive intervention.
Collapse
Affiliation(s)
- James William Price
- Ascension St. Vincent Occupational Medicine Clinic, Evansville, IN, USA.,College of Osteopathic Medicine, Marion University, Indianapolis, IN, USA
| |
Collapse
|
14
|
Cashin AG, Rizzo RRN, Wand BM, O'Connell NE, Lee H, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane Reviews. Hippokratia 2021. [DOI: 10.1002/14651858.cd014691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Aidan G Cashin
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Rodrigo RN Rizzo
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Health Sciences, Faculty of Medicine and Health; The University of New South Wales; Sydney Australia
| | - Benedict M Wand
- School of Physiotherapy; The University of Notre Dame Australia; Fremantle Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse; Brunel University London; Uxbridge UK
| | - Hopin Lee
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS); University of Oxford; Oxford UK
- School of Medicine and Public Health; The University of Newcastle; Newcastle Australia
| | - Matthew K Bagg
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Edel O'Hagan
- Prince of Wales Clinical School, Faculty of Medicine; The University of New South Wales; Sydney Australia
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
| | - Christopher G Maher
- Sydney School of Public Health; The University of Sydney; Sydney Australia
- Institute for Musculoskeletal Health; The University of Sydney and Sydney Local Health District; Sydney Australia
| | | | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Earth and Life Sciences; VU University Amsterdam; Amsterdam Netherlands
| | - James H McAuley
- Centre for Pain IMPACT; Neuroscience Research Australia; Sydney Australia
- School of Health Sciences, Faculty of Medicine and Health; The University of New South Wales; Sydney Australia
| |
Collapse
|
15
|
See QY, Tan JNB, Kumar DS. Acute low back pain: diagnosis and management. Singapore Med J 2021; 62:271-275. [PMID: 34409471 DOI: 10.11622/smedj.2021086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Qin Yong See
- Care and Health Integration, Changi General Hospital, Singapore
| | | | | |
Collapse
|
16
|
Bernardes JM, Monteiro-Pereira PE, Gómez-Salgado J, Ruiz-Frutos C, Dias A. Healthcare workers' knowledge for safe handling and moving of the patient. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2021; 28:2105-2111. [PMID: 34261410 DOI: 10.1080/10803548.2021.1955484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives. Healthcare workers are at risk of injury during patient handling activities. There is a lack of research in safe patient handling. The objective of this study was to examine the knowledge level of safe patient handling among Brazilian healthcare workers and to analyze its associated factors. Methods. This cross-sectional study was performed in two hospitals and 47 outpatient facilities with 644 participants in Brazil. Healthcare workers completed a self-administered questionnaire about their working characteristics, history of lower back pain and knowledge of safe patient handling. Results. The mean score of safe patient handling knowledge was 11.89 out of 22 maximum points. More than half (59%) of the participants did not see the risk of their activity. Educational level, type of healthcare facility and outpatient clinics were associated with safe patient handling knowledge in the logistic regression model. Conclusion. There was a substantial deficit in safe patient handling knowledge. There is a need for courses and textbooks to move beyond ineffective preventive strategies and minimize the risk of manual patient handling. Healthcare workers are at risk of injury during patient handling activities. Nursing schools in developing countries must focus on researching this topic to ensure safe patient handling.
Collapse
Affiliation(s)
- João Marcos Bernardes
- Graduate Program in Collective/Public Health, Botucatu Medical School, São Paulo State University (UNESP), Brazil
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, Universidad de Huelva, Spain.,Safety and Health Postgraduate Program, Universidad Espíritu Santo, Ecuador
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, Universidad de Huelva, Spain.,Safety and Health Postgraduate Program, Universidad Espíritu Santo, Ecuador
| | - Adriano Dias
- Graduate Program in Collective/Public Health, Botucatu Medical School, São Paulo State University (UNESP), Brazil
| |
Collapse
|
17
|
Abstract
Low back pain is a common problem that is the leading cause of disability and is associated with high costs. Evaluation focuses on identification of risk factors indicating a serious underlying condition and increased risk for persistent disabling symptoms in order to guide selective use of diagnostic testing (including imaging) and treatments. Nonpharmacologic therapies, including exercise and psychosocial management, are preferred for most patients with low back pain and may be supplemented with adjunctive drug therapies. Surgery and interventional procedures are options in a minority of patients who do not respond to standard treatments.
Collapse
Affiliation(s)
- Roger Chou
- Oregon Health & Science University, Portland, Oregon
| |
Collapse
|
18
|
Myung E, Neto JD, Murta GA, Vieira A, Gomes de Lima PR, Lessa L, Bernardo WM. ANAMT Technical Guideline (DT 05): prevention of occupational low back pain through back belts, lumbar support or braces. Rev Bras Med Trab 2020; 16:524-531. [PMID: 32754669 DOI: 10.5327/z1679443520180334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 11/11/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Low back pain is a considerable global public health problem. Use of back belts in occupational settings arises from the expectation of countless biomechanical benefits, which together would contribute to the prevention of this problem. OBJECTIVE To orient students, physicians and health institutions on the use of back belts, lumbar support or braces for prevention of low back pain or injury among asymptomatic workers. METHOD The present guideline was developed based on a systematic literature review; 809 studies were located in database MEDLINE and 571 in EMBASE and Cochrane CENTRAL. Evaluating back-belt use as preventive intervention against low back pain demands quantifying benefits, harms and difficulties to implementation, as well as the methodological quality of primary studies. CONCLUSION Despite the weak benefits reflected in the individual, partial and isolated results of a few studies, there is no consistent evidence for the use of back belts, lumbar supports or braces for primary prevention of low back pain or occupational low back injury among workers. According to the available evidence, back-belt use is not associated with reduction of absenteeism.
Collapse
Affiliation(s)
- Eduardo Myung
- Guidelines Unit, Associação Nacional de Medicina do Trabalho - São Paulo (SP), Brazil
| | - José Domingos Neto
- Guidelines Unit, Associação Nacional de Medicina do Trabalho - São Paulo (SP), Brazil
| | | | - Anielle Vieira
- Guidelines Unit, Associação Nacional de Medicina do Trabalho - São Paulo (SP), Brazil
| | | | - Leandro Lessa
- Guidelines Unit, Associação Nacional de Medicina do Trabalho - São Paulo (SP), Brazil
| | | |
Collapse
|
19
|
Huang R, Ning J, Chuter VH, Taylor JB, Christophe D, Meng Z, Xu Y, Jiang L. Exercise alone and exercise combined with education both prevent episodes of low back pain and related absenteeism: systematic review and network meta-analysis of randomised controlled trials (RCTs) aimed at preventing back pain. Br J Sports Med 2019; 54:766-770. [PMID: 31672696 DOI: 10.1136/bjsports-2018-100035] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We aimed to investigate which prevention strategies for low back pain (LBP) are most effective. DESIGN We completed a Bayesian network meta-analysis to summarise the comparative effectiveness of LBP prevention strategies. The primary outcomes were an episode of LBP and LBP-associated work absenteeism represented as ORs with associated 95% credibility intervals (CrIs). We ranked all prevention strategies with surface under the cumulative ranking curve (SUCRA) analysis. DATA SOURCES PubMed, EMBASE and CENTRAL databases were searched along with manual searches of retrieved articles. We only included randomised controlled trials (RCTs) that reported an episode of LBP and/or LBP-associated work absenteeism evaluating LBP prevention strategies were included. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Data were independently extracted by two investigators, and RCT quality was assessed using the Cochrane Risk of Bias tool. RESULTS AND SUMMARY Forty RCTs were included. Exercise combined with education (OR: 0.59, CrI: 0.41 to 0.82) and exercise alone (OR: 0.59, CrI: 0.36 to 0.92) both prevented LBP episodes; exercise combined with education and education alone both had large areas under the curve (SUCRA: 81.3 and 79.4, respectively). Additionally, exercise (OR: 0.04, CrI: 0.00 to 0.34) prevented LBP-associated work absenteeism, with exercise and the combination of exercise and education ranking highest (SUCRA: 99.0 and 60.2, respectively). CONCLUSIONS Exercise alone and exercise combined with education can prevent episodes of LBP and LBP-related absenteeism. TRIAL REGISTRATION NUMBER PROSPERO 42017056884.
Collapse
Affiliation(s)
- Rongzhong Huang
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China.,Department of Gerontology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Ning
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China
| | - Vivienne H Chuter
- School of Health Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Jeffrey Bruce Taylor
- Physical Therapy, High Point University, High Point, North Carolina, USA.,Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Demoulin Christophe
- Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
| | - Zengdong Meng
- Department of Orthopedics, First People's Hospital of YunNan Province, YunNan, China
| | - Yu Xu
- Statistical Laboratory, Chongqing Chuangxu Lifescience Institute, Chongqing, China
| | - Lihong Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of YunNan Province, Kunming, China
| |
Collapse
|
20
|
Palsson TS, Travers MJ, Rafn T, Ingemann-Molden S, Caneiro JP, Christensen SW. The use of posture-correcting shirts for managing musculoskeletal pain is not supported by current evidence - a scoping review of the literature. Scand J Pain 2019; 19:659-670. [PMID: 31075089 DOI: 10.1515/sjpain-2019-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS The concept of bad posture being a dominant driver of pain is commonly held belief in the society. This may explain the significant attention supportive clothing such as posture-correcting shirts has recently gained in Scandinavia and the USA. The aim of this scoping review was to present an overview and synthesis of the available evidence for the use of posture-correcting shirts aimed at reducing pain or postural discomfort and optimising function/posture. METHODS A systematic search was conducted for literature investigating the effect of posture-correcting shirts on musculoskeletal pain or function. PubMed, Embase, CINAHL, PEDro and the Cochrane Library were searched for relevant literature. Results of the searches were evaluated by two independent reviewers in three separate steps based on title, abstract and full text. For data synthesis, the population, intervention, comparator and outcome were extracted. The quality of the literature was evaluated using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) assessment tool or the RoB 2.0 tool for individually randomized, parallel group trials. The overall confidence in the literature was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 136 articles were identified and six of these were included in the review. These studies were heterogeneous with regards to aims, outcomes and methods, presenting contrasting results. The overall findings were that posture-correcting shirts change posture and subjectively have a positive effect on discomfort, energy levels and productivity. The quality of the included literature was poor to fair with only one study being of good quality. The risk of bias was serious or critical for the included studies. Overall, this resulted in very low confidence in available evidence. An important limitation of all studies was that they were conducted in pain-free individuals. CONCLUSIONS The contrasting findings and the low quality of current literature, questions the intended effect of posture-correcting shirts and whether the changes it creates are in fact useful for clinical practice. Moreover, the findings are contrasted by the available evidence regarding posture and pain with a particular focus on whether this management strategy may have a detrimental effect on people living with musculoskeletal pain. A major limitation to the existing literature on the effect of posture-correcting shirts is that no studies have investigated their effect in clinical populations. IMPLICATIONS Based on the available literature and the major limitation of no studies investigating clinical populations, there is no good quality evidence to support recommendation of posture-correcting shirts as a management strategy for musculoskeletal pain. Promotion of this product may reinforce the inaccurate and unhelpful message that poor posture leads to pain. The efficacy of such garments should be tested in clinical populations and not only in pain-free individuals, to assess whether there is any meaningful benefit of this management approach. Until then, the use of posture-correcting shirts for musculoskeletal pain is not supported by current evidence.
Collapse
Affiliation(s)
- Thorvaldur Skuli Palsson
- Associate Professor, Department of Health Science and Technology, SMI® Aalborg University, Frederik Bajers Vej 7A-205, Aalborg, Denmark, Phone: +4530220937
| | - Mervyn J Travers
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Trine Rafn
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - Stian Ingemann-Molden
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark
| | - J P Caneiro
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.,Body Logic Physiotherapy Clinic, Perth, Australia
| | - Steffan Wittrup Christensen
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg, Denmark.,Department of Health Science and Technology, SMI® Aalborg University, Aalborg, Denmark
| |
Collapse
|
21
|
Bataller-Cervero AV, Rabal-Pelay J, Roche-Seruendo LE, Lacárcel-Tejero B, Alcázar-Crevillén A, Villalba-Ruete JA, Cimarras-Otal C. Effectiveness of lumbar supports in low back functionality and disability in assembly-line workers. INDUSTRIAL HEALTH 2019; 57:588-595. [PMID: 30651407 PMCID: PMC6783285 DOI: 10.2486/indhealth.2018-0179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/27/2018] [Indexed: 06/07/2023]
Abstract
Low back pain (LBP) is a common problem in manufacturing workers. Several strategies have been proposed in order to reduce the pain and/or improve functionality. Among them, lumbar supports are a common solution prescribed for lumbar pain relief. Most of the studies in the literature only consider subjective sensations of the workers for evaluation assessment. This study applies biomechanical tests (a flexion-relaxation test and a functional movement evaluation test) to analyse the effectiveness of flexible lumbar supports in functionality and disability versus placebo intervention, consisting of kinesiotape placed on the low back without any stress. 28 workers participated in the study, randomised in control and intervention groups with a two months' intervention. None of the biomechanical tests showed statistical differences in between-groups pre-post changes. No benefits of wearing a flexible lumbar support during the workday have been found in these assembly-line workers versus placebo intervention.
Collapse
|
22
|
Meyer T, Wulff K. Issues of comorbidity in clinical guidelines and systematic reviews from a rehabilitation perspective. Eur J Phys Rehabil Med 2019; 55:364-371. [DOI: 10.23736/s1973-9087.19.05786-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Setchell J, Costa N, Ferreira M, Hodges PW. What decreases low back pain? A qualitative study of patient perspectives. Scand J Pain 2019; 19:597-603. [DOI: 10.1515/sjpain-2019-0018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 03/28/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background and aims
This study aimed to determine, from the perspective of individuals living with the condition, what decreases their low back pain (LBP). LBP affects most people at some point during their life. The condition has a meaningful effect on people’s lives including pain, reduced physical and social function, mood fluctuations, and a reduced ability to work. Despite a considerable amount of research on the topic, few strategies to reduce LBP are considered successful, and there has been little investigation into what individuals with the condition believe reduce it. This study aimed to address this gap in the literature by investigating what individuals with the condition believe reduces their LBP.
Methods
We employed a descriptive qualitative design using a custom-built online survey. Participants were 130 adults in Australia who self-identified as having current or having had previous LBP with or without co-morbidities. Data from the survey responses were analysed using content analysis to determine which management approaches participants considered to be effective in reducing their LBP.
Results
Participants most commonly said that they believed their LBP was reduced by: heat/cold (86, 66%), medication (84, 64.1%), and rest (78, 60%). Next most common was activity/exercise (73, 55.7%). Other factors such as consulting a health professional (52, 39.7%), stretching/therapeutic exercise (50, 38.1%), resting from aggravating activities (45, 34.3%), and psychological changes (41, 31.3%) were mentioned, but considerably less often.
Conclusions
Current literature points to the inefficacy of many of the factors participants reported as helping to reduce the effects of their condition, including the treatments that were most commonly listed by the participants in this study, namely: heat/cold, medication and rest. A possible cause of this discrepancy might be that individuals with LBP consider temporary relief (on a scale of hours) to be an acceptable outcome, whereas clinical trials tend to consider efficacy by long term outcomes (on a scale of weeks, months or years).
Implications
There are several implications of this research. From one perspective, there is the implication that public education about efficacious treatments may need to be enhanced as there is a discrepancy between research findings and the perspectives of individuals living with LBP. On the other hand, these findings also suggest that it is timely to re-examine the focus of LBP research to consider outcomes that are valuable to people living with the condition, which this study implies should include short term or temporary effects. The findings may also help clinicians tailor management to suit the individual patients by increasing the awareness that patient and research perspectives may at times diverge.
Collapse
Affiliation(s)
- Jenny Setchell
- The University of Queensland , School of Health and Rehabilitation Sciences , Brisbane , Australia
| | - Nathalia Costa
- The University of Queensland , School of Health and Rehabilitation Sciences , Brisbane , Australia
| | - Manuela Ferreira
- Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School , The University of Sydney , Sydney , Australia
| | - Paul W. Hodges
- The University of Queensland , School of Health and Rehabilitation Sciences , Brisbane , Australia
| |
Collapse
|
24
|
Healy A, Farmer S, Pandyan A, Chockalingam N. A systematic review of randomised controlled trials assessing effectiveness of prosthetic and orthotic interventions. PLoS One 2018; 13:e0192094. [PMID: 29538382 PMCID: PMC5851539 DOI: 10.1371/journal.pone.0192094] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/16/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Assistive products are items which allow older people and people with disabilities to be able to live a healthy, productive and dignified life. It has been estimated that approximately 1.5% of the world's population need a prosthesis or orthosis. OBJECTIVE The objective of this study was to systematically identify and review the evidence from randomized controlled trials assessing effectiveness and cost-effectiveness of prosthetic and orthotic interventions. METHODS Literature searches, completed in September 2015, were carried out in fourteen databases between years 1995 and 2015. The search results were independently screened by two reviewers. For the purpose of this manuscript, only randomized controlled trials which examined interventions using orthotic or prosthetic devices were selected for data extraction and synthesis. RESULTS A total of 342 randomised controlled trials were identified (319 English language and 23 non-English language). Only 4 of these randomised controlled trials examined prosthetic interventions and the rest examined orthotic interventions. These orthotic interventions were categorised based on the medical conditions/injuries of the participants. From these studies, this review focused on the medical condition/injuries with the highest number of randomised controlled trials (osteoarthritis, fracture, stroke, carpal tunnel syndrome, plantar fasciitis, anterior cruciate ligament, diabetic foot, rheumatoid and juvenile idiopathic arthritis, ankle sprain, cerebral palsy, lateral epicondylitis and low back pain). The included articles were assessed for risk of bias using the Cochrane Risk of Bias tool. Details of the clinical population examined, the type of orthotic/prosthetic intervention, the comparator/s and the outcome measures were extracted. Effect sizes and odds ratios were calculated for all outcome measures, where possible. CONCLUSIONS At present, for prosthetic and orthotic interventions, the scientific literature does not provide sufficient high quality research to allow strong conclusions on their effectiveness and cost-effectiveness.
Collapse
Affiliation(s)
- Aoife Healy
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Sybil Farmer
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| | - Anand Pandyan
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
- School of Health & Rehabilitation, Keele University, Keele, United Kingdom
| | - Nachiappan Chockalingam
- School of Life Sciences and Education, Staffordshire University, Stoke On Trent, United Kingdom
| |
Collapse
|
25
|
Ardakani EM, Leboeuf-Yde C, Walker BF. Failure to define low back pain as a disease or an episode renders research on causality unsuitable: results of a systematic review. Chiropr Man Therap 2018; 26:1. [PMID: 29321845 PMCID: PMC5759306 DOI: 10.1186/s12998-017-0172-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/20/2017] [Indexed: 12/03/2022] Open
Abstract
Background Causative factors may be different for the very first onset of symptoms of the ‘disease’ of low back pain (LBP) than for ensuing episodes that occur after a pain-free period. This differentiation hinges on a life-time absence of low back pain at first onset and short-term absence for further episodes. In this systematic review, we explored whether researchers make these distinctions when investigating the causality of LBP. Methods A literature search of PUBMED, CINAHL, and SCOPUS databases was performed from January 2010 until September 2016 using the search terms ‘low back pain’ or ‘back pain’ and ‘risk factor’ or ‘caus*’ or ‘predict*’ or ‘onset’ or ‘first-time’ or ‘inception’ or ‘incidence’. Two reviewers extracted information on study design, types of episodes of back pain to distinguish the disease of LBP and recurring episodes, and also to determine the definitions of disease- or pain-free periods. Results Thirty-three articles purporting to study causes of LBP were included. Upon scrutiny, 31 of the 33 articles were unclear as to what type of causality they were studying, that of the ‘disease’ or the episode, or a mere association with LBP. Only 9 studies used a prospective study design. Five studies appeared to investigate the onset of the disease of LBP, however, only one study truly captured the first incidence of LBP, which was the result of sports injury. Six appeared to study episodes but only one clearly related to the concept of episodes. Therefore, among those 11 studies, nine included both first-time LBP and episodes of LBP. Consequently, 22 studies related to the prevalence of LBP, as they probably included a mixture of first-time, recurring and ongoing episodes without distinction. Conclusion Recent literature concerning the causality of LBP does not differentiate between the ‘disease’ of LBP and its recurring episodes mainly due to a lack of a clear definition of absence of LBP at baseline. Therefore, current research is not capable of providing a valid answer on this topic.
Collapse
Affiliation(s)
- Emad M Ardakani
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
| | - Charlotte Leboeuf-Yde
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA 6150 Australia.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bruce F Walker
- School of Health Professions, Murdoch University, 90 South St, Murdoch, WA 6150 Australia
| |
Collapse
|
26
|
Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Gabriele Schorr S. Non-Specific Low Back Pain. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:883-890. [PMID: 29321099 PMCID: PMC5769319 DOI: 10.3238/arztebl.2017.0883] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 07/28/2017] [Accepted: 10/26/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND For many years, low back pain has been both the leading cause of days lost from work and the leading indication for medical rehabilitation. The goal of the German Disease Management Guideline (NDMG) on nonspecific low back pain is to improve the treatment of patients with this condition. METHODS The current update of the NDMG on non-specific low back pain is based on articles retrieved by a systematic search of the literature for systematic reviews. Its recommendations for diagnosis and treatment were developed by a collaborative effort of 29 scientific medical societies and organizations and approved in a formal consensus process. RESULTS If the history and physical examination do not arouse any suspicion of a dangerous underlying cause, no further diagnostic evaluation is indicated for the time being. Passive, reactive measures should be taken only in combination with activating measures, or not at all. When drugs are used for symptomatic treatment, patients should be treated with the most suitable drug in the lowest possible dose and for as short a time as possible. CONCLUSION A physician should be in charge of the overall care process. The patient should be kept well informed over the entire course of his or her illness and should be encouraged to adopt a healthful lifestyle, including regular physical exercise.
Collapse
Affiliation(s)
- Jean-François Chenot
- Section Family Medicine, Institute for Community Medicine, University Hospital of Greifswald
| | | | - Bernd Kladny
- Department of Orthopedics, Fachklinik Herzogenaurach
| | - Frank Petzke
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
| | - Michael Pfingsten
- ain Clinic, Center for Anesthesiology, Emergency and Intensive Care Medicine, University Hospital Göttingen
| | | | | |
Collapse
|
27
|
Mi J, Ye J, Zhao X, Zhao J. Effects of lumbosacral orthoses on postural control in individuals with or without non-specific low back pain. 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 2017; 27:180-186. [PMID: 29071410 DOI: 10.1007/s00586-017-5355-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 10/04/2017] [Accepted: 10/17/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the effect of lumbosacral orthoses (LSOs) on postural control in individuals with or without non-specific low back pain (NSLBP). METHODS Individuals with NSLBP (n = 28) and healthy controls (n = 28) were enrolled to assess the postural control with or without LSOs. Postural control was tested using the Balance Master® NeuroCom system by the modified clinical test of sensory interaction and balance. RESULTS Relative to controls, patients with NSLBP had deficits in postural control with greater center of pressure (COP) sway velocity when standing on firm surface (with eyes open: p = 0.002; with eyes closed: p = 0.002) and standing on foam surface (with eyes open: p = 0.024; with eyes closed: p < 0.001). In the braced condition, the COP sway decreased in all subjects with or without NSLBP when standing on foam surface. There was no significant difference in the effect of LSOs on postural control between NSLBP group and healthy controls. CONCLUSION Individuals with NSLBP have poorer postural control than controls. LSOs seem to improve postural control when standing on unstable surfaces in subjects with or without NSLBP. The effect of LSOs on postural control may not depend on the level of baseline.
Collapse
Affiliation(s)
- Jie Mi
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jiling Ye
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Xin Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
| | - Jie Zhao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
| |
Collapse
|
28
|
[Conservative treatment of nonspecific, chronic low back pain : Evidence of the efficacy - a systematic literature review]. DER ORTHOPADE 2017; 45:573-8. [PMID: 27075679 DOI: 10.1007/s00132-016-3248-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Non-specific chronic low back pain (NSCLBP): Which conservative therapy shows an evident effectiveness - A review of the current literature. MATERIALS AND METHODS Our results are based on literature reviews of current randomised control studies, reviews and meta-analysis drawn from the Cochrane Library and Medline-Database between the years 2004 until 2015. German and English Studies were included. We focused on different conservative Treatments of NSCLBP, which are listed at, the NVL-Guidelines. Based on the given evidence we evaluated their effectiveness. RESULTS As part of the review we identified 4657 Publications, 85 were included in this study. Therapeutic options such as bed rest, TENS, Massage, Spine Supports, Back Schools and Antidepressants showed no evident effectiveness. Injections, NSAR analgesic therapy, Thermotherapy and Opioid analgesic therapy indicated a short-time effectiveness. A long term success (> 6 weeks) however, can not be shown. Only the Movement therapy can, in the summation of the included studies, postulate an evident (Evidence Level I) long-term effect treating NSCLBP. Only a few therapy options indicate a significant evident effectiveness for treating NSCLBP conservatively. At short notice methods such as injection therapy, thermo-therapy and analgesic therapies with NSAR and/or opioids help coping the acute phase. In the long term only movement therapy seems to provide an evident effectiveness. In the case of therapy-refractory NSCLBP a multimodal therapy should be considered.
Collapse
|
29
|
Jeon ET, Jung JH, Moon JH, Jung KS, Won YS, Kim SJ, Hahm SC, Cho HY. The effects of spinal support device on pain and extensibility of the hamstrings in patients with non-specific low back pain. J Phys Ther Sci 2017; 29:1301-1304. [PMID: 28878452 PMCID: PMC5574329 DOI: 10.1589/jpts.29.1301] [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: 03/20/2017] [Accepted: 05/09/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The objective of this study was to investigate the effects of spinal support device (SSD) on pain and hamstring extensibility in patients with non-specific low back pain (NSLBP). [Subjects and Methods] 20 patients with NSLBP were recruited and randomly assigned to either the SSD group or the control group. In the SSD group, SSD was applied; in the control group, bed rest in supine position was performed. Both groups underwent treatment 20 min/day, 3 times a week, for a duration of 4 weeks. To assess the hamstring extensibility, sit and reach test (SRT) was performed. To assess pain pressure threshold (PPT) of the sacroiliac joint, a pressure algometer was used. Visual analog scale (VAS) was used to quantify pain. [Results] The SSD group showed a significant improvement in sacroiliac joint pain with increased VAS, and the control group showed a significantly increased VAS after intervention. In the SSD group, VAS was significantly increased, but SRT was not changed compared with the control group. [Conclusion] These results demonstrated that an application of SSD effectively attenuates low back pain. Therefore, SSD may be a suitable intervention for pain control in patients with NSLBP.
Collapse
Affiliation(s)
- Eun Tae Jeon
- Department of Physical Therapy, Graduate School, Gachon University, Republic of Korea.,Department of Physical Therapy, Graduate School, Gachon University, Republic of Korea
| | - Jin-Hwa Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
| | - Jong Hoon Moon
- Department of Occupational Therapy, Graduate School, Gachon University, Republic of Korea
| | - Kyoung-Sim Jung
- Department of Occupational Therapy, Semyung University, Republic of Korea
| | - Young Sik Won
- Department of Occupational Therapy, Shinsung University, Republic of Korea
| | - Sung-Jin Kim
- Department of Physical Therapy, Sahmyook University, Republic of Korea
| | - Suk-Chan Hahm
- Department of Rehabilitation Standard and Policy, National Rehabilitation Research Institute, National Rehabilitation Center, Republic of Korea
| | - Hwi-Young Cho
- Department of Physical Therapy, College of Health Science, Gachon University, Republic of Korea
| |
Collapse
|
30
|
Takasaki H, Miki T. The impact of continuous use of lumbosacral orthoses on trunk motor performance: a systematic review with meta-analysis. Spine J 2017; 17:889-900. [PMID: 28323240 DOI: 10.1016/j.spinee.2017.03.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbosacral orthosis (LSO) is prescribed by general practitioners for the management of low back pain. It may be speculated that continuous use of an LSO for a prolonged period reduces mechanical loading to the trunk muscle in daily living and results in impairments of the trunk muscle. PURPOSE This study aims to investigate whether trunk motor performances are impaired by the continuous use of an LSO. STUDY DESIGN/SETTING This is a systematic review with meta-analysis. MATERIALS AND METHODS A systematic search was undertaken using PubMed, EMBASE, MEDLINE, CINAHL, SCOPUS, and Cochrane Library from inception to November 2016. Inclusion criteria were (1) the use of an LSO for ≥2 days, (2) the use of a soft LSO designed for musculoskeletal conditions, (3) absence of cointervention except education, and (4) measures of trunk motor performance. The following were excluded: (1) studies with insufficient data and (2) studies with poor methodological quality (<9/16) in the modified McMaster Critical Review Form for Quantitative Studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to determine the quality of evidence. RESULTS Data of eight studies were analyzed. The most common measures for motor performances were the maximum strength of the trunk flexors and extensors and the endurance and fatigability of the trunk extensors. In all measures, 95% confidence intervals of the pooled standardized mean difference between the control or preintervention group and the intervention or postintervention group included zero. Further, quality of evidence ranged from low to very low in the GRADE system in all findings of the meta-analyses. CONCLUSIONS The meta-analyses demonstrated no negative effect by the continuous use of an LSO for 1-6 months. However, the quality of evidence ranged from low to very low, and more high-quality trials are required to draw a definitive conclusion on the impact of the continuous use of an LSO on trunk motor performances.
Collapse
Affiliation(s)
- Hiroshi Takasaki
- Department of Physical Therapy, Saitama Prefectural University, Sannomiya 820, Kosigaya, Saitama, 343-8540, Japan.
| | - Takahiro Miki
- Department of Rehabilitation, Sapporo Maruyama Orthopaedic Hospital, 1-1-3, Kita 7 Nishi 27, Chuo-ku, Sapporo, Hokkaido 060-0007, Japan
| |
Collapse
|
31
|
Machado GC, Ferreira PH, Maher CG, Latimer J, Steffens D, Koes BW, Li Q, Ferreira ML. Transient physical and psychosocial activities increase the risk of nonpersistent and persistent low back pain: a case-crossover study with 12 months follow-up. Spine J 2016; 16:1445-1452. [PMID: 27503263 DOI: 10.1016/j.spinee.2016.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 06/27/2016] [Accepted: 08/02/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A previous study has shown that transient physical and psychosocial activities increased the risk of developing low back pain. However, the link between these factors in triggering nonpersistent or persistent episodes remains unclear. PURPOSE We aimed to investigate the association of transient exposures to physical and psychosocial activities with the development of nonpersistent or persistent low back pain. STUDY DESIGN This was a case-crossover study with 12 months follow-up. PATIENT SAMPLE We included 999 consecutive participants seeking care for a sudden onset of low back pain. OUTCOME MEASURES Development of low back pain was the outcome measure. MATERIALS AND METHODS At baseline, participants reported transient exposures to 12 predefined activities over the 4 days preceding pain onset. After 12 months, participants were asked whether they had recovered and the date of recovery. Exposures in the 2-hour period preceding pain onset (case window) were compared with the 2-hour period, 24 hours before pain onset (control window) in a case-crossover design for all participants. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CI), and interaction analyses were used to compare estimates of nonpersistent (i.e., <6 weeks duration) and persistent cases. This study received funding from Australia's National Health and Medical Research Council (APP1003608). RESULTS There were 832 participants (83%) who completed the 12 months follow-up successfully. Of these, 430 participants had nonpersistent low back pain (<6 weeks duration), whereas 352 reported persistent symptoms (≥6 weeks duration). Exposure to several transient activities, such as manual tasks involving heavy loads, awkward postures, live people or animals, moderate or vigorous physical activity, and being fatigued or tired during a task or activity, significantly increased the risk of both nonpersistent and persistent low back pain, with ORs ranging from 2.9 to 11.7. Overall, the risk of developing a persistent or a nonpersistent episode of low back pain associated with the included physical factors did not differ significantly. CONCLUSIONS Our results revealed that previously identified triggers contribute equally to the development of both nonpersistent and persistent low back pain. Future prevention strategies should focus on controlling exposure to these triggers as they have the potential to decrease the burden associated with both acute and chronic low back pain.
Collapse
Affiliation(s)
- Gustavo C Machado
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
| | - Paulo H Ferreira
- Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Chris G Maher
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Daniel Steffens
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Qiang Li
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Manuela L Ferreira
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
32
|
Katsuhira J, Matsudaira K, Oka H, Iijima S, Ito A, Yasui T, Yozu A. Efficacy of a trunk orthosis with joints providing resistive force on low back load during level walking in elderly persons. Clin Interv Aging 2016; 11:1589-1597. [PMID: 27877028 PMCID: PMC5108480 DOI: 10.2147/cia.s108033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The effects of lumbosacral and spinal orthoses on low back pain and gait are not exactly clear. We previously developed a trunk orthosis with joints providing resistive force on low back load to decrease such load, and confirmed its positive effects during level walking in healthy young adults. Therefore, we aimed to determine the efficacy of this trunk orthosis during level walking in healthy elderly subjects. METHODS Fifteen community-dwelling elderly subjects performed level walking at a self-selected speed without an orthosis, with our orthosis, and with a lumbosacral orthosis. Kinematic and kinetic data were recorded using a three-dimensional motion analysis system, and erector spinae activity was recorded by electromyography. RESULTS When comparing the three conditions, our orthosis showed the following effects: it decreased the peak extension moment, increased the peak flexion moment, decreased the lateral bending angle, increased the peak thoracic extension angle, and had significantly lower erector spinae activity and significantly larger peak pelvic forward tilt angles. CONCLUSION Our orthosis with joints providing resistive force decreased low back load and modified trunk and pelvis alignments during level walking in healthy elderly people.
Collapse
Affiliation(s)
- Junji Katsuhira
- Faculty of Medical Technology, Department of Prosthetics and Orthotics and Assistive Technology, Niigata University of Health and Welfare, Niigata; Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo
| | - Shinno Iijima
- International University of Health and Welfare Hospital, Tochigi
| | - Akihiro Ito
- International University of Health and Welfare Hospital, Tochigi
| | | | - Arito Yozu
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
33
|
Hilde G, Gutke A, Slade SC, Stuge B. Physical therapy interventions for pelvic girdle pain (PGP) after pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Gunvor Hilde
- Akershus University Hospital; Department of Obstetrics and Gynecology; Sykehusveien 25 Lørenskog Akershus Norway 1478
| | - Annelie Gutke
- Sahlgrenska Academy, University of Gothenburg; Institute of Neuroscience and Physiology, Department of Health and Rehabilitation/Physiotherapy; Gothenburg Sweden 405 30
| | - Susan C Slade
- Monash University; Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Malvern Victoria Australia
- Monash University; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine; Malvern Victoria Australia
| | - Britt Stuge
- Oslo University Hospital; Department of Orthopaedics; Kirkeveien 166 Oslo Norway N-0407
| |
Collapse
|
34
|
Cui JZ, Geng ZS, Zhang YH, Feng JY, Zhu P, Zhang XB. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial. Braz J Med Biol Res 2016; 49:S0100-879X2016000300704. [PMID: 26840703 PMCID: PMC4763824 DOI: 10.1590/1414-431x20155092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/05/2015] [Indexed: 12/04/2022] Open
Abstract
Intracutaneous sterile water injection (ISWI) is used for relief of low back pain
during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following
whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized,
double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of
acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between
18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an
11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive
either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment;
n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45,
and 90 min and 1 day after treatment. The secondary outcome was functional
improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1
day after treatment. The mean VAS score was significantly lower in the ISWI group
than in the control group at 10, 45, and 90 min, and 1 day after injection
(P<0.05, t-test). The mean increment in PSFS score of the ISWI
group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2.
Our study showed that ISWI was effective for relieving pain and improving function in
aLBP patients at short-term follow-up. ISWI might be an alternative treatment for
aLBP patients, especially in areas where medications are not available, as well as in
specific patients (e.g., those who are pregnant or have asthma), who are unable to
receive medications or other forms of analgesia because of side effects.
Collapse
Affiliation(s)
- J Z Cui
- Department of Pain Treatment, The First People's Hospital of Lianyungang City, Jiangsu Province, Lianyungang, China
| | - Z S Geng
- Department of Pain Treatment, The First People's Hospital of Lianyungang City, Jiangsu Province, Lianyungang, China
| | - Y H Zhang
- Department of Pain Treatment, The First People's Hospital of Lianyungang City, Jiangsu Province, Lianyungang, China
| | - J Y Feng
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Jiangsu Province, Lianyungang, China
| | - P Zhu
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Jiangsu Province, Lianyungang, China
| | - X B Zhang
- Department of Anesthesiology, The First People's Hospital of Lianyungang City, Jiangsu Province, Lianyungang, China
| |
Collapse
|
35
|
Chu J, Bruyninckx F, Neuhauser DV. Chronic refractory myofascial pain and denervation supersensitivity as global public health disease. BMJ Case Rep 2016; 2016:bcr-2015-211816. [PMID: 26768433 DOI: 10.1136/bcr-2015-211816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chronic pain with a 30.3% global prevalence significantly impacts universal health. Low back pain has a 9.4% prevalence worldwide causing the most widespread disability. Neck pain ranks 4th highest regarding years lived with disability with a 4.9% prevalence worldwide. The principal cause of pain in 85% of patients visiting a tertiary pain clinic has a myofascial origin. The root cause is multifocal neuromuscular ischaemia at myofascial trigger points from muscle tightening and shortening following spondylotic radiculopathy induced partial denervation. Chronic refractory myofascial pain (CRMP) is a neuromusculoskeletal disease needing management innovations. Using electrical twitch-obtaining intramuscular stimulation (eToims), we provide objective evidence of denervation supersensitivity in multiple myotomes as cause, aggravation and maintenance of CRMP. This study underscores our previous findings that eToims is safe and efficacious for long-term use in CRMP. eToims aids potential prevention (pre-rehabilitation), simultaneous diagnosis, treatment (rehabilitation) and prognosis in real time for acute and CRMP management.
Collapse
Affiliation(s)
- J Chu
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - F Bruyninckx
- Department of Physical Medicine and Rehabilitation, Leuven University Hospitals, Leuven, Belgium
| | - D V Neuhauser
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
36
|
Dorner TE, Crevenna R. Preventive aspects regarding back pain. Wien Med Wochenschr 2015; 166:15-21. [PMID: 26695480 DOI: 10.1007/s10354-015-0413-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/07/2015] [Indexed: 11/30/2022]
Abstract
Prevention, as the act of keeping from happening, aims to avert things that would occur if no intervention would be taken. From the epidemiology of back pain, consequences of the disease that are worth preventing can be derived. Biological, psychological, and social factors lead to back pain and chronification and ultimately to various adverse outcomes. The most important preventable consequences of back pain include loss of ability to function in daily life, loss of work productivity, sickness absence, and disability pension, excessive and inappropriate healthcare utilisation, impairments in quality of life, and disturbance of sexual life. The most important tools for prevention of back pain lie within rehabilitation after acute pain treatment and include exercise and physical training as well as health education and increasing health literacy. The bio-psycho-social nature of back pain must be taken into account in all preventive measures.
Collapse
Affiliation(s)
- Thomas E Dorner
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria.
| | - Richard Crevenna
- Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| |
Collapse
|
37
|
Katsuhira J, Matsudaira K, Yasui T, Iijima S, Ito A. Efficacy of a trunk orthosis with joints providing resistive force on low-back load in elderly persons during static standing. Clin Interv Aging 2015; 10:1413-20. [PMID: 26366062 PMCID: PMC4562746 DOI: 10.2147/cia.s85294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Postural alignment of elderly people becomes poor due to aging, possibly leading to low-back pain and spinal deformity. Although there are several interventions for treating these conditions, no previous study has reported the effectiveness of a spinal orthosis or lumbosacral orthosis (LSO) in healthy elderly people without specific spinal deformity. We therefore developed a trunk orthosis to decrease low-back muscle activity while training good postural alignment through resistive force provided by joints with springs (here, called the ORF, which stands for orthosis with joints providing resistive force) as a preventive method against abnormal posture and low-back pain in healthy elderly persons. Patients and methods Fifteen community-dwelling elderly men participated in this study. Participants stood freely for 10 seconds in a laboratory setting under three conditions: without an orthosis, with the ORF, and with an LSO. The Damen corset LSO was selected as it is frequently prescribed for patients with low-back pain. Postural alignment during static standing was recorded using a three-dimensional motion capture system employing infrared cameras. Two force plates were used to record center of pressure. Electromyograms were obtained for bilateral erector spinae (ES), left internal abdominal oblique, and right gluteus medius muscles. Results Pelvis forward tilt angle tended to increase while wearing the ORF and decrease while wearing the LSO, but these results were not significant compared to no orthosis. Thorax extension angle and thorax angle on pelvis coordinate system significantly increased while wearing the ORF compared to the other two conditions. ES activity significantly decreased while wearing the ORF compared to the other two conditions. Internal oblique activity was significantly smaller while wearing the LSO than with no orthosis. Center of pressure did not significantly differ among the conditions. Conclusion The ORF significantly improved trunk alignment and decreased ES activity in healthy elderly subjects during static standing.
Collapse
Affiliation(s)
- Junji Katsuhira
- Department of Nursing and Rehabilitation Science at Odawara, International University of Health and Welfare, Odawara, Kanagawa, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
| | - Tadashi Yasui
- Kawamura-Gishi Company, Ltd., Daito-shi, Osaka, Japan
| | - Shinno Iijima
- Graduate School of International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Akihiro Ito
- Graduate School of International University of Health and Welfare, Otawara, Tochigi, Japan
| |
Collapse
|
38
|
Larivière C, Caron JM, Preuss R, Mecheri H. The effect of different lumbar belt designs on the lumbopelvic rhythm in healthy subjects. BMC Musculoskelet Disord 2014; 15:307. [PMID: 25234136 PMCID: PMC4190283 DOI: 10.1186/1471-2474-15-307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 09/11/2014] [Indexed: 11/30/2022] Open
Abstract
Background Research suggests that in some patients with low back pain, lumbar belts (LB) may derive secondary prophylactic benefits. It remains to be determined, however, which patients are most likely to benefit from prophylactic LB use, and which LB design is optimal for this purpose. The objective of this study was to determine the effect of different lumbar belts designs on range of motion and lumbopelvic rhythm. Methods Healthy subjects (10 males; 10 females) performed five standing lumbar flexion/extension cycles, with knees straight, during a control (no belt) and four lumbar belt experimental conditions (extensible, with and without dorsal and ventral panels; non-extensible). Motion of the pelvis and lumbar spine was measured with 3D angular inertial sensors. Results The results suggest that adding dorsal and ventral panels to an extensible LB produces the largest lumbar spine restrictions among the four tested lumbar belt designs, which in turn also altered the lumbopelvic rhythm. On a more exploratory basis, some sex differences were seen and the sex × experimental condition interaction just failed to reach significance. Conclusions LB may provide some biomechanical benefit for patients with low back disorders, based on the protection that may be provided against soft tissue creep-based injury mechanisms. More comprehensive assessment of different LB designs, with additional psychological and neuromuscular measurement outcomes, however, must first be conducted in order to produce sound recommendations for LB use. Future research should also to take sex into account, with sufficient statistical power to clearly refute or confirm the observed trends. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-307) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Christian Larivière
- Occupational Safety and Health Research Institute Robert-Sauvé (IRSST), 505, boul, De Maisonneuve Ouest, Montreal, Quebec H3A 3C2, Canada.
| | | | | | | |
Collapse
|
39
|
Kuijer PPF, Verbeek JH, Visser B, Elders LA, Van Roden N, Van den Wittenboer ME, Lebbink M, Burdorf A, Hulshof CT. An Evidence-Based Multidisciplinary Practice Guideline to Reduce the Workload due to Lifting for Preventing Work-Related Low Back Pain. Ann Occup Environ Med 2014; 26:16. [PMID: 24999432 PMCID: PMC4081511 DOI: 10.1186/2052-4374-26-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
We developed an evidence-based practice guideline to support occupational safety and health (OSH) professionals in assessing the risk due to lifting and in selecting effective preventive measures for low back pain (LBP) in the Netherlands. The guideline was developed at the request of the Dutch government by a project team of experts and OSH professionals in lifting and work-related LBP. The recommendations for risk assessment were based on the quality of instruments to assess the risk on LBP due to lifting. Recommendations for interventions were based on a systematic review of the effects of worker- and work directed interventions to reduce back load due to lifting. The quality of the evidence was rated as strong (A), moderate (B), limited (C) or based on consensus (D). Finally, eight experts and twenty-four OSH professionals commented on and evaluated the content and the feasibility of the preliminary guideline. For risk assessment we recommend loads heavier than 25 kg always to be considered a risk for LBP while loads less than 3 kg do not pose a risk. For loads between 3-25 kg, risk assessment shall be performed using the Manual handling Assessment Charts (MAC)-Tool or National Institute for Occupational Safety and Health (NIOSH) lifting equation. Effective work oriented interventions are patient lifting devices (Level A) and lifting devices for goods (Level C), optimizing working height (Level A) and reducing load mass (Level C). Ineffective work oriented preventive measures are regulations to ban lifting without proper alternatives (Level D). We do not recommend worker-oriented interventions but consider personal lift assist devices as promising (Level C). Ineffective worker-oriented preventive measures are training in lifting technique (Level A), use of back-belts (Level A) and pre-employment medical examinations (Level A). This multidisciplinary evidence-based practice guideline gives clear criteria whether an employee is at risk for LBP while lifting and provides an easy-reference for (in)effective risk reduction measures based on scientific evidence, experience, and consensus among OSH experts and practitioners.
Collapse
Affiliation(s)
- P Paul Fm Kuijer
- Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
| | - Jos Ham Verbeek
- Centre of Excellence, the Netherlands Society of Occupational Medicine (NVAB), Utrecht, the Netherlands ; Finnish Institute of Occupational Health, Kuopio, Finland
| | - Bart Visser
- Amsterdam School of Health Professions, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Leo Am Elders
- Centre of Excellence, the Netherlands Society of Occupational Medicine (NVAB), Utrecht, the Netherlands
| | - Nico Van Roden
- Dutch Society of Safety Science, Eindhoven, the Netherlands
| | | | - Marian Lebbink
- Centre of Excellence, the Netherlands Society of Occupational Medicine (NVAB), Utrecht, the Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, the Netherlands
| | - Carel Tj Hulshof
- Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands ; Centre of Excellence, the Netherlands Society of Occupational Medicine (NVAB), Utrecht, the Netherlands
| |
Collapse
|
40
|
Cheville AL, Basford JR. Role of rehabilitation medicine and physical agents in the treatment of cancer-associated pain. J Clin Oncol 2014; 32:1691-702. [PMID: 24799472 PMCID: PMC5569680 DOI: 10.1200/jco.2013.53.6680] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To provide an overview of rehabilitation medicine- and physical modality-based approaches to cancer pain management, and to highlight the fact that these approaches are generally used in conjunction and that a majority are focused on minimizing pain during periods of mobility and the performance of activities of daily living. METHODS We performed a nonsystematic literature review and provide a description of the current standard of care. RESULTS Rehabilitative and physical modalities used to manage pain can be grouped into four categories: those that modulate nociception, stabilize or unload painful structures, influence physiological processes that indirectly influence nociception, or alleviate pain arising from the overloading of muscles and connective tissues that often occurs after surgery or with sarcopenia in late-stage cancer. Most modalities have been pragmatically refined over the years, and many have an evidence base, although few have been explicitly validated in the oncologic setting. With few exceptions, they are patient controlled and free of adverse effects. CONCLUSION Physical modalities and rehabilitation medicine offer a range of pain management approaches that may serve as beneficial adjuncts to the conventional systemic and interventional analgesic strategies used to control cancer-related pain. These approaches may be particularly beneficial to patients with movement-associated pain and those who are ambivalent regarding pharmacoanalgesia.
Collapse
|
41
|
Zarghooni K, Beyer F, Siewe J, Eysel P. The orthotic treatment of acute and chronic disease of the cervical and lumbar spine. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 110:737-42. [PMID: 24280429 DOI: 10.3238/arztebl.2013.0737] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/12/2013] [Accepted: 08/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Orthoses are external aids that are often used to treat pain and diseases affecting the spine, such as lumbago, whiplash, and disc herniation. In this review, we assess the effectiveness and complications of orthotic treatment for typical spinal conditions and after spinal surgery. The orthotic treatment of fractures and postural abnormalities are beyond the scope of this article. METHOD This review is based on a selective search in the Medline database with consideration of controlled trials, systematic reviews, and the recommendations of the relevant medical societies. RESULTS Three relevant systematic reviews and four controlled trials were found. Very few controlled trials to date have studied the efficacy of orthotic treatment compared to other conservative treatments and surgery. No definitive evidence was found to support the use of orthoses after surgery, in lumbar radiculopathy, or after whiplash injuries of the cervical spine. In a single trial, short-term immobilization was an effective treatment of cervical radiculopathy. Orthoses are not recommended for nonspecific low back pain. The potential complications of cervical orthoses include pressure-related skin injuries and dysphagia. CONCLUSION No definitive evidence as yet supports the use of orthoses after spinal interventions or in painful conditions of the cervical or lumbar spine. They should, therefore, be used only after individual consideration of the indications in each case.
Collapse
Affiliation(s)
- Kourosh Zarghooni
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Centre for Clinical Trials, University of Cologne
| | | | | | | |
Collapse
|
42
|
Abstract
This article is based on educating readers and physicians about the use of footwear and orthotics for themselves and their patients, to treat diseases and enhance functionality in sports and daily life.
Collapse
Affiliation(s)
- Muhammad Nausherwan Khan
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Penn State Hershey Medical Group, 121 Nyes Road, Suite A, Family Medicine Offices, Harrisburg, PA 17112, USA.
| | | | | |
Collapse
|
43
|
Rostami M, Noormohammadpour P, Sadeghian AH, Mansournia MA, Kordi R. The effect of lumbar support on the ultrasound measurements of trunk muscles: a single-blinded randomized controlled trial. PM R 2013; 6:302-8; quiz 308. [PMID: 24107427 DOI: 10.1016/j.pmrj.2013.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 07/22/2013] [Accepted: 09/20/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the effect of lumbopelvic belts on the thickness of lateral abdominal muscles and the cross-sectional area (CSA) of lumbar multifidus (LM) muscles. DESIGN A single-blinded randomized controlled trial. SETTING An academic and tertiary care referral spine and sports medicine center. PARTICIPANTS Sixty healthy volunteers with no history of low back pain in the previous year. METHODS The subjects were allocated into belt and control groups. Lumbar belts were given to the subjects in the belt group, and they were asked to use the belts during the study period except during sleeping hours. The subjects were assessed at baseline and at 4 and 8 weeks. MAIN OUTCOME MEASURES The thickness of lateral abdominal muscles and the CSA of the LM muscles were measured by ultrasound with the patient in the hook-lying position on an examination table. RESULTS The thickness of lateral abdominal muscles and the CSA of LM muscles on both sides decreased significantly among healthy subjects in the belt group after 8 weeks. CONCLUSION The results of this study show that lumbopelvic belts might influence the ultrasonographic measurements of lateral abdominal and LM muscles and thereby spine stability.
Collapse
Affiliation(s)
- Mohsen Rostami
- Sports Medicine Research Center, School of Medicine, Tehran University of Medical Sciences; Spine Division, Noorafshar Rehabilitation & Sports Medicine Hospital; and Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran(∗)
| | - Pardis Noormohammadpour
- Sports Medicine Research Center, School of Medicine, Tehran University of Medical Sciences; and Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran(†)
| | - Amir Hossein Sadeghian
- Sports Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran(‡)
| | - Mohammad Ali Mansournia
- Sports Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran(§)
| | - Ramin Kordi
- Sports Medicine Research Center, School of Medicine, Tehran University of Medical Sciences, No. 7, Al-e-Ahmad Highway, P.O. Box 14395-578, Tehran, Iran; Spine Division, Noorafshar Rehabilitation & Sports Medicine Hospital; and Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran(‖).
| |
Collapse
|
44
|
|
45
|
Jagadish A, Nandyala SV, Marquez-Lara A, Singh K, Lee YP. Spinal Interventions—The Role in the Athlete. OPER TECHN SPORT MED 2013. [DOI: 10.1053/j.otsm.2013.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
46
|
Aickin M, McCaffery A, Pugh G, Tick H, Ritenbaugh C, Hicks P, Pelletier KR, Cao J, Himick D, Monahan J. Description of a clinical stream of back-pain patients based on electronic medical records. Complement Ther Clin Pract 2013; 19:158-76. [DOI: 10.1016/j.ctcp.2013.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 10/26/2022]
|
47
|
Affiliation(s)
- Edzard Ernst
- Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
| |
Collapse
|
48
|
What Does the Cochrane Collaboration Say about the Treatment of Pain? Physiother Can 2012; 63:383-4. [PMID: 22654244 DOI: 10.3138/physio.63.3.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
49
|
Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Manniche C. Rest versus exercise as treatment for patients with low back pain and Modic changes. A randomized controlled clinical trial. BMC Med 2012; 10:22. [PMID: 22376791 PMCID: PMC3348080 DOI: 10.1186/1741-7015-10-22] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/29/2012] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Clinical experience suggests that many patients with Modic changes have relatively severe and persistent low back pain (LBP), which typically appears to be resistant to treatment. Exercise therapy is the recommended treatment for chronic LBP, however, due to their underlying pathology, Modic changes might be a diagnostic subgroup that does not benefit from exercise. The objective of this study was to compare the current state-of-the art treatment approach (exercise and staying active) with a new approach (load reduction and daily rest) for people with Modic changes using a randomized controlled trial design. METHODS Participants were patients from an outpatient clinic with persistent LBP and Modic changes. They were allocated using minimization to either rest therapy for 10 weeks with a recommendation to rest for two hours daily and the option of using a flexible lumbar belt or exercise therapy once a week for 10 weeks. Follow-up was at 10 weeks after recruitment and 52 weeks after intervention and the clinical outcome measures were pain, disability, general health and global assessment, supplemented by weekly information on low back problems and sick leave measured by short text message (SMS) tracking. RESULTS In total, 100 patients were included in the study. Data on 87 patients at 10 weeks and 96 patients at one-year follow-up were available and were used in the intention-to-treat analysis. No statistically significant differences were found between the two intervention groups on any outcome. CONCLUSIONS No differences were found between the two treatment approaches, 'rest and reduced load' and 'exercise and staying active', in patients with persistent LBP and Modic changes. TRIAL REGISTRATION ClinicalTrials.gov: NCT00454792.
Collapse
Affiliation(s)
- Rikke K Jensen
- Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt, Middelfart, Denmark.
| | | | | | | | | |
Collapse
|
50
|
Steffens D, Ferreira ML, Maher CG, Latimer J, Koes BW, Blyth FM, Ferreira PH. Triggers for an episode of sudden onset low back pain: study protocol. BMC Musculoskelet Disord 2012; 13:7. [PMID: 22273001 PMCID: PMC3292970 DOI: 10.1186/1471-2474-13-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Accepted: 01/24/2012] [Indexed: 11/21/2022] Open
Abstract
Background Most research on risk factors for low back pain has focused on long term exposures rather than factors immediately preceding the onset of low back pain. The aim of this study is to quantify the transient increase in risk of a sudden episode of low back pain associated with acute exposure to a range of common physical and psychological factors. Methods/design This study uses a case-crossover design. One thousand adults with a sudden onset of low back pain presenting to primary care clinicians will be recruited. Basic demographic and clinical information including exposure to putative triggers will be collected using a questionnaire. These triggers include exposure to hazardous manual tasks, physical activity, a slip/trip or fall, consumption of alcohol, sexual activity, being distracted, and being fatigued or tired. Exposures in the case window (0-2 hours from the time when participants first notice their back pain) will be compared to exposures in two control time-windows (one 24-26 hours and another 48-50 hours before the case window). Discussion The completion of this study will provide the first-research based estimates of the increase in risk of a sudden episode of acute low back pain associated with transient exposure to a range of common factors thought to trigger low back pain.
Collapse
Affiliation(s)
- Daniel Steffens
- Musculoskeletal division, The George Institute for Global Health, Sydney Medical School, The University of Sydney, PO Box M201, Missenden Road, Sydney, New South Wales 2050, Australia
| | | | | | | | | | | | | |
Collapse
|