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Heelas L, Soni A, Barker K. Do baseline patient reported outcome measures predict changes in self-reported function, following a chronic pain rehabilitation programme? Br J Pain 2023; 17:532-545. [PMID: 37974636 PMCID: PMC10642500 DOI: 10.1177/20494637231190190] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background Interdisciplinary pain management programmes, based on cognitive-behavioural principles, aim to improve physical and psychological functioning and enhance self-management in people living with chronic pain. Currently there is insufficient evidence about whether psychological, biological or social factors are predictive of positive outcomes following pain rehabilitation. This study aims to evaluate predictors of change in Brief Pain Inventory - pain interference score (BPI) in a clinical data set to determine whether age, sex and baseline outcome measures are predictive of improvement in pain interference following pain rehabilitation. Methods A retrospective, pragmatic observational analysis of routinely collected clinical data in two pain rehabilitation programmes, Balanced Life Programme (BLP) and Get Back Active (GBA) was conducted. Standard regression and hierarchical regression analyses were used to identify predictors of change to assess temporal changes in BPI. Responder analysis was also conducted. Results Standard regression analyses of 208 (BLP) and 310 (GBA) patients showed that higher baseline BPI and better physical performance measures predicted better improvement in BPI across both programmes. Hierarchical regression showed that age and sex accounted for 2.7% (BLP) and 0.002% (GBA) of the variance in change in BPI. After controlling for age and sex, the other measures explained an additional 23% (BLP) and 19% (GBA) of the variance, p = < .001 where BPI and physical performance measures were consistently statistically significant predictors, p < .05. Responder analysis also showed that pain interference and physical performance were significantly associated with improvement (p = < .0005). Conclusions The combination of high self-reported pain interference and better physical performance measures may be a useful indicator of who would benefit from interdisciplinary rehabilitation. Further validation of the results is required.
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Affiliation(s)
- L Heelas
- Physio Research Unit ouh and NDORMs, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Soni
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Karen Barker
- Physio Research Unit ouh and NDORMs, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Gandomi F, Soufivand P, Ezati M, Salimi M, Assar S, Pournazari M, Abbasi H. The effect of Aqua Stretching exercises and Pilates on pain, function and spine posture in patients with ankylosing spondylitis: a randomized controlled trial. BMC Sports Sci Med Rehabil 2022; 14:183. [PMID: 36271391 PMCID: PMC9585788 DOI: 10.1186/s13102-022-00577-0] [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: 06/12/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
Background Aqua Pilates and Aqua Stretch exercises are different and new methods for the rehabilitation of musculoskeletal disorders. This study aimed to compare the effectiveness of Aqua Stretch and Aqua Pilates interventions in the treatment of pain, function, and posture of the spine in ankylosing spondylitis (AS) patients. Methods Forty patients participated in this study who were randomly allocated into Aqua Stretch, aqua Pilates, and control. The experimental groups received four 60-min training sessions each week for six weeks. However, the control group had only its routine drug treatment (NSAIDs & Anti TNF). Pain with Visual Analog Scale (VAS), function with Bath Ankylosing Spondylitis Functional Index (BASFI) and 40-m walking test (MWT), quality of life with ankylosing spondylitis quality of life (ASQoL), and posture of the spine with the Spinal Mouse were evaluated. Evaluations were performed before and after the interventions. Repeated measure ANOVA was employed to determine the main and interaction effects. Results Aqua Stretch and Aqua Pilates had a significant effect on pain (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001), BASFI (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.02), 40-MWT (Aqua-Pilates: P = 0.006; Aqua-Stretch: P = 0.0001) and ASQoL (Aqua-Pilates: P = 0.01; Aqua-Stretch: P = 0.001), spinal range of motion (ROM) (Aqua-Pilates: P = 0.0001; Aqua-Stretch: P = 0.0001) at a similar ratio. However, the control group did not present any improvement in these factors (P > 0.05). Moreover, the minimal clinically important difference (MCID) revealed that the Aqua Stretch group performed better than the Aqua Pilates group in terms of VAS, ASQOL, and 40-MWT factors. Conclusions Aqua Stretch and Aqua Pilates had statistically the same effect on improving pain, function, quality of life, and spinal ROM, while MCID results revealed that the Aqua Stretch group performed better than the Aqua Pilates in terms of VAS-ASQOL-40-MWT. Trial registration It is notable that local ethics committee approval was obtained (IR.KUMS.REC.1399.1137), and the study was registered in Iranian Registry of Clinical Trials (IRCT; IRCT20190426043377N3; registered on 22/05/2021, https://fa.irct.ir/user/trial/56058/view) and patient recruitments were started on 06/07/2021.
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Affiliation(s)
- Farzaneh Gandomi
- Sports Injuries and Corrective Exercises Department, Sport Sciences Faculty, Razi University, Kermanshah, Iran
| | - Parviz Soufivand
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Mozhgan Ezati
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Salimi
- Sports Injuries and Corrective Exercises Department, Sport Sciences Faculty, Tehran University, Tehran, Iran
| | - Shirin Assar
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Pournazari
- Rheumatology Department, Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Homayoun Abbasi
- Sports Management Department, Sport Sciences Faculty, Razi University, Kermanshah, Iran
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Cuenca-Garcia M, Marin-Jimenez N, Perez-Bey A, Sánchez-Oliva D, Camiletti-Moiron D, Alvarez-Gallardo IC, Ortega FB, Castro-Piñero J. Reliability of Field-Based Fitness Tests in Adults: A Systematic Review. Sports Med 2022; 52:1961-1979. [PMID: 35064915 DOI: 10.1007/s40279-021-01635-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Physical fitness is a powerful predictor of morbidity and mortality, and is therefore a useful indicator for public health monitoring. To assess physical fitness, field-based tests are time-efficient, inexpensive, have minimal equipment requirements, and can be easily administered to a large number of individuals. OBJECTIVE The objective of this systematic review was to examine the reliability of existing field-based fitness tests used in adults aged 19-64 years. METHODS A systematic search of two electronic databases (MEDLINE and Web of Science) was conducted from inception to 8 June 2021 by two independent researchers. Each study was classified as high, low, or very low quality according to the description of the participants, the time interval between measurements, the description of the results, and the appropriateness of statistics. Three levels of evidence (strong, moderate, and limited) were established according to the number of studies and the consistency of their findings. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO reference number, CRD42019118480). RESULTS Of 17,010 records identified, 129 original studies examining the reliability of field-based fitness tests in adults were considered eligible. The reliability was assessed of tests of cardiorespiratory fitness (33 studies: 30 of high quality), musculoskeletal fitness (92 studies: 78 of high quality), and motor fitness (22 studies, all of high quality). There was strong evidence indicating: (i) the high reliability of the cardiorespiratory fitness tests: 20-m shuttle run, 6-min step, and 6-min walk; (ii) the high reliability of the musculoskeletal fitness tests: handgrip strength, back-leg strength, Sorensen, trunk flexion sustained, 5-reps sit-to-stand, sit-and-reach and toe-touch, and moderate reliability bilateral side bridge and prone bridge tests; and (iii) the moderate reliability and low reliability, respectively, of the motor fitness tests T-test and single-leg stand. We found moderate evidence indicating the moderate or high reliability of the following tests: Chester, sit-up, partial curl-up, flexion-rotation trunk, timed stair ascent, pull-up, bent-arm hang, standing broad jump, hop sequence, trunk lift, timed-up-and-go, and hexagon agility. Evidence for the reliability of balance and gait speed tests was inconclusive. Other field-based fitness tests demonstrated limited evidence, mainly due to there being only few studies. CONCLUSIONS This review provides an evidence-based proposal of the more reliable field-based fitness tests for adults aged 19-64 years. Our findings identified a need for more high-quality studies designed to assess the reliability of field-based tests of lower and upper body explosive and endurance muscular strength, and motor fitness (i.e., balance and gait speed tests) in adults.
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Affiliation(s)
- Magdalena Cuenca-Garcia
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Nuria Marin-Jimenez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain.
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain.
| | - Alejandro Perez-Bey
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - David Sánchez-Oliva
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
- ACAFYDE Research Group, Faculty of Sport Sciences, University of Extremadura, Caceres, Spain
| | - Daniel Camiletti-Moiron
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Inmaculada C Alvarez-Gallardo
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
| | - Francisco B Ortega
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, 18071, Granada, Spain
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Jose Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, School of Education, University of Cádiz, Puerto Real, Avenida República Saharaui S/N, 11519, Puerto Real, Cádiz, Spain
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cadiz, Spain
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Objective measures of functional impairment for degenerative diseases of the lumbar spine: a systematic review of the literature. Spine J 2019; 19:1276-1293. [PMID: 30831316 DOI: 10.1016/j.spinee.2019.02.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/24/2019] [Accepted: 02/24/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT The accurate determination of a patient's functional status is necessary for therapeutic decision-making and to critically appraise treatment efficacy. Current subjective patient-reported outcome measure (PROM)-based assessments have limitations and can be complimented by objective measures of function. PURPOSE To systematically review the literature and provide an overview on the available objective measures of function for patients with degenerative diseases of the lumbar spine. STUDY DESIGN/SETTING Systematic review of the literature. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Two reviewers independently searched the PubMed, Web of Science, EMBASE, and SCOPUS databases for permutations of the words "objective," "assessment," "function," "lumbar," and "spine" including articles on human subjects with degenerative diseases of the lumbar spine that reported on objective measures of function, published until September 2018. Risk of bias was not assessed. No funding was received. The authors report no conflicts of interest. RESULTS Of 2,389 identified articles, 82 were included in the final analysis. There was a significant increase of 0.12 per year in the number of publications dealing with objective measures of function since 1989 (95% CI 0.08-0.16, p<.001). Some publications studied multiple diagnoses and objective measures. The United States was the leading nation in terms of scientific output for objective outcome measures (n=21; 25.6%), followed by Switzerland (n=17; 20.7%), Canada, Germany, and the United Kingdom (each n=6; 7.3%). Our search revealed 21 different types of objective measures, predominantly applied to patients with lumbar spinal stenosis (n=67 publications; 81.7%), chronic/unspecific low back pain (n=28; 34.2%) and lumbar disc herniation (n=22; 26.8%). The Timed-Up-and-Go test was the most frequently applied measure (n=26 publications; 31.7%; cumulative number of reported subjects: 5,181), followed by the Motorized Treadmill Test (n=25 publications; 30.5%, 1,499 subjects) and with each n=9 publications (11.0%) the Five-Repetition Sit-To-Stand test (955 subjects), as well as accelerometry analyses (336 subjects). The reliability and validity of many of the less-applied objective measures was uncertain. There was profound heterogeneity in their application and interpretation of results. CONCLUSIONS Clinical studies on patients with lumbar degenerative diseases increasingly employ objective measures of function, which offer high potential for improving the quality of outcome measurement in patient-care and research. This review provides an overview on available options. Our findings call for an agreement and standardization in terms of test selection, conduction and analysis to facilitate comparison of results across cohorts. PROSPERO REGISTRATION NUMBER CRD42019122622.
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Jakobsson M, Gutke A, Mokkink LB, Smeets R, Lundberg M. Level of Evidence for Reliability, Validity, and Responsiveness of Physical Capacity Tasks Designed to Assess Functioning in Patients With Low Back Pain: A Systematic Review Using the COSMIN Standards. Phys Ther 2019; 99:457-477. [PMID: 30566577 PMCID: PMC6488491 DOI: 10.1093/ptj/pzy159] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 10/23/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Physical capacity tasks (ie, observer-administered outcome measures that comprise a standardized activity) are useful for assessing functioning in patients with low back pain. PURPOSE The purpose of this study was to systematically review the level of evidence for the reliability, validity, and responsiveness of physical capacity tasks. DATA SOURCES MEDLINE, CINAHL, PsycINFO, Scopus, the Cochrane Library, and relevant reference lists were used as data sources. STUDY SELECTION Two authors independently selected articles addressing the reliability, validity, and responsiveness of physical capacity tasks, and a third author resolved discrepancies. DATA EXTRACTION AND QUALITY ASSESSMENT One author performed data extraction, and a second author independently checked the data extraction for accuracy. Two authors independently assessed the methodological quality with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 4-point checklist, and a third author resolved discrepancies. DATA SYNTHESIS AND ANALYSIS Data synthesis was performed by all authors to determine the level of evidence per measurement property per physical capacity task. The 5-repetition sit-to-stand, 5-minute walk, 50-ft (∼15.3-m) walk, Progressive Isoinertial Lifting Evaluation, and Timed "Up & Go" tasks displayed moderate to strong evidence for positive ratings of both reliability and construct validity. The 1-minute stair-climbing, 5-repetition sit-to-stand, shuttle walking, and Timed "Up & Go" tasks showed limited evidence for positive ratings of responsiveness. LIMITATIONS The COSMIN 4-point checklist was originally developed for patient-reported outcome measures and not physical capacity tasks. CONCLUSIONS The 5-repetition sit-to-stand, 50-ft walk, 5-minute walk, Progressive Isoinertial Lifting Evaluation, Timed "Up & Go," and 1-minute stair-climbing tasks are promising tests for the measurement of functioning in patients with chronic low back pain. However, more research on the measurement error and responsiveness of these tasks is needed to be able to fully recommend them as outcome measures in research and clinical practice.
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Affiliation(s)
- Max Jakobsson
- Back in Motion Research Group, Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Mölndal Hospital, Göteborgsvägen 31, 431 80 Mölndal, Gothenburg, 41326 Sweden,Address all correspondence to Dr Jakobsson at:
| | - Annelie Gutke
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg
| | - Lidwine B Mokkink
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School of CAPHRI, Maastricht University, Maastricht, the Netherlands; and CIR Revalidatie, Eindhoven, the Netherlands
| | - Mari Lundberg
- Division of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg; Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; and Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
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Yazdani S, Dizji E, Alizadeh F, Hassanlouei H. Effect of chronic idiopathic low back pain on the kinetic gait characteristics in different foot masks. J Biomech 2018; 79:243-247. [DOI: 10.1016/j.jbiomech.2018.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 07/18/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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Denteneer L, Van Daele U, Truijen S, De Hertogh W, Meirte J, Stassijns G. Reliability of physical functioning tests in patients with low back pain: a systematic review. Spine J 2018; 18:190-207. [PMID: 28882521 DOI: 10.1016/j.spinee.2017.08.257] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to provide a comprehensive overview of physical functioning tests in patients with low back pain (LBP) and to investigate their reliability. DATA SOURCES A systematic computerized search was finalized in four different databases on June 24, 2017: PubMed, Web of Science, Embase, and MEDLINE. STUDY SELECTION Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed during all stages of this review. Clinical studies that investigate the reliability of physical functioning tests in patients with LBP were eligible. The methodological quality of the included studies was assessed with the use of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. To come to final conclusions on the reliability of the identified clinical tests, the current review assessed three factors, namely, outcome assessment, methodological quality, and consistency of description. DATA SYNTHESIS A total of 20 studies were found eligible and 38 clinical tests were identified. Good overall test-retest reliability was concluded for the extensor endurance test (intraclass correlation coefficient [ICC]=0.93-0.97), the flexor endurance test (ICC=0.90-0.97), the 5-minute walking test (ICC=0.89-0.99), the 50-ft walking test (ICC=0.76-0.96), the shuttle walk test (ICC=0.92-0.99), the sit-to-stand test (ICC=0.91-0.99), and the loaded forward reach test (ICC=0.74-0.98). For inter-rater reliability, only one test, namely, the Biering-Sörensen test (ICC=0.88-0.99), could be concluded to have an overall good inter-rater reliability. None of the identified clinical tests could be concluded to have a good intrarater reliability. CONCLUSIONS Further investigation should focus on a better overall study methodology and the use of identical protocols for the description of clinical tests. The assessment of reliability is only a first step in the recommendation process for the use of clinical tests. In future research, the identified clinical tests in the current review should be further investigated for validity. Only when these clinimetric properties of a clinical test have been thoroughly investigated can a final conclusion regarding the clinical and scientific use of the identified tests be made.
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Affiliation(s)
- Lenie Denteneer
- Faculty of Medicine and Health Sciences, Rehabilitation and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium.
| | - Ulrike Van Daele
- Faculty of Medicine and Health Sciences, Rehabilitation and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Steven Truijen
- Faculty of Medicine and Health Sciences, Rehabilitation and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Willem De Hertogh
- Faculty of Medicine and Health Sciences, Rehabilitation and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jill Meirte
- Faculty of Medicine and Health Sciences, Rehabilitation and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Gaetane Stassijns
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Physical Medicine and Rehabilitation, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium
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Seo KE, Park TJ. Effects of gyrokinesis exercise on the gait pattern of female patients with chronic low back pain. J Phys Ther Sci 2016; 28:511-4. [PMID: 27065537 PMCID: PMC4793001 DOI: 10.1589/jpts.28.511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/06/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of the present study was to use kinematic variables to identify the
effects of 8/weeks’ performance of a gyrokinesis exercise on the gait pattern of females
with chronic low back pain. [Subjects] The subjects of the present study were females in
their late 20s to mid 30s who were chronic back pain patients. [Methods] A 3-D motion
analysis system was used to measure the changes in their gait patterns between pre and
post-gyrokintic exercise. The SPSS 21.0 statistics program was used to perform the paired
t-test, to compare the gait patterns of pre-post-gyrokinesis exercise. [Results] In the
gait analysis, pre-post-gyrokinesis exercise gait patterns showed statistically
significant differences in right and left step length, stride length, right-left step
widths, and stride speed. [Conclusion] Gait pattern analysis revealed increases in step
length, stride length, and stride speed along with a decrease in step width after 8 weeks
of gyrokinesis exercise, demonstrating it improved gait pattern.
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Affiliation(s)
- Kook-Eun Seo
- Department of Sports Science, Pusan National University, Republic of Korea
| | - Tae-Jin Park
- Department of Design Institute, Inje University, Republic of Korea
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Ratter J, Radlinger L, Lucas C. Several submaximal exercise tests are reliable, valid and acceptable in people with chronic pain, fibromyalgia or chronic fatigue: a systematic review. J Physiother 2014; 60:144-50. [PMID: 25084634 DOI: 10.1016/j.jphys.2014.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 06/26/2014] [Indexed: 01/02/2023] Open
Abstract
QUESTION Are submaximal and maximal exercise tests reliable, valid and acceptable in people with chronic pain, fibromyalgia and fatigue disorders? DESIGN Systematic review of studies of the psychometric properties of exercise tests. PARTICIPANTS People older than 18 years with chronic pain, fibromyalgia and chronic fatigue disorders. INTERVENTION Studies of the measurement properties of tests of physical capacity in people with chronic pain, fibromyalgia or chronic fatigue disorders were included. OUTCOME MEASURES Studies were required to report: reliability coefficients (intraclass correlation coefficient, alpha reliability coefficient, limits of agreements and Bland-Altman plots); validity coefficients (intraclass correlation coefficient, Spearman's correlation, Kendal T coefficient, Pearson's correlation); or dropout rates. RESULTS Fourteen studies were eligible: none had low risk of bias, 10 had unclear risk of bias and four had high risk of bias. The included studies evaluated: Åstrand test; modified Åstrand test; Lean body mass-based Åstrand test; submaximal bicycle ergometer test following another protocol other than Åstrand test; 2-km walk test; 5-minute, 6-minute and 10-minute walk tests; shuttle walk test; and modified symptom-limited Bruce treadmill test. None of the studies assessed maximal exercise tests. Where they had been tested, reliability and validity were generally high. Dropout rates were generally acceptable. The 2-km walk test was not recommended in fibromyalgia. CONCLUSION Moderate evidence was found for reliability, validity and acceptability of submaximal exercise tests in patients with chronic pain, fibromyalgia or chronic fatigue. There is no evidence about maximal exercise tests in patients with chronic pain, fibromyalgia and chronic fatigue.
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Affiliation(s)
| | - Lorenz Radlinger
- Applied Research and Development Physiotherapy, Health Division, Bern University of Applied Sciences, Switzerland
| | - Cees Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Medical Faculty, University of Amsterdam, Academic Medical Centre, Amsterdam, The Netherlands
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Eck JC, Sharan A, Ghogawala Z, Resnick DK, Watters WC, Mummaneni PV, Dailey AT, Choudhri TF, Groff MW, Wang JC, Dhall SS, Kaiser MG. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 7: Lumbar fusion for intractable low-back pain without stenosis or spondylolisthesis. J Neurosurg Spine 2014; 21:42-7. [DOI: 10.3171/2014.4.spine14270] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Establishing an appropriate treatment strategy for patients presenting with low-back pain, in the absence of stenosis or spondylolisthesis, remains a controversial subject. Inherent to this situation is often an inability to adequately identify the source of low-back pain to justify various treatment recommendations, such as lumbar fusion. The current evidence does not identify a single best treatment alternative for these patients. Based on a number of prospective, randomized trials, comparable outcomes, for patients presenting with 1- or 2-level degenerative disc disease, have been demonstrated following either lumbar fusion or a comprehensive rehabilitation program with a cognitive element. Limited access to such comprehensive rehabilitative programs may prove problematic when pursuing this alternative. For patients whose pain is refractory to conservative care, lumbar fusion is recommended. Limitations of these studies preclude the ability to present the most robust recommendation in support of lumbar fusion. A number of lesser-quality studies, primarily case series, also support the use of lumbar fusion in this patient population.
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Affiliation(s)
- Jason C. Eck
- 1Center for Sports Medicine and Orthopaedics, Chattanooga, Tennessee
| | - Alok Sharan
- 2Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Zoher Ghogawala
- 3Alan and Jacqueline Stuart Spine Research Center, Department of Neurosurgery, Lahey Clinic, Burlington, and Tufts University School of Medicine, Boston, Massachusetts
| | - Daniel K. Resnick
- 4Department of Neurosurgery, University of Wisconsin, Madison, Wisconsin
| | | | - Praveen V. Mummaneni
- 6Department of Neurological Surgery, University of California, San Francisco, California
| | - Andrew T. Dailey
- 7Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Tanvir F. Choudhri
- 8Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael W. Groff
- 9Department of Spinal Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey C. Wang
- 10Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Sanjay S. Dhall
- 6Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael G. Kaiser
- 11Department of Neurosurgery, Columbia University, New York, New York
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Physiotherapy for Sleep Disturbance in People With Chronic Low Back Pain: Results of a Feasibility Randomized Controlled Trial. Arch Phys Med Rehabil 2013; 94:2083-92. [DOI: 10.1016/j.apmr.2013.04.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 11/18/2022]
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A home exercise programme is no more beneficial than advice and education for people with neurogenic claudication: results from a randomised controlled trial. PLoS One 2013; 8:e72878. [PMID: 24098633 PMCID: PMC3787048 DOI: 10.1371/journal.pone.0072878] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 07/14/2013] [Indexed: 11/30/2022] Open
Abstract
Objective To compare the effectiveness of a physiotherapy programme with a control treatment of advice and education in patients with neurogenic claudication symptoms. Design Pragmatic randomised controlled clinical trial. Setting Primary care-based musculoskeletal service. Patients Adults aged 50 or over with neurogenic claudication symptoms causing limitation of walking. Interventions Condition-specific home exercises combined with advice and education, or advice and education alone. Main outcome measures The primary outcome was the difference in improvement of symptom severity scores on the Swiss Spinal Stenosis Scale at eight weeks. Secondary outcomes included measures of physical function, pain and general well-being at eight weeks and 12 months. Results There was no significant difference between groups in the Swiss Spinal Stenosis symptom severity scale at eight weeks (t = 0.47, p = 0.643): mean change (SD) control group −0.18 (0.47), treatment group −0.10 (0.66), difference (95% CI) 0.08 (−0.19, 0.35); baseline-adjusted difference 0.06 (−0.19, 0.31)]. An unplanned subgroup analysis suggested that for patients with the top 25% of baseline symptom severity scores, the physiotherapy exercise programme resulted in an improvement in the primary outcome, and modest but consistently better secondary outcomes at both time-points compared to the control group. The effectiveness in different subgroups requires further direct evaluation. Conclusions In the treatment of patients with neurogenic claudication symptoms, a physiotherapist-prescribed home exercise programme is no more effective than advice and education. Ethical approval The study was approved by Leeds Central Ethics Committee and informed consent was given by all participating patients. Copyright The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licensees in perpetuity, in all forms, formats and media (whether known now or created in the future), to i) publish, reproduce, distribute, display and store the Contribution, ii) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or, abstracts of the Contribution, iii) create any other derivative work(s) based on the Contribution, iv) to exploit all subsidiary rights in the Contribution, v) the inclusion of electronic links from the Contribution to third party material where-ever it may be located; and, vi) licence any third party to do any or all of the above. Trial registration ISRCTN 78288224 – doi10.1186/ISRCTN35836727; UKCRN 4814.
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Nicotra A, King NKK, Catley M, Mendoza N, McGregor AH, Strutton PH. Evaluation of corticospinal excitability in cervical myelopathy, before and after surgery, with transcranial magnetic stimulation: a pilot study. 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 2012; 22:189-96. [PMID: 23132280 DOI: 10.1007/s00586-012-2554-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 07/17/2012] [Accepted: 10/10/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE A pilot study to examine the impact of cervical myelopathy on corticospinal excitability, using transcranial magnetic stimulation, and to investigate whether motor evoked potential (MEP) and silent period (SP) recruitment curve (RC) parameters can detect changes in corticospinal function pre- and post-surgery. METHODS We studied six cervical myelopathy patients undergoing surgery and six healthy controls. Clinical and functional scores and neurophysiological parameters were examined prior to and 3 months following the surgery. RESULTS MEP latencies for abductor pollicis brevis (APB) and tibialis anterior (TA) muscles and central motor conduction time were prolonged pre- and post-surgery; SP durations were differentially altered. There were significant differences in parameters of RCs for (1) MEP area in APB (max values, S50) and TA (slope) between controls and patients pre- and post-surgery and (2) SP duration in APB (max values) between patients pre-surgery and controls. CONCLUSIONS The findings of this pilot study suggest an uncoupling of excitatory and inhibitory pathways, which persists at 3 months following cord decompression. RCs for MEP and SP at 3 months provide more information on the functional status of the cord and prompts for a longer term follow-up.
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Affiliation(s)
- Alessia Nicotra
- Department of Clinical Neurophysiology, West London Neurosciences Centre, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, W6 8RF, UK
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14
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Boer LM, Asijee GM, van Schayck OCP, Schermer TRJ. How do dyspnoea scales compare with measurement of functional capacity in patients with COPD and at risk of COPD? PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:202-7. [PMID: 22453664 DOI: 10.4104/pcrj.2012.00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In primary care, formal functional capacity testing is not always feasible. Guidelines for family practitioners suggest the use of dyspnoea scales to assess exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). AIMS To examine whether the use of activity-based dyspnoea scales can substitute for actual functional capacity testing. METHODS 128 subjects (49% at risk of COPD, 24% GOLD stage I, 17% GOLD stage II, 9% GOLD stage III) performed an Incremental Shuttle Walk Test (ISWT) and completed the Medical Research Council dyspnoea scale (MRC), Baseline Dyspnoea Index (BDI), Oxygen Cost Diagram (OCD), Clinical COPD Questionnaire (CCQ), and St George's Respiratory Questionnaire (SGRQ). RESULTS Analysis of variance showed that the relationship between the ISWT and the MRC dyspnoea scale was statistically significant but moderate (p < 0.001, R2 = 0.166). Correlations between the ISWT and the other dyspnoea scales were also moderate (correlation coefficients 0.34-0.42). Combining the dyspnoea scales in one analysis resulted in a proportion of explained variance of the ISWT of 21.4% (R2 = 0.214). CONCLUSIONS Dyspnoea scales cannot substitute for formal functional capacity testing. Authors of COPD guidelines should consider stating more specifically that the MRC and similar scales measure (self-reported) activity-related dyspnoea but cannot replace objectively measured functional capacity.
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Affiliation(s)
- Lonneke M Boer
- Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Hughes SPF, Freemont AJ, Hukins DWL, McGregor AH, Roberts S. The pathogenesis of degeneration of the intervertebral disc and emerging therapies in the management of back pain. ACTA ACUST UNITED AC 2012; 94:1298-304. [DOI: 10.1302/0301-620x.94b10.28986] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article reviews the current knowledge of the intervertebral disc (IVD) and its association with low back pain (LBP). The normal IVD is a largely avascular and aneural structure with a high water content, its nutrients mainly diffusing through the end plates. IVD degeneration occurs when its cells die or become dysfunctional, notably in an acidic environment. In the process of degeneration, the IVD becomes dehydrated and vascularised, and there is an ingrowth of nerves. Although not universally the case, the altered physiology of the IVD is believed to precede or be associated with many clinical symptoms or conditions including low back and/or lower limb pain, paraesthesia, spinal stenosis and disc herniation. New treatment options have been developed in recent years. These include biological therapies and novel surgical techniques (such as total disc replacement), although many of these are still in their experimental phase. Central to developing further methods of treatment is the need for effective ways in which to assess patients and measure their outcomes. However, significant difficulties remain and it is therefore an appropriate time to be further investigating the scientific basis of and treatment of LBP.
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Affiliation(s)
- S. P. F. Hughes
- Imperial College London, South
Kensington Campus, London SW7 2AZ, UK
| | - A. J. Freemont
- University of Manchester, Oxford
Road, Manchester M13 9PL, UK
| | | | - A. H. McGregor
- Imperial College London, South
Kensington Campus, London SW7 2AZ, UK
| | - S. Roberts
- Robert Jones and Agnes Hunt Orthopaedic
Hospital NHS Foundation Trust, and ISTM,
Keele University, Oswestry, Shropshire SY10
7AG, UK
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16
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Kelly G, Blake C, Power C, O'Keeffe D, Fullen B. The impact of spinal cord stimulation on physical function and sleep quality in individuals with failed back surgery syndrome: A systematic review. Eur J Pain 2011; 16:793-802. [DOI: 10.1002/j.1532-2149.2011.00092.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2011] [Indexed: 11/11/2022]
Affiliation(s)
- G.A. Kelly
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre; University College Dublin; Ireland
| | - C. Blake
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre; University College Dublin; Ireland
| | - C.K. Power
- Department of Anaesthesia and Pain Medicine; Adelaide and Meath Hospital; Tallaght; Dublin; Ireland
| | - D. O'Keeffe
- Department of Anaesthesia and Pain Medicine; St. Vincent's University Hospital; Dublin; Ireland
| | - B.M. Fullen
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre; University College Dublin; Ireland
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Lee JH, Fell DW, Kim K. Plantar Pressure Distribution During Walking: Comparison of Subjects with and without Chronic Low Back Pain. J Phys Ther Sci 2011. [DOI: 10.1589/jpts.23.923] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeon Hyeong Lee
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
| | - Dennis W. Fell
- Department of Physical Therapy, University of South Alabama
| | - Kyoung Kim
- Department of Physical Therapy, College of Rehabilitation Science, Daegu University
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Pons T, Shipton EA. Multilevel lumbar fusion and postoperative physiotherapy rehabilitation in a patient with persistent pain. Physiother Theory Pract 2010; 27:238-45. [DOI: 10.3109/09593985.2010.483268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hurley DA, Eadie J, O'Donoghue G, Kelly C, Lonsdale C, Guerin S, Tully MA, van Mechelen W, McDonough SM, Boreham CAG, Heneghan C, Daly L. Physiotherapy for sleep disturbance in chronic low back pain: a feasibility randomised controlled trial. BMC Musculoskelet Disord 2010; 11:70. [PMID: 20398349 PMCID: PMC2873461 DOI: 10.1186/1471-2474-11-70] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 04/16/2010] [Indexed: 12/03/2022] Open
Abstract
Background Sleep disturbance is becoming increasingly recognised as a clinically important symptom in people with chronic low back pain (CLBP, low back pain >12 weeks), associated with physical inactivity and depression. Current research and international clinical guidelines recommend people with CLBP assume a physically active role in their recovery to prevent chronicity, but the high prevalence of sleep disturbance in this population may be unknowingly limiting their ability to participate in exercise-based rehabilitation programmes and contributing to poor outcomes. There is currently no knowledge concerning the effectiveness of physiotherapy on sleep disturbance in people with chronic low back pain and no evidence of the feasibility of conducting randomized controlled trials that comprehensively evaluate sleep as an outcome measure in this population. Methods/Design This study will evaluate the feasibility of a randomised controlled trial (RCT), exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. A presenting sample of 60 consenting patients will be recruited in the physiotherapy department of Beaumont Hospital, Dublin, Ireland, and randomly allocated to one of the three groups in a concealed manner. The main outcomes will be sleep quality (self-report and objective measurement), and self-reported functional disability, pain, quality of life, fear avoidance, anxiety and depression, physical activity, and patient satisfaction. Outcome will be evaluated at baseline, 3 months and 6 months. Qualitative telephone interviews will be embedded in the research design to obtain feedback from a sample of participants' about their experiences of sleep monitoring, trial participation and interventions, and to inform the design of a fully powered future RCT. Planned analysis will explore trends in the data, effect sizes and clinically important effects (quantitative data), and thematic analysis (qualitative data). Discussion This study will evaluate the feasibility of a randomised controlled trial exploring the effects of three forms of physiotherapy (supervised general exercise programme, individualized walking programme and usual physiotherapy, which will serve as the control group) on sleep quality in people with chronic low back pain. Trial Registration Current controlled trial ISRCTN54009836
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Affiliation(s)
- Deirdre A Hurley
- UCD School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin 4, Ireland.
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20
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Self-reported assessment of disability and performance-based assessment of disability are influenced by different patient characteristics in acute 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 2009; 19:633-40. [PMID: 19851791 DOI: 10.1007/s00586-009-1180-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Revised: 07/27/2009] [Accepted: 09/15/2009] [Indexed: 10/20/2022]
Abstract
For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach's alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson's correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson's correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach's alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics. In particular, it appears self-reported measures of disability are more influenced by the patient's psychological status than performance-based measures of disability.
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Hurley DA, O'Donoghue G, Tully MA, Moffett JK, van Mechelen W, Daly L, Boreham CA, McDonough SM. A walking programme and a supervised exercise class versus usual physiotherapy for chronic low back pain: a single-blinded randomised controlled trial. (The Supervised Walking In comparison to Fitness Training for Back Pain (SWIFT) Trial). BMC Musculoskelet Disord 2009; 10:79. [PMID: 19573247 PMCID: PMC2714003 DOI: 10.1186/1471-2474-10-79] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 07/02/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic low back pain (CLBP) is a persistent disabling condition with rising significant healthcare, social and economic costs. Current research supports the use of exercise-based treatment approaches that encourage people with CLBP to assume a physically active role in their recovery. While international clinical guidelines and systematic reviews for CLBP support supervised group exercise as an attractive first-line option for treating large numbers of CLBP patients at low cost, barriers to their delivery include space and time restrictions in healthcare settings and poor patient attendance. The European Clinical Guidelines have identified the need for research in the use of brief/minimal contact self-activation interventions that encourage participation in physical activity for CLBP. Walking may be an ideally suited form of individualized exercise prescription as it is easy to do, requires no special skills or facilities, and is achievable by virtually all ages with little risk of injury, but its effectiveness for LBP is unproven. METHODS AND DESIGN This study will be an assessor-blinded randomized controlled trial that will investigate the difference in clinical effectiveness and costs of an individualized walking programme and a supervised general exercise programme compared to usual physiotherapy, which will act as the control group, in people with chronic low back pain. A sample of 246 patients will be recruited in Dublin, Ireland through acute general hospital outpatient physiotherapy departments that provide treatment for people with CLBP. Patients will be randomly allocated to one of the three groups in a concealed manner. The main outcomes will be functional disability, pain, quality of life, fear avoidance, back beliefs, physical activity, satisfaction and costs, which will be evaluated at baseline, and 3, 6 and 12 months [follow-up by pre-paid postage]. Qualitative telephone interviews and focus groups will be embedded in the research design to obtain feedback about participants' experiences of the interventions and trial participation, and to inform interpretation of the quantitative data. Planned analysis will be by intention to treat (quantitative data) and thematic analysis (qualitative data) DISCUSSION The trial will evaluate the effectiveness of a walking programme and a supervised general exercise programme compared to usual physiotherapy in people with CLBP. TRIAL REGISTRATION Current controlled trial ISRCTN17592092.
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Affiliation(s)
- Deirdre A Hurley
- School of Physiotherapy & Performance Science, University College Dublin, Dublin 4, Ireland.
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Ortega FB, Artero EG, Ruiz JR, Vicente-Rodriguez G, Bergman P, Hagströmer M, Ottevaere C, Nagy E, Konsta O, Rey-López JP, Polito A, Dietrich S, Plada M, Béghin L, Manios Y, Sjöström M, Castillo MJ. Reliability of health-related physical fitness tests in European adolescents. The HELENA Study. Int J Obes (Lond) 2009; 32 Suppl 5:S49-57. [PMID: 19011654 DOI: 10.1038/ijo.2008.183] [Citation(s) in RCA: 206] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine the reliability of a set of health-related physical fitness tests used in the European Union-funded Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study on lifestyle and nutrition among adolescents. DESIGN A set of physical fitness tests was performed twice in a study sample, 2 weeks apart, by the same researchers. PARTICIPANTS A total of 123 adolescents (69 males and 54 females, aged 13.6+/-0.8 years) from 10 European cities participated in the study. MEASUREMENTS Flexibility, muscular fitness, speed/agility and aerobic capacity were tested using the back-saver sit and reach, handgrip, standing broad jump, Bosco jumps (squat jump, counter movement jump and Abalakov jump), bent arm hang, 4 x 10 m shuttle run, and 20-m shuttle run tests. RESULTS The ANOVA analysis showed that neither systematic bias nor sex differences were found for any of the studied tests, except for the back-saver sit and reach test, in which a borderline significant sex difference was observed (P=0.044). The Bland-Altman plots graphically showed the reliability patterns, in terms of systematic errors (bias) and random error (95% limits of agreement), of the physical fitness tests studied. The observed systematic error for all the fitness assessment tests was nearly 0. CONCLUSIONS Neither a learning nor a fatigue effect was found for any of the physical fitness tests when repeated. The results also suggest that reliability did not differ between male and female adolescents. Collectively, it can be stated that the reliability of the set of physical fitness tests examined in this study is acceptable. The data provided contribute to a better understanding of physical fitness assessment in young people.
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Affiliation(s)
- F B Ortega
- Department of Physiology, School of Medicine, University of Granada, Granada, Spain.
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The MRC spine stabilization trial: surgical methods, outcomes, costs, and complications of surgical stabilization. Spine (Phila Pa 1976) 2008; 33:2334-40. [PMID: 18784631 DOI: 10.1097/brs.0b013e318186a8b2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A review of the surgical costs and results in a group of patients randomly allocated to surgery as part of a large prospective randomized trial of patients with chronic back pain. OBJECTIVE To report the observational data from the surgical arm of a randomized trial comparing surgery with intensive rehabilitation for chronic low back pain. Clinical and economic data are reported. SUMMARY OF BACKGROUND DATA Surgery for chronic low back pain is a well established but unproven intervention. The most cost-effective technique for spinal stabilization is still not established. METHODS One hundred six patients with chronic low back pain were randomized to the surgical group of a randomized trial comparing spinal fusion of the lumbar with a 3 week intensive rehabilitation program. The primary outcomes were the Oswestry Disability Index (ODI) and the Shuttle Walking Test measured at baseline and 2 years postrandomization. Patients were stratified by preoperative diagnosis, smoking habit, and litigation. Complications were assessed and costs analyzed. RESULTS Of the 176 surgical patients, 56 underwent postero-lateral fusion, 57 underwent interbody fusion, and 24 underwent flexible stabilization of the spine. The mean ODI for all patients in the surgical arm of the trial improved from a baseline of 46.5 (SD 14.6) to 34.2 (SD 21) at 2 years. Health care costs were higher ( 3109 pounds difference) for more complex procedures, and nearly 6 times as many early complications occurred with the more complex procedures. Smoking and unemployment were associated with worse results whereas litigation did not adversely affect the outcome. CONCLUSION These observational changes in the ODI after surgery are similar to those reported from other studies of spinal fusion. More complex surgery is more expensive with more complications than postero-lateral fusion.
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Schröder C, Johnston M, Teunissen L, Notermans N, Helders P, van Meeteren N. Perceived Control is a Concurrent Predictor of Activity Limitations in Patients With Chronic Idiopathic Axonal Polyneuropathy. Arch Phys Med Rehabil 2007; 88:63-9. [PMID: 17207677 DOI: 10.1016/j.apmr.2006.10.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate (1) whether control perceptions (person's perception of ease or difficulty of performing behavior) and emotions contribute to activity limitations and if so (2) whether these variables mediate the relation between impairment and activity limitations in patients with chronic idiopathic axonal polyneuropathy (CIAP). DESIGN Cross-sectional study. SETTING Outpatient clinics of a university medical center. PARTICIPANTS Fifty-six patients diagnosed with CIAP. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Control perceptions about performing activities (questionnaire based on the theory of planned behavior), emotions (Hospital Anxiety and Depression Scale), activity limitations (performance: Shuttle Walk Test [SWT]; self-report: Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36] physical functioning subscale, self-reported ability to walk), and physical impairments (muscle strength, sensory function). RESULTS Control perceptions significantly (P<.01) correlated with all measures of activity limitations (r range, .58-.69). Hierarchical multiple regression analyses showed that perceived control explained 9% of the variance in the SWT (beta=.34, P<.01), 12% in the SF-36 (beta=.40, P<.01), and 24% in ability to walk (beta=.54, P<.01). In all measures of activity limitations, perceived control significantly mediated the effect of impairment. CONCLUSIONS Perceived control explained and mediated variance in activity limitations, whereas emotions did not. This suggests that increasing patients' perceptions of control might enhance performance of activities, even without changes in impairment.
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Affiliation(s)
- Carin Schröder
- Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, Sections of Rehabilitation Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Campbell H, Rivero-Arias O, Johnston K, Gray A, Fairbank J, Frost H. Responsiveness of objective, disease-specific, and generic outcome measures in patients with chronic low back pain: an assessment for improving, stable, and deteriorating patients. Spine (Phila Pa 1976) 2006; 31:815-22. [PMID: 16582856 DOI: 10.1097/01.brs.0000207257.64215.03] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of outcome data collected prospectively from 250 patients recruited to the UK Spine Stabilization Trial. OBJECTIVES To compare the responsiveness of the Shuttle Walking Test (SWT), which is an objective outcome measure, with that of a disease-specific (the Oswestry Disability Index) and 2 generic (the EQ-5D and SF-36) instruments in patients with chronic low back pain (LBP). SUMMARY OF BACKGROUND DATA Studies assessing the performance of subjective disease-specific and generic measures have increased in recent years, although there is a paucity of research reporting the responsiveness of objective measures in patients with LBP. The focus of investigation has been on responsiveness to improvements in LBP symptoms. For patients with deteriorating health, it remains largely unclear how outcome instruments perform. METHODS Baseline and 12-month outcome data collected on 250 patients with chronic LBP recruited to the Spine Stabilization Trial were analyzed using traditional measures of responsiveness. Analyses were performed for 3 groups of patients: those who rated their health status as improved, deteriorated, and stable at 12 months. RESULTS The SWT was shown by all measures to be responsive to health improvement, although less so than other instruments. All instruments were able to detect small-to-moderate reductions in health. Instrument floor effects may be responsible for small SF-36 change scores recorded for deteriorating patients. CONCLUSIONS Although shown to be responsive, including the SWT alongside disease-specific and generic instruments is unlikely to add additional information. All instruments appear responsive to patient deterioration, however, further research for the SF-36 is required.
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Affiliation(s)
- Helen Campbell
- Health Economics Research Centre, Department of Public Health, University of Oxford, United Kingdom.
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Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 2005; 330:1233. [PMID: 15911537 PMCID: PMC558090 DOI: 10.1136/bmj.38441.620417.8f] [Citation(s) in RCA: 394] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2005] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. DESIGN Multicentre randomised controlled trial. SETTING 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. PARTICIPANTS 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for spinal fusion. INTERVENTION Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy. MAIN OUTCOME MEASURE The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure. RESULTS 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was -4.1 (95% confidence interval -8.1 to -0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures. CONCLUSIONS Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.
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Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R. Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ (CLINICAL RESEARCH ED.) 2005. [PMID: 15911537 DOI: 10.1136/bmj.38441.620417.bf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the clinical effectiveness of surgical stabilisation (spinal fusion) compared with intensive rehabilitation for patients with chronic low back pain. DESIGN Multicentre randomised controlled trial. SETTING 15 secondary care orthopaedic and rehabilitation centres across the United Kingdom. PARTICIPANTS 349 participants aged 18-55 with chronic low back pain of at least one year's duration who were considered candidates for spinal fusion. INTERVENTION Lumbar spine fusion or an intensive rehabilitation programme based on principles of cognitive behaviour therapy. MAIN OUTCOME MEASURE The primary outcomes were the Oswestry disability index and the shuttle walking test measured at baseline and two years after randomisation. The SF-36 instrument was used as a secondary outcome measure. RESULTS 176 participants were assigned to surgery and 173 to rehabilitation. 284 (81%) provided follow-up data at 24 months. The mean Oswestry disability index changed favourably from 46.5 (SD 14.6) to 34.0 (SD 21.1) in the surgery group and from 44.8 (SD14.8) to 36.1 (SD 20.6) in the rehabilitation group. The estimated mean difference between the groups was -4.1 (95% confidence interval -8.1 to -0.1, P = 0.045) in favour of surgery. No significant differences between the treatment groups were observed in the shuttle walking test or any of the other outcome measures. CONCLUSIONS Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions. The statistical difference between treatment groups in one of the two primary outcome measures was marginal and only just reached the predefined minimal clinical difference, and the potential risk and additional cost of surgery also need to be considered. No clear evidence emerged that primary spinal fusion surgery was any more beneficial than intensive rehabilitation.
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