Lumbar segmental mobility disorders: comparison of two methods of defining abnormal displacement kinematics in a cohort of patients with non-specific mechanical low back pain

Journal ArticleBackground: Lumbar segmental rigidity (LSR) and lumbar segmental instability (LSI) are believed to be associated with low back pain (LBP), and identification of these disorders is believed to be useful for directing intervention choices. Previous studies have focussed on lumbar segmental rotation and translation, but have used widely varying methodologies. Cut-off points for the diagnosis of LSR & LSI are largely arbitrary. Prevalence of these lumbar segmental mobility disorders (LSMDs) in a non-surgical, primary care LBP population has not been established. Methods: A cohort of 138 consecutive patients with recurrent or chronic low back pain (RCLBP) were recruited in this prospective, pragmatic, multi-centre study. Consenting patients completed pain and disability rating instruments, and were referred for flexion-extension radiographs. Sagittal angular rotation and sagittal translation of each lumbar spinal motion segment was measured from the radiographs, and compared to a reference range derived from a study of 30 asymptomatic volunteers. In order to define reference intervals for normal motion, and define LSR and LSI, we approached the kinematic data using two different models. The first model used a conventional Gaussian definition, with motion beyond two standard deviations (2sd) from the reference mean at each segment considered diagnostic of rotational LSMD and translational LSMD. The second model used a novel normalised within-subjects approach, based on mean normalised contributionto-total-lumbar-motion. An LSMD was then defined as present in any segment that contributed motion beyond 2sd from the reference mean contribution-to-normalised-total-lumbar-motion. We described reference intervals for normal segmental mobility, prevalence of LSMDs under each model, and the association of LSMDs with pain and disability. Results: With the exception of the conventional Gaussian definition of rotational LSI, LSMDs were found in statistically significant prevalences in patients with RCLBP. Prevalences at both the segmental and patient level were generally higher using the normalised within-subjects model (2.8 to 16.8% of segments; 23.3 to 35.5% of individuals) compared to the conventional Gaussian model (0 to 15.8%; 4.7 to 19.6%). LSMDs are associated with presence of LBP, however LSMDs do not appear to be strongly associated with higher levels of pain or disability compared to other forms of non-specific LBP. Conclusion: LSMDs are a valid means of defining sub-groups within non-specific LBP, in a conservative care population of patients with RCLBP. Prevalence was higher using the normalised within-subjects contribution-to-total-lumbar-motion approach

Evidence from satellite altimetry for small-scale convection in the mantle

Small scale convection can be defined as that part of the mantle circulation in which upwellings and downwellings can occur beneath the lithosphere within the interiors of plates, in contrast to the large scale flow associated with plate motions where upwellings and downwellings occur at ridges and trenches. The two scales of convection will interact so that the form of the small scale convection will depend on how it arises within the large scale flow. Observations based on GEOS-3 and SEASAT altimetry suggest that small scale convection occurs in at least two different ways

Translation, cross-cultural adaptation and psychometric properties of the Nepali versions of numerical pain rating scale and global rating of change

Background: Pain intensity and patients' impression of global improvement are widely used patient-reported outcome measures (PROMs) in clinical practice and research. They are commonly assessed using the Numerical Pain Rating Scale (NPRS) and Global Rating of Change (GROC) questionnaires. The GROC is essential as an anchor for evaluating the psychometric properties of PROMs. Both of these PROMs are translated to many languages and have shown excellent psychometric properties. Their availability in Nepali would facilitate pain research and cross-cultural comparison of research findings. Therefore, the objectives of this study were to translate and cross-culturally adapt the NPRS and GROC into Nepali and to assess the psychometric properties of the Nepali version of the NPRS (NPRS-NP). Methods: After translating and cross-culturally adapting the NPRS and GROC into Nepali using recommended guidelines, NPRS-NP was administered to 104 individuals with musculoskeletal pain twice. The Nepali version of the GROC (GROC-NP) was administered at the follow-up for anchor-based assessment. (1) Test-retest reliability and minimum detectable change (MDC) among the stable group, (2) construct validity (by single sample t-test within the improved group and independent sample t-test between groups), and (3) concurrent validity were assessed. Receiver operating characteristic (ROC) curves were plotted to determine the responsiveness of the NPRS-NP using the area under the curve (AUC), and minimum important changes (MIC) for small, medium and large improvements. Results: Significant cultural adaptations were required to obtain relevant Nepali versions of both the NPRS and GROC. The NPRS-NP showed excellent test-retest reliability and a MDC of 1.13 points. NPRS-NP demonstrated a good construct validity by significant within-group difference in mean of NPRS score- t(63)= 7.57, P < 0.001 and statistically significant difference of mean score- t(98)= -4.24, P < .001 between the stable and improved groups. It demonstrated moderate concurrent correlation with the GROC-NP; r = 0.43, P < 0.01. Responsiveness of the NPRS-NP was shown at three levels with AUC = 0.68-0.82, and MIC = 1.17-1.33. Conclusions: The NPRS and GROC were successfully translated and culturally adapted into Nepali. The NPRS-NP demonstrated good reliability, validity and responsiveness in assessing musculoskeletal pain intensity in a Nepali population

Function-based Intersubject Alignment of Human Cortical Anatomy

Making conclusions about the functional neuroanatomical organization of the human brain requires methods for relating the functional anatomy of an individual's brain to population variability. We have developed a method for aligning the functional neuroanatomy of individual brains based on the patterns of neural activity that are elicited by viewing a movie. Instead of basing alignment on functionally defined areas, whose location is defined as the center of mass or the local maximum response, the alignment is based on patterns of response as they are distributed spatially both within and across cortical areas. The method is implemented in the two-dimensional manifold of an inflated, spherical cortical surface. The method, although developed using movie data, generalizes successfully to data obtained with another cognitive activation paradigm—viewing static images of objects and faces—and improves group statistics in that experiment as measured by a standard general linear model (GLM) analysis

Management of Osteoarthritis: A guide to non-surgical intervention Including the exercise therapy and manual therapy treatment protocols used in the MOA Trial

The MOA trial (Management of Osteoarthritis, or Maimoatanga Mate Köiwi) was a randomised clinical trial that aimed to investigate the long-term effectiveness and cost-effectiveness of both a multi-modal, individualised, supervised exercise therapy programme, and an individualised manual therapy programme, compared with usual medical care, for the management of pain and disability in adults with hip or knee OA. The first chapter of this book provides an introduction to OA and its management. The subsequent chapters provide the detailed treatment protocols delivered in the MOA trial.Non Peer Reviewe

Shared neural codes for visual and semantic information about familiar faces in a common representational space

Processes evoked by seeing a personally familiar face encompass recognition of visual appearance and activation of social and person knowledge. Whereas visual appearance is the same for all viewers, social and person knowledge may be more idiosyncratic. Using between-subject multivariate decoding of hyperaligned functional magnetic resonance imaging data, we investigated whether representations of personally familiar faces in different parts of the distributed neural system for face perception are shared across individuals who know the same people. We found that the identities of both personally familiar and merely visually familiar faces were decoded accurately across brains in the core system for visual processing, but only the identities of personally familiar faces could be decoded across brains in the extended system for processing nonvisual information associated with faces. Our results show that personal interactions with the same individuals lead to shared neural representations of both the seen and unseen features that distinguish their identities

Isostatic equilibrium in spherical coordinates and implications for crustal thickness on the Moon, Mars, Enceladus, and elsewhere

Isostatic equilibrium is commonly defined as the state achieved when there are no lateral gradients in hydrostatic pressure, and thus no lateral flow, at depth within the lower viscosity mantle that underlies a planetary body's outer crust. In a constant-gravity Cartesian framework, this definition is equivalent to the requirement that columns of equal width contain equal masses. Here we show, however, that this equivalence breaks down when the spherical geometry of the problem is taken into account. Imposing the "equal masses" requirement in a spherical geometry, as is commonly done in the literature, leads to significant lateral pressure gradients along internal equipotential surfaces, and thus corresponds to a state of disequilibrium. Compared with the "equal pressures" model we present here, the "equal masses" model always overestimates the compensation depth--by ~27% in the case of the lunar highlands and by nearly a factor of two in the case of Enceladus.Comment: 23 pages of text; 3 figures; accepted for publication in GR