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Lee D, Cha B, Kim J, Choi YS, Kim M, Han I, Min K. Paraspinal muscles atrophy on both sides and at multiple levels after unilateral lumbar partial discectomy. Medicine (Baltimore) 2023; 102:e32688. [PMID: 36701703 PMCID: PMC9857383 DOI: 10.1097/md.0000000000032688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To identify the changes in cross-sectional areas (CSAs) and fatty infiltration of both sides of the paravertebral muscles and their associations with prognostic factors in patients who underwent unilateral lumbar discectomy. We retrospectively reviewed 27 patients who underwent magnetic resonance imaging before and after 1- or 2-level lumbar discectomy. The CSAs and functional cross-sectional areas of the paraspinal muscles were bilaterally measured from L1 to L2 to L5 to S1 based on T2-weighted axial images. These parameters were compared pre-and postoperatively. CSAs and functional cross-sectional areas decreased also in non-operative, non-surgical levels, not only in operated levels after discectomy. In the correlation analysis, the CSA of psoas major muscle at L1 to L2 was significantly decreased in patients with lower preoperative lordosis (r = 0.598, P = .040). The postoperative CSA of psoas major muscle at L4 to L5 was lower in those with the higher Pfirrmann grade (r = -0.590, P = .002); however, the CSA of quadratus lumborum muscle at L1 to L2 showed the opposite result (r = 0.526, P = .036). Similar results were also observed in the partial correlation adjusted for age and postoperative duration. Patients who underwent discectomy experienced overall paraspinal muscle atrophy in the lumbar region, including surgical and non-surgical sites. Such atrophic changes emphasized the need for core strengthening and lumbar rehabilitation from the early period after partial discectomy.
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Affiliation(s)
- Doyoung Lee
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Byungwoo Cha
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jongwook Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Yong-Soo Choi
- Department of Biotechnology, CHA University, Seongnam, Korea
| | - MinYoung Kim
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Inbo Han
- Department of Neurosurgery, Spine Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyunghoon Min
- Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
- * Correspondence: Kyunghoon Min, Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea (e-mail: )
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Aldemir K, Gürkan A. The effect of pedometer-supported walking and telemonitoring after disc hernia surgery on pain and disability levels and quality of life. Int J Nurs Pract 2021; 27:e12917. [PMID: 33594720 DOI: 10.1111/ijn.12917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/25/2020] [Accepted: 01/01/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to determine the effect of pedometer-supported walking and telemonitoring after lumbar disc hernia surgery on pain and disability levels and quality of life. METHODS This was a randomized controlled trial with two randomly selected groups conducted between March 2018 and January 2019. Sixty-seven participants (33 in the intervention group and 34 in the control group) who had undergone lumbar microdiscectomy were allocated to receive and not to receive walking exercise. Pain and disability levels and quality of life of groups were tested with the McGill Pain Questionnaire, the Oswestry Disability Index and the 36-Item Short Form Survey. Measurements were taken 3 weeks after surgery and following completion of the first, second and third months. RESULTS Compared with the control group, pain level at the first and second months and disability level at the second and third months in the intervention group were significantly lower (p < 0.05), and in the third month, subdimension scores of quality of life (the physical role difficulty, energy and vitality, mental health, social functionality and pain) were higher (p < 0.05). CONCLUSIONS Walking after herniated disc surgery decreased pain and disability levels and increased the quality of life; nurses can encourage adherence to walking as an effective intervention.
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Affiliation(s)
- Kadriye Aldemir
- School of Susehri Health High, Sivas Cumhuriyet University, Sivas, Turkey
| | - Aysel Gürkan
- Department of Nursing, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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3
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Rowley KM, Engel T, Kulig K. Trunk and hip muscle activity during the Balance-Dexterity task in persons with and without recurrent low back pain. J Electromyogr Kinesiol 2019; 50:102378. [PMID: 31783332 DOI: 10.1016/j.jelekin.2019.102378] [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: 07/16/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022] Open
Abstract
Coordination of the trunk and hips is crucial for successful dynamic balance in many activities of daily living. Persons with recurrent low back pain (rLBP), both while symptomatic and during periods of symptom remission, exhibit dysfunctional muscle activation patterns and coordination of these joints. In a novel dynamic balance task where persons in remission from rLBP exhibit dissociated trunk motion, it is unknown how trunk and hip musculature are coordinated. Activation of hip and trunk muscles were acquired from nineteen persons with and without rLBP during the Balance-Dexterity Task, which involves balancing on one limb while compressing an unstable spring with the other. There were no between-group differences in activation amplitude for any muscle groups tested. In back-healthy control participants, hip and trunk muscle activation amplitudes increased proportionally in response to the added instability of the spring (R = 0.837, p < 0.001). Increases in muscle activation amplitudes in the group in remission from rLBP were not proportional (R = 0.113, p = 0.655). Instead, hip muscle activation in this group was associated with task performance, i.e. dexterous control of the spring (R = 0.676, p = 0.002). These findings highlight atypical coordination of hip and trunk musculature potentially related to task demands in persons with rLBP even during remission from pain.
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Affiliation(s)
- K Michael Rowley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
| | - Tilman Engel
- University of Potsdam, Department of Sports and Health Sciences, University Outpatient Clinic, Potsdam, Germany
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Gorelikov AE, Melnikova EA, Razumov AN, Rassulova MA, Rud IM. [Rehabilitation of the patients presenting with the operated spine syndrome during the complicated postoperative period after discectomy]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2017; 94:40-47. [PMID: 29376974 DOI: 10.17116/kurort201794540-47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/29/2017] [Indexed: 11/17/2022]
Abstract
This article presents an analytical review of the literature concerning the problem of rehabilitation of the patients following the surgical treatment of hernias of intervertebral disks. The relevance of this problem and the importance of the related research activities in the context of neurorehabilitation are beyond any doubt. Despite the obvious progress in the modernization of the methods and technologies for medical rehabilitation, the number of re-operations in connection with the recurrences of herniated discs remains too high and the overall success thus far achieved in this field falls short of expectations. The authors discuss in detail the need for and the contemporary approaches to the rehabilitative treatment of the patients undergoing vertebral microdiscectomy including medication therapy, physiotherapy an therapeutic physical exercises. The variants of the application of magnetic stimulation during the early period of the rehabilitative treatment of the patients following the minimally invasive interventions for discogenic radiculopathy are considered.
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Affiliation(s)
- A E Gorelikov
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
| | - E A Melnikova
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
| | - A N Razumov
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
| | - M A Rassulova
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
| | - I M Rud
- Moscow Scientific and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine
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Jabłońska R, Ślusarz R, Królikowska A, Haor B, Zając M. Assessment and Determinants of Spinal Pain in the Course of Disc Disorders Treated Surgically. Med Sci Monit 2016; 22:4446-4454. [PMID: 27865095 PMCID: PMC5119686 DOI: 10.12659/msm.898252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Intervertebral disc disease is defined as a complex of structural changes in the aftermath of disorders of mutual elements, the structure of which form the discus intervertebralis and the spinal canal. The present work assessed pain in patients who were surgically treated due to spinal discopathy and analyzed factors that determine the condition. Material/Methods The research was carried on a group of 187 patients diagnosed with discopathy of the lumbosacral and cervical segment. The data are discussed in the context of medical records and the Visual Analogue Scale used for pain assessment. We used a prospective study plan with a 3-time assessment. Results The pain level observed among patients prior to the procedure (M=6.52) was higher than after 7 days (M=3.15) and 6 months from the operation (M= 3.45). The highest level of pain (M=6.88), with a relatively high consistency among the patients (SD=2.25), was observed in the case of left-side hernia (H=7.31; p=0.023). The influence of the analyzed factors on pain experience markedly increased by the third assessment (R2=0.14), and was strongly associated with the type of work performed by the patient. Conclusions Surgical operation significantly reduces pain in patients with disc disorders. The level of pain is predominantly affected by the location of the hernia and the type of work performed by the patient.
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Affiliation(s)
- Renata Jabłońska
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Robert Ślusarz
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Agnieszka Królikowska
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Beata Haor
- Department of Neurological and Neurosurgical Nursing, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland
| | - Magdalena Zając
- Department of Psychology, Kazimierz Wielki University in Bydgoszcz, Bydgoszcz, Poland
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Rushton A, Calcutt A, Heneghan N, Heap A, White L, Calvert M, Goodwin P. Descriptive analysis of a 1:1 physiotherapy outpatient intervention post primary lumbar discectomy: one arm of a small-scale parallel randomised controlled trial across two UK sites. BMJ Open 2016; 6:e012151. [PMID: 28186932 PMCID: PMC5128994 DOI: 10.1136/bmjopen-2016-012151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE There is a lack of high-quality evidence for physiotherapy post lumbar discectomy. Substantial heterogeneity in treatment effects may be explained by variation in quality, administration and components of interventions. An optimised physiotherapy intervention may reduce heterogeneity and improve patient benefit. The objective was to describe, analyse and evaluate an optimised 1:1 physiotherapy outpatient intervention for patients following primary lumbar discectomy, to provide preliminary insights. DESIGN A descriptive analysis of the intervention embedded within an external pilot and feasibility trial. SETTING Two UK spinal centres. PARTICIPANTS Participants aged ≥18; post primary, single level, lumbar discectomy were recruited. INTERVENTION The intervention encompassed education, advice, mobility and core stability exercises, progressive exercise, and encouragement of early return to work/activity. Patients received ≤8 sessions for ≤8 weeks, starting 4 weeks post surgery (baseline). OUTCOMES Blinded outcome assessment at baseline and 12 weeks (post intervention) included the Roland Morris Disability Questionnaire. STarT Back data were collected at baseline. Statistical analyses summarised participant characteristics and preplanned descriptive analyses. Thematic analysis grouped related data. FINDINGS Twenty-two of 29 allocated participants received the intervention. STarT Back categorised n=16 (55%) participants 'not at low risk'. Physiotherapists identified reasons for caution for 8 (36%) participants, commonly risk of overdoing activity (n=4, 18%). There was no relationship between STarT Back and physiotherapists' evaluation of caution. Physiotherapists identified 154 problems (mean (SD) 5.36 (2.63)). Those 'not at low risk', and/or requiring caution presented with more problems, and required more sessions (mean (SD) 3.14 (1.16)). CONCLUSIONS Patients present differently and therefore require tailored interventions. These differences may be identified using clinical reasoning and outcome data. TRIAL REGISTRATION NUMBER ISRCTN33808269; post results.
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Affiliation(s)
- A Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A Calcutt
- Department of Physiotherapy, Aneurin Bevan University Health Board, Ebbw Vale, UK
| | - N Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - A Heap
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - L White
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - M Calvert
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - P Goodwin
- Health Professions Department (Physiotherapy), Manchester, UK
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Alimohammadi N, Eslami M, Yousefi H, Tabesh H. The effect of continuing care on patient's quality-of-life after disc surgery in neurosurgery and very important person wards. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2015; 4:106. [PMID: 27462648 PMCID: PMC4946271 DOI: 10.4103/2277-9531.171820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Today, lumbar herniation discs, a prevalent problem with a sign of lumbar and feet pain in society. Removal of disk by surgery decrease pain but reduce quality-of-life (QOL). In some cases, lake of following and caring of patient after surgery, herniation disc recurrent. Previous studies show that patient education and followings is important, therefore, this study aimed to investigate the effect of continuing care on patient QOL after disc surgery in neurosurgery and very important person (VIP) ward in Al-Zahra Hospital. MATERIALS AND METHODS This study is a clinical trial conducted on 64 patients hospitalized in the neurosurgery and VIP wards of Al-Zahra Hospital, in Isfahan, Iran, in 2013. The patients were selected by simple sampling method and were randomly assigned to two groups (study and control). Patients' response to short form-36 questionnaire before and 4 weeks and 3 months after continuing care in study group, and simultaneously, in the control group. RESULTS Repeated measures ANOVA showed a significant difference in mean of physical and psychological dimensions before and 4 weeks and 3 months after intervention in study group (P < 0.05), but in control group, the difference was not significant (P = 0.8). Pairwise comparison of mean physical and psychological dimensions at different time points by Fisher's least significant difference showed that there was a significant difference in the intervention group (P < 0.022). But in the control group, there was no significant difference between pairs of time points (P > 0.18). CONCLUSION Continuing care improves dimensions of patients' QOL, and it is recommended as a nursing and nonmedical intervention in disc surgery patients.
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Affiliation(s)
| | | | - Hojatollah Yousefi
- Department of Adult Nursing, School of Nursing and Midwifery, Al-Zahra Hospital, Isfahan, Iran
| | - Homayoon Tabesh
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Rushton A, Heneghan NR, Calvert M, Heap A, White L, Goodwin PC. Physiotherapy Post Lumbar Discectomy: Prospective Feasibility and Pilot Randomised Controlled Trial. PLoS One 2015; 10:e0142013. [PMID: 26562660 PMCID: PMC4642943 DOI: 10.1371/journal.pone.0142013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate: acceptability and feasibility of trial procedures; distribution of scores on the Roland Morris Disability Questionnaire (RMDQ, planned primary outcome); and efficient working of trial components. DESIGN AND SETTING A feasibility and external pilot randomised controlled trial (ISRCTN33808269, assigned 10/12/2012) was conducted across 2 UK secondary care outpatient physiotherapy departments associated with regional spinal surgery centres. PARTICIPANTS Consecutive consenting patients aged >18 years; post primary, single level, lumbar discectomy. INTERVENTIONS Participants were randomised to either 1:1 physiotherapy outpatient management including patient leaflet, or patient leaflet alone. MAIN OUTCOME MEASURES Blinded assessments were made at 4 weeks post surgery (baseline) and 12 weeks post baseline (proposed primary end point). Secondary outcomes included: Global Perceived Effect, back/leg pain, straight leg raise, return to work/function, quality of life, fear avoidance, range of movement, medication, re-operation. RESULTS At discharge, 110 (44%) eligible patients gave consent to be contacted. 59 (54%) patients were recruited. Loss to follow up was 39% at 12 weeks, with one site contributing 83% losses. Mean (SD) RMDQ was 10.07 (5.58) leaflet and 10.52 (5.94) physiotherapy/leaflet at baseline; and 5.37 (4.91) leaflet and 5.53 (4.49) physiotherapy/leaflet at 12 weeks. 5.1% zero scores at 12 weeks illustrated no floor effect. Sensitivity to change was assessed at 12 weeks with mean (SD) change -4.53 (6.41), 95%CI -7.61 to -1.44 for leaflet; and -6.18 (5.59), 95%CI -9.01 to -3.30 for physiotherapy/leaflet. RMDQ mean difference (95%CI) between change from baseline to twelve weeks was 1.65(-2.46 to 5.75). Mean difference (95%CI) between groups at 12 weeks was -0.16 (-3.36 to 3.04). Participant adherence with treatment was good. No adverse events were reported. CONCLUSIONS Both interventions were acceptable, and it is promising that they both demonstrated a trend in reducing disability in this population. A randomised controlled trial, using a different trial design, is needed to ascertain the effectiveness of combining the interventions into a stepped care intervention and comparing to a no intervention arm. Findings will guide design changes for an adequately powered randomised controlled trial, using RMDQ as the primary outcome. TRIAL REGISTRATION ISRCTN registry 33808269.
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Affiliation(s)
- Alison Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Melanie Calvert
- Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Alison Heap
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Louise White
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Peter C Goodwin
- Health Professions Department (Physiotherapy), Manchester Metropolitan University, Birley Fields, Manchester, United Kingdom
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Goodwin PC, Wright CC, Allan C, Crowther L, Darley C, Heap A, Paul E, White L, Rushton A. Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study. BMJ Open 2015; 5:e006069. [PMID: 25762227 PMCID: PMC4360785 DOI: 10.1136/bmjopen-2014-006069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To produce free, expert-informed postoperative information for lumbar discectomy patients, satisfying UK National Health Service Information Standards. DESIGN A mixed methods approach utilising the Delphi technique and focus groups. SETTING Five spinal centres across the UK. PARTICIPANTS Panel members included 23 physiotherapists, 11 patients and 17 spinal surgeons. INTERVENTION Three rounds of questionnaires including open and closed questions and attendance at a clinician/patient focus group. RESULTS Response rates of 85%, 26% and 35% were achieved for the Delphi rounds. Ten clinicians and six patients participated in the focus groups. Consensus for leaflet sections was achieved in round 1 and content in round 3. The focus groups informed further revisions. CONCLUSIONS A consensually agreed, Information Standard compliant, patient lumbar discectomy leaflet was produced containing: (1) normal spine anatomy; (2) anatomy disc herniation and surgery; (3) back protection strategies and (4) frequently asked questions. Illustrations of exercises enable tailoring to the individual patient.
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Affiliation(s)
- P C Goodwin
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - C C Wright
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - C Allan
- Physiotherapy Department, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - L Crowther
- Physiotherapy Department, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - C Darley
- Physiotherapy Department, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, UK
| | - A Heap
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - E Paul
- Physiotherapy Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - L White
- Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Rushton
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Beneck GJ, Popovich JM, Selkowitz DM, Azen S, Kulig K. Intensive, progressive exercise improves quality of life following lumbar microdiskectomy: a randomized controlled trial. Clin Rehabil 2014; 28:892-901. [DOI: 10.1177/0269215514525059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: The purpose of the study was to examine changes in quality of life measures in patients who have undergone an intensive exercise program following a single level microdiskectomy. Design: Randomized controlled trial with blinded examiners. Setting: The study was conducted in outpatient physical therapy clinics. Subjects: Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy allocated to receive exercise and education or education only. Interventions: A 12-week periodized exercise program of lumbar extensor strength and endurance training, and mat and upright therapeutic exercises was administered. Outcome measures: Quality of life was tested with the Short Form 36 (SF-36). Measurements were taken 4–6 weeks postsurgery and following completion of the 12-week intervention program. Since some participants selected physical therapy apart from the study, analyses were performed for both an as-randomized (two-group) design and an as-treated (three-group) design. Results: In the two-group analyses, exercise and education resulted in a greater increase in SF-36 scales, role physical (17.8 vs. 12.1) and bodily pain (13.4 vs. 8.4), and the physical component summary (13.2 vs. 8.9). In the three-group analyses, post-hoc comparisons showed exercise and education resulted in a greater increase in the SF-36 scales, physical function (10.4 vs. 5.6) and bodily pain (13.7 vs. 8.2), and the physical component summary (13.7 vs. 8.9) when compared with usual physical therapy. Conclusions: An intensive, progressive exercise program combined with education increases quality of life in patients who have recently undergone lumbar microdiskectomy.
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Affiliation(s)
- George J Beneck
- Department of Physical Therapy California State University Long Beach, Long Beach, CA, USA
| | - John M Popovich
- Center for Orthopedic Research, Michigan State University, East Lansing, MI, USA
| | - David M Selkowitz
- Department of Physical Therapy Education, Western University of Health Sciences, Pomona, CA, USA
| | - Stan Azen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Silva MAC, Dias JM, Silva MF, Mazuquin BF, Abrão T, Cardoso JR. Análise comparativa da atividade elétrica do músculo multífido durante exercícios do Pilates, série de Williams e Spine Stabilization. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUÇÃO: A fraqueza da musculatura paraespinhal está relacionada à etiologia da dor lombar. Atualmente existem vários métodos que apresentam exercícios para o fortalecimento dessa musculatura. OBJETIVOS: Comparar e analisar o sinal eletromiográfico do músculo multífido bilateralmente durante exercícios do método Pilates, série de Williams e Spine Stabilization. MATERIAIS E MÉTODOS: Participaram do estudo dez mulheres voluntárias e saudáveis que realizaram os exercícios leg pull front support modificado do Pilates, o quarto exercício da série adicional de Williams e o quadruped exercise do Spine Stabilization. O sinal foi normalizado pelo pico eletromiográfico da atividade dinâmica e foram ajustados para 2000 amostras por segundo e o filtro em uma frequência de passagem de 20 a 450 Hz. A ANOVA foi utilizada para verificar diferenças entre os exercícios, o teste t para amostras dependentes foi usado para comparar a ativação entre os lados direito e esquerdo do multífido para cada exercício. RESULTADOS E CONSIDERAÇÕES FINAIS: Na comparação entre os exercícios, observaram-se diferenças significativas para o músculo multífido a favor do exercício do método Pilates tanto na fase concêntrica quanto na excêntrica, o que demonstra ser o exercício de melhor ativação elétrica para o músculo analisado.
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12
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Shin SS, Lee YW, Song CH. Effects of Lumbar Stabilization Exercise on Postural Sway of Patients with Adolescent Idiopathic Scoliosis during Quiet Sitting. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Yong Woo Lee
- Department of Physical Therapy, Sahmyook University
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13
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Kim IH, Kim JH, Lee JU, Kim MY, Kim B, Kim J. The Effect of an Early Lumbar Exercise Program on Trunk Strength and the Oswestry Disability Index after Herniated Nucleus Pulposus Surgery. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Il-Hyun Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Ju-Hyun Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Jeong-Uk Lee
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Mee-Young Kim
- Graduate School of Rehabilitation & Health Science, Doctoral Course, Yongin University
| | - Bokyung Kim
- Department of Physiology, Institute of Functional Genomics, School of Medicine, Konkuk University
| | - Junghwan Kim
- Department of Physical Therapy, College of Public Health & Welfare Yongin University
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Abstract
BACKGROUND Low back pain affects a substantial number of adults each year and is persistent or recurrent for many. Self-efficacy is an important predictor of functional recovery. OBJECTIVE The purpose of this investigation was to assess the preliminary reliability and validity of the Low Back Activity Confidence Scale (LoBACS) for individuals with histories of low back pain or lumbar surgery. DESIGN Two overlapping samples of patients who had undergone a microdiskectomy participated: a test-retest sample of 21 individuals and a validity sample of 53 individuals. METHODS Low Back Activity Confidence Scale items pertaining to self-efficacy for functional activities (FnSE subscale), self-regulation of back health (Self-RegSE subscale), and regular exercise (ExSE subscale) were generated from existing literature and clinical observations. The test-retest sample completed the LoBACS twice, approximately 10 days apart. The validity sample completed the LoBACS and measures of functional performance, self-reported leisure and occupational physical activity, pain, fear beliefs, disability, and quality of life. RESULTS The FnSE, Self-RegSE, and ExSE subscale scores and LoBACS total score had excellent to acceptable test-retest reliability (intraclass correlation coefficients of .924, .634, .710, and .850, respectively) and internal consistency (Cronbach α coefficients of .924, .804, .941, and .911, respectively). The LoBACS subscales were correlated in expected directions with physical performance, physical activity, pain, fear beliefs, disability, and quality of life, providing initial evidence of concurrent validity. CONCLUSIONS The findings provide preliminary content and concurrent validity and interrater and internal consistency reliability for the LoBACS measure of self-efficacy for individuals with histories of low back pain and lumbar microdiskectomy.
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Dupeyron A, Ribinik P, Gélis A, Genty M, Claus D, Hérisson C, Coudeyre E. Education in the management of low back pain. Literature review and recall of key recommendations for practice. Ann Phys Rehabil Med 2011; 54:319-35. [DOI: 10.1016/j.rehab.2011.06.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 05/26/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
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Kessler JT, Melloh M, Zweig T, Aghayev E, Röder C. Development of a documentation instrument for the conservative treatment of spinal disorders in the International Spine Registry, Spine Tango. 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 2010; 20:369-79. [PMID: 20532924 DOI: 10.1007/s00586-010-1474-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 04/15/2010] [Accepted: 05/25/2010] [Indexed: 11/28/2022]
Abstract
Spine Tango is the first and only International Spine Registry in operation to date. So far, only surgical spinal interventions have been recorded and no comparable structured and comprehensive documentation instrument for conservative treatments of spinal disorders is available. This study reports on the development of a documentation instrument for the conservative treatment of spinal disorders by using the Delphi consensus method. It was conducted with a group of international experts in the field. We also assessed the usability of this new assessment tool with a prospective feasibility study on 97 outpatients and inpatients with low back or neck pain undergoing conservative treatment. The new 'Spine Tango conservative' questionnaire proved useful and suitable for the documentation of pathologies, conservative treatments and outcomes of patients with low back or neck problems. A follow-up questionnaire seemed less important in the predominantly outpatient setting. In the feasibility study, between 43 and 63% of patients reached the minimal clinically important difference in pain relief and Core Outcome Measures Index at 3 months after therapy; 87% of patients with back pain and 85% with neck pain were satisfied with the received treatment. With 'Spine Tango conservative' a first step has been taken to develop and implement a complementary system for documentation and evaluation of non-surgical spinal interventions and outcomes within the framework of the International Spine Registry. It proved useful and feasible in a first pilot study, but it will take the experience of many more cases and therapists to develop a version similarly mature as the surgical instruments of Spine Tango.
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Affiliation(s)
- J T Kessler
- Center for Osteopathy Zürich, Mainaustrasse 15, 8008 Zurich, Switzerland
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Time courses of adaptation in lumbar extensor performance of patients with a single-level microdiscectomy during a physical therapy exercise program. J Orthop Sports Phys Ther 2010; 40:336-44. [PMID: 20479532 DOI: 10.2519/jospt.2010.3141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Longitudinal single-cohort study. OBJECTIVE To characterize the time course of performance adaptations during a postsurgical exercise intervention following a single-level microdiscectomy. BACKGROUND Patients with a recent history of lumbar microdiscectomy are functionally limited, weak, have compromised paraspinal musculature, and benefit from an exercise program. METHODS Patients (n = 48) with a single-level microdiscectomy participated in a 12-week (36 sessions) comprehensive strength and endurance exercise program starting 4 to 6 weeks postsurgery. Lumbar extensor strength was quantified as the degree from horizontal on a modified Sorensen test procedure. Patients unable to assume the horizontal position were assumed to have strength deficits. Lumbar muscular endurance performance was quantified by the amount of time patients could hold the Sorensen test position at the horizontal. The time rate of lumbar muscular endurance adaptations were analyzed using longitudinal growth curve modeling. RESULTS The adherence rate of this program was low (67%). Twenty percent of the patients were identified as having strength deficits. These deficits were corrected in all patients within 3 to 9 weeks. Linear mixed-model results suggest an improvement of 5.6 seconds in hold time per week of exercise. Both the initial level of endurance and the rates of improvements were highly individualized. CONCLUSION The time course of musculoskeletal performance adaptations in persons with a history of lumbar surgery is highly individualized. When compared to normative endurance times, the results of this study indicate that the number of sessions and duration of therapy needed to generate meaningful adaptations of the paraspinal musculature is longer than what is typically provided in the clinic postsurgery. LEVEL OF EVIDENCE Therapy, level 4.J Orthop Sports Phys Ther 2010;40(6):336-344, Epub 13 May 2010. doi:10.2519/jospt.2010.3141.
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An intensive, progressive exercise program reduces disability and improves functional performance in patients after single-level lumbar microdiskectomy. Phys Ther 2009; 89:1145-57. [PMID: 19778981 DOI: 10.2522/ptj.20080052] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Restoration of physical function following lumbar microdiskectomy may be influenced by the postoperative care provided. OBJECTIVE The purpose of this study was to examine the effectiveness of a new interventional protocol to improve functional performance in patients who have undergone a single-level lumbar microdiskectomy. SETTING The study was conducted in physical therapy outpatient clinics. DESIGN AND PARTICIPANTS Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy were randomly allocated to receive education only or exercise and education. INTERVENTION AND MEASUREMENTS The exercise intervention consisted of a 12-week periodized program of back extensor strength (force-generating capacity) and endurance training and mat and upright therapeutic exercises. The Oswestry Disability Index (ODI) and physical measures of functional performance were tested 4 to 6 weeks postsurgery and 12 weeks later, following completion of the intervention program. Because some participants sought physical therapy outside of the study, postintervention scores were analyzed for both an as-randomized (2-group) design and an as-treated (3-group) design. RESULTS In the 2-group analyses, exercise and education resulted in a greater reduction in ODI scores and a greater improvement in distance walked. In the 3-group analyses, post hoc comparisons showed a significantly greater reduction in ODI scores following exercise and education compared with the education-only and usual physical therapy groups. LIMITATIONS The limitations of this study include a lack of adherence to group assignment, disproportionate therapist contact time among treatment groups, and multiple use of univariate analyses. CONCLUSIONS An intensive, progressive exercise program combined with education reduces disability and improves function in patients who have undergone a single-level lumbar microdiskectomy.
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Abstract
STUDY DESIGN Cochrane systematic review of randomized controlled trials. OBJECTIVE To evaluate the effects of active rehabilitation for adults after first-time lumbar disc surgery. SUMMARY OF BACKGROUND DATA Several rehabilitation programs are available for individuals after lumbar disc surgery, however, little is known about the efficacy of these treatments. METHODS Search strategies were performed on CENTRAL (The Cochrane Library 2007, Issue 2) and MEDLINE, EMBASE, CINAHL, and PsycINFO up to May 2007. All randomized controlled trials without language limitations were included. Pairs of review authors independently assessed studies for eligibility and risk of bias. A meta-analysis was performed with clinically homogeneous studies. The GRADE approach was used to determine the quality of evidence. RESULTS Fourteen studies were included, 7 of which had a low risk of bias. Most programs were only assessed in 1 study. Statistical pooling was only completed for 3 comparisons in which exercises started 4 to 6 weeks postsurgery: exercise programs versus no treatment, high versus low intensity exercise programs, and supervised versus home exercises. We found low quality evidence (3 randomized controlled trials [RCTs], N = 122) that exercises are more effective than no treatment for pain at short-term follow-up (weighted mean difference [WMD]:-11.13; 95% CI: -18.44 to -3.82) and moderate evidence (2 RCTs, N = 102) that exercises are more effective for functional status on short-term follow-up (WMD: -6.50; 95% CI: -9.26 to -3.74). None of the studies reported that exercises increased the reoperation rate. We also found low quality evidence (2 RCTs, N = 103) that high intensity exercises are slightly more effective than low intensity exercise programs for pain in the short-term (WMD: -10.67; 95% CI: -17.04 to -4.30) and moderate evidence (2 RCTs, N = 103) that they are more effective for functional status in the short-term (standardized mean difference [SMD] -0.77; 95% CI: -1.17 to -0.36). Finally, we found low quality evidence (3 RCTs, N = 95) that there were no significant differences between supervised and home exercises for short-term pain relief (SMD: -1.12; 95% CI: -2.77-0.53) or functional status (3 RCT, N = 95; SMD -1.17; 95% CI: -2.63-0.28). CONCLUSION Exercise programs starting 4 to 6 weeks postsurgery seem to lead to a faster decrease in pain and disability than no treatment. High intensity exercise programs seem to lead to a faster decrease in pain and disability than low intensity programs. There were no significant differences between supervised and home exercises for pain relief, disability, or global perceived effect. There is no evidence that active programs increase the reoperation rate after first-time lumbar surgery.
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Effects of electrical stimulation program on trunk muscle strength, functional capacity, quality of life, and depression in the patients with low back pain: a randomized controlled trial. Rheumatol Int 2008; 29:947-54. [DOI: 10.1007/s00296-008-0819-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 11/27/2008] [Indexed: 10/21/2022]
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Edimansyah B, Rusli B, Naing L. Effects of short duration stress management training on self-perceived depression, anxiety and stress in male automotive assembly workers: a quasi-experimental study. J Occup Med Toxicol 2008; 3:28. [PMID: 19021918 PMCID: PMC2600780 DOI: 10.1186/1745-6673-3-28] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Accepted: 11/21/2008] [Indexed: 11/10/2022] Open
Abstract
To examine the effects of short duration stress management training (SMT) on self-perceived depression, anxiety and stress in male automotive assembly workers, 118 male automotive workers from Pekan, Pahang (n = 60, mean age = 40.0 years, SD = 6.67) and Kota Bharu, Kelantan (n = 58, mean age = 38.1 years, SD = 5.86) were assigned to experimental and control group, respectively. A SMT program consisting of aerobic exercise, stress management manual, video session, lecture, question and answer session, and pamphlet and poster session were conducted in the experimental group. A validated short-form Malay version of the Depression Anxiety Stress Scales (DASS-21) were self-administered before and after the intervention program in the experimental and control group and their time and group interaction effects were examined using the repeated measure ANOVA test. Results indicated that the mean (SD) scores for DASS-Depression (p = 0.036) and DASS-Anxiety (p = 0.011) were significantly decreased, respectively, after the intervention program in the experimental group as compared to the control group (significant time-group interaction effects). No similar effect was observed for the mean (SD) scores for DASS-Stress (p = 0.104). However, the mean (SD) scores for subscales of DASS-Depression (Dysphoria, p = 0.01), DASS-Anxiety (Subjective Anxiety, p = 0.007, Situational Anxiety, p = 0.048), and DASS-Stress (Nervous Arousal, p = 0.018, Easily Upset, p = 0.047) showed significant time and group interaction effects. These findings suggest that short duration SMT is effective in reducing some aspects of self-perceived depression, anxiety and stress in male automotive workers.
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Affiliation(s)
- Ba Edimansyah
- Clinical School Johor Bahru, Tan Sri Jeffrey Cheah School of Medicine, Monash University, JKR 1235, Bukit Azah, 80100 Johor Bahru, Johor, Malaysia.
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Mayer J, Mooney V, Dagenais S. Evidence-informed management of chronic low back pain with lumbar extensor strengthening exercises. Spine J 2008; 8:96-113. [PMID: 18164458 DOI: 10.1016/j.spinee.2007.09.008] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 09/29/2007] [Indexed: 02/03/2023]
Abstract
The management of chronic low back pain (CLBP) has proven very challenging in North America, as evidenced by its mounting socioeconomic burden. Choosing among available nonsurgical therapies can be overwhelming for many stakeholders, including patients, health providers, policy makers, and third-party payers. Although all parties share a common goal and wish to use limited health-care resources to support interventions most likely to result in clinically meaningful improvements, there is often uncertainty about the most appropriate intervention for a particular patient. To help understand and evaluate the various commonly used nonsurgical approaches to CLBP, the North American Spine Society has sponsored this special focus issue of to The Spine Journal, titled Evidence-Informed Management of Chronic Low Back Pain Without Surgery. Articles in this supplement were contributed by leading spine practitioners and researchers, who were invited to summarize the best available evidence for a particular intervention and encouraged to make this information accessible to nonexperts. Each of the articles contains five sections (description, theory, evidence of efficacy, harms, and summary) with common subheadings to facilitate comparison across the 24 different interventions profiled in this special focus issue, blending narrative and systematic review methodology as deemed appropriate by the authors. It is hoped that articles in this special focus issue will be informative and aid in decision making for the many stakeholders evaluating nonsurgical interventions for CLBP.
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Affiliation(s)
- John Mayer
- School of Physical Therapy and Rehabilitation Sciences, College of Medicine, University of South Florida, Tampa, FL 33612-4766, USA.
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