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Juszt J, Benedek N, Mohay G, Herbert Z, Győri Á, Mosdósi B. [A rare condition underlying childhood back pain: chronic nonbacterial osteomyelitis]. Orv Hetil 2024; 165:595-600. [PMID: 38619881 DOI: 10.1556/650.2024.33021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/22/2024] [Indexed: 04/17/2024]
Affiliation(s)
- Janka Juszt
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Gyermekgyógyászati Klinika Pécs, József A. u. 7., 7624 Magyarország
| | - Noémi Benedek
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Gyermekgyógyászati Klinika Pécs, József A. u. 7., 7624 Magyarország
| | - Gabriella Mohay
- 2 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Orvosi Képalkotó Klinika Pécs Magyarország
| | - Zsuzsanna Herbert
- 3 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Pécsi Diagnosztikai Központ Pécs Magyarország
| | - Ádám Győri
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Gyermekgyógyászati Klinika Pécs, József A. u. 7., 7624 Magyarország
| | - Bernadett Mosdósi
- 1 Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ, Gyermekgyógyászati Klinika Pécs, József A. u. 7., 7624 Magyarország
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van de Minkelis J, Peene L, Cohen SP, Staats P, Al-Kaisy A, Van Boxem K, Kallewaard JW, Van Zundert J. 6. Persistent spinal pain syndrome type 2. Pain Pract 2024. [PMID: 38616347 DOI: 10.1111/papr.13379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Persistent Spinal Pain Syndrome (PSPS) refers to chronic axial pain and/or extremity pain. Two subtypes have been defined: PSPS-type 1 is chronic pain without previous spinal surgery and PSPS-type 2 is chronic pain, persisting after spine surgery, and is formerly known as Failed Back Surgery Syndrome (FBSS) or post-laminectomy syndrome. The etiology of PSPS-type 2 can be gleaned using elements from the patient history, physical examination, and additional medical imaging. Origins of persistent pain following spinal surgery may be categorized into an inappropriate procedure (eg a lumbar fusion at an incorrect level or for sacroiliac joint [SIJ] pain); technical failure (eg operation at non-affected levels, retained disk fragment, pseudoarthrosis), biomechanical sequelae of surgery (eg adjacent segment disease or SIJ pain after a fusion to the sacrum, muscle wasting, spinal instability); and complications (eg battered root syndrome, excessive epidural fibrosis, and arachnoiditis), or undetermined. METHODS The literature on the diagnosis and treatment of PSPS-type 2 was retrieved and summarized. RESULTS There is low-quality evidence for the efficacy of conservative treatments including exercise, rehabilitation, manipulation, and behavioral therapy, and very limited evidence for the pharmacological treatment of PSPS-type 2. Interventional treatments such as pulsed radiofrequency (PRF) of the dorsal root ganglia, epidural adhesiolysis, and spinal endoscopy (epiduroscopy) might be beneficial in patients with PSPS-type 2. Spinal cord stimulation (SCS) has been shown to be an effective treatment for chronic, intractable neuropathic limb pain, and possibly well-selected candidates with axial pain. CONCLUSIONS The diagnosis of PSPS-type 2 is based on patient history, clinical examination, and medical imaging. Low-quality evidence exists for conservative interventions. Pulsed radiofrequency, adhesiolysis and SCS have a higher level of evidence with a high safety margin and should be considered as interventional treatment options when conservative treatment fails.
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Affiliation(s)
- Johan van de Minkelis
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Anesthesiology and Pain Medicine, Elisabeth-Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Laurens Peene
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
| | - Steven P Cohen
- Anesthesiology, Neurology, Physical Medicine & Rehabilitation and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Anesthesiology and Physical Medicine & Rehabilitation, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Peter Staats
- Anesthesiology and Pain Medicine, National Spine and Pain Centers, Shrewsbury, New Jersey, USA
| | - Adnan Al-Kaisy
- Pain Management Department, Gassiot House, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Koen Van Boxem
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
| | - Jan Willem Kallewaard
- Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Jan Van Zundert
- Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
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Haworth L, May K, Janssen J, Selfe J, Chohan A. Does an alternative breast support garment provide symptomatic relief for larger breasted women with chronic non-specific back pain? Prosthet Orthot Int 2024; 48:213-222. [PMID: 38595180 PMCID: PMC11005674 DOI: 10.1097/pxr.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/21/2023] [Accepted: 07/20/2023] [Indexed: 04/11/2024]
Abstract
BACKGROUND Nonsurgical guidelines recommend implementing a correctly fitted bra when managing back pain among larger breasted women. Achieving this is challenging with current bra solutions, sizing principles, and fitting approaches. Persistent wearing of an ill-fitting bra can cause negative health implications, including non-specific back pain. OBJECTIVES This study investigated immediate and short-term biomechanical and pain responses to changing breast support garment among larger breasted women with non-specific back pain. METHODS Participants (n = 24) performed a standing task, drop jumps, and seated typing tasks while bra and spinal kinematic data were recorded. Five breast support conditions were assessed: participants' usual bra (control), a professionally fitted bra in the immediate term (standard) and after 4 weeks wear (standard28), and a bra with an alternative design, measurement, and fitting approach in both the immediate term (alternative) and after 4 weeks wear (alternative28). A bra fit assessment and clinical pain/disability questionnaires were included. RESULTS All participants failed the bra fit assessment in the control bra, compared with 87.5% (n = 21) in the standard and 4.2% (n = 1) in the alternative bras. The standard28 and alternative28 bras provided symptomatic relief, with the alternative28 bra improving a greater number of outcome measures. Reduced nipple-sternal-notch distance was observed only in the alternative28 bra condition. CONCLUSIONS Symptomatic relief may be associated with the resting position of the breast tissue on the anterior chest wall. The alternative bra may provide potential clinical benefit if implemented as part of a nonsurgical or conservative pain management strategy. Alternative breast support garments should be considered to provide solutions to the problems associated with traditional bras.
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Affiliation(s)
- Lauren Haworth
- Allied Health Research Unit, University of Central Lancashire, Preston, United Kingdom
| | - Karen May
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | - Jessie Janssen
- Institute of Therapeutic and Midwifery Sciences, IMC University of Applied Science Krems, Krems an der Donau, Austria
| | - James Selfe
- Health, Psychology and Communities, Manchester Metropolitan University, Manchester, United Kingdom
| | - Ambreen Chohan
- Allied Health Research Unit, University of Central Lancashire, Preston, United Kingdom
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Shim GY, Kim MS, Kim HJ, Park Y, Kim SW, Yoo MC. A 42-year-old patient with renal cell carcinoma presenting as low back pain: A case report. Medicine (Baltimore) 2024; 103:e37639. [PMID: 38552083 PMCID: PMC10977550 DOI: 10.1097/md.0000000000037639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/02/2024] Open
Abstract
RATIONALE Renal cell carcinoma (RCC) is the most common renal neoplasm, accounting for 2.4% of all cancers in Korea. Although the usual clinical manifestations of RCC include flank pain, hematuria, and palpable mass, RCC is generally characterized by a lack of early warning signs and is mostly discovered incidentally in advanced stage. This case report describes a 42-year-old Korean man diagnosed with giant RCC who presented with simple back pain. PATIENT CONCERNS The clinical manifestation of a 42-year-old Korean man was chronic back pain. DIAGNOSES Contrast-enhanced computed tomography showed a 19.1-cm sized heterogeneous enhancing mass on the right kidney and tumor thrombosis extending into inferior vena cava. INTERVENTION Due to the large size of the tumor and extensive tumor thrombosis, the multidisciplinary team decided to administer neoadjuvant chemotherapy and an anticoagulant. Following 12 cycles of treatment with nivolumab and cabozantinib, he underwent a right radical nephrectomy with an adrenalectomy and tumor thrombectomy. OUTCOMES Treatment was successful and posttreatment he started a cancer rehabilitation program. He was followed-up as an outpatient and no longer complains of back pain. LESSONS RCC can manifest clinically as back pain, with diagnosis being difficult without appropriate imaging modalities. RCC should be included in the differential diagnosis of patients with low back pain, even at a young age.
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Affiliation(s)
- Ga Yang Shim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Min-Su Kim
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hong Jun Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yewan Park
- Department of Internal Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - So-Woon Kim
- Department of Pathology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Myung Chul Yoo
- Department of Physical and Rehabilitation Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
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El Hasbani G, Nicolas J, Najjar V, Jawad ASM, Uthman I. Sarcoidosis as a cause of chronic back pain: a case report. Sarcoidosis Vasc Diffuse Lung Dis 2024; 41:e2024007. [PMID: 38567561 PMCID: PMC11008322 DOI: 10.36141/svdld.v41i1.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 10/31/2023] [Indexed: 04/04/2024]
Abstract
While sarcoidosis is typically a multisystem disease, it can, in some instances, exclusively affect the vertebrae, leading to back pain. Additionally, sarcoidosis may manifest with inflammation of the sacroiliac joints, not meeting the criteria for spondyloarthritis, yet contributing to back pain. In this report, we present a case involving a previously healthy 55-year-old woman who sought medical attention due to chronic back pain. She was subsequently diagnosed with spinal sarcoidosis, based on MRI, PET scan, and biopsy results. Furthermore, treatment with prednisolone monotherapy demonstrated substantial improvement in her symptoms.
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Affiliation(s)
- Georges El Hasbani
- Department of Medicine, Hartford Healthcare St. Vincent’s Medical Center, Bridgeport, CT, USA
| | - Jessica Nicolas
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vicky Najjar
- Department of Pathology, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Ali SM Jawad
- Department of Rheumatology, Royal London Hospital, London, UK
| | - Imad Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Hong S, Chen L, Zhou X, Huang Y, Tian Y, Hu H, Yu B, Wu H, Yang C, Lv Z, Lv L. Genetically predicted causal effects of gut microbiota on spinal pain: a two-sample Mendelian randomization analysis. Front Microbiol 2024; 15:1357303. [PMID: 38591041 PMCID: PMC10999687 DOI: 10.3389/fmicb.2024.1357303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Background Observational studies have hinted at a correlation between the gut microbiota and spinal pain (SP). However, the impact of the gut microbiota on SP remains inconclusive. Methods In this study, we employed a two-sample Mendelian randomization (MR) analysis to explore the causal relationship between the gut microbiota and SP, encompassing neck pain (NP), thoracic spine pain (TSP), low back pain (LBP), and back pain (BP). The compiled gut microbiota data originated from a genome-wide association study (GWAS) conducted by the MiBioGen consortium (n = 18,340). Summary data for NP were sourced from the UK Biobank, TSP from the FinnGen Biobank, and LBP from both the UK Biobank and FinnGen Biobank. Summary data for BP were obtained from the UK Biobank. The primary analytical approach for assessing causal relationships was the Inverse Variance Weighted (IVW) method, supplemented by various sensitivity analyses to ensure result robustness. Results The IVW analysis unveiled 37 bacterial genera with a potential causal relationship to SP. After Benjamini-Hochberg corrected test, four bacterial genera emerged with a strong causal relationship to SP. Specifically, Oxalobacter (OR: 1.143, 95% CI 1.061-1.232, P = 0.0004) and Tyzzerella 3 (OR: 1.145, 95% CI 1.059-1.238, P = 0.0007) were identified as risk factors for LBP, while Ruminococcaceae UCG011 (OR: 0.859, 95% CI 0.791-0.932, P = 0.0003) was marked as a protective factor for LBP, and Olsenella (OR: 0.893, 95% CI 0.839-0.951, P = 0.0004) was recognized as a protective factor for low back pain or/and sciatica. No significant heterogeneity or horizontal pleiotropy was observed through alternative testing methods. Conclusion This study establishes a causal relationship between the gut microbiota and SP, shedding light on the "gut-spine" axis. These findings offer novel perspectives for understanding the etiology of SP and provide a theoretical foundation for potential interventions targeting the gut microbiota to prevent and treat SP.
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Affiliation(s)
- Shuangwei Hong
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Longhao Chen
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xingchen Zhou
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yuanshen Huang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yu Tian
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huijie Hu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Bei Yu
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hongjiao Wu
- Hangzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chao Yang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
| | - Zhizhen Lv
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Research Institute of Tuina (Spinal disease), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lijiang Lv
- The Third Affiliated Hospital of Zhejiang Chinese Medical University (Zhongshan Hospital of Zhejiang Province), Hangzhou, Zhejiang, China
- The Third School of Clinical Medicine (School of Rehabilitation Medicine), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Research Institute of Tuina (Spinal disease), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Calodney A, Azeem N, Buchanan P, Skaribas I, Antony A, Kim C, Girardi G, Vu C, Bovinet C, Vogel R, Li S, Jassal N, Josephson Y, Lubenow T, Lam CM, Deer TR. Safety, Efficacy, and Durability of Outcomes: Results from SECURE: A Single Arm, Multicenter, Prospective, Clinical Study on a Minimally Invasive Posterior Sacroiliac Fusion Allograft Implant. J Pain Res 2024; 17:1209-1222. [PMID: 38524688 PMCID: PMC10961068 DOI: 10.2147/jpr.s458334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction Research suggests that sacroiliac joint (SIJ) dysfunction is responsible for 15% to 30% of reported low back pain cases. Recently, there has been an increasing interest in SIJ fusion using minimally invasive surgery (MIS) due to safety. Initially, devices designed for MIS were intended for lateral approaches. A minimally invasive sacroiliac fusion implant for use with a posterior approach has been developed and is regulated for clinical use under the regulatory framework required for human cells, tissues, or cellular or tissue-based products (HCT/Ps). Methods A multi-center, prospective, single-arm study was launched after initial studies provided preliminary data to support safety, efficacy, and durability of this minimally invasive sacroiliac posterior fusion LinQ allograft implant (NCT04423120). Preliminary results were reported previously. Final results for the full participant cohort are presented here. Results One-hundred and fifty-nine (159) participants were enrolled across 16 investigational sites in the US between January 2020 and March 2022. One-hundred and twenty-two (122) participants were implanted. At the 1-month follow-up, 82 participants satisfied all criteria for the composite responder endpoint, representing 73.2% of the study cohort. These results stayed consistent across the remaining study timepoints with 66.0%, 74.4%, and 73.5% of participants classified as responders at the 3-, 6- and 12-month follow-up visits, respectively. VAS scores were significantly reduced (p < 0.0001) and ODI scores were significantly improved (p < 0.0001). All domains of the PROMIS-29 were also significantly improved (all p's <0.0001). Only one procedure-related serious AE was reported in the study. Conclusion These results suggest that the posterior approach LinQ Implant System is a safe and effective treatment for sacroiliac joint dysfunction at 12 months, with results that are favorable compared to outcomes reported for an FDA-cleared lateral approach.
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Affiliation(s)
| | - Nomen Azeem
- Florida Spine and Pain Specialists, Tampa, FL, USA
| | - Patrick Buchanan
- Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA
| | | | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | | | | | - Chau Vu
- Evolve Restoration Center, Santa Rosa, CA, USA
| | | | - Rainer Vogel
- Comprehensive and Interventional Pain Management, Henderson, NV, USA
| | - Sean Li
- Premier Pain Centers, Shrewsbury, NJ, USA
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Toh ZA, Berg B, Han QYC, Hey HWD, Pikkarainen M, Grotle M, He HG. Clinical Decision Support System Used in Spinal Disorders: Scoping Review. J Med Internet Res 2024; 26:e53951. [PMID: 38502157 PMCID: PMC10988379 DOI: 10.2196/53951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Spinal disorders are highly prevalent worldwide with high socioeconomic costs. This cost is associated with the demand for treatment and productivity loss, prompting the exploration of technologies to improve patient outcomes. Clinical decision support systems (CDSSs) are computerized systems that are increasingly used to facilitate safe and efficient health care. Their applications range in depth and can be found across health care specialties. OBJECTIVE This scoping review aims to explore the use of CDSSs in patients with spinal disorders. METHODS We used the Joanna Briggs Institute methodological guidance for this scoping review and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) statement. Databases, including PubMed, Embase, Cochrane, CINAHL, Web of Science, Scopus, ProQuest, and PsycINFO, were searched from inception until October 11, 2022. The included studies examined the use of digitalized CDSSs in patients with spinal disorders. RESULTS A total of 4 major CDSS functions were identified from 31 studies: preventing unnecessary imaging (n=8, 26%), aiding diagnosis (n=6, 19%), aiding prognosis (n=11, 35%), and recommending treatment options (n=6, 20%). Most studies used the knowledge-based system. Logistic regression was the most commonly used method, followed by decision tree algorithms. The use of CDSSs to aid in the management of spinal disorders was generally accepted over the threat to physicians' clinical decision-making autonomy. CONCLUSIONS Although the effectiveness was frequently evaluated by examining the agreement between the decisions made by the CDSSs and the health care providers, comparing the CDSS recommendations with actual clinical outcomes would be preferable. In addition, future studies on CDSS development should focus on system integration, considering end user's needs and preferences, and external validation and impact studies to assess effectiveness and generalizability. TRIAL REGISTRATION OSF Registries osf.io/dyz3f; https://osf.io/dyz3f.
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Affiliation(s)
- Zheng An Toh
- National University Hospital, National University Health System, Singapore, Singapore
| | - Bjørnar Berg
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Hwee Weng Dennis Hey
- Division of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Minna Pikkarainen
- Department of Rehabilitation and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, Oulu Business School, Oulu University, Oulu, Finland
- Department of Product Design, Oslo Metropolitan University, Oslo, Norway
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Koszela K. A three-stage concept of spine pathology treatment - a different perspective. Reumatologia 2024; 62:58-63. [PMID: 38558895 PMCID: PMC10979373 DOI: 10.5114/reum/183911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/09/2024] [Indexed: 04/04/2024] Open
Abstract
Spinal pathologies develop in patients of all ages and may have various underlying factors. These factors include, among others, myofascial pain syndromes, disc herniation and spinal degeneration. Treatment alone, both causal and symptomatic, is not always sufficient in certain situations. The aim of this paper is to discuss the question of comprehensive treatment of spine pathologies focusing on a three-stage treatment concept. An important aspect is to determine the risk factors and their reduction, or at least modification, i.e. the first stage of the discussed treatment concept. Then, medical treatment aimed at a specific pathology, including both conservative and surgical methods, allows the cause of the pathology to be removed, i.e. the second stage of the discussed concept. And finally, timely and specialized, broadly understood rehabilitation allowing to maintain the effect of medical therapy. The implemented rehabilitation can be considered as the third stage of the discussed treatment concept.
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Affiliation(s)
- Kamil Koszela
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatric, Rheumatology and Rehabilitation, Warsaw, Poland
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10
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Albana MF, Chayes DR, Abuattieh OM, Radcliff KE. Microdiscectomy Insurance Medical Necessity Criteria Are Inconsistent and Unnecessarily Restrictive. Int J Spine Surg 2024; 18:1-8. [PMID: 37402507 DOI: 10.14444/8521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Microdiscectomy for patients with chronic lumbar radiculopathy refractory to conservative therapy has significantly better outcomes than continued nonoperative management. The North American Spine Society (NASS) outlined specific criteria to establish medical necessity for elective lumbar microdiscectomy. We hypothesized that insurance providers have substantial variability among one another and from the NASS guidelines. METHODS A cross-sectional analysis of US national and local insurance companies was conducted to assess policies on coverage recommendations for lumbar microdiscectomy. Insurers were selected based on their enrollment data and market share of direct written premiums. The top 4 national insurance providers and the top 3 state-specific providers in New Jersey, New York, and Pennsylvania were selected. Insurance coverage guidelines were accessed through a web-based search, provider account, or telephone call to the specific provider. If no policy was provided, it was documented as such. Preapproval criteria were entered as categorical variables and consolidated into 4 main categories: symptom criteria, examination criteria, imaging criteria, and conservative treatment. RESULTS The 13 selected insurers composed roughly 31% of the market share in the United States and approximately 82%, 62%, and 76% of the market share for New Jersey, New York, and Pennsylvania, respectively. Insurance descriptions of symptom criteria, imaging criteria, and the definition of conservative treatment had substantial differences as compared with those defined by NASS. CONCLUSION Although a guideline to establish medical necessity was developed by NASS, many insurance companies have created their own guidelines, which have resulted in inconsistent management based on geographic location and selected provider. CLINICAL RELEVANCE Providers must be cognizant of the differing preapproval criteria needed for each in-network insurance company in order to provide effective and efficient care for patients with lumbar radiculopathy. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Mohamed F Albana
- Department of Orthopedic Surgery, Inspira Health, Vineland, NJ, USA
| | - Dylan R Chayes
- Department of Orthopedic Surgery, Inspira Health, Vineland, NJ, USA
| | - Omar M Abuattieh
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - Kris E Radcliff
- Spinal Disc Institute, Orthopedic Spine Surgeon, Somers Point, NJ, USA
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Alam MF, Ansari S, Zaki S, Sharma S, Nuhmani S, Alnagmoosh A, Alsubaiei ME. Effects of physical interventions on pain and disability in chronic low back pain with pronated feet: a systematic review and meta-analysis. Physiother Theory Pract 2024:1-15. [PMID: 38433468 DOI: 10.1080/09593985.2024.2325581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND A link between pronated feet (PF) and chronic low back pain (CLBP) has been reported in the literature. However, physical interventions (PI) like physiotherapy and orthotics mainly target the lower back, neglecting the broader biomechanical impacts of PF that affect the feet, ankles, and overall posture. Currently, there is a lack of comprehensive meta-analyses or systematic reviews on this subject. OBJECTIVES This systematic review with a meta-analysis aimed to evaluate the effects of PI on pain and disability in patients having CLBP with PF. METHODS From inception until October 15, 2023, Medline/PubMed, Web of Science, and Scopus databases were searched using the desired keywords for randomized control trials (RCTs). The quality of the RCTs was evaluated using the PEDro scale and risk of bias tool. RESULTS Four studies involving 268 patients were identified, two compared custom-made foot orthoses to non-biomechanical foot insoles, while the other two used exercises. The meta-analysis included four studies for pain and three for disability. The results showed a significant change in pain [-2.43 (95% CI -2.73 to -2.13, p < .001)] and disability of -6.69 (95% CI -8.04 to -5.33, p < .001)]. CONCLUSIONS This systematic review and meta-analysis of four RCTs elucidates that PI, specifically targeting PF, significantly alleviate pain and reduce disability in patients having CLBP with PF. These findings advocate for integrating foot-based PI within the treatment protocols for patients suffering from CLBP accompanied by PF.
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Affiliation(s)
- Md Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Sumbul Ansari
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Abdullah Alnagmoosh
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Mohammed Essa Alsubaiei
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
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12
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Wasser JG, Bruner ML, Chen C, Vincent HK. Identifying Risk Factors for Preexisting or Developing Low Back Pain in Youth, High School, and Collegiate Lacrosse Players Using 3-Dimensional Motion Analysis. Orthop J Sports Med 2024; 12:23259671241231958. [PMID: 38496334 PMCID: PMC10943740 DOI: 10.1177/23259671241231958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 03/19/2024] Open
Abstract
Background Low back pain (LBP) is a common condition that can affect athletes of all ages. The risk factors for LBP onset and worsening associated with the lacrosse shooting motion are not yet known. Purpose To identify training and biomechanical factors associated with preexisting LBP and development of LBP over 6 months in youth, high school, and collegiate lacrosse players. Study Design Case-control study; Level of evidence, 3. Methods A total of 128 lacrosse players were enrolled in this study between January 2016 and January 2019. Player characteristics, lacrosse experience, and participation in other sports were self-reported. At baseline and 2-, 4-, and 6-month follow-ups, the players self-rated the presence and severity of LBP using a numeric pain rating scale (0-10 points). Participants were grouped according to LBP symptoms: no LBP at any time point (n = 102), preexisting LBP (n = 17), or developed LBP within the 6-month period (n = 9). The lacrosse shooting motion was captured via 3-dimensional motion analysis, and kinematic and kinetic variables were recorded. A Low Back Stress Index was used to estimate lumbar stress as a function of pelvic acceleration at the time of maximum lateral trunk lean during the shot. Univariate analyses of covariance and logistic regression models were used to address study aims. Results Compared with the no-LBP group, the preexisting LBP group demonstrated 13.9% to 22.9% lower maximum angular velocities at the pelvis, trunk, and shoulders in the transverse plane (P < .05), 19.3% less collective pelvis-shoulder rotation in the transverse plane (P = .015), and 4.5% more knee flexion excursion (P = .063). The developed-LBP group produced 2.3% to 11.1% higher angular velocities in the pelvis, trunk, and shoulder and generated maximum pelvic acceleration values 36% to 42% higher than the remaining groups (P < .05 for both). Mean Low Back Stress Index values were not statistically significant among the groups (no LBP: 12,504 ± 13,076 deg2/s2; preexisting LBP: 8808 ± 10,174 deg2/s2; developed LBP: 19,389 ± 13,590 deg2/s2; P = .157). Conclusion Preexisting LBP was associated with significantly restricted motion of the pelvis, trunk, and shoulders during a lacrosse shot. Excessive pelvic acceleration may be related to the development of LBP in lacrosse players.
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Affiliation(s)
- Joseph G. Wasser
- Department of Physical Medicine & Rehabilitation, University of Florida, Gainesville, Florida, USA
| | - Michelle L. Bruner
- Department of Orthopaedics, University of Florida, Gainesville, Florida, USA
| | - Cong Chen
- Department of Orthopaedics, University of Florida, Gainesville, Florida, USA
| | - Heather K. Vincent
- Department of Physical Medicine & Rehabilitation, University of Florida, Gainesville, Florida, USA
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13
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Bitterli T, Schmid D, Ettinger L, Krupkova O, Bach FC, Tryfonidou MA, Meij BP, Pozzi A, Steffen F, Wuertz‐Kozak K, Smolders LA. Targeted screening of inflammatory mediators in spontaneous degenerative disc disease in dogs reveals an upregulation of the tumor necrosis superfamily. JOR Spine 2024; 7:e1292. [PMID: 38222814 PMCID: PMC10782068 DOI: 10.1002/jsp2.1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/28/2023] [Accepted: 09/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background The regulation of inflammatory mediators in the degenerating intervertebral disc (IVD) and corresponding ligamentum flavum (LF) is a topic of emerging interest. The study aimed to investigate the expression of a broad array of inflammatory mediators in the degenerated LF and IVD using a dog model of spontaneous degenerative disc disease (DDD) to determine potential treatment targets. Methods LF and IVD tissues were collected from 22 normal dogs (Pfirrmann grades I and II) and 18 dogs affected by DDD (Pfirrmann grades III and IV). A qPCR gene array was used to investigate the expression of 80 inflammatory genes for LF and IVD tissues, whereafter targets of interest were investigated in additional tissue samples using qPCR, western blot (WB), and immunohistochemistry. Results Tumor necrosis factor superfamily (TNFSF) signaling was identified as a regulated pathway in DDD, based on the significant regulation (n-fold ± SD) of various TNFSF members in the degenerated IVD, including nerve growth factor (NGF; -8 ± 10), CD40LG (464 ± 442), CD70 (341 ± 336), TNFSF Ligand 10 (9 ± 8), and RANKL/TNFSF Ligand 11 (85 ± 74). In contrast, TNFSF genes were not significantly affected in the degenerated LF compared to the control LF. Protein expression of NGF (WB) was significantly upregulated in both the degenerated LF (4.4 ± 0.5) and IVD (11.3 ± 5.6) compared to the control group. RANKL immunopositivity was significantly upregulated in advanced stages of degeneration (Thompson grades IV and V) in the nucleus pulposus and annulus fibrosus of the IVD, but not in the LF. Conclusions DDD involves a significant upregulation of various TNFSF members, with tissue-specific expression profiles in LF and IVD tissues. The differential involvement of TNFSF members within multiple spinal tissues from the same individual provides new insights into the inflammatory processes involved in DDD and may provide a basis to formulate hypotheses for the determination of potential treatment targets.
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Affiliation(s)
- Thomas Bitterli
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - David Schmid
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Ladina Ettinger
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Olga Krupkova
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
- Spine SurgeryUniversity Hospital BaselBaselSwitzerland
- Department of BiomedicineUniversity of Basel & University Hospital Basel, Tissue EngineeringBaselSwitzerland
| | - Frances C. Bach
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Björn P. Meij
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtthe Netherlands
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Frank Steffen
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - Karin Wuertz‐Kozak
- Institute for Biomechanics, ETH ZurichZurichSwitzerland
- Department of Biomedical EngineeringRochester Institute of Technology (RIT)RochesterNew YorkUSA
- Schön Clinic Munich Harlaching, Spine CenterAcademic Teaching Hospital and Spine Research Institute of the Paracelsus Medical University Salzburg (Austria)MunichGermany
| | - Lucas A. Smolders
- Clinic for Small Animal Surgery, Department for Small Animals, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
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Alsaqqa RM, Alghamdi MK, Basamih K, AlSulami M, Almajnooni M, Al Saedi ZS, Alhudhudi WH, Shatla M. Knowledge of Back Pain and Spinal Disorders Among the General Population in the Western Region of Saudi Arabia. Cureus 2024; 16:e55587. [PMID: 38576677 PMCID: PMC10994650 DOI: 10.7759/cureus.55587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Low back pain (LBP) is one of the most common global health problems and the second most common reason for seeking medical advice. However, most LBP does not indicate a serious disorder. Over half of the Saudi Arabian population experiences LBP at least once in their lives. Therefore, it is important to assess and understand how people manage this health problem. This study assessed back pain and spinal disorder knowledge among the general population in Saudi Arabia's western region. Methods This was a cross-sectional study of the general population in western Saudi Arabia. The data were collected using an online, self-administered, Arabic version of the validated questionnaire about LBP. A statistical analysis of the collected data was performed using a software program. Results A total of 754 eligible participants completed the questionnaire. Less than half of the participants could correctly define acute and chronic LBP and sciatica. Only 19.2% of participants were aware that medical history and clinical examinations are used to diagnose LBP. Young participants, university graduates, and unmarried participants had good LBP knowledge. Conclusion This study showed that the general population of Saudi Arabia in the Western region needs more knowledge about the definitions of acute and chronic LBP. However, they had fair knowledge about the aggravating factors and triggers of LBP. Young participants had better knowledge about LBP. Awareness campaigns with brochures and flyers can be used to increase the population's knowledge.
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Affiliation(s)
| | | | - Khalid Basamih
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Maria AlSulami
- Faculty of Medicine, Umm Al-Qura University, Makkah, SAU
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15
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Alghamdi GA, Alghamdi FA, Almatrafi RM, Sadis AY, Shabkuny RA, Alzahrani SA, Alessa MQ, Hafiz WA. The Prevalence of Musculoskeletal Injuries Among Pilgrims During the 2023 Hajj Season: A Cross-Sectional Study. Cureus 2024; 16:e56754. [PMID: 38650809 PMCID: PMC11033698 DOI: 10.7759/cureus.56754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/25/2024] Open
Abstract
Background Hajj, the annual Islamic pilgrimage, brings together over two million pilgrims in the city of Makkah to participate in a series of rituals. Given the physically demanding nature of the Hajj, pilgrims are susceptible to musculoskeletal (MSK) injuries and exhaustion. MSK pain and injuries are frequent occurrences among pilgrims, necessitating an assessment of the scope of this issue. Therefore, the primary objective of this study was to determine the prevalence of MSK injuries among pilgrims during the 2023 Hajj season. Methods This is a cross-sectional questionnaire-based study that was conducted in the city of Makkah, Saudi Arabia, during the 2023 Hajj season. Results A total of 463 pilgrims were included in the analysis. The most frequently reported types of injuries were muscular injuries (169, 45.4%), primarily characterized by pain (99, 58.6%), muscle spasms (55, 32.5%), and muscle tears (eight, 4.7%). The second most commonly reported MSK injury was bony injuries (97, 26.1%), which included fractures, followed by 79 cases (21.2%) of joint injuries, predominantly featuring pain (69, 87.3%) and joint prolapse (10, 12.7%). Notably, 27 pilgrims (7.3%) suffered from ligament injuries, including tears. Regarding the mechanisms or causes of these MSK injuries, the most frequently reported factors were fatigue (206, 55.4%), falls (76, 20.4%), crowding (34, 9.1%), accidents (30, 8.1%), and the use of wheelchairs (14, 3.8%). Additionally, it is noteworthy that muscular injuries were more prevalent among all age groups, particularly among young-aged pilgrims, while joint injuries were more common among elderly pilgrims. Conclusion MSK injuries are prevalent among pilgrims, with muscular injuries being the most frequently encountered. This underscores a noteworthy public health concern that necessitates attention from the Ministry of Health of Saudi Arabia.
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Affiliation(s)
- Ghidaa A Alghamdi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Faisal A Alghamdi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Renad M Almatrafi
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Arwa Y Sadis
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Rozan A Shabkuny
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Saad A Alzahrani
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Mohammed Q Alessa
- Department of Medicine and Surgery, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Waleed A Hafiz
- Department of Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
- Department of Medicine, Al-Noor Specialist Hospital, Makkah, SAU
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16
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Romano M, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Kotwicki T, Maier-Hennes A, Arienti C, Negrini S. Therapeutic exercises for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2024; 2:CD007837. [PMID: 38415871 PMCID: PMC10900302 DOI: 10.1002/14651858.cd007837.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Adolescent idiopathic scoliosis (AIS) is a pathology that changes the three-dimensional shape of the spine and trunk. While AIS can progress during growth and cause cosmetic issues, it is usually asymptomatic. However, a final spinal curvature above the critical threshold of 30° increases the risk of health problems and curve progression in adulthood. The use of therapeutic exercises (TEs) to reduce the progression of AIS and delay or avoid other, more invasive treatments is still controversial. OBJECTIVES To evaluate the effectiveness of TE, including generic therapeutic exercises (GTE) and physiotherapeutic scoliosis-specific exercises (PSSE) in treating AIS, compared to no treatment, other non-surgical treatments, or between treatments. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases, and two clinical trials registers to 17 November 2022. We also screened reference lists of articles. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing TE with no treatment, other non-surgical treatments (braces, electrical stimulation, manual therapy), and different types of exercises. In the previous version of the review, we also included observational studies. We did not include observational studies in this update since we found sufficient RCTs to address our study aims. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Our major outcomes were progression of scoliosis (measured by Cobb angle, trunk rotation, progression, bracing, surgery), cosmetic issues (measured by surface measurements and perception), and quality of life (QoL). Our minor outcomes were back pain, mental health, and adverse effects. MAIN RESULTS We included 13 RCTs (583 participants). The percentage of females ranged from 50% to 100%; mean age ranged from 12 to 15 years. Studies included participants with Cobb angles from low to severe. We judged 61% of the studies at low risk for random sequence generation and 46% at low risk for allocation concealment. None of the studies could blind participants and personnel. We judged the subjective outcomes at high risk of performance and detection bias, and the objective outcomes at high risk of detection bias in six studies and at low risk of bias in the other six studies. One study did not assess any objective outcomes. Comparing TE versus no treatment, we are very uncertain whether TE reduces the Cobb angle (mean difference (MD) -3.6°, 95% confidence interval (CI) -5.6 to -1.7; 2 studies, 52 participants). Low-certainty evidence indicates PSSE makes little or no difference in the angle of trunk rotation (ATR) (MD -0.8°, 95% CI -3.8 to 2.1; 1 study, 45 participants), may reduce the waist asymmetry slightly (MD -0.5 cm, 95% CI -0.8 to -0.3; 1 study, 45 participants), and may result in little to no difference in the score of cosmetic issues measured by the Spinal Appearance Questionnaire (SAQ) General (MD 0.7 points, 95% CI -0.1 to 1.4; 1 study, 16 participants). PSSE may result in little to no difference in self-image measured by the Scoliosis Research Society - 22 Patient Questionnaire (SRS-22) (MD 0.3 points, 95% CI -0.3 to 0.9; 1 study, 16 participants) and improve QoL slightly measured by SRS-22 Total score (MD 0.3 points, 95% CI 0.1 to 0.4; 2 studies, 61 participants). Only Cobb angle results were clinically meaningful. Comparing PSSE plus bracing versus bracing, low-certainty evidence indicates PSSE plus bracing may reduce Cobb angle (-2.2°, 95% CI -3.8 to -0.7; 2 studies, 84 participants). Comparing GTE plus other non-surgical interventions versus other non-surgical interventions, low-certainty evidence indicates GTE plus other non-surgical interventions may reduce Cobb angle (MD -8.0°, 95% CI -11.5 to -4.5; 1 study, 80 participants). We are uncertain whether PSSE plus other non-surgical interventions versus other non-surgical interventions reduces Cobb angle (MD -7.8°, 95% CI -12.5 to -3.1; 1 study, 18 participants) and ATR (MD -8.0°, 95% CI -12.7 to -3.3; 1 study, 18 participants). PSSE plus bracing versus bracing alone may make little to no difference in subjective measurement of cosmetic issues as measured by SAQ General (-0.2 points, 95% CI -0.9 to 0.5; 1 study, 34 participants), self-image score as measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -0.3 to 0.5; 1 study, 34 participants), and QoL measured by SRS-22 Total score (MD 0.2 points, 95% CI -0.1 to 0.5; 1 study, 34 participants). None of these results were clinically meaningful. Comparing TE versus bracing, we are very uncertain whether PSSE allows progression of Cobb angle (MD 2.7°, 95% CI 0.3 to 5.0; 1 study, 60 participants), changes self-image measured by SRS-22 Self-Image (MD 0.1 points, 95% CI -1.0 to 1.1; 1 study, 60 participants), and QoL measured by SRS-22 Total score (MD 3.2 points, 95% CI 2.1 to 4.2; 1 study, 60 participants). None of these results were clinically meaningful. Comparing PSSE with GTE, we are uncertain whether PSSE makes little or no difference in Cobb angle (MD -3.0°, 95% CI -8.2 to 2.1; 4 studies, 192 participants; very low-certainty evidence). PSSE probably reduces ATR (clinically meaningful) (-MD 3.0°, 95% CI -3.4 to -2.5; 2 studies, 138 participants). We are uncertain about the effect of PSSE on QoL measured by SRS-22 Total score (MD 0.26 points, 95% CI 0.11 to 0.62; 3 studies, 168 participants) and on self-image measured by SRS-22 Self-Image and Walter Reed Visual Assessment Scale (standardised mean difference (SMD) 0.77, 95% CI -0.61 to 2.14; 3 studies, 168 participants). Further, low-certainty evidence indicates that 38/100 people receiving GTE may progress more than 5° Cobb versus 7/100 receiving PSSE (risk ratio (RR) 0.19, 95% CI 0.67 to 0.52; 1 study, 110 participants). None of the included studies assessed adverse effects. AUTHORS' CONCLUSIONS The evidence on the efficacy of TE is currently sparse due to heterogeneity, small sample size, and many different comparisons. We found only one study following participants to the end of growth showing the efficacy of PSSE over TE. This result was weakened by adding studies with short-term results and unclear preparation of treating physiotherapists. More RCTs are needed to strengthen the current evidence and study other highly clinically relevant outcomes such as QoL, psychological and cosmetic issues, and back pain.
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Affiliation(s)
- Michele Romano
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | - Silvia Minozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), Milan, Italy
| | | | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
| | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Domańska-Kruppa N, Wierzbicka M, Stefanik E. Advances in the Clinical Diagnostics to Equine Back Pain: A Review of Imaging and Functional Modalities. Animals (Basel) 2024; 14:698. [PMID: 38473083 DOI: 10.3390/ani14050698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
Back pain is common in ridden horses. Back diseases in horses include Impinging Dorsal Spinous Processes, Ventral Spondylosis, Osteoarthritis of Articular Process, Intervertebral Discs Disease, Vertebral Fractures, Conformational Abnormalities, Desmopathy of the Supraspinous Ligament, Desmopathy of the Intraspinous Ligament, and Longissimus Muscle Strain. Back pain may also develop as a result of lameness (particularly hindlimb lameness). A poorly fitting saddle and an unbalanced rider are also considered important factors influencing the development of back pain in horses. The conventional diagnosis of equine back pain includes a clinical examination and diagnostic imaging examination using ultrasound, radiography, and thermography. Advanced diagnostic modalities of equine back pain involve the objectification of standard procedures through the use of algometers, a lameness locator, biometric mats, and the geometric morphometrics method. In addition to modern diagnostic methods, such as computed tomography and scintigraphy, advances in the diagnosis of equine back pain include the use of electromyography and functional electrical stimulation. The aim of this review article is to familiarize clinicians with the usefulness and capabilities of conventional diagnostic protocols and advanced diagnostic modalities. Although orthopedic examination and traditional diagnostic methods will remain the foundation of the diagnosis of back diseases, modern methods meet the growing expectations towards high-performance horses and allow for deeper diagnostics and objective monitoring of rehabilitation and training progress.
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Affiliation(s)
- Natalia Domańska-Kruppa
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Małgorzata Wierzbicka
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
| | - Elżbieta Stefanik
- Department of Large Animal Diseases and Clinic, Institute of Veterinary Medicine, Warsaw University of Life Sciences, 02-787 Warsaw, Poland
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18
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Melman A, Teng MJ, Coombs DM, Li Q, Billot L, Lung T, Rogan E, Marabani M, Hutchings O, Maher CG, Machado GC. A Virtual Hospital Model of Care for Low Back Pain, Back@Home: Protocol for a Hybrid Effectiveness-Implementation Type-I Study. JMIR Res Protoc 2024; 13:e50146. [PMID: 38386370 PMCID: PMC10921332 DOI: 10.2196/50146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Low back pain (LBP) was the fifth most common reason for an emergency department (ED) visit in 2020-2021 in Australia, with >145,000 presentations. A total of one-third of these patients were subsequently admitted to the hospital. The admitted patient care accounts for half of the total health care expenditure on LBP in Australia. OBJECTIVE The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce the length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, representations and readmissions to the traditional hospital, demonstrate noninferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. METHODS This is a hybrid effectiveness-implementation type-I study. To evaluate effectiveness, we plan to conduct an interrupted time-series study at 3 metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged 16 years or older with a primary diagnosis of musculoskeletal LBP presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an "audit and feedback" process. The implementation of "Back@Home" will be evaluated over 12 months and compared to a 48-month preimplementation period using monthly time-series trends in the average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the preimplementation period. Linear segmented regression will identify changes in the level and slope of fitted lines, indicating immediate effects of the intervention, as well as effects over time. The data will be fully anonymized, with informed consent collected for patient-reported outcomes. RESULTS As of December 6, 2023, a total of 108 patients have been cared for through Back@Home. A total of 6 patients have completed semistructured interviews regarding their experience of virtual hospital care for nonserious back pain. All outcomes will be evaluated at 6 months (August 2023) and 12 months post implementation (February 2024). CONCLUSIONS This study will serve to inform ongoing care delivery and implementation strategies of a novel model of care. If found to be effective, it may be adopted by other health districts, adapting the model to their unique local contexts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50146.
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Affiliation(s)
- Alla Melman
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Min Jiat Teng
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Danielle M Coombs
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Qiang Li
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laurent Billot
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Thomas Lung
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Eileen Rogan
- Department of Medicine, Canterbury Hospital, Sydney Local Health District, Sydney, Australia
| | - Mona Marabani
- Department of Medicine, Canterbury Hospital, Sydney Local Health District, Sydney, Australia
| | - Owen Hutchings
- RPA Virtual Hospital, Sydney Local Health District, Sydney, Australia
| | - Chris G Maher
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
| | - Gustavo C Machado
- Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia
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Brandt T, Heinz E, Klaaßen Y, Limbara S, Mörsdorf M, Schinköthe T, Schmidt A. The MedXFit-study - CrossFit as a workplace health intervention: a one-year, prospective, controlled, longitudinal, intervention study. Front Public Health 2024; 12:1304721. [PMID: 38450146 PMCID: PMC10915069 DOI: 10.3389/fpubh.2024.1304721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/01/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Workplace health interventions aim to motivate employees toward healthy behaviors to improve fitness and health in the long-term. We investigated whether CrossFit® is an effective training concept to achieve these goals in inactive employees with sedentary occupations. Methods The study followed a prospective, controlled intervention design. Employees were invited to participate in intervention group (IG) or control group (CG) on their own preferences. Inclusion criteria were a predominantly sedentary occupation and execution of less than two muscle and/or mobility enhancing training sessions per week at the time of enrolling. The IG did at least two times a week a CrossFit training of 1 h. Mobility, strength, well-being, and back-issues were measured at the beginning, after 6, and 12 months. Participants in the CG were free to choose any other activities offered at the same time (e.g., circuit training, meditation, full body stability training). Adherence, respectively, behavioral change and maintenance qualities were evaluated based on the COM-B system and presence of behavior maintenance motives. Results 89 employees were enrolled into the trial, from where 21 dropped out due to external factors (24%). From the remaining participants, 10 out of 39 (26%) in the IG and 1 out of 29 (4%) in the CG stopped for intrinsic reasons, leading to a non-adherence to the intervention of 22 percentage points. Motivation for behavioral change and maintenance in the IG was primarily driven by enhanced physical and psychological capability. Development of physical capability was evident by significant improvements (p < 0.001) in the IG compared to the CG for mobility (d = 3.3), maximal isometric strength (min. d = 1.7, max. d = 2.5), as well as reduction in pain intensity (p = 0.003, r = 0.4) and frequency (p = 0.009, r = 0.35) after 12 months. Significant improvements between the 6-month and the 12-month measurement in mobility and 6 out of 8 strength measures within the IG indicated the effectiveness of CrossFit beyond the beginner phase. Conclusion CrossFit is a motivating training concept that led to long-term health and fitness improvements in inactive employees doing sedentary work and should be given greater consideration in workplace health promotion.
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Affiliation(s)
- Tom Brandt
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Elisabeth Heinz
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Yannik Klaaßen
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Selina Limbara
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | - Marian Mörsdorf
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
| | | | - Annette Schmidt
- Institute of Sports Science, University of the Bundeswehr Munich, Neubiberg, Germany
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20
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Natoli A, Jones MD, Long V, Mouatt B, Walker ED, Gibbs MT. How do people with chronic low back pain perceive specific and general exercise? A mixed methods survey. Pain Pract 2024. [PMID: 38379359 DOI: 10.1111/papr.13354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE Exercise prescriptions for chronic low back pain (CLBP) often utilize reductionistic, trunk-focused exercise aimed at addressing proposed pain mechanisms. It is unknown if the use of these trunk-focused exercises imply beliefs to people with CLBP about the rationale for their use (e.g., etiology), even without concurrent biomedical narratives. This study aimed to explore people's perceptions of specific and general exercise without an accompanying narrative when experiencing CLBP. METHODS An anonymous online survey was distributed. Mixed methods were utilized for analysis. Six-point Likert scales categorized people's beliefs about individual exercises. Open-ended questions were used to gather further beliefs which were then coded into themes. RESULTS People with CLBP perceived specific exercise as more beneficial than general exercise. Eight themes and five subthemes were defined. A high volume of positive beliefs were centered around strengthening the low back and abdominal musculature, emphasizing the importance of correct technique. Negative beliefs were held against spinal flexion and external load. Both positive and negative beliefs were underpinned by spinal/pelvic stability being important as well as certain exercises being achievable or not. CONCLUSION This study demonstrated that people with CLBP consider specific exercises to be more beneficial than general exercises for CLBP. Specific exercises irrespective of an accompanying narrative can imply meaning about the intent of an exercise. Understanding this requires practitioners to be mindful when prescribing and communicating exercise.
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Affiliation(s)
- A Natoli
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - M D Jones
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - V Long
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - B Mouatt
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - E D Walker
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - M T Gibbs
- School of Health Sciences, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
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21
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Karataş Ö, Karataş S. Quality and comprehensiveness of YouTube videos on back pain during pregnancy. Int J Gynaecol Obstet 2024. [PMID: 38366748 DOI: 10.1002/ijgo.15419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES Back pain during pregnancy is a common issue that impacts the quality of life for many women. YouTube has become an increasingly popular source of health information. Pregnant women often turn to YouTube for advice on managing back pain, but the quality of available videos is highly variable. This study aimed to assess the quality and comprehensiveness of YouTube videos related to back pain during pregnancy. METHODS A YouTube search was conducted using the keyword "back pain in pregnancy", and the first 100 resulting videos were included in the study. After a thorough review and exclusion of ineligible videos, the final sample consisted of 71 videos. Various parameters such as the number of views, likes, viewer interaction, video age, uploaded source (healthcare or nonhealthcare), and video length were evaluated for all videos. RESULTS Regarding the source of the videos, 44 (61.9%) were created by healthcare professionals, while 27 (38%) were created by nonprofessionals. Videos created by healthcare professionals had significantly higher scores in terms of DISCERN score, Journal of the American Medical Association (JAMA) score, and Global Quality Scale (GQS) (P < 0.001). Our findings indicate a statistically significant and strong positive correlation among the three scoring systems (P < 0.001). CONCLUSION Videos created by healthcare professionals were generally of higher quality, but many videos were still rated as low-moderate quality. The majority of videos focused on self-care strategies, with fewer discussing other treatment options. Our findings highlight the need for improved quality and comprehensiveness of YouTube videos on back pain during pregnancy.
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Affiliation(s)
- Özlem Karataş
- Department of Physical Medicine and Rehabilitation Pinarbasi Neighbourhood, Dumlupinar Boulevard, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Selim Karataş
- Department of Obstetrics and Gynecology, Olimpos Private Hospital, Antalya, Turkey
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22
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Zheng JX, Zhang XF, Liu SH, Ye F, Ji SG, Wen XZ. Exercise Therapy Research in Ankylosing Spondylitis-Induced Back Pain: A Bibliometric Study (2004-2023). Med Sci Monit 2024; 30:e943196. [PMID: 38347712 PMCID: PMC10874108 DOI: 10.12659/msm.943196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS), a chronic inflammatory disease predominantly causing back pain, affects up to 0.5% of the global population, more commonly in males. Frequently undiagnosed in early stages, AS is often associated with comorbid depression and anxiety, imposing significant healthcare burdens. Despite available pharmaceutical treatments, exercise therapy (ET) has emerged as an effective, side-effect-free alternative, particularly for managing AS-induced back pain. This study aims to explore the research trends in ET for treating AS back pain from 2004-2023. MATERIAL AND METHODS A comprehensive analysis of 437 articles, sourced from the Science Citation Index-Expanded within the Web of Science Core Collection, was conducted using CiteSpace 6.2.R5. This study spanned from 2004 to October 15, 2023, examining publications, authors, institutions, and keywords to assess keyword co-occurrences, temporal progressions, and citation bursts. RESULTS Research interest in ET for AS began escalating around 2008 and has since shown steady growth. The USA emerged as a significant contributor, with Van der Heijde, Desiree, and RUDWALEIT M being notable authors. Key institutions include Assistance Publique Hopitaux Paris and UDICE-French Research Universities, with ANN RHEUM DIS being the most influential journal. The field's evolution is marked by interdisciplinary integration and branching into various sub-disciplines. CONCLUSIONS Exercise therapy for AS-induced back pain is a growing research area, necessitating further exploration in clinical management and rehabilitation strategies. The relationship between ET and osteoimmunological mechanisms remains a focal point for future research, with a trend towards personalized and interdisciplinary treatment approaches.
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23
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Klessinger S, Casser HR, Gillner S, Koepp H, Kopf A, Legat M, Meiler K, Norda H, Schneider M, Scholz M, Slotty PJ, Tronnier V, Vazan M, Wiechert K. Radiofrequency Denervation of the Spine and the Sacroiliac Joint: A Systematic Review based on the Grades of Recommendations, Assesment, Development, and Evaluation Approach Resulting in a German National Guideline. Global Spine J 2024:21925682241230922. [PMID: 38321700 DOI: 10.1177/21925682241230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
STUDY DESIGN Systematic review of the literature and subsequent meta-analysis for the development of a new guideline. OBJECTIVES This manuscript summarizes the recommendations from a new clinical guideline published by the German Spine Society. It covers the current evidence on recommendations regarding the indication, test blocks and use of radiofrequency denervation. The guidelines aim is to improve patient care and efficiency of the procedure. METHODS A multidisciplinary working group formulated recommendations based on the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) approach and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. RESULTS 20 clinical questions were defined for guideline development, with 87.5% consensus achieved by committee members for one recommendation and 100% consensus for all other topics. Specific questions that were addressed included clinical history, examination and imaging, conservative treatment before injections, diagnostic blocks, the injected medications, the cut-off value in pain-reduction for a diagnostic block as well as the number of blocks, image guidance, the cannula trajectories, the lesion size, stimulation, repeat radiofrequency denervation, sedation, cessation or continuation of anticoagulants, the influence of metal hardware, and ways to mitigate complications. CONCLUSION Radiofrequency (RF) denervation of the spine and the SI joint may provide benefit to well-selected individuals. The recommendations of this guideline are based on very low to moderate quality of evidence as well as professional consensus. The guideline working groups recommend that research efforts in relation to all aspects of management of facet joint pain and SI joint pain should be intensified.
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Affiliation(s)
- Stephan Klessinger
- Neurochirurgie Biberach, Biberach, Germany
- Universitätsklinikum Ulm, Ulm, Germany
| | | | | | - Holger Koepp
- Wirbelsäulenzentrum, St Josefs-Hospital, Wiesbaden, Germany
| | - Andreas Kopf
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Matti Scholz
- ATOS Orthopädische Klinik Braunfels GmbH & Co KG, Braunfels, Germany
| | | | | | - Martin Vazan
- Wirbelsäulen- und Rückenzentrum Dresden, Praxis für Neurochirurgie, Dresden, Germany
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24
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Sanchis-Soler G, Tortosa-Martinez J, Sebastia-Amat S, Chulvi-Medrano I, Cortell-Tormo JM. Is Acute Lower Back Pain Associated with Heart Rate Variability Changes? A Protocol for Systematic Reviews. Healthcare (Basel) 2024; 12:397. [PMID: 38338282 PMCID: PMC10855181 DOI: 10.3390/healthcare12030397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
Acute lower back pain (ALBP) is an extremely common musculoskeletal problem. ALBP consists of a sudden onset of short-duration pain in the lower back. However, repeated attacks can make the pain chronic. It can be measured through a self-report scale as well as through physical and physiological evaluations. Heart Rate Variability (HRV) has been used to evaluate the body's response to pain. However, to the best of our knowledge, no clear consensus has been reached regarding the relationship between both variables and on an optimal protocol for ALBP evaluation based on HRV. The objective of this review is to analyze the relationship and effectiveness of HRV as an instrument for measuring ALBP. Furthermore, we consider the influence of different types of interventions in this relationship. The protocol of this review was previously recorded in the International Prospective Register of Systematic Reviews (number CRD42023437160). The PRISMA guidelines for systematic reviews and PubMed, WOS and Scopus databases are employed. Studies with samples of adults with ALBP are included. This study sets out a systematic review protocol to help identify the relationship between HRV and ALBP. Understanding this relationship could help in designing early detection or action protocols that alleviate ALBP.
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Affiliation(s)
- Gema Sanchis-Soler
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Juan Tortosa-Martinez
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Sergio Sebastia-Amat
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
| | - Ivan Chulvi-Medrano
- Department of Physical and Sports Education, University of Valencia, 46010 Valencia, Spain;
| | - Juan Manuel Cortell-Tormo
- Department of General and Specific Didactics, University of Alicante, 03690 San Vicente del Raspeig, Spain; (G.S.-S.); (S.S.-A.); (J.M.C.-T.)
- Health, Physical Activity and Sports Technology (HEALTH-TECH), University of Alicante, 03690 San Vicente del Raspeig, Spain
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25
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Park AJ, Hagerman TK, Richter KN, Vorhies AP, Clark CR. A woman with back pain. J Am Coll Emerg Physicians Open 2024; 5:e13075. [PMID: 38223531 PMCID: PMC10787342 DOI: 10.1002/emp2.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/14/2023] [Indexed: 01/16/2024] Open
Affiliation(s)
- Andrew J. Park
- Department of Emergency MedicineHenry Ford HospitalDetroitMichiganUSA
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26
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Ankar P, Arya NP, Fating T, Sasun AR. Optimizing Physiotherapeutic Approaches in Parkinson's Disease Post-spinal Fixation Surgery: A Case Report. Cureus 2024; 16:e54149. [PMID: 38496068 PMCID: PMC10940556 DOI: 10.7759/cureus.54149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Patients with Parkinson's disease (PD) exhibit both a severe neuromuscular disorder and low bone quality at presentation. These issues are made worse by inactivity and a chairbound state. Each and every pathologic and degenerative process that affects the naturally aging spine also affects these individuals. Stooped posture is a symptom of a disease and can easily cause spinal degeneration. PD is associated with many physical abnormalities that cause a unique and specific need for rehabilitation. Patients' experiences highlight the challenges doctors face in diagnosis, treatment, and rehabilitation. This case report details the rehabilitation of a 67-year-old patient with PD who underwent spinal fixation for spinal stenosis and presented with complaints of weakness in both lower limbs. An advanced rehabilitation program was devised, primarily emphasizing strength training to enhance overall functionality. Pre- and post-intervention assessments were conducted, encompassing range of motion (ROM), manual muscle testing (MMT), Oswestry Disability Index, Functional Independence Measure, Lower Limb Functional Scale, and Berg Balance Scale, all of which demonstrated noteworthy improvements in joints ROM, strength, functional independence, balance, and lower limb function. This case report underscores the significance of rehabilitation programs in such cases, highlighting their important role in enhancing overall functioning.
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Affiliation(s)
- Prajyot Ankar
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Neha P Arya
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tejaswini Fating
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anam R Sasun
- Community Health Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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27
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Ma T, Qi H, Mao Y, Wang Y, Duan B, Ma K. Comparative Efficacy and Safety of Antidepressants for Patients with Chronic Back Pain: A Network Meta-Analysis. J Clin Pharmacol 2024; 64:205-214. [PMID: 37794650 DOI: 10.1002/jcph.2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/30/2023] [Indexed: 10/06/2023]
Abstract
Various antidepressants have introduced in clinical practice for pain management, but it is important to understand how to properly use them. We therefore performed a systematic review and network meta-analysis to compare and rank the efficacy and safety of antidepressants for patients with chronic back pain. We identified eligible randomized controlled trials (RCTs) that investigated the efficacy and safety of antidepressants for chronic back pain from PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov, searching from inception to May 2023. Six categories of antidepressants for the treatment of chronic back pain were included, and the surface under the cumulative ranking probabilities was applied to rank the treatment strategies. Overall, we selected 19 RCTs recruiting 2903 patients for the meta-analysis. Tricyclic antidepressants presented the best relative effects for relief in pain score (surface under the cumulative ranking, 84.4%). The results of pairwise comparison analyses found the use of serotonin-noradrenaline reuptake inhibitors (SNRIs) significantly reduced pain score and low disability score compared with placebo, irrespective of treatment duration. Noradrenaline-dopamine reuptake inhibitors (relative risk [RR], 2.80; 95% confidence interval [CI], 1.30-6.03; P = .008) and SNRIs (RR, 1.17; 95% CI, 1.07-1.27; P < .001) significantly increased the risk of adverse events. SNRIs were associated with an increased risk of withdrawal due to adverse events (RR, 2.37; 95% CI, 1.64-3.43; P < .001). This study found that antidepressants are more efficacious than placebos for treating chronic back pain, and tricyclic antidepressants are the most likely medications that lead to pain relief.
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Affiliation(s)
- Tao Ma
- Department of Algology, Qinghai Provincial People's Hospital, Xining, China
| | - Hongyu Qi
- Department of Gastroenterology, Qinghai Provincial People's Hospital, Xining, China
| | - Yuanrong Mao
- Department of Algology, Qinghai Provincial People's Hospital, Xining, China
| | - Ya Wang
- Department of Algology, Qinghai Provincial People's Hospital, Xining, China
| | - Baolin Duan
- Department of Algology, Qinghai Provincial People's Hospital, Xining, China
| | - Ke Ma
- Department of Algology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Patel NP, Jameson J, Johnson C, Kloster D, Calodney A, Kosek P, Pilitsis J, Bendel M, Petersen E, Wu C, Cherry T, Lad S, Yu C, Sayed D, Goree J, Lyons MK, Sack A, Bruce D, Bharara M, Province-Azalde R, Caraway D, Kapural L. Durable responses at 24 months with high-frequency spinal cord stimulation for nonsurgical refractory back pain. J Neurosurg Spine 2024; 40:229-239. [PMID: 37976509 DOI: 10.3171/2023.9.spine23504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the 24-month durability of pain relief, function, quality of life, and safety outcomes for patients with nonsurgical refractory back pain (NSRBP) treated with high-frequency spinal cord stimulation (SCS) within a large, national, multicenter randomized controlled trial (RCT). METHODS Following the completion of an RCT comparing high-frequency SCS plus CMM with CMM alone for the treatment of NSRBP, patients gave additional consent for a follow-up extension to 24 months. Presented is the cohort analysis of all patients treated with high-frequency SCS following the optional crossover at 6 months. The outcomes assessed to 24 months included responder rate of ≥ 50% pain relief measured according to the visual analog scale [VAS]), disability (Oswestry Disability Index [ODI]), quality of life (EQ-5D 5-level [EQ-5D-5L]), opioid reduction. RESULTS Of the 125 patients who received a permanent implant, 121 completed the 12-month follow-up, 101 gave additional consent for extended follow-up, and 98 completed the 24-month follow-up. At 24 months after implantation, the mean back pain VAS score was reduced by 73% and the responder rate was 82%. ODI and EQ-5D-5L both improved by at least double the minimal clinically important difference for each measure. No unexpected adverse events were observed, and the rates of serious adverse events (3.4%) and device explantations (4.8%) were low. CONCLUSIONS The addition of high-frequency SCS to CMM in patients with NSRBP offers profound improvements at 24 months in pain, function, quality of life, and reduced opioid use. This study provides much-needed evidence to inform current clinical practice for managing patients with NSRBP.
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Affiliation(s)
- Naresh P Patel
- 1Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona
| | | | | | | | | | - Peter Kosek
- 6Oregon Neurosurgery Specialists, Springfield, Oregon
| | - Julie Pilitsis
- 7Department of Neurosurgery, Albany Medical Center, Albany, New York
| | - Markus Bendel
- 8Department of Pain Management, Mayo Clinic, Rochester, Minnesota
| | - Erika Petersen
- 9Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Chengyuan Wu
- 10Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Taissa Cherry
- 11Department of Pain Management, Kaiser Permanente, Redwood City, California
| | - Shivanand Lad
- 12Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | - Cong Yu
- 13Swedish Health Services, Seattle, Washington
| | - Dawood Sayed
- 14Department of Pain Management, University of Kansas Hospital, Kansas City, Kansas
| | - Johnathan Goree
- 9Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mark K Lyons
- 1Department of Neurosurgery, Mayo Clinic, Phoenix, Arizona
| | - Andrew Sack
- 14Department of Pain Management, University of Kansas Hospital, Kansas City, Kansas
| | - Diana Bruce
- 11Department of Pain Management, Kaiser Permanente, Redwood City, California
| | - Manish Bharara
- 15Clinical Research, Nevro Corp., Redwood City, California; and
| | | | - David Caraway
- 15Clinical Research, Nevro Corp., Redwood City, California; and
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Singh N, Pritzlaff S, Bautista B, Yan C, Wilson MD, Chang J, Fishman SM. Correlation between epidural space depth measured with ultrasound and MRI compared to clinical loss of resistance when performing lumbar epidural steroid injection. Reg Anesth Pain Med 2024:rapm-2023-105135. [PMID: 38267075 DOI: 10.1136/rapm-2023-105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND This prospective study assessed the accuracy of MRI and ultrasound (US) measurements as a preprocedural assessment tool for predicting clinical loss of resistance depth (CLORD) during fluoroscopy-guided lumbar epidural steroid injections (ESIs). MATERIALS AND METHODS Sixty patients enrolled received lumbar ESIs at an academic chronic pain clinic. The MRI measurement calculated the distance between the skin and the posterior epidural space, while US measurements included transverse and parasagittal oblique views of the interlaminar space. The epidural space measurements were compared with the CLORD during the performance of the prone epidural injections. The differences in measurements were analyzed using two one-sided tests for equivalency with a 0.5 equivalency margin. The intraclass correlation coefficients between CLORD and the imaging modalities were estimated using mixed effects models. RESULTS MRI was equivalent to CLORD with a mean difference of -0.2 cm (95% CI -0.39 to -0.11). US transverse and US parasagittal oblique measurements were not equivalent to and underestimated CLORD with mean differences of -0.98 cm (90% CI -1.8 to -0.77) and -0.79 cm (90% CI -1.0 to -5.9), respectively. The intraclass correlation coefficients between MRI and CLORD were the highest at 0.85, compared with 0.65 and 0.73 for transverse and parasagittal oblique US views, respectively. CONCLUSIONS MRI measurements are preferable over US for preprocedural assessment of patients receiving lumbar ESIs for predicting CLORD.
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Affiliation(s)
- Naileshni Singh
- Department of Anesthesiolgy and Pain Medicine, University of California Davis, Sacramento, California, USA
| | - Scott Pritzlaff
- Department of Anesthesiolgy and Pain Medicine, University of California Davis, Sacramento, California, USA
| | - Barry Bautista
- School of Medicine, University of California Davis, Sacramento, California, USA
| | - Charley Yan
- School of Medicine, University of California Davis, Sacramento, California, USA
| | - Machelle D Wilson
- Public Health Sciences, Division of Biostatistics, University of California Davis, School of Medicine, Sacramento, California, USA
| | - Jennifer Chang
- Department of Radiology, University of California San Diego, La Jolla, California, USA
| | - Scott M Fishman
- Department of Anesthesiolgy and Pain Medicine, University of California Davis, Sacramento, California, USA
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Miedema M, Anderson A. Outcomes of transforaminal epidural injection of amniotic membrane/umbilical cord particulate for lumbar radiculopathy: a case series. Front Pain Res (Lausanne) 2024; 5:1322848. [PMID: 38317671 PMCID: PMC10839066 DOI: 10.3389/fpain.2024.1322848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024] Open
Abstract
Background Radiculopathy can be a debilitating condition. Amniotic membrane/umbilical cord (AM/UC) particulate is a relatively new injectable treatment modality. Herein we report the outcomes of epidural injection of AM/UC particulate in managing lumbar radiculopathy. Methods Consecutive patients with lumbar radiculopathy who received epidural injection of AM/UC particulate for lumbar radiculopathy were included. Primary outcome was change in pain as measured by the 11-point numerical rating scale. Safety was assessed by AM/UC- and procedure-related complications. Paired t-tests were used to determine statistical significance. Results A total of 12 patients with a mean age of 56.7 ± 21.0 years were included in the analysis. The patients were previously treated with physical therapy (91.7%), chiropractic corrective measures (16.7%), epidural steroid injection (83.3%), and radiofrequency ablation (8.3%). Two patients (16.7%) were taking opioids for chronic pain syndrome. After AM/UC injection, the average pain score decreased from 6.6 ± 1.5 to 5.2 ± 1.9 at 1-3 months, 2.0 ± 1.4 at 6 months, and 2.9 ± 1.4 at last mean follow-up of 21.3 ± 11.1 months (p < 0.001). No patients required subsequent treatment or surgery. There were also no complications. Conclusion This case series supports the preliminary safety and shows potential benefit of epidural AM/UC particulate injection in this cohort of patients with lumbar radiculopathy pain.
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Affiliation(s)
- Mark Miedema
- Department of Orthopaedics, Ozark Orthopaedics, Fayetteville, AR, United States
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Kim SY, Na HS, Park JI, Lee KO, Shin HJ. Comparison of the Effect of Landmark-Based Midline and Paramedian Approaches on Spinal Anesthesia-Related Complications in Adult Patients: A Meta-Analysis of Randomized Controlled Trials. Medicina (Kaunas) 2024; 60:178. [PMID: 38276057 PMCID: PMC10819311 DOI: 10.3390/medicina60010178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
Background and Objectives: Spinal anesthesia is widely used in various types of surgery. However, several complications can occur afterward. This study aimed to identify differences in the incidence of anesthesia-related complications according to the approach methods (midline versus paramedian) for landmark-based spinal anesthesia. Materials and Methods: We searched electronic databases, including PubMed, EMBASE, CENTRAL, Scopus, and Web of Science, for eligible randomized controlled trials. The primary outcome was post-dural puncture headache (PDPH) incidence, and secondary outcomes were low back pain (LBP) incidence and success rate in the first trial of spinal anesthesia. We estimated the odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. Results: In total, 2280 patients from 13 randomized controlled trials were included in the final analysis. The incidence rates of PDPH were 5.9% and 10.4% in the paramedian and midline approach groups, respectively. The pooled effect size revealed that the incidence of PDPH (OR: 0.43, 95% CI [0.22-0.83]; p = 0.01; I2 = 53%) and LBP (OR: 0.27, 95% CI [0.16-0.44]; p < 0.001; I2 = 16%) decreased, and the success rate in the first attempt was higher (OR: 2.30, 95% CI [1.36-3.87]; p = 0.002; I2 = 35%) with the paramedian than with the midline approach. Conclusions: Paramedian spinal anesthesia reduced PDPH and LBP and increased the success rate of the first attempt.
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Affiliation(s)
- Su Yeon Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (S.Y.K.); (H.-S.N.); (J.I.P.); (K.-O.L.)
| | - Hyo-Seok Na
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (S.Y.K.); (H.-S.N.); (J.I.P.); (K.-O.L.)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
| | - Ji In Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (S.Y.K.); (H.-S.N.); (J.I.P.); (K.-O.L.)
| | - Keum-O Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (S.Y.K.); (H.-S.N.); (J.I.P.); (K.-O.L.)
| | - Hyun-Jung Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (S.Y.K.); (H.-S.N.); (J.I.P.); (K.-O.L.)
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea
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Schepens C, BOUCHE K, BRAECKMAN L, ROMBAUTS P, LINDEN P, PARLEVLIET T. THE MULTIDISCIPLINARY BIOPSYCHOSOCIAL REHABILITATION PROGRAMME FOR PATIENTS WITH CHRONIC SPINAL PAIN: OUTCOMES WITH WORK STATUS AS THE PRIMARY FOCUS. J Rehabil Med Clin Commun 2024; 7:5250. [PMID: 38264066 PMCID: PMC10802782 DOI: 10.2340/jrmcc.v7.5250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
Objective To assess the efficacy of the multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients as to work status, physical functioning, pain intensity, health-related quality of life and the psychosocial domain. Design This is a retrospective, single-centre, observational cohort study. Subjects/Patients A total of 209 subjects (mean age 41.5 ± 11.4 years) with chronic spinal pain participated in the rehabilitation programme. Methods Evaluations were conducted through standardized questionnaires at baseline and at the end of the rehabilitation programme. Results Patients were more likely to be at work. Sick leave and work VAS changed significantly. Patients in blue-collar jobs are less likely to return to work. Pain intensity, physical functioning, health-related quality of life and lumbar and cervical range of motion improved significantly. Conclusion The multidisciplinary biopsychosocial rehabilitation programme for chronic spinal patients improved the rate of return to work. In daily clinical practice, attention must be given to reducing mobility issues in daily life in order to get patients back to work. The occupational therapist should give patients with blue-collar jobs sufficient attention early in the programme in order to achieve a higher rate of return to work.
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Affiliation(s)
| | - Katie BOUCHE
- Physical and Rehabilitation Medicine, Ghent University, Ghent
| | - Lutgart BRAECKMAN
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | | | - Patrick LINDEN
- Physical and Rehabilitation Medicine, AZ Delta, Roeselare
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Koroth J, Chitwood C, Kumar R, Lin WH, Reves BT, Boyce T, Reineke TM, Ellingson AM, Johnson CP, Stone LS, Chaffin KC, Simha NK, Ogle BM, Bradley EW. Identification of a novel, MSC-induced macrophage subtype via single-cell sequencing: implications for intervertebral disc degeneration therapy. Front Cell Dev Biol 2024; 11:1286011. [PMID: 38274272 PMCID: PMC10808728 DOI: 10.3389/fcell.2023.1286011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/22/2023] [Indexed: 01/27/2024] Open
Abstract
Intervertebral disc (IVD) degeneration is a common pathological condition associated with low back pain. Recent evidence suggests that mesenchymal signaling cells (MSCs) promote IVD regeneration, but underlying mechanisms remain poorly defined. One postulated mechanism is via modulation of macrophage phenotypes. In this manuscript, we tested the hypothesis that MSCs produce trophic factors that alter macrophage subsets. To this end, we collected conditioned medium from human, bone marrow-derived STRO3+ MSCs. We then cultured human bone marrow-derived macrophages in MSC conditioned medium (CM) and performed single cell RNA-sequencing. Comparative analyses between macrophages cultured in hypoxic and normoxic MSC CM showed large overlap between macrophage subsets; however, we identified a unique hypoxic MSC CM-induced macrophage cluster. To determine if factors from MSC CM simulated effects of the anti-inflammatory cytokine IL-4, we integrated the data from macrophages cultured in hypoxic MSC CM with and without IL-4 addition. Integration of these data sets showed considerable overlap, demonstrating that hypoxic MSC CM simulates the effects of IL-4. Interestingly, macrophages cultured in normoxic MSC CM in the absence of IL-4 did not significantly contribute to the unique cluster within our comparison analyses and showed differential TGF-β signaling; thus, normoxic conditions did not approximate IL-4. In addition, TGF-β neutralization partially limited the effects of MSC CM. In conclusion, our study identified a unique macrophage subset induced by MSCs within hypoxic conditions and supports that MSCs alter macrophage phenotypes through TGF-β-dependent mechanisms.
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Affiliation(s)
- Jinsha Koroth
- Department of Orthopedic Surgery, Medical School, University of Minnesota, Minneapolis, MN, United States
| | - Casey Chitwood
- Department of Biomedical Engineering, College of Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Ramya Kumar
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, CO, United States
- Department of Chemistry, College of Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Wei-Han Lin
- Department of Biomedical Engineering, College of Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Theresa M. Reineke
- Department of Chemistry, College of Science and Engineering, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
| | - Arin M. Ellingson
- Department of Orthopedic Surgery, Medical School, University of Minnesota, Minneapolis, MN, United States
- Department of Rehabilitation Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Casey P. Johnson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, United States
| | - Laura S. Stone
- Department of Anesthesiology, School of Medicine, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Brenda M. Ogle
- Department of Chemical and Biological Engineering, Colorado School of Mines, Golden, CO, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
| | - Elizabeth W. Bradley
- Department of Orthopedic Surgery, Medical School, University of Minnesota, Minneapolis, MN, United States
- Stem Cell Institute, University of Minnesota, Minneapolis, MN, United States
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Krishnan S, Brovman EY, Jones MR, Manzi JE, Kim JS, Rao N, Urman RD. Racial and socioeconomic disparities in kyphoplasty among the Medicare population. Pain Pract 2024; 24:76-81. [PMID: 37606504 DOI: 10.1111/papr.13286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/02/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Kyphoplasty is a minimally invasive treatment for chronic refractory pain secondary to spinal compression fracture. This study investigates racial and socioeconomic disparities in kyphoplasty among the Medicare population. MATERIALS AND METHODS This study utilized data from the Medicare Limited Data Sets (LDS), a CMS administrative claims database. Patients aged 18 and older with ICD code consistent with spinal pathology and compression fractures were included. Outcome was defined as kyphoplasty by race and socioeconomic status (SES) with low SES defined by dual enrollment in Medicare/Medicaid. RESULTS There was a total of 215,502 patients gathered from CMS data, and 717 (0.33%) of these patients underwent kyphoplasty during the study period. Of these patients, 458 (63.8%) were female, the average age was 76.5 years old, 655 (91.3%) were White, 20 (2.7%) were Black, 9 (1.3%) were Hispanic, and 98 (13.7%) were Medicare/Medicaid dual eligible. White patients (32,317/157,177 [20.6%]) were less likely to be dual enrollment eligible in Medicare and Medicaid than Black (5407/13,522 [39.9%]), Hispanic (2833/3675 [77.1%]), Asian (2087/3312 [63.0%]), or North American Native patients (778/1578 [49.1%]). Multivariate regression (MVR) analysis was performed and showed that Blacks were less likely than Whites to have a kyphoplasty performed (OR 0.46 [95% CI: 0.29-0.72], p-value <0.001). Although Hispanics (OR 0.95 [0.49-1.86]), North American Native (OR 0.82 [0.3-2.19]), and unknown race had a decreased odd of undergoing kyphoplasty, it was not statistically significant. CONCLUSION Our study showed after adjustment for pertinent comorbidities, Medicare/Medicaid dual-eligible patients and Black patients were significantly less likely to receive kyphoplasty than White patients with Medicare.
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Affiliation(s)
- Sindhu Krishnan
- Department of Anesthesiology, Perioperative and Pain Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ethan Y Brovman
- Department of Anesthesiology, Perioperative and Pain Medicine, Tufts Medical Center/Tufts Medical School, Boston, Massachusetts, USA
| | - Mark R Jones
- Pain Medicine of the South, Knoxville, Tennessee, USA
| | - Joseph Emanuele Manzi
- Pain Division, Department of Anesthesiology, Weill Cornell School of Medicine and NewYork-Presbyterian Hospital, New York, New York, USA
| | | | | | - Richard D Urman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Jain S, Cloud GW, Gordon AM, Lam AW, Vakharia RM, Saleh A, Razi AE. Cannabis Use Disorder Is Associated With Longer In-Hospital Lengths of Stay, Higher Rates of Medical Complications, and Costs of Care Following Primary 1- to 2-Level Lumbar Fusion. Global Spine J 2024; 14:67-73. [PMID: 35395920 PMCID: PMC10676152 DOI: 10.1177/21925682221093965] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case-control study. OBJECTIVES The purpose of this study is to assess whether cannabis use disorder (CUD) patients undergoing primary 1- to 2-level lumbar fusion (1-2LF) for the treatment of degenerative lumbar spine disorders have higher rates of: (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) healthcare expenditures. MATERIALS AND METHODS A retrospective case-control study of the MSpine dataset of the PearlDiver claims from January 2007 to March 2018 was performed. Patients with CUD undergoing 1-2LF were queried and matched to a comparison group in a 1:5 ratio by age, sex, and various medical comorbidities yielding 22, 815 patients within the study (CUD = 3805; control = 19 010). Outcomes analyzed included LOS, 90-day medical complications, and costs. A P-value less than .004 was considered significant. RESULTS This study found CUD patients undergoing primary 1-2LF experience longer in-hospital LOS (4- vs. 3-days, P < .0001). Additionally, CUD patients were found to have significantly higher frequency and odds-ratios (OR) (31.88 vs. 18.01% OR: 1.41, P < .0001) of adverse events within ninety days following their procedure. CUD patients also had significantly higher day of surgery ($18,946.79 vs. $15,691.02, P < .0001) and 90 days healthcare expenditures ($21,469.01 vs. $19,556.71, P < .0001). CONCLUSION Patients with CUD can prepare for increased LOS, complications, and costs following primary 1-2LF. The study can be used to educate these patients of the potential outcomes following their procedure.
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Affiliation(s)
- Shreya Jain
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Geoffrey W. Cloud
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
- College of Medicine, State University of New York Downstate, Brooklyn, NY, USA
| | - Adam M. Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Aaron W. Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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Rosas Pereira A, Costa M, Costa GG, Carvalho AS. Anorexia Nervosa and Osteoporosis: A Possible Complication to Remember. Cureus 2024; 16:e52670. [PMID: 38380189 PMCID: PMC10877225 DOI: 10.7759/cureus.52670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/22/2024] Open
Abstract
Anorexia nervosa (AN) belongs to the spectrum of food disorders and affects approximately 2.9 million people worldwide. It is responsible for numerous and serious medical complications. Osteoporosis is a common complication, and the decrease in bone mineral density (BMD) is one of the few potentially irreversible consequences of AN. When associated with AN, it can manifest at a very young age, possibly leading to irreparable damage. We describe the case of a 30-year-old woman with a one-year evolution diagnosis of AN, complaining of back pain. Physical examination revealed a slight elevation of the right shoulder and pain at compression of paravertebral right dorsal musculature with a palpable strained muscle. Full-length X-ray imaging of the dorsal spine revealed a slight dextroconvex dorsolumbar scoliosis. A dorsal spine computerized tomography (CT) was performed, confirming a fracture of the upper platform of the sixth dorsal vertebrae. Osteodensitometry showed lumbar spine osteoporosis and femoral osteopenia. The decrease in BMD and, later on, the development of osteoporosis can occur in both types of AN. It is a severe complication that affects up to 50% of these patients. It can be irreversible and increase the lifetime risk of bone fractures and, therefore, morbimortality. Low body weight and body mass index (BMI) strongly correlate with the decrease in BMD. Treatment of osteoporosis associated with AN is not standardized and clearly labeled. Weight gain is described as the strategy with the most impact in reversing the loss of bone mass and increasing the BMD. The regularization of gonadal function also seems to independently potentiate the increase of BMD. The occurrence of long bone and vertebrae fractures frequently results in a decrease in height and chronic back pain, culminating in greater morbimortality and healthcare costs. This clinical case aims to show theclose relationship between restrictive food disorders and the decrease of BMD and the subsequent development of osteoporosis and its complications. Although rare in young and healthy people, when associated with restrictive food disorders, it should raise a red flag in its clinical evaluation. Preventing osteoporosis development and reduction of fracture risk in this population is essential. The current absence of consistent evidence regarding screening of osteoporosis in this particular group should raise awareness and promote further larger-scale studies to establish standardized recommendations concerning not only screening but also pharmacological treatment of osteoporosis in patients with AN.
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Affiliation(s)
| | - Marta Costa
- Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu Dão Lafões, PRT
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Bovonratwet P, Vaishnav AS, Mok JK, Urakawa H, Dupont M, Melissaridou D, Shahi P, Song J, Shinn DJ, Dalal SS, Araghi K, Sheha ED, Gang CH, Qureshi SA. Association Between Patient Reported Outcomes Measurement Information System Physical Function With Postoperative Pain, Narcotics Consumption, and Patient-Reported Outcome Measures Following Lumbar Microdiscectomy. Global Spine J 2024; 14:225-234. [PMID: 35623628 PMCID: PMC10676173 DOI: 10.1177/21925682221103497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine association between preoperative Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores with postoperative pain, narcotics consumption, and patient-reported outcome measures (PROMs) following single-level lumbar microdiscectomy. METHODS Consecutive patients who underwent single-level lumbar microdiscectomy were identified from May 2017-May 2020. Patients were grouped by their preoperative PROMIS-PF scores: mild disability (score≥40), moderate disability (score 30-39.9), and severe disability (score<30). Preoperative PROMIS-PF subgroups were tested for association with inpatient postoperative pain, total inpatient narcotics consumption, time to narcotic use cessation as well as improvements in postoperative PROMIS-PF, ODI, VAS-Leg Pain, VAS-Back Pain, SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS) at 2-, 6-, 12-weeks, 6-month, 1-year, 2-year follow-up. RESULTS A total of 127 patients were included. Patients with greater disability reported higher inpatient maximum Visual Analog Scale (VAS) pain scores (P = .023) and total inpatient narcotics consumption (P = .008) but no difference in time to narcotic cessation after surgery (P = .373). However, patients with greater preoperative disability also demonstrated greater improvement from baseline in PROMIS-PF, ODI, SF-12 PCS, and SF-12 MCS at 2-week follow-up (P < .05). These higher improvements from baseline for patients with greater preoperative disability were sustained for PROMIS-PF, ODI, and VAS-Leg Pain at 2-year follow-up (P < .05). CONCLUSIONS Patients with greater preoperative disability, as measured by PROMIS-PF, had increased inpatient postoperative pain and narcotics consumption, but also higher improvement from baseline in long-term PROMs. This data can be utilized for patient counseling and setting expectations.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani S. Vaishnav
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Jung K. Mok
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Hikari Urakawa
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Marcel Dupont
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Junho Song
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel J. Shinn
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sidhant S. Dalal
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan D. Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Catherine H. Gang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY, USA
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Roveshti MM, Pouya AB, Pirposhteh EA, Khedri B, Khajehnasiri F, Poursadeqiyan M. Work-related musculoskeletal disorders and related risk factors among bakers: A systematic review. Work 2024; 77:463-476. [PMID: 37718825 DOI: 10.3233/wor-220165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WRMSDs) and ergonomic risk factors are very common in bakery workers. OBJECTIVE The purpose of this study is to (1) assess the prevalence of musculoskeletal disorders among bakers because they use automated machines or traditional baking, and (2) to determine the strategies to prevent musculoskeletal disorders in bakers. METHODS A systematic review of PubMed, Scopus, and Web of Science was conducted from the beginning to February 4, 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Mesh keywords and phrases were used to execute the search strategy. Information on MSDs and ergonomic risk factors in bakery workers was collected. Two reviewers worked independently on study selection, data extraction, and paper quality ranking. RESULTS This study identified 14 papers from seven countries. Although the prevalence of MSDs in bakery workers has been studied, only a handful of them have been studied ergonomic risk factors, and the findings have been very limited. The association between different risk factors and MSDs seemed significant compared to many other occupational diseases. The traditional bread-baking system and lack of mechanization may increase the risk of MSDs in bakery workers. CONCLUSION WRMSDs for bakery workers have been less studied than other occupational diseases. Our systematic review found several significant relations between the factors influencing the prevalence of MSDs. This study also showed the comparison of traditional and modern cooking systems with diseases of the upper limbs, shoulders, and back pain as possible fields for future research.
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Affiliation(s)
- Mehran Maleki Roveshti
- Department of Occupational Health and Safety Engineering, School of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amin Babaei Pouya
- Department of Occupational Health and Safety Engineering, School of Health, Ardabil Universityof Medical Sciences, Ardabil, Iran
| | - Elham Akhlaghi Pirposhteh
- Department of Occupational Health and Safety Engineering, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Behzad Khedri
- Department of Social Work, Social Studies Faculty, Hanze University of Applied Science, Groningen, The Netherlands
| | - Farahnaz Khajehnasiri
- Department of Community Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Poursadeqiyan
- Department of Occupational Health and Safety Engineering, School of Health, Ardabil Universityof Medical Sciences, Ardabil, Iran
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
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Mok S, Chu ECP. The Importance of Early Detection of Spinal Tumors Through Magnetic Resonance Imaging in Chiropractic Practices. Cureus 2024; 16:e51440. [PMID: 38298283 PMCID: PMC10829055 DOI: 10.7759/cureus.51440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 02/02/2024] Open
Abstract
Primary spinal tumors such as schwannomas are uncommon causes of back pain that can be easily missed during the initial workup. Delayed diagnosis is associated with further neurological impairment. A 46-year-old man presented with a six-month history of progressive lower back pain and left leg radiculopathy. Previous treatments failed, including medications, physical therapy, acupuncture, and chiropractic manipulations. Examination revealed weakness (4/5) in left knee extension and ankle dorsiflexion. Magnetic resonance imaging (MRI) revealed a 2-cm intraspinal schwannoma at the L4 level with nerve root compression. The patient underwent laminectomy and gross total resection without any complications. The patient had near-complete symptomatic resolution six weeks postoperatively and returned to normal functioning. After four months of postoperative rehabilitation, the patient remained asymptomatic. This case reinforces the urgent need for early MRI in the presence of neurological deficits and other symptoms, despite normal radiographs. An increased suspicion of spinal tumors can prevent delays in diagnosis and minimize adverse outcomes. Multidisciplinary care optimizes the treatment of complex cases.
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Affiliation(s)
- Sharon Mok
- Chiropractic and Physiotherapy Clinic, New York Medical Group, Hong Kong, CHN
| | - Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Clinic, New York Medical Group, Hong Kong, CHN
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Abstract
Radiofrequency ablation (RFA) has been utilized since the 1970s to treat various painful conditions. The technology has evolved from its initial use to treat lumbar facet mediated pain with monopolar lesioning to now treat a plethora of chronic pain conditions. This article reviews Abbott Corporation's (IL, USA) IonicRF™ generator. The IonicRF generator utilizes an intelligent power algorithm that improves efficiency and reduces procedure time. The generator also carries a wide range of RFA therapies such as monopolar, bipolar, pulsed or pulsed dose radiofrequency. Additionally, the IonicRF RFA generator is compatible with the Simplicity™ RF probe (Abbott) which allows for efficient and effective denervation of the sacroiliac joint.
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Affiliation(s)
| | - Chau Vu
- Evolve Restorative Center, Santa Rosa, CA 95403, USA
| | - Jason E Pope
- Evolve Restorative Center, Santa Rosa, CA 95403, USA
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Sąsiadek M, Jacków-Nowicka J. Degenerative disease of the spine: How to relate clinical symptoms to radiological findings. ADV CLIN EXP MED 2024; 33:91-98. [PMID: 37549011 DOI: 10.17219/acem/163357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/05/2023] [Accepted: 04/17/2023] [Indexed: 08/09/2023]
Abstract
Degenerative disease of the spine (DDS) is one of the most common pathological conditions in humans. The clinical presentation of DDS is highly variable, ranging from mild pain to severe neurological symptoms. When more severe clinical symptoms are present, it is necessary to use imaging methods, such as magnetic resonance imaging (MRI), to confirm the diagnosis and establish the extent of the disease in order to determine proper treatment. There are several MRI changes which, based on clinicoradiological studies, are believed to be potential sources of pain and other clinical symptoms in DDS, including compression of the nerve root or spinal cord by disc herniations or osteophytes, recent ("active") disc herniation, Modic type 1 degenerative changes of the vertebral bodies, degenerative changes of the vertebral endplates (erosive intervertebral osteochondrosis), marked degenerative changes of the facet joints and ligamenta flava, degenerative spinal canal stenosis, degenerative spondylolisthesis, and Baastrup's disease. The authors analyzed the relationship of the MRI findings mentioned above with clinical symptoms of DDS, as well as the differentiation between DDS and nondegenerative diseases, which can manifest with similar clinical signs. The role of contrast-enhanced MRI and advanced MR techniques (e.g., high field MRI, functional MRI and MR spectroscopy) was also discussed. To establish an appropriate treatment for DDS, it is important to emphasize in the MRI report specific changes, which might be the cause of the pain and other clinical signs, as well as to rule out nondegenerative lesions, especially neoplasms, infections and rheumatoid disorders.
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Affiliation(s)
- Marek Sąsiadek
- Department of General and Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Poland
| | - Jagoda Jacków-Nowicka
- Department of General and Interventional Radiology and Neuroradiology, Chair of Radiology, Wroclaw Medical University, Poland
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Skazalski C, Whiteley R, Sattler T, Kozamernik T, Bahr R. Knee, Low Back, and Shoulder Problems Among University and Professional Volleyball Players: Playing With Pain. J Athl Train 2024; 59:81-89. [PMID: 36913632 PMCID: PMC10783468 DOI: 10.4085/1062-6050-0476.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
CONTEXT The knee, low back, and shoulder account for most overuse injuries in volleyball. Previous researchers have used methodology that did not examine the extent of injury burden and effect on performance. OBJECTIVE To develop a more accurate and complete understanding regarding the weekly prevalence and burden of knee, low back, and shoulder problems within the highest levels of men's volleyball, including the role that preseason complaints, match participation, player position, team, and age have on complaints. DESIGN Descriptive epidemiology study. SETTING Professional volleyball clubs and the National Collegiate Athletic Association Division I program. PATIENTS OR OTHER PARTICIPANTS A total of 75 male volleyball players, representing 4 teams playing in their country's respective premier league (Japan, Qatar, Turkey, and the United States), participated over a 3-season period. MAIN OUTCOME MEASURE(S) Players completed a weekly questionnaire (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire) reporting pain related to their sport and the extent to which knee, low back, and shoulder problems affected participation, training volume, and performance. Problems leading to moderate or severe reductions in training volume or performance or the inability to participate were considered substantial problems. RESULTS The mean weekly prevalence of knee, low back, and shoulder problems based on 102 player-seasons was 31% (95% CI = 28%, 34%), 21% (95% CI = 18%, 23%), and 19% (95% CI = 18%, 21%), respectively. Most players (93%, 95/102 player-seasons) reported some level of knee (79%, n = 81/102 player-seasons), low back (71%, n = 72/102 player-seasons), or shoulder (67%, n = 68/102 player-seasons) complaints during the season. Most players (58%, n = 59/102 player-seasons) experienced at least 1 episode of substantial problems affecting the knee (33%, n = 34/102 player-seasons), low back (27%, n = 28/102 player-seasons), or shoulder (27%, n = 28/102 player-seasons). Players with preseason complaints had more in-season complaints than teammates without preseason problems (mean weekly prevalence: knee, 42% versus 8%, t49 = -18.726, P < .001; low back, 34% versus 6%, t32 = -12.025, P < .001; shoulder, 38% versus 8%, t30 = -10.650, P < .001). CONCLUSION Nearly all included elite male volleyball players experienced knee, low back, or shoulder problems, and most had at least 1 bout that substantially reduced training participation or sport performance. These findings suggest that knee, low back, and shoulder problems result in greater injury burden than previously reported.
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Affiliation(s)
- Christopher Skazalski
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences
| | - Rod Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Tine Sattler
- Faculty of Sport, University of Ljubljana, Slovenia
| | | | - Roald Bahr
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences
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Schmidt AM, Clausen SA, Agerbo K, Jørgensen A, Appel CW, Sørensen VN. Video interpretation in a medical spine clinic: A descriptive study of a diverse population and intervention. Scand J Pain 2024; 24:sjpain-2023-0100. [PMID: 38639579 DOI: 10.1515/sjpain-2023-0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES Back pain is one of the most challenging health conditions to manage. Healthcare providers face additional challenges when managing back pain for patients with culturally diverse backgrounds including addressing linguistic barriers and understanding patients' cultural beliefs about pain and healthcare. Knowledge about patients with culturally diverse backgrounds experiencing back pain and the interventions available to them is limited. Therefore, this study aims to describe the characteristics of patients with culturally diverse backgrounds experiencing back pain and the video interpretation intervention offered to them and further to explore the clinician's perspective on this intervention. METHODS Data were collected from the electronic medical records and the Interpreter Gateway. Four clinicians participated in a group interview, where they described and evaluated the video interpretation intervention in detail inspired by the template for intervention description and replication (TIDieR) checklist and guide. RESULTS A total of 119 (68%) patients accepted the intervention (53% women, mean 44 years). These patients represent 24 different languages, with 50% having at least one hospital-registered diagnosis and a mean number of five outpatient contacts, 1 year before receiving the intervention. Fifty-seven patients did not accept the intervention and declined interpretation or opted to use relatives or through video conferencing equipment. The intervention was positively evaluated by the clinicians. CONCLUSIONS The detailed description of the population and the intervention together with the clinician perspective provides a valuable foundation for developing and refining similar interventions, allocating resources, and designing future research studies. The intervention consisted of a consultation lasting up to 2 h delivered by a rheumatologist and a physiotherapist, with a remote interpreter connected.
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Affiliation(s)
- Anne Mette Schmidt
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Stine Aalkjær Clausen
- The Medical Spine Clinic, Medical Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Karina Agerbo
- The Medical Spine Clinic, Medical Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Anette Jørgensen
- The Medical Spine Clinic, Medical Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Charlotte Weiling Appel
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Vibeke Neergaard Sørensen
- The Medical Spine Clinic, Medical Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Canós-Verdecho Á, Robledo R, Izquierdo RM, Bermejo A, Gallach E, Abejón D, Argente-Navarro MP, Peraita-Costa I, Morales-Suárez-Varela M. Quantum Molecular Resonance Radiofrequency Disc Decompression and Percutaneous Microdiscectomy for Lumbar Radiculopathy. J Clin Med 2023; 13:234. [PMID: 38202241 PMCID: PMC10779544 DOI: 10.3390/jcm13010234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Within the practice of pain management, one of the most commonly encountered events is low back pain. Lumbar radiculopathy (LR) is a pain syndrome caused by the compression or irritation of the nerve roots in the lower back due to lumbar disc herniation, vertebra degeneration, or foramen narrowing. Symptoms of LR include low back pain that propagates toward the legs, numbness, weakness, and loss of reflexes. The aim of this study is to assess the long-term effectiveness of quantum molecular resonance disc decompression and its combination with a percutaneous microdiscectomy using Grasper© forceps (QMRG) in patients with persistent lumbar radiculopathy (LR) in relation to patient physical stress status. The main outcome measures of this prospective observational study were DN4, NRS, ODI, SF12, PGI, CGI, and MOS Sleep Scale. An improvement 12 months post-intervention was observed in patients without physical stress, presenting better overall results. The mean change was over the minimal clinically important difference in 64.3% of outcome measures studied for the whole sample. QMRG appears to be an effective treatment option for LR, but a reduction in physical stress is needed to ensure long-term effectiveness.
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Affiliation(s)
- Ángeles Canós-Verdecho
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Ruth Robledo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Rosa M. Izquierdo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Ara Bermejo
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
| | - Elisa Gallach
- Multidisciplinary Pain Management Unit, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain (R.R.)
- Psychiatry Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - David Abejón
- Multidisciplinary Pain Management Unit, Hospital Universitario Quirónsalud, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Spain
| | - María Pilar Argente-Navarro
- Anaesthesiology Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
- Surgical Specialties Department, Hospital Universitari i Politècnic La Fe, Av. de Fernando Abril Martorell, 106, 46026 Valencia, Spain
| | - Isabel Peraita-Costa
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Morales-Suárez-Varela
- Research Group in Social and Nutritional Epidemiology, Pharmacoepidemiology and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Faculty of Pharmacy, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100 Burjassot, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute (ISCIII), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
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Kang SH, Lynch L, Wolf E, Mirka GA. Quantifying the effectiveness of a passive trunk-support exosuit at reducing erector spinae muscle fatigue during a quasi-static posture maintenance task. Ergonomics 2023:1-10. [PMID: 38108329 DOI: 10.1080/00140139.2023.2295214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
The objective of this study was to explore the effectiveness of a passive back-support exosuit at reducing low back muscle fatigue during an 18-minute trunk posture maintenance task. On two separate days sixteen participants performed an 18-minute trunk posture profile that reflected trunk flexion postures observed during a challenging vascular surgery procedure. On one day they performed the procedure with the support of the exosuit, on the other day without. Test contractions were performed every three minutes to capture the time-dependent electromyographic activity of the bilateral erector spinae muscles. Time domain (amplitude) and frequency domain (median frequency) measures of erector spinae muscle fatigue were assessed. Results revealed that the exosuit significantly reduced the measures of erector spinae muscle fatigue in terms of both amplitude (6.1%) and median frequency (5.3%), demonstrating a fatigue reduction benefit of the exosuit in a realistic surgical posture maintenance task.
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Affiliation(s)
- Sang Hyeon Kang
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Laura Lynch
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Emma Wolf
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
| | - Gary A Mirka
- The Physical Ergonomics and Biomechanics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA, USA
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Sauer AK, Vigouroux M, Dougherty PM, Cata JP, Ingelmo PM. Pain Experience and Sensory Changes in Astronauts During and After Short-Lasting Commercial Spaceflight: A Proof-of-Concept Study. J Pain Res 2023; 16:4253-4266. [PMID: 38107368 PMCID: PMC10723599 DOI: 10.2147/jpr.s440630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023] Open
Abstract
Space travel has been associated with musculoskeletal pain, yet little is known about the nociceptive changes and pain experience during spaceflight. This preliminary study aims to investigate the pain experience and sensory alterations in astronauts following a 17-day mission to the International Space Station (ISS) on Axiom Space's AX-1 commercial space flight. Two participants were enrolled, and data were collected pre-flight, in-flight, post-flight, and three-month post-flight. Validated pain questionnaires assessed anxiety, catastrophizing, impact on physical and mental health, disability, and overall pain experience. Qualitative interviews were conducted post-landing and conditioned pain modulation (CPM) and quantitative sensory testing (QST) were performed. Both astronauts reported musculoskeletal pain during and after the flight, which was managed with anti-inflammatories and stretching techniques. Pain levels returned to baseline after three months. Pain questionnaires revealed heightened pain experiences in-flight and immediately post-flight, although their adequacy in assessing pain in space is uncertain. Qualitative interviews allowed astronauts to describe their pain experiences during the flight. Sensory changes included increased mechanical touch detection thresholds, temporal pain summation, heat pain thresholds, and differences in conditioned pain modulation post-flight. This preliminary study suggested that spaceflight may affect various aspects of sensory perception and regulation in astronauts, albeit in a variable manner. More data are needed to gain insight of on gain and loss of sensory functions during space missions. Further investigation into the multifactorial stressors affecting the somatosensory system during space travel could contribute to advancements in space and pain medicine.
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Affiliation(s)
- Andrea K Sauer
- Department of Anesthesia, University of Bonn, Bonn, Germany
| | - Marie Vigouroux
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Patrick M Dougherty
- Department of Pain Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA
| | - Juan Pablo Cata
- Department of Anesthesia and Perioperative Medicine, The University of Texas – MD Anderson Cancer Center, Houston, TX, USA
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Pablo M Ingelmo
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
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47
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Ta KNT, Bai CH, Chuang KJ. Prevention of Work Absence Due to Back Pain: A Network Meta-Analysis. Eur J Investig Health Psychol Educ 2023; 13:2891-2903. [PMID: 38131899 PMCID: PMC10871117 DOI: 10.3390/ejihpe13120200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
This paper reviewed the most effective strategies for preventing work absence due to back pain (BP) and BP episodes (the number of people reporting back pain). We searched randomized controlled trials (RCTs) of prevention strategies for BP from previous meta-analyses, PubMed, CENTRAL, and Embase and conducted a network meta-analysis. Thirteen RCTs (2033 participants) were included. Low- to high-quality evidence showed that exercise combined with ergonomics, education, back belts, and education combined with ergonomics did not prevent sickness absenteeism or BP episodes. There was moderate-quality evidence that exercise, especially resistance exercise, was the best prevention strategy to reduce the number of people reporting absenteeism due to BP (risk ratio [RR] = 0.10; 95% CI: 0.01 to 0.69). Moderate-quality evidence suggested that resistance and stretching exercises combined with education was the best prevention strategy to reduce pain (RR = 0.80; 95% CI: 0.67 to 0.96) and the number of absenteeism days for BP (standardized mean difference [SMD] = -0.39; 95% CI: -0.77 to -0.02). In conclusion, exercise, especially resistance and stretching exercises, and exercise combined with education were ranked as the best interventions to prevent sickness absenteeism and BP episodes.
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Affiliation(s)
- Kim-Ngan Thi Ta
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 235, Taiwan
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei City 235, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, New Taipei City 235, Taiwan
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48
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Leite Pereira C, Grad S, Gonçalves RM. Biomarkers for intervertebral disc and associated back pain: From diagnosis to disease prognosis and personalized treatment. JOR Spine 2023; 6:e1280. [PMID: 38156062 PMCID: PMC10751979 DOI: 10.1002/jsp2.1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 12/30/2023] Open
Abstract
Biomarkers are commonly recognized as objective indicators of a medical state or clinical outcome and have been widely used as clinical and diagnostic tools and surrogate endpoints in many pathological conditions. In the context of intervertebral disc (IVD) and associated back pain, also known as degenerative disc disease (DDD), the use of biomarkers has been poorly explored. DDD is currently diagnosed using imaging techniques and subjective pain scales, limiting an objective association between DDD and pain levels, as well as an evaluation of disease progression. There is a need for objective and reliable measurements for DDD, pain and pathology progression. DDD predictors could also help clinicians in deciding on the optimal treatment for distinct patient groups. This review addresses the current candidate biomarkers in DDD, including imaging, genetic, metabolite and protein-based parameters, both at the tissue and systemic levels, that may become a major advance in the diagnosis and prognosis of the disease, as well as in the management of therapeutic approaches to DDD.
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Affiliation(s)
- Catarina Leite Pereira
- I3S, Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB, Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
| | | | - Raquel M. Gonçalves
- I3S, Instituto de Investigação e Inovação em SaúdeUniversidade do PortoPortoPortugal
- INEB, Instituto de Engenharia BiomédicaUniversidade do PortoPortoPortugal
- ICBAS, Instituto de Ciências Biomédicas Abel SalazarUniversidade do PortoPortoPortugal
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Clark KE, Jawad AS. Clinical vignette: Impingement of the lumbar spinous processes causing lumbar back pain. J R Coll Physicians Edinb 2023; 53:288-289. [PMID: 37966032 DOI: 10.1177/14782715231211018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
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50
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Kirby E, MacMillan A, Liew BXW, Brinkley A, Bateman A. Characterising the interventions designed to affect the reporting of musculoskeletal imaging: a scoping review protocol using the COM-B model. BMJ Open 2023; 13:e072150. [PMID: 38011964 PMCID: PMC10685969 DOI: 10.1136/bmjopen-2023-072150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/07/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Attributing musculoskeletal (MSK) pain to normal and commonly occurring imaging findings, such as tendon, cartilage and spinal disc degeneration, has been shown to increase people's fear of movement, reduce their optimism about recovery and increase healthcare costs. Interventions seeking to reduce the negative effects of MSK imaging reporting have had little effect. To understand the ineffectiveness of these interventions, this study seeks to scope their behavioural targets, intended mechanisms of action and theoretical underpinnings. This information alongside known barriers to helpful reporting can enable researchers to refine or create new more targeted interventions. METHODS AND ANALYSIS The scoping review will be conducted in accordance with the JBI methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Search terms will be devised by the research team. Searches of MEDLINE, EMBASE, CINAHL, AMED and PsycINFO from inception to current day will be performed. The review will include studies, which have developed or evaluated interventions targeting the reporting of MSK imaging. Studies targeting the diagnosis of serious causes of MSK pain will be excluded. Two independent authors will extract study participant data using predefined extraction templates and intervention details using the Template for Intervention Description and Replication checklist. Interventions will be coded and mapped to the technique, mechanism of action and behavioural target according to the Capability, Opportunity, Motivation-Behaviour (COM-B) model categories. Any explicit models or theories used to inform the selection of interventions will be extracted and coded. The study characteristics, behaviour change techniques identified, behavioural targets according to the COM-B and context specific theories within the studies will be presented in narrative and table form. ETHICS AND DISSEMINATION The information from this review will be used to inform an intervention design process seeking to improve the communication of imaging results. The results will also be disseminated through a peer-reviewed publication, conference presentations and stakeholder events.
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Affiliation(s)
- Edward Kirby
- MSK Physiotherapy Dept, Essex Partnership University NHS Foundation Trust, Wickford, UK
| | - Andrew MacMillan
- Research department, University College of Osteopathy, London, UK
| | - Bernard X W Liew
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Andrew Brinkley
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Andrew Bateman
- School of Health and Social Care, University of Essex, Colchester, UK
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