Effects of dynamic stabilization exercises and muscle energy technique on selected biopsychosocial outcomes for patients with chronic non-specific low back pain: a double-blind randomized controlled trial

OBJECTIVES

Low back pain is the most prevalent musculoskeletal condition, and causes activity limitations which result in reduced work productivity and high medical expenditure. The management of this condition has been challenging to both clinicians and researchers. While the use of Muscle Energy Technique (MET) as a potentially effective treatment strategy seems promising, studies examining MET combined with exercise therapy are scarce and studies with strong methodology are lacking. Therefore, this study aims to determine the effects of a combination of Dynamic Stabilization Exercises (DSE) and MET on selected biopsychosocial outcomes compared to DSE alone or conventional physiotherapy in the management of chronic non-specific low back pain (NSLBP).

METHODS

A total of 125 (80 male and 45 female) patients with chronic NSLBP were involved in this study, they were recruited from Rasheed Shekoni Teaching hospital and Federal Medical centre Birnin-Kudu, Jigawa State, Nigeria. A random number generator method was used to allocate patients to either DSE + MET (n=41), DSE alone (n=39) or conventional physiotherapy (n=45). Interventions were administered twice a week over 12 weeks. Outcome measures included pain intensity, lumbar (flexion and extension) range of motion, functional-disability, self-perceived health status, limitations in activities and participation restrictions. These were assessed at baseline, mid-intervention at six weeks, post-intervention at 12 weeks and long term follow-up at 24 weeks. Data was analyzed using repeated-measures ANOVA to determine significance difference within groups and between groups.

RESULTS

All intervention groups showed within-groups changes of the study outcomes over time (p<0.001). However, between-group comparisons showed greater improvements in pain intensity (F=7.91, p<0.001), lumbar ROM (flexion F=1.51, p<0.001; extension F=3.25, p<0.001), activity limitations/participation restrictions (F=3.7, p<0.001) and health status (F=10.9, p<0.001) for the intervention in which MET and DSE were combined. The MET plus DSE interventions were superior to DSE and convention physiotherapy for all outcome measures, except for functional disability (F=0.53, p=0.590).

CONCLUSIONS

The data from this study showed MET combined with DSE had greater therapeutic benefits compared to DSE or conventional physiotherapy on selected biopsychosocial outcomes in patients with chronic NSLBP. The findings from the study show that the combination of MET with DSE is safe and has beneficial effects in the management of patients with chronic NSLBP.

CLINICAL TRIAL REGISTRATION

The study protocol has been registered with www.ClinicalTrial.gov with the registration number NCT3449810.

The effect of muscles energy technique in the management of chronic mechanical low back pain: A scoping review

BACKGROUND

The Muscle Energy Technique (MET) is one of the treatments of choice for the management of chronic mechanical low back pain (MLBP); however, there is a paucity of evidence to justify its effectiveness.

OBJECTIVES

The objectives of this review are to explore, analyze and summarize the available evidence related to the effectiveness of MET in the management of chronic MLBP.

METHOD

The scoping review methodology was adopted based on a recommendation from the work of Arksey and O'Malley, to systematically appraise literature and map the existing evidence on the effectiveness of MET in the management of chronic MLBP. A systematic search was performed comprising of an electronic search of online databases using key search terms and subsided by a hand search to identify the existing literature on the topic which was summarized and discussed.

RESULT

Initially 25,195 hits were identified which were screened to examine their eligibility based on predetermined inclusion criteria after removing duplicate articles. Eleven articles met the inclusion criteria and were discussed.

CONCLUSIONS

Generally there exists a scarcity of published articles on the effect of MET in chronic MLBP. However, the analysis of the retrieved articles showed that the MET procedure is a favourable intervention that is safe (i.e. no adverse effects) and can be effective as a standalone treatment or in combination with other treatment strategies for patients with chronic MLBP with the potential to provide numerous physical and psychosocial benefits.

Does exercise program of endurance and strength improve health-related quality of life in persons living with HIV-related distal symmetrical polyneuropathy? A randomized controlled trial

BACKGROUND

The most common HIV neurological comorbidity, Distal Symmetrical Peripheral Neuropathy (DSPN), is characterized by severe symptoms and reduced quality of life. Exercise has consistently been mentioned as one of the non-pharmacological therapies for the rehabilitation of individuals with HIV, but little is known about an exercise program to recommend to people living with HIV (PLWHIV)-related DSPN. The purpose of this study was to investigate the effectiveness of aerobic (AE) or progressive resisted exercise (PRE) on quality of life (QOL) in a person living with HIV-related DSPN.

METHOD

A randomized controlled trial was conducted with 136 persons living with HIV-related Neuropathy, including 6 domains of QOL within WHOQOL-BREF, 45 in the AE (used ergometer), 44 in the PRE (used quadriceps bench), and 47 in the control group (CG). The outcome measures (QOL) data were analyzed using the inferential statistic of Friedman for within-group with post hoc analysis of Wilcoxon signed Test. A Kruskal-Wallis test was carried out for between-groups with post hoc analysis of Mann-Whitney to find where significant differences exist.

RESULTS

The results indicated significant differences within experimental groups in all six domains p < 0.05. Similarly, the result indicated significant differences within the CG in Physical, level of independence, and Spirituality/Religions domains (p = 0.002, p = 0.035, p = 0.006). However, the results indicated significant differences between experimental groups and CG.

CONCLUSION

These findings indicated that strength and endurance exercise of moderate intensity have a positive effect on QOL in PLWHIV-related DSPN. Clinical trial No. http://apps.who.int/trialsearch/default.aspx (PACTR201707002173240).

Effects of combination therapy and infrared radiation on pain, physical function, and quality of life in subjects with knee osteoarthritis: A randomized controlled study

Background:

Knee osteoarthritis (KOA) is a common degenerative articular disease that causes disability and poor quality of life (QoL) of the individuals. Electrotherapeutic agents such as therapeutic ultrasound (US), interferential current (IFC), and infrared radiation are used in the treatment. It is not clear which of these agents is the best in improving these variables.

Objective:

The study aimed to compare the effects of the combined application of US and IFC therapies and infrared radiation on pain, functional activities, and QoL in people with KOA.

Methods:

In a randomized controlled study, 60 participants were randomized into two groups, the combination therapy group (CTG) and the infrared radiation group (IRG). Each group received 15-min treatment three times per week for 12 weeks. The visual analog scale (VAS) was used to assess the pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for functional activities and the Short Form Health Survey questionnaire for QoL.

Results:

Participants in the CTG had a significant (p<0.05) reduction in pain and significant (p<0.05) improvement in functional activities and QoL compared to the IRG.

Conclusion:

The results of this study support the use of the combination of IFC and US therapies to reduce pain and improve function and QoL for KOA patients.

Prevalence of musculoskeletal disorders in patients with diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM) is associated with musculoskeletal disorders (MSDs) and is often not clinically diagnosed and managed. There are also no systematic reviews of literature relating to the prevalence of MSDs among people with diabetes.

OBJECTIVE

To determine the prevalence and areas of the body affected by MSDs in diabetic patients.

METHODS

A literature search of the electronic databases of CINAH, PubMed, Web of Science and Google Scholar using the keywords of "MSDs and DM" as the search term was conducted. Pooled estimates were calculated using a meta-analysis of proportion.

RESULTS

Five thousand and eighty-eight studies were identified from the databases; 21 studies fulfilled the inclusion criteria and were included in the review. Five studies were of high quality, 13 were of moderate quality and three were of low quality. The prevalence of all types of MSDs among patients with diabetes was 58.15% (95% CI 41.4%-73.9%). The hand was the most common area of the body affected being 33.05% (95% CI 21.1-46.13) followed by the shoulder.

CONCLUSIONS

A high prevalence of MSDs was found among diabetic patients with the hand and shoulder being the most frequently reported areas affected. However, future studies with a larger sample and the relevant type of diabetes are required.

Effect of Rebound Exercises and Circuit Training on Complications Associated with Type 2 Diabetes: Protocol for a Randomized Controlled Trial

Background

The incidence of type 2 diabetes mellitus, a chronic lifestyle disease, and its complications are on the rise. Exercise has been documented as being effective in the management of musculoskeletal pain, depression, and reduction of hyperglycemia in diabetic patients. However, there is no consensus regarding the types of exercise that reduce musculoskeletal pain and depression and improve quality of life as well as respiratory function among individuals with type 2 diabetes.

Objective

The objective of this study is to determine the effects of rebound and circuit training on musculoskeletal pain, blood glucose level, cholesterol level, quality of life, depression, and respiratory parameters in patients with type 2 diabetes mellitus.

Methods

A total of 70 participants are expected to be recruited in this single blind randomized controlled trial. Computer-generated random numbers will be used to randomize the participants into 3 groups, namely, the rebound exercise group, the circuit exercise group, and the control group. Measurements will be taken at baseline and at the end of the 8 weeks of the study. Participants’ musculoskeletal pain will be assessed using the visual analog scale, quality of life will be assessed using the SF 12 Health Survey Questionnaire, depression using the Beck Depression Inventory, respiratory parameters using the spirometer, and biochemical parameters such as glucose level and cholesterol level using the glucometer. Data will be analyzed using descriptive statistics and inferential statistics of multivariate analysis of variance between the groups and paired t test within the group. Alpha will be set at .05.

Results

The results of this study will identify the effectiveness of rebound exercise and circuit training, compared with the control, in the management of type 2 diabetes mellitus and on quality of life, musculoskeletal pain, depression, glycemic control, cholesterol level, as well as improvement in respiratory function.

Conclusions

Though different additional strategies such as exercise and dietary and lifestyle modifications exist for the control of type 2 diabetes, they are mostly applied for the control of glucose level. No strategies have been identified for the control of complications associated with diabetes such as musculoskeletal pain, depression, and reduction in quality of life.

Trial Registration

Clinicaltrials.gov NCT03200795; https://clinicaltrials.gov/ct2/show/NCT03200795 (Archived by WebCite at http://www.webcitation.org/6mBgcj6z7)

Mandatory continuing professional development in South Africa: Rehabilitation therapists' perspective

Aims:

In 2007, Health Professions Council of South Africa (HPCSA) introduced mandatory continuing professional development (CPD), which enables therapists to acquire new knowledge and skills to improve patient care. To remain registered, therapists must meet CPD standards by formal HPCSA audits; however, latest figures revealed a compliance rate of 35% due to non-attendance of CPD activities. This study reviewed the experiences of therapists to identify barriers and obtain suggestions to improve attendance.

Methodology:

This cross-sectional descriptive study used a questionnaire with closed and open questions to explore the aims from a sample of 138 rehabilitation therapists, comprising speech and language therapists (9%), occupational therapists (21%) and physiotherapists (70%), attending an ethics workshop.

Results:

Eighty five (62%) supported CPD and 97 (71%) supported compulsory ethics. Short 1 to 3 day courses, mini-congresses and journal club activities were the most frequently-attended events. Barriers to CPD were: time, cost of courses, cost of travel due to geographical distance, staff shortages, lack of employee support, and multi-disciplinary or inappropriate courses. Suggestions for improving attendance were: introducing state subsidised and corporate sponsorships, increased in-service journal club activities, tele- and video-conferences, on-line presentations, and profession-specific courses.

Conclusion:

Therapists support mandatory CPD, but stakeholders must take cognisance of the barriers and suggestions to improve CPD attendance and compliance.