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Wesselink E, Elliott J, Pool-Goudzwaard A, Coppieters M, Pevenage P, Di Ieva A, Weber II K. Quantifying lumbar paraspinal intramuscular fat: Accuracy and reliability of automated thresholding models. N Am Spine Soc J 2024; 17:100313. [PMID: 38370337 PMCID: PMC10869289 DOI: 10.1016/j.xnsj.2024.100313] [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] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/20/2024]
Abstract
Background The reported level of lumbar paraspinal intramuscular fat (IMF) in people with low back pain (LBP) varies considerably across studies using conventional T1- and T2-weighted magnetic resonance imaging (MRI) sequences. This may be due to the different thresholding models employed to quantify IMF. In this study we investigated the accuracy and reliability of established (two-component) and novel (three-component) thresholding models to measure lumbar paraspinal IMF from T2-weighted MRI. Methods In this cross-sectional study, we included MRI scans from 30 people with LBP (50% female; mean (SD) age: 46.3 (15.0) years). Gaussian mixture modelling (GMM) and K-means clustering were used to quantify IMF bilaterally from the lumbar multifidus, erector spinae, and psoas major using two and three-component thresholding approaches (GMM2C; K-means2C; GMM3C; and K-means3C). Dixon fat-water MRI was used as the reference for IMF. Accuracy was measured using Bland-Altman analyses, and reliability was measured using ICC3,1. The mean absolute error between thresholding models was compared using repeated-measures ANOVA and post-hoc paired sample t-tests (α = 0.05). Results We found poor reliability for K-means2C (ICC3,1 ≤ 0.38), moderate to good reliability for K-means3C (ICC3,1 ≥ 0.68), moderate reliability for GMM2C (ICC3,1 ≥ 0.63) and good reliability for GMM3C (ICC3,1 ≥ 0.77). The GMM (p < .001) and three-component models (p < .001) had smaller mean absolute errors than K-means and two-component models, respectively. None of the investigated models adequately quantified IMF for psoas major (ICC3,1 ≤ 0.01). Conclusions The performance of automated thresholding models is strongly dependent on the choice of algorithms, number of components, and muscle assessed. Compared to Dixon MRI, the GMM performed better than K-means and three-component performed better than two-component models for quantifying lumbar multifidus and erector spinae IMF. None of the investigated models accurately quantified IMF for psoas major. Future research is needed to investigate the performance of thresholding models in a more heterogeneous clinical dataset and across different sites and vendors.
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Affiliation(s)
- E.O. Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences – Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - J.M. Elliott
- The University of Sydney, Faculty of Medicine and Health and the Northern Sydney Local Health District, The Kolling Institute, Sydney, Australia
| | - A. Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences – Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | - M.W. Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences – Program Musculoskeletal Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Brisbane and Gold Coast, Australia
| | | | - A. Di Ieva
- Computational Neurosurgery (CNS) Lab, Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 1, 75 Talavera Road, Sydney, NSW 2109, Australia
| | - K.A. Weber II
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Wesselink EO, Pool-Goudzwaard A, De Leener B, Law CSW, Fenyo MB, Ello GM, Coppieters MW, Elliott JM, Mackey S, Weber KA. Investigating the associations between lumbar paraspinal muscle health and age, BMI, sex, physical activity, and back pain using an automated computer-vision model: A UK Biobank study. Spine J 2024:S1529-9430(24)00080-9. [PMID: 38417587 DOI: 10.1016/j.spinee.2024.02.013] [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] [Received: 10/12/2023] [Revised: 02/06/2024] [Accepted: 02/18/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND CONTEXT The role of lumbar paraspinal muscle health in back pain (BP) is not straightforward. Challenges in this field have included the lack of tools and large, heterogenous datasets to interrogate the association between muscle health and BP. Computer-vision models have been transformative in this space, enabling the automated quantification of muscle health and the processing of large datasets. PURPOSE To investigate the associations between lumbar paraspinal muscle health and age, sex, BMI, physical activity, and BP in a large, heterogenous dataset using an automated computer-vision model. DESIGN Cross-sectional study. PATIENT SAMPLE Participants from the UK Biobank with abdominal Dixon fat-water MRI (N=9,564) were included (41.8% women, mean [SD] age: 63.5 [7.6] years, BMI: 26.4 [4.1] kg/m2) of whom 6,953 reported no pain, 930 acute BP, and 1,681 chronic BP. OUTCOME MEASURES Intramuscular fat (IMF) and average cross-sectional area (aCSA) were automatically derived using a computer-vision model for the left and right lumbar multifidus (LM), erector spinae (ES), and psoas major (PM) from the L1 to L5 vertebral levels. METHODS Two-tailed partial Pearson correlations were generated for each muscle to assess the relationships between the muscle measures (IMF and aCSA) and age (controlling for BMI, sex, and physical activity), BMI (controlling for age, sex, and physical activity), and physical activity (controlling for age, sex, and BMI). One-way ANCOVA was used to identify sex differences in IMF and aCSA for each muscle while controlling for age, BMI, and physical activity. Similarly, one-way ANCOVA was used to identify between-group differences (no pain, acute BP, and chronic BP) for each muscle and along the superior-inferior expanse of the lumbar spine while controlling for age, BMI, sex, and physical activity (α=0.05). RESULTS Females had higher IMF (LM mean difference [MD]=11.1%, ES MD=10.2%, PM MD=0.3%, p<.001) and lower aCSA (LM MD=47.6 mm2, ES MD=350.0 mm2, PM MD=321.5 mm2, p<.001) for all muscles. Higher age was associated with higher IMF and lower aCSA for all muscles (r≥0.232, p<.001) except for LM and aCSA (r≤0.013, p≥.267). Higher BMI was associated with higher IMF and aCSA for all muscles (r≥0.174, p<.001). Higher physical activity was associated with lower IMF and higher aCSA for all muscles (r≥0.036, p≤.002) except for LM and aCSA (r≤0.010, p≥.405). People with chronic BP had higher IMF and lower aCSA than people with no pain (IMF MD≤1.6%, aCSA MD≤27.4 mm2, p<.001) and higher IMF compared to acute BP (IMF MD≤1.1%, p≤.044). The differences between people with BP and people with no pain were not spatially localized to the inferior lumbar levels but broadly distributed across the lumbar spine. CONCLUSIONS Paraspinal muscle health is associated with age, BMI, sex, and physical activity with the exception of the association between LM aCSA and age and physical activity. People with BP (chronic>acute) have higher IMF and lower aCSA than people reporting no pain. The differences were not localized but broadly distributed across the lumbar spine. When interpreting measures of paraspinal muscle health in the research or clinical setting, the associations with age, BMI, sex, and physical activity should be considered.
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Affiliation(s)
- Evert Onno Wesselink
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA.
| | - Annelies Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; SOMT University of Physiotherapy, Softwareweg 5, 3821 BN Amersfoort, the Netherlands
| | - Benjamin De Leener
- Department of Computer Engineering and Software Engineering, Polytechnique Montreal, 2900 Edouard Montpetit Blvd, Quebec H3T 1J4, Canada
| | - Christine Sze Wan Law
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Meredith Blair Fenyo
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Gabriella Marie Ello
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Michel Willem Coppieters
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 9, 1081 BT Amsterdam, The Netherlands; School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, 170 Kessels Road, 4111 Brisbane, Australia
| | - James Matthew Elliott
- The University of Sydney, Faculty of Medicine and Health and the Northern Sydney Local Health District, The Kolling Institute, Reserve Road, St Leonards NSW Sydney 2065, Australia
| | - Sean Mackey
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Kenneth Arnold Weber
- Division of Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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Peters R, Schmitt M, Mutsaers B, Buyl R, Verhagen A, Pool-Goudzwaard A, Koes B. Identifying Patient Characteristics Associated With the Occurrence of Post Treatment Non-serious Adverse Events After Cervical Spine Manual Therapy Treatment in Patients With Neck Pain. Arch Phys Med Rehabil 2023; 104:277-286. [PMID: 36037878 DOI: 10.1016/j.apmr.2022.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To compare prevalence rates of serious and non-serious adverse events after manipulation and mobilization and to identify risk factors of serious and non-serious adverse events following 4 types of manual therapy treatment in patients with neck pain. DESIGN A prospective cohort study in primary care manual therapy practice. PARTICIPANTS Patients with neck pain (N=686) provided data on adverse events after 1014 manipulation treatments, 829 mobilization treatments, 437 combined manipulation and mobilization treatments, and 891 treatments consisting of "other treatment modality". INTERVENTIONS Usual care manual therapy. MAIN OUTCOME MEASURES A chi-square test was performed to explore differences in prevalence rates. Logistic regression analysis was performed within the 4 treatment groups. A priori we defined associations between patient-characteristics and adverse events of odds ratio (OR)>2 or OR<0.5 as clinically relevant. RESULTS No serious adverse events, such as cervical artery dissection or stroke, were reported. With regard to non-serious adverse events, we found that these are common after manual therapy treatment: prevalence rates are ranging from 0.3% to 64.7%. We found a statistically significant difference between the 4 types of treatments, detrimental to mobilization treatment. Logistic regression analysis resulted in 3 main predictors related to non-serious adverse events after manual therapy treatment: smoking (OR ranges from 2.10 [95% confidence interval [CI] 1.37-3.11] to 3.33 [95% CI 1.83-5.93]), the presence of comorbidity (OR ranges from 2.32 [95% CI 1.22-4.44] to 3.88 [95% CI 1.62-9.26]), and female sex (OR ranges from 0.22 [95% CI 0.11-0.46] to 0.49 [95% CI 0.28-0.86]). CONCLUSION There is a significant difference in the occurrence of non-serious adverse events after mobilization compared with manipulation or a combination of manipulation and mobilization. Non-serious adverse events in manual therapy practice are common and are associated with smoking and the presence of comorbidity. In addition, women are more likely to report non-serious adverse events.
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Affiliation(s)
- Renske Peters
- SOMT, University of Physiotherapy, Amersfoort, The Netherlands; Erasmus Medical Centre, Department of General Practice, Rotterdam, The Netherlands.
| | - Maarten Schmitt
- Rotterdam Hogeschool, University of Applied Science, Rotterdam, The Netherlands
| | - Bert Mutsaers
- SOMT, University of Physiotherapy, Amersfoort, The Netherlands; Erasmus Medical Centre, Department of General Practice, Rotterdam, The Netherlands; Avans Hogeschool, University of Applied Sciences, Breda, The Netherlands
| | - Ronald Buyl
- BISI, VUB, University of Brussels, Jette, Belgium
| | - Arianne Verhagen
- University of Technology Sydney, Discipline of Physiotherapy, Sydney, Australia
| | - Annelies Pool-Goudzwaard
- SOMT, University of Physiotherapy, Amersfoort, The Netherlands; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, The Netherlands
| | - Bart Koes
- Erasmus Medical Centre, Department of General Practice, Rotterdam, The Netherlands; Center for Muscle and Joint Health, University of Southern Denmark Odense, Denmark
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Peters R, van Trijffel E, van Rosmalen J, Mutsaers B, Pool-Goudzwaard A, Verhagen A, Koes B. Non-serious adverse events do not influence recovery in patients with neck pain treated with manual therapy; an observational study. Musculoskelet Sci Pract 2022; 61:102607. [PMID: 35772317 DOI: 10.1016/j.msksp.2022.102607] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Renske Peters
- SOMT University of Physiotherapy, Amersfoort, the Netherlands; Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands.
| | - Emiel van Trijffel
- SOMT University of Physiotherapy, Amersfoort, the Netherlands; Experimental Anatomy Research Department, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands.
| | - Bert Mutsaers
- Avans University of Applied Sciences, Breda, the Netherlands.
| | - Annelies Pool-Goudzwaard
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands; MOVE Research Institute, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Arianne Verhagen
- University of Technology Sydney, Discipline of Physiotherapy, Sydney, Australia.
| | - Bart Koes
- Department of General Practice, Erasmus Medical Centre, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.
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Pellekooren S, Donker M, Reijnders E, Boutalab L, Ostelo R, van Tulder M, Pool-Goudzwaard A. The introduction of advanced practice physiotherapy within Dutch primary care is a quest for possibilities, added value, and mutual trust: a qualitative study amongst advanced practice physiotherapists and general practitioners. BMC Health Serv Res 2022; 22:529. [PMID: 35449100 PMCID: PMC9026935 DOI: 10.1186/s12913-022-07906-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/14/2022] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Despite the increased deployment and added value of Advanced Practitioner Physiotherapy (APP) in musculoskeletal care internationally, APP is not yet widely accepted within Dutch primary care. This may be due to specific constraints in the implementation of APP within the Dutch healthcare system. This study aimed to explore the experiences and perceptions of Advanced Practitioner Physiotherapists (APPs) and General Practitioners (GPs) with respect to implementing APP within Dutch primary care. Methods This explorative and interpretive qualitative study included 12 APPs and 3 GPs who were in various stages of implementing an APP care model. Semi-structured interviews were conducted between January and March 2021. The topic list was based on existing literature, the personal input of researchers, and the Constellation Approach framework. Data were analysed using a thematic inductive approach. Results Four main themes emerged from the data; 1) Both GPs’ trust in APP and a clear added value of APP are critical for starting implementation, 2) APPs need continuous support from GPs, 3) APPs believe that their position needs strengthening, and 4) Implementation of the APP model creates tension over ownership. These four themes highlight the perceived difficulties in gaining trust, lack of clarity over the added value of APP, ambiguity over APPs’ professional profile and positioning, a need on behalf of GPs to maintain authority, lack of reimbursement structure, and the struggle APPs face to strike a balance with current care. Conclusion This study demonstrates that implementing an APP model of care is challenging, in part, because the deployment of APP does not sufficiently align with the core values of GPs, while GPs appear reluctant to hand over control of elements of patient care to APPs. APPs do not appear to have ownership over the implementation, given their strong dependence on the practice, values and needs of GPs. Trial registration Ethical approval was obtained from the Medical Ethics Committee of VU University Medical Centre in Amsterdam; reference number 2020.17 . All participants were asked to provide written informed consent prior to participating in the study. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07906-6.
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Affiliation(s)
- Sylvia Pellekooren
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands. .,Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.
| | - Marianne Donker
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Eddy Reijnders
- Huisartsopleiding VUmc, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Lamyae Boutalab
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Amsterdam Movement Sciences Research Institute, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Maurits van Tulder
- Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behavioral & Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, The Netherlands.,SOMT University of Physiotherapy, Amersfoort, The Netherlands
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Pool-Goudzwaard A, Beales D, Bussey M. Introduction to the special issue on pelvic pain. Musculoskelet Sci Pract 2020; 48:102168. [PMID: 32560870 PMCID: PMC7146657 DOI: 10.1016/j.msksp.2020.102168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Annelies Pool-Goudzwaard
- Faculty of Human Movement Sciences, Research Institute MOVE, Vrije Universiteit Amsterdam, Van der Boechorststraat, 9, Amsterdam, 1081 BT, Netherlands.
| | - Darren Beales
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, Australia.
| | - Melanie Bussey
- School of Physical Education Sport and Exercise Sciences, University of Otago, New Zealand.
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Arnold P, Njemini R, Vantieghem S, Gorus E, Pool-Goudzwaard A, Buyl R, Bautmans I. Reaction time in healthy elderly is associated with chronic low-grade inflammation and advanced glycation end product. Exp Gerontol 2018; 108:118-124. [DOI: 10.1016/j.exger.2018.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/21/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
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Pool-Goudzwaard A, Groeneveld W, Coppieters MW, Waterink W. Changes in spontaneous overt motor execution immediately after observing others' painful action: two pilot studies. Exp Brain Res 2018; 236:2333-2345. [PMID: 29876631 PMCID: PMC6061486 DOI: 10.1007/s00221-018-5290-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 05/15/2018] [Indexed: 11/05/2022]
Abstract
Research has demonstrated that motor control is directly influenced by observation of others’ action, stimulating the mirror neuron system. In addition, there is evidence that both emotion and empathy after observing a painful stimulus affects motor cortical excitability and reaction times. Aim of the present two pilot studies is a) to test for significant influence of observing other’s painful bending of the trunk on execution of the same activity in a self-directed bending action (study 1) and to compare these results with a bending action according to a strict bending protocol (study 2). In addition to study 1, differences between Low Back Pain (LBP) patients versus healthy subjects are tested. Video footage of a (1) neutral, (2) painful, and (3) happy bending action was presented in random order. Changes in flexion–relaxation phenomenon (FRP) of back muscles were studied directly after watching the videos with surface EMG, in study 1 during a self-directed bending action in LBP patients and healthy subjects, in study 2 according to a strict bending protocol. FRP ratios were calculated by a custom-made analysis scheme tested for sufficient reliability prior to both studies. Evoked emotions were measured with an Emotional Questionnaire after each video. A Mixed Model ANOVA was used to test for the effect video and the difference between LBP and healthy subjects on the FRP-rs. Differences in evoked emotion will be tested with a Wilcoxon Signed Rank Test. In study 1, 24 healthy controls and 16 LBP patients FRP-rs were significantly influenced after observing a painful video in all subjects versus a happy and neutral video (p = 0.00). No differences were present between LBP and healthy controls. All subjects experienced more fear after observation of the painful video (p 0.05). In study 2, 6 healthy subjects followed the strict FRP bending protocol for three times after observing each video. No significant changes occurred in FRPs per video compared to FRPs of six healthy subjects carrying out the spontaneous bending activity. Observing a painful action in another person changes motor performance and increases fear in both people with and without back pain, during self-directed trunk flexion, but not during a protocolled trunk flexion.
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Affiliation(s)
- Annelies Pool-Goudzwaard
- Amsterdam Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands. .,Somt University of Physiotherapy, Amersfoort, The Netherlands.
| | - Wim Groeneveld
- Department of Neuroscience, Faculty of Health Sciences and Medicine, ErasmusMC University, Rotterdam, The Netherlands
| | - Michel W Coppieters
- Amsterdam Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Wim Waterink
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
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Mens JMA, Pool-Goudzwaard A. The transverse abdominal muscle is excessively active during active straight leg raising in pregnancy-related posterior pelvic girdle pain: an observational study. BMC Musculoskelet Disord 2017; 18:372. [PMID: 28841825 PMCID: PMC5574111 DOI: 10.1186/s12891-017-1732-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies suggest that impairment of motor control is the mechanical component of the pathogenesis of painful disorders in the lumbo-sacral region; however, this theory is still unproven and the results and recommendations for intervention remain questionable. The need for a force to compress both innominate bones against the sacrum is the basis for treatment of pregnancy-related pelvic girdle pain (PGP). Therefore, it is advised to use a pelvic belt and do exercises to enhance contraction of the muscles which provide this compression. However, our clinical experience is that contraction of those muscles appears to be excessive in PGP. Therefore, in patients with long-lasting pregnancy-related posterior PGP, there is a need to investigate the contraction pattern of an important muscle that provides a compressive force, i.e. the transverse abdominal muscle (TrA), during a load transfer test, such as active straight leg raising (ASLR). METHODS TrA thickness was measured by means of ultrasound imaging at rest and during ASLR in 43 non-pregnant women with ongoing posterior PGP that started during a pregnancy or delivery, and in 39 women of the same age group who had delivered at least once and had no current PGP (healthy controls). RESULTS In participants with PGP, the median TrA thickness increase with respect to rest during ipsilateral and contralateral ASLR was 31% (SD 46%) and 31% (SD 57%), respectively. In healthy controls, these values were 11% (SD 25%) and 13% (SD 22%), respectively. CONCLUSIONS Significant excessive contraction of the TrA is present during ASLR in patients with long-lasting pregnancy-related posterior PGP. The present findings do not support the idea that contraction of the TrA is decreased in long-lasting pregnancy-related PGP. This implies that there is no rationale for the prescription of exercises to enhance contraction of TrA in patients with long-lasting pregnancy-related PGP.
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Affiliation(s)
- Jan M A Mens
- Department of Rehabilitation Medicine & Physical Therapy, Erasmus University Medical Centre, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,MOVE research Institute, Faculty of behavioural and movement sciences VU University Amsterdam, Amsterdam, The Netherlands.
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Scholten-Peeters GGM, Coppieters MW, van Berlo DY, Pool-Goudzwaard A, Bernsmann K. Support and preferences for intermediate health care services for back and neck pain: a survey among members of the Dutch patient association for spinal pain. J Eval Clin Pract 2016; 22:726-31. [PMID: 26987459 DOI: 10.1111/jep.12524] [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] [Received: 09/04/2015] [Revised: 01/26/2016] [Accepted: 01/27/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Recent health care reforms in the Netherlands have led to the introduction of intermediate health care. Intermediate health care combines features of primary care and secondary (hospital) care. It is characterized by a task shift from hospital care to primary care. The initial experiences of medical specialists and general practitioners with intermediate health care are positive. However, the patients' perspectives regarding this reform are unknown. This study aimed to evaluate the level of support from patients with back and/or neck pain for intermediate health care services and to provide insight into their preferences how this care should be organized. METHODS A cross-sectional survey was conducted in which members of the patient association for spinal pain in the Netherlands completed electronic questionnaires to measure the level of support and preferred organization of intermediate health care services. RESULTS Questionnaires were returned by 367 patients (response rate: 51%). Respondents supported the concept of intermediate health care (numeric rating scale: 7/10). Aspects considered important for intermediate health care included knowledge and expertise of staff, multidisciplinary cooperation, patient contact time, reimbursement via health insurance, quality control of care, evidence-based treatments and electronic medical records. Although intermediate care is a health care reform, patients continued to think according to traditional primary and secondary care constitutions. CONCLUSIONS Patients with neck and/or back pain support the introduction of intermediate health care services and have explicit preferences regarding its organization, but may need to be better informed when intermediate care is introduced.
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Affiliation(s)
- Gwendolijne G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands. .,Department of Physical Therapy, University of Applied Sciences, Breda, The Netherlands.
| | - Michel W Coppieters
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands.,Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Didier Yjy van Berlo
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Human Movement Sciences, Faculty of Behaviour and Movement Sciences, Vrije Universiteit Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Kai Bernsmann
- Department of Orthopaedic Surgery, University of Duisburg-Essen, Essen, Germany
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Pool J, Cagnie B, Pool-Goudzwaard A. Risks in teaching manipulation techniques in master programmes. ACTA ACUST UNITED AC 2016; 25:e1-4. [PMID: 27319283 DOI: 10.1016/j.math.2016.05.335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/08/2016] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
Abstract
High Velocity Techniques (HVT) in the (high) cervical spine are part of the standard curricula of manual therapy educational programmes. Little is known about the risk or the presence of adverse events during skills training sessions. This article describes two cases of students with both being at risk for an adverse event; one with a congenital artery aberration and one with cancer in the high cervical region. Teachers and educational programme developers should take risk management into account when teaching HVT.
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Affiliation(s)
- Jan Pool
- University of Applied Sciences Utrecht, Utrecht, The Netherlands.
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Annelies Pool-Goudzwaard
- Faculty of Behavioural and Movement Sciences, MOVE Research Institute, VU University Amsterdam, The Netherlands
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Gnat R, Spoor K, Pool-Goudzwaard A. The influence of simulated transversus abdominis muscle force on sacroiliac joint flexibility during asymmetric moment application to the pelvis. Clin Biomech (Bristol, Avon) 2015; 30:827-31. [PMID: 26094778 DOI: 10.1016/j.clinbiomech.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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] [Received: 02/19/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of so-called local muscle system in motor control of the lower back and pelvis is a subject of ongoing debate. Prevailing beliefs in stabilizing function of this system were recently challenged. This study investigated the impact of in vitro simulated force of transversely oriented fibres of the transversus abdominis muscle (a part of the local system) on flexibility of the sacroiliac joint during asymmetric moment application to the pelvis. METHODS In 8 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixed contralateral innominate. Ranges of motion of the sacroiliac joint were recorded using the Vicon Motion Capture System. Load-deformation curves were plotted and flexibility of the sacroiliac joint was calculated separately for anterior and posterior rotations of the innominate, with and without simulated muscle force. FINDINGS Flexibility of the sacroiliac joint was significantly bigger during anterior rotation of the innominate, as compared to posterior rotation (Anova P<0.05). After application of simulated force of transversus abdominis, flexibility of the joint did not change both during anterior and posterior rotations of the innominate. INTERPRETATION A lack of a stiffening effect of simulated transversus abdominis force on the sacroiliac joint was demonstrated. Earlier hypotheses suggesting a stiffening influence of this muscle on the pelvis cannot be confirmed. Consistent with previous findings smaller flexibility of the joint recorded during posterior rotation of the innominate may be of clinical importance for physio- and manual therapists. However, major limitations of the study should be acknowledged: in vitro conditions and simulation of only solitary muscle force.
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Affiliation(s)
- Rafael Gnat
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Motion Analysis Laboratory, Faculty of Physiotherapy, University of Physical Education, ul. Mikolowska 72, 40-065 Katowice, Poland; Faculty of Physiotherapy, Academy of Business, ul. Cieplaka 1c, 41-300 DąbrowaGórnicza, Poland.
| | - Kees Spoor
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Annelies Pool-Goudzwaard
- Department of Neuroscience, Erasmus MC, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Van der Boechorststraat, 9, 1081 BT Amsterdam, The Netherlands
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Arnold P, Vantieghem S, Gorus E, Lauwers E, Fierens Y, Pool-Goudzwaard A, Bautmans I. Age-related differences in muscle recruitment and reaction-time performance. Exp Gerontol 2015; 70:125-30. [PMID: 26264255 DOI: 10.1016/j.exger.2015.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 03/27/2015] [Revised: 06/26/2015] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
Previously, we showed that prolonged reaction-time (RT) in older persons is related to increased antagonist muscle co-activation, occurring already before movement onset. Here, we studied whether a difference in temporal agonist and antagonist muscle activation exists between young and older persons during an RT-test. We studied Mm. Biceps (antagonist muscle) & Triceps (agonist muscle) Brachii activation time by sEMG in 60 young (26 ± 3 years) and 64 older (80 ± 6 years) community-dwelling subjects during a simple point-to-point RT-test (moving a finger using standardized elbow-extension from one pushbutton to another following a visual stimulus). RT was divided in pre-movement-time (PMT, time for stimulus processing) and movement-time (MT, time for motor response completion). Muscle activation time 1) following stimulus onset (PMAT) and 2) before movement onset (MAT) was calculated. PMAT for both muscles was significantly longer for the older subjects compared to the young (258 ± 53 ms versus 224 ± 37 ms, p=0.042 for Biceps and 280 ± 70 ms versus 218 ± 43 ms for Triceps, p<0.01). Longer agonist muscle PMAT was significantly related to worse PMT and RT in young (respectively r=0.76 & r=0.68, p<0.001) and elderly (respectively r=0.42 & r=0.40, p=0.001). In the older subjects we also found that the antagonist muscle activated significantly earlier than the agonist muscle (-22 ± 55 ms, p=0.003). We conclude that in older persons, besides the previously reported increased antagonist muscle co-activation, the muscle firing sequence is also profoundly altered. This is characterized by a delayed muscle activation following stimulus onset, and a significantly earlier recruitment of the antagonist muscle before movement onset.
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Affiliation(s)
- Pauline Arnold
- SOMT, Stichting Opleiding Musculoskeletale Therapie, Softwareweg 5, 3821 BN Amersfoort, The Netherlands; Frailty in Ageing Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Stijn Vantieghem
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Ellen Gorus
- Gerontology Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Geriatrics Department, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | - Elien Lauwers
- Frailty in Ageing Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Yves Fierens
- Radiology Department, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium
| | - Annelies Pool-Goudzwaard
- SOMT, Stichting Opleiding Musculoskeletale Therapie, Softwareweg 5, 3821 BN Amersfoort, The Netherlands
| | - Ivan Bautmans
- SOMT, Stichting Opleiding Musculoskeletale Therapie, Softwareweg 5, 3821 BN Amersfoort, The Netherlands; Gerontology Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing Research Department, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium; Geriatrics Department, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, B-1090 Brussels, Belgium.
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Verkerk K, Luijsterburg PA, Heymans MW, Ronchetti I, Miedema HS, Koes BW, Pool-Goudzwaard A. Prognostic factors and course for successful clinical outcome quality of life and patients' perceived effect after a cognitive behavior therapy for chronic non-specific low back pain: A 12-months prospective study. ACTA ACUST UNITED AC 2015; 20:96-102. [DOI: 10.1016/j.math.2014.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 07/05/2014] [Accepted: 07/07/2014] [Indexed: 10/25/2022]
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Verkerk K, Luijsterburg P, Pool-Goudzwaard A, Heymans M, Ronchetti I, Miedema H, Koes B. Prognosis and course of work-participation in patients with chronic non-specific low back pain: A 12-month follow-up cohort study. J Rehabil Med 2015; 47:854-9. [DOI: 10.2340/16501977-2006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gnat R, Spoor K, Pool-Goudzwaard A. Simulated transversus abdominis muscle force does not increase stiffness of the pubic symphysis and innominate bone: an in vitro study. Clin Biomech (Bristol, Avon) 2013; 28:262-7. [PMID: 23312210 DOI: 10.1016/j.clinbiomech.2012.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The transversus abdominis muscle is thought to exert a stiffening effect on the sacroiliac joints. However, it is unknown whether this muscle is capable of increasing pubic symphysis and innominate bone stiffness during load exerted on the pelvis. The objective of this study is to investigate whether in vitro simulated force of transversely oriented fibres of the transversus abdominis increases stiffness of the pubic symphysis and innominate bone. METHODS In 15 embalmed specimens an incremental moment was applied in the sagittal plane to one innominate with respect to the fixated contralateral innominate. For pubic symphysis motion and innominate bone deformation load-deformation curves were plotted and slopes of adjusted linear regression lines were calculated. The slopes are considered to be a measure of pubic symphysis and innominate bone stiffness. Slopes were tested for significant differences before and after simulation of the transversus abdominis force. FINDINGS Stiffness of pubic symphysis and innominate bone does not change under influence of simulated force of the transversus abdominis. For pubic symphysis, the slope of the regression line hardly changes, from 0.0341mm/Nm (SD 0.0277) before transversus abdominis force simulation to 0.0342mm/Nm (SD 0.0273) during simulation. For innominate bone, the mean slope increases minimally, from 0.0368mm/Nm (SD 0.0369) to 0.0413mm/Nm (SD 0.0395), respectively. INTERPRETATION Simulation of the force of a single muscle - transversus abdominis - does not increase stiffness of the pubic symphysis and innominate bone. The hypothesized stiffening influence of the transversus abdominis on the pelvic ring was not confirmed in vitro.
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Affiliation(s)
- Rafael Gnat
- Department of Neuroscience, Faculty of Medicine and Health Sciences, Erasmus MC, Dr. Molewaterplein 50, 3015 GE Rotterdam, The Netherlands.
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Mens JM, Huis in ’t Veld YH, Pool-Goudzwaard A. The Active Straight Leg Raise test in lumbopelvic pain during pregnancy. ACTA ACUST UNITED AC 2012; 17:364-8. [DOI: 10.1016/j.math.2012.01.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 01/11/2012] [Accepted: 01/18/2012] [Indexed: 01/13/2023]
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Mens JMA, Huis in 't Veld YH, Pool-Goudzwaard A. Severity of signs and symptoms in lumbopelvic pain during pregnancy. ACTA ACUST UNITED AC 2012; 17:175-9. [PMID: 22248704 DOI: 10.1016/j.math.2011.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 12/19/2011] [Accepted: 12/22/2011] [Indexed: 01/13/2023]
Abstract
Data on the severity of signs and symptoms of lumbopelvic pain (LPP) during pregnancy are scarce. Therefore, this cross-sectional study examines the severity of LPP and pain-related signs and symptoms. Women with an uncomplicated pregnancy of 20-30 weeks were invited to participate. They rated their pain and fatigue on a numerical rating scale, and pain location was indicated on a drawing. Disability was scored on the Quebec Back Pain Disability Scale (QBPDS) and urine incontinence on a Likert scale. Physical examination consisted of the Active Straight Leg Raise (ASLR) test, the Posterior Pelvic Pain Provocation (PPPP) test and pain score, and force during isometric bilateral hip adduction. Of all 182 participants, 60.4% reported LPP. Mean pain level was 3.6 (SD 2.2); in 20.0% of the women the score was >5. The mean score on the QBPDS was 27 (SD 16); in 20.9% the score was >40. Compared to women without LPP, women with LPP more frequently suffered back pain in the past (p<0.001), had a higher body mass index (p<0.01), more often had urinary incontinence (p<0.05), had less isometric hip adduction force (p<0.001), had more pain on isometric hip adduction (p<0.01), had a higher ASLR score (p<0.001) and more had often a positive PPPP test (p<0.001). Fatigue was not related to LPP during pregnancy. The main conclusion is that pain and disability of LPP during pregnancy can be interpreted as mild to moderate in most cases, and as severe in about 20%.
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Affiliation(s)
- Jan M A Mens
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Verkerk K, Luijsterburg PAJ, Ronchetti I, Miedema HS, Pool-Goudzwaard A, van Wingerden JP, Koes BW. Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study. BMC Musculoskelet Disord 2011; 12:252. [PMID: 22047019 PMCID: PMC3221649 DOI: 10.1186/1471-2474-12-252] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 11/02/2011] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain. METHODS/DESIGN All participating patients were recruited (Jan 2003-Dec 2008) from the same rehabilitation centre and were evaluated by means of (postal) questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement) behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours), followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months) and long-term (12 months) follow-up after start of therapy. DISCUSSION In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint.
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Affiliation(s)
- Karin Verkerk
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
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Bautmans I, Vantieghem S, Gorus E, Grazzini YR, Fierens Y, Pool-Goudzwaard A, Mets T. Age-related differences in pre-movement antagonist muscle co-activation and reaction-time performance. Exp Gerontol 2011; 46:637-42. [PMID: 21419212 DOI: 10.1016/j.exger.2011.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
Multiple causes contribute to the prolonged reaction-times (RT) observed in elderly persons. The involvement of antagonist muscle co-activation remains unclear. Here the Mm. Biceps and Triceps Brachii activation in 64 apparently healthy elderly (80 ± 6 years) and 60 young (26 ± 3 years) subjects were studied during a simple RT-test (moving a finger using standardized elbow-extension from one pushbutton to another following a visual stimulus). RT was divided in pre-movement-time (PMT, time for stimulus processing) and movement-time (MT, time for motor response completion). RT-performance was significantly worse in elderly compared to young; the slowing was more pronounced for MT than PMT (respectively 101 ± 10 ms and 41 ± 6 ms slower, p<0.01). Elderly subjects showed significantly higher (p<0.01) antagonist muscle co-activation during the PMT-phase, which was significantly related to worse MT and RT (p<0.01). During the MT-phase, antagonist muscle co-activation was similar for both groups. It can be concluded that increased antagonist muscle co-activation in elderly persons occurs in an early phase, already before the start of the movement. These findings provide further understanding of the underlying mechanisms of age-related slowing of human motor performance.
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Affiliation(s)
- Ivan Bautmans
- Frailty in Ageing research Unit, Vrije Universiteit Brussel, Laarbeeklaan 103, B-1090 Brussels, Belgium.
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Slieker-ten Hove M, Pool-Goudzwaard A, Eijkemans M, Steegers-Theunissen R, Burger C, Vierhout M. Erratum to: Prediction model and prognostic index to estimate clinically relevant pelvic organ prolapse in a general female population. Int Urogynecol J 2010. [PMCID: PMC4969760 DOI: 10.1007/s00192-009-1072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marijke Slieker-ten Hove
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Softwareweg 5, 3821 BN Amersfoort, The Netherlands
| | | | - Marinus Eijkemans
- Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Regine Steegers-Theunissen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department Paediatrics/Paediatric Cardiology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
- Department Clinical Genetics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Curt Burger
- Department of Obstetrics and Gynaecology/Division of Gynaecologic Oncology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Mark Vierhout
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Snijders CJ, Hermans PFG, Niesing R, Jan Kleinrensink G, Pool-Goudzwaard A. Effects of slouching and muscle contraction on the strain of the iliolumbar ligament. ACTA ACUST UNITED AC 2007; 13:325-33. [PMID: 17553728 DOI: 10.1016/j.math.2007.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Revised: 08/31/2005] [Accepted: 03/05/2007] [Indexed: 11/27/2022]
Abstract
The study consisted of biomechanical modelling and in vitro experiments. The objective of the study was to find a mechanical cause of acute low back pain (LBP) in everyday situations. The precise mechanism producing LBP is still under discussion. Most biomechanical studies link the concepts of stooped postures and buckling instability of the spine under high compressive load. No biomechanical model addresses situations with small or neglectable compressive spinal load. The proposed conceptual model describes strain on the iliolumbar ligaments (ILs) when slouching from standing upright. Delayed or absent recruitment of back muscles that protect against hyperkyphosis of the lumbar spine is a conditional factor. Erector spinae and multifidus muscle forces are included, representing a bifurcation in back muscle force: one part acting on the iliac bones and one part acting on the sacrum. The multifidus muscle action on the sacrum may produce nutation which can be counteracted by pelvic floor muscles, which would link back problems and pelvic floor problems. The effect of simulated muscle tension on the ILs and the L5-S1 intervertebral disc angle was measured using embalmed specimens. Forces were applied to simulate erector spinae and sacral part of multifidus tension, bilateral up to 100 N each. Strain gauge sensors registered elongation of the ILs. Explorative biomechanical model calculations show that dynamic slouching, driven by upper body weight and (as an example) rectus abdominis muscle force may produce failure load of the spinal column and the ILs. The quasi-static test on embalmed specimens showed a significant increase of IL elongation with simulated rectus abdominis muscle force. Adding erector spinae or multifidus muscle tension eased the ILs. Sudden slouching of the upright trunk may create failure risk for the spine and ILs. This loading mode may be prevented by controlling loss of lumbar lordosis with erector spinae and multifidus muscle force.
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Affiliation(s)
- Chris J Snijders
- Department of Biomedical Physics and Technology, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Mens J, Hoek van Dijke G, Pool-Goudzwaard A, van der Hulst V, Stam H. Possible harmful effects of high intra-abdominal pressure on the pelvic girdle. J Biomech 2006; 39:627-35. [PMID: 16439232 DOI: 10.1016/j.jbiomech.2005.01.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2004] [Accepted: 01/13/2005] [Indexed: 11/17/2022]
Abstract
The present study explores the hypothesis that a high intra-abdominal pressure (IAP) loads the ligaments of the pelvic girdle to such an extent that frequent periods of high IAP might cause pain and/or interfere with recovery of patients with pelvic girdle pain (PGP). In a theoretical model the size of the load of IAP on the pelvic girdle was computed. The diameters of abdomen and pelvis needed for the calculations were measured on MRI scans; the IAP values during activities were gained from literature. In slim, healthy subjects the calculated load on the pelvic ring during activities of daily living was 26.0-52.0 N with peaks to 135 N. During straining, vigorous work or heavy exercises the load could increase to values ranging from 104 to 520 N. The load is higher in subjects with pain or fatigue, or in case of a distended abdomen. When the load on the pelvic ring induced by IAP is larger than 100 N, the force exceeds the force at which a pelvic belt relieves complaints in PGP; at 90 N, the force is larger than the force at which isometric hip adduction provokes pain in PGP. We conclude that the size of the load induced by IAP on the pelvic girdle seems to be sufficient to cause pain in patients with PGP and might interfere with recovery. It seems worthwhile to give patients with PGP instructions to reduce IAP as much as possible during activities.
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Affiliation(s)
- Jan Mens
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 Rotterdam, GD, The Netherlands.
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Pool-Goudzwaard A, van Dijke GH, van Gurp M, Mulder P, Snijders C, Stoeckart R. Contribution of pelvic floor muscles to stiffness of the pelvic ring. Clin Biomech (Bristol, Avon) 2004; 19:564-71. [PMID: 15234479 DOI: 10.1016/j.clinbiomech.2004.02.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2003] [Accepted: 02/25/2004] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A biomechanical study in embalmed specimens, on the relation between applied tension in the pelvic floor muscles, stiffness of the pelvic ring and generation of movement in the sacroiliac joints. OBJECTIVE To gain insight into the effect of tension in the pelvic floor muscles on stiffness of the pelvic ring. Background. According to a model on selfbracing pelvic floor muscles have the capacity to stiffen the sacroiliac joints. However, this capacity has not been demonstrated in vitro yet. METHODS In 18 embalmed specimens an incremental moment was applied to the sacroiliac joints to induce rotation of the innominate bones in the sagittal plane. After assessment of the relationship between rotation angle and moment, springs were applied to the pelvis to simulate tension in the pelvic floor muscles. During the simulated tension the measurements were repeated. Differences in stiffness before and after applying springs were tested for significance. RESULTS In females, simulated tension in the pelvic floor muscles stiffened the sacroiliac joints with 8.5% (P < 0.05). In males no significant changes occurred. In both sexes a backward rotation of the sacrum occurred due to simulated tension in the pelvic floor muscles (P < 0.05). The sacroiliac joints of female specimens were more mobile in comparison to male specimens (P < 0.05). CONCLUSIONS In females, pelvic floor muscles have the capacity to increase stiffness of the pelvic ring. In addition, these muscles can generate a backward rotation of the sacrum in both sexes. RELEVANCE The ability of pelvic floor muscles to increase stiffness of the pelvic ring is of importance in patients with impairment of pelvic stability, especially in pelvic pain patients. Increased activity of these pelvic floor muscles might compensate for loss of pelvic stability by stiffening the pelvic ring and restoring proper load transfer through the lumbopelvic region.
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Affiliation(s)
- Annelies Pool-Goudzwaard
- Department of Biomedical Physics and Technology, Faculty of Medicine and Allied Health Sciences, Erasmus Medical Center, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
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Pool-Goudzwaard A, Hoek van Dijke G, Mulder P, Spoor C, Snijders C, Stoeckart R. The iliolumbar ligament: its influence on stability of the sacroiliac joint. Clin Biomech (Bristol, Avon) 2003; 18:99-105. [PMID: 12550807 DOI: 10.1016/s0268-0033(02)00179-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN In human specimens the influence of the iliolumbar ligament on sacroiliac joint stability was tested during incremental moments applied to the sacroiliac joints. OBJECTIVES To assess whether the iliolumbar ligament is able to restrict sacroiliac joint mobility in embalmed cadavers. BACKGROUND Firstly, the sacroiliac joint can play an important role in non-specific low back pain; hence, its mobility and stability are of special interest. Secondly, the iliolumbar ligament is considered to be an important source of chronic low back pain. Data on a functional relation between the iliolumbar ligament and sacroiliac joint mobility are lacking. METHODS In 12 human specimens an incremental moment was applied to the sacroiliac joint to induce rotation in the sagittal plane. After the assessment of the relationship between rotation angle and moment in the intact situation, specific parts of the iliolumbar ligaments were transected. After each partial transection the measurements were repeated. RESULTS Sacroiliac joint mobility in the sagittal plane was significantly increased after a total cut of both iliolumbar ligaments. This increase was in particular due to the transection of a specific part of the iliolumbar ligament, the ventral band. CONCLUSIONS The main conclusions are: (a) the iliolumbar ligaments restrict sacroiliac joint sagittal mobility; (b) the ventral band of the iliolumbar ligament contributes most to this restriction. RELEVANCE In embalmed human cadavers, the mobility of the sacroiliac joint increases after sequential cutting of specific parts of the iliolumbar ligaments. It can be expected that severance of this ligament during surgery will lead to increase of mobility and hence loss of stability of the sacroiliac joint. As a consequence adjacent structures will be affected. This may well be a cause of pain in patients with failed back surgery.
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Affiliation(s)
- Annelies Pool-Goudzwaard
- Department of Biomedical Physics and Technology, Faculty of Medicine and Allied Health Sciences, Erasmus University, Postbus 1738, 3000 DR, Rotterdam, Netherlands.
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