Bewegungskontrolldysfunktion als Subgruppe von unspezifischen Rückenschmerzen

Zusammenfassung: Schmerzen des untere Rückens sind meist unspezifisch, d.h. es gibt keinen spezifischen medizinischen Grund für die Schmerzen. Eine Subgruppierung unspezifischer Rückenschmerzen wurde deswegen als einer der wichtigsten Forschungsschwerpunkte genannt. Eine mögliche Subgruppe ist die Bewegungskontrolldysfunktion, bei der der Patient seine Bewegungen nicht bewusst kontrollieren kann. Eine Testbatterie wurde entwickelt und validiert, um diese Patientengruppe zu untersuchen und zu behandeln. Sie besteht aus 6Bewegungstests und wurde als reliabel bewertet. Mit diesem Testverfahren können Personen mit Rückenschmerzen zuverlässig von gesunden Personen unterschieden werden. Ebenfalls untersucht wurde der Zusammenhang mit der Körperwahrnehmung. Dabei zeigte sich, dass Zweipunktdiskriminationsfähigkeit mit der verschlechterten Bewegungskontrolle des Rückens korreliert. Eine Fallserienstudie (n=38) ergab, dass diesen Patienten mit spezifischen Übungen gut geholfen werden kann. Da es in dieser Studie keine Kontrollgruppe gab, kann jedoch eine Kausalität nicht hergestellt werde

Muskuloskeletale Beschwerden als größte Kostenverursacher: Immenses Sparpotenzial durch Physiotherapie

Zusammenfassung: Hintergrund: Beschwerden des Bewegungsapparats, die selten lebensgefährlich sind, stellen die größten Kostenverursacher unseres Gesundheitssystems dar. Die häufigsten Behandlungsoptionen bei Beschwerden von Rücken, Schulter und Knie sind operatives Vorgehen oder Physiotherapie. Methode: In diesem Übersichtsartikel wurden Studien untersucht, in denen bei den häufigsten Diagnosen Rücken-, Schulter- und Kniebeschwerden die Effektivität von Operationen mit der physiotherapeutischen Vorgehens verglichen wurden. Resultate: Die große Mehrzahl der Studien zeigte keine signifikanten Unterschiede zwischen beiden Vorgehensweisen. Schlussfolgerungen: Bei Beschwerden des Bewegungsapparats waren in den meisten Fällen keine statistisch signifikanten Unterschiede zwischen operativen und physiotherapeutischen Maßnahmen festzustellen. Allerdings ist Physiotherapie sehr viel kostengünstige

Alhaisten rikkipitoisuuksien määritys kaivosteollisuuden tarpeisiin ICP-MS-tekniikalla

Tiivistelmä. Rikki on yksi tärkeistä alkuaineista kaivosteollisuuden ympäristövaikutuksia arvioitaessa. Rikkiyhdisteitä esiintyy kaivosteollisuuden eri prosesseissa, joten rikkiyhdisteiden päästöjä ympäristöön on seurattava. Louhittavissa malmeissa rikkiä esiintyy sulfidimuodossa, ja sulfidi hapettuu helposti ympäristölle haitalliseksi sulfaatiksi. Rikastusprosesseissa käytetään useita rikkiä sisältäviä kemikaaleja. Tutkielmassa näistä tarkemmin käsitellään vaahdotusprosesseissa käytettäviä, ympäristölle haitallisia ksantaatteja. Rikkiä päätyy kaivosalueilta myös ympäröiviin vesiin, minkä vuoksi rikkiä määritetään myös vesistöistä kaivosteollisuuden päästöjen seuraamiseksi. Alhaisten rikkipitoisuuksien määritykseen soveltuu hyvin ICP-MS-tekniikka (induktiivisesti kytketty plasma-massaspektrometria), jonka etuja ovat muun muassa kyky analysoida tarkasti alkuaineen eri isotooppeja sekä määrittää näytteen alkuainekoostumuksia. ICP-MS-tekniikan mittaustarkkuus on hyvä, mutta määritykseen liittyy häiriöitä, jotka jaetaan spektraalisiin ja ei-spektraalisiin häiriöihin. Spektraalisia häiriöitä ovat muun muassa isobaariset häiriöt, molekyyli-ionien häiriöt sekä kahdesti varautuneet ionit. Ei-spektraalisia häiriöitä aiheutuu esimerkiksi matriisihäiriöistä ja fysikaalisista häiriöistä. Rikkiä on haastavaa määrittää tarkasti perinteisellä kvadrupoli-ICP-MS-tekniikalla lähinnä rikin määritykseen liittyvien spektraalisten häiriöiden takia. Muun muassa hapen eri yhdisteet ja isotoopit häiritsevät rikin määrittämistä. Tämän vuoksi on kehitelty ICP-MS-tekniikan sovelluksia rikin tarkkaan ja häiriöttömään määritykseen. Mittauksissa on hyödynnetty esimerkiksi tandem massaspektrometriaa (MS/MS), nestekromatografiaa (LC), laserablaatiota (LA) ja korkearesoluutioisia ICP-MS-laitteita. Sovellutuksia on hyödynnetty rikin määrittämiseen vesinäytteistä sekä muista ympäristönäytteistä. Myös ksantaattien määrittäminen vaatii sovelletun ICP-MS-tekniikan. Joitakin sovellutuksia on hyödynnetty rikin isotooppisuhteen määrittämiseen. Näytetyypin mukaan valitun oikean sovellutuksen avulla rikin määritykseen liittyvät häiriöt voidaan minimoida, jolloin saadaan tarkkoja mittaustuloksia

Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Non-specific low back pain (NSLBP) in subacute and chronic stages can be treated effectively with exercise therapy. Research guidelines recommend evaluating different treatments in defined subgroups of patients with NSLBP. A subgroup of patients with movement control impairment (MCI) improved significantly on patient specific function and disability in a previous case series after movement control exercises.</p> <p>Methods/Design</p> <p>In a randomised controlled trial (RCT) we will compare the effectiveness of movement control and general exercise in patients with MCI. 106 participants aged 18 - 75 will be recruited in 5 outpatient hospital departments and 7 private practices.</p> <p>Patients randomly assigned to the movement control exercise group will be instructed to perform exercises according to their MCI. The general exercise group will follow an exercise protocol aimed at improving endurance and flexibility. Patients in both groups will receive 9 - 18 treatments and will be instructed to do additional exercises at home.</p> <p>The primary outcome is the level of disability assessed using the patient specific functional scale (PSFS) which links the perceived pain to functional situations and is measured before treatment and at 6 and 12 months follow-up. Secondary outcomes concern low back pain related disability (Roland Morris questionnaire, RMQ), graded chronic pain scale (GCPS), range of motion and tactile acuity.</p> <p>Discussion</p> <p>To our knowledge this study will be the first to compare two exercise programs for a specific subgroup of patients with NSLBP and MCI. Results of this study will provide insight into the effectiveness of movement control exercise and contribute to our understanding of the mechanisms behind MCI and its relation to NSLBP.</p> <p>Trial registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN80064281">ISRCTN80064281</a></p

Inter-examiner reproducibility of tests for lumbar motor control

<p>Abstract</p> <p>Background</p> <p>Many studies show a relation between reduced lumbar motor control (LMC) and low back pain (LBP). However, test circumstances vary and during test performance, subjects may change position. In other words, the reliability - i.e. reproducibility and validity - of tests for LMC should be based on quantitative data. This has not been considered before. The aim was to analyse the reproducibility of five different quantitative tests for LMC commonly used in daily clinical practice.</p> <p>Methods</p> <p>The five tests for LMC were: repositioning (RPS), sitting forward lean (SFL), sitting knee extension (SKE), and bent knee fall out (BKFO), all measured in cm, and leg lowering (LL), measured in mm Hg. A total of 40 subjects (14 males, 26 females) 25 with and 15 without LBP, with a mean age of 46.5 years (SD 14.8), were examined independently and in random order by two examiners on the same day. LBP subjects were recruited from three physiotherapy clinics with a connection to the clinic's gym or back-school. Non-LBP subjects were recruited from the clinic's staff acquaintances, and from patients without LBP.</p> <p>Results</p> <p>The means and standard deviations for each of the tests were 0.36 (0.27) cm for RPS, 1.01 (0.62) cm for SFL, 0.40 (0.29) cm for SKE, 1.07 (0.52) cm for BKFO, and 32.9 (7.1) mm Hg for LL. All five tests for LMC had reproducibility with the following ICCs: 0.90 for RPS, 0.96 for SFL, 0.96 for SKE, 0.94 for BKFO, and 0.98 for LL. Bland and Altman plots showed that most of the differences between examiners A and B were less than 0.20 cm.</p> <p>Conclusion</p> <p>These five tests for LMC displayed excellent reproducibility. However, the diagnostic accuracy of these tests needs to be addressed in larger cohorts of subjects, establishing values for the normal population. Also cut-points between subjects with and without LBP must be determined, taking into account age, level of activity, degree of impairment and participation in sports. Whether reproducibility of these tests is as good in daily clinical practice when used by untrained examiners also needs to be examined.</p

Quantum-mechanical model of the Kerr-Newman black hole

We consider a Hamiltonian quantum theory of stationary spacetimes containing a Kerr-Newman black hole. The physical phase space of such spacetimes is just six-dimensional, and it is spanned by the mass $M$, the electric charge $Q$ and angular momentum $J$ of the hole, together with the corresponding canonical momenta. In this six-dimensional phase space we perform a canonical transformation such that the resulting configuration variables describe the dynamical properties of Kerr-Newman black holes in a natural manner. The classical Hamiltonian written in terms of these variables and their conjugate momenta is replaced by the corresponding self-adjoint Hamiltonian operator and an eigenvalue equation for the Arnowitt-Deser-Misner (ADM) mass of the hole, from the point of view of a distant observer at rest, is obtained. In a certain very restricted sense, this eigenvalue equation may be viewed as a sort of "Schr\"odinger equation of black holes". Our "Schr\"odinger equation" implies that the ADM mass, electric charge and angular momentum spectra of black holes are discrete, and the mass spectrum is bounded from below. Moreover, the spectrum of the quantity $M^2-Q^2-a^2$, where $a$ is the angular momentum per unit mass of the hole, is strictly positive when an appropriate self-adjoint extension is chosen. The WKB analysis yields the result that the large eigenvalues of $M$, $Q$ and $a$ are of the form $\sqrt{2n}$, where $n$ is an integer. It turns out that this result is closely related to Bekenstein's proposal on the discrete horizon area spectrum of black holes.Comment: 30 pages, 3 figures, RevTe

The translation, validity and reliability of the German version of the Fremantle Back Awareness Questionnaire

Background: The Fremantle Back Awareness Questionnaire (FreBAQ) claims to assess disrupted self-perception of the back. The aim of this study was to develop a German version of the Fre-BAQ (FreBAQ-G) and assess its test-retest reliability, its known-groups validity and its convergent validity with another purported measure of back perception. Methods: The FreBaQ-G was translated following international guidelines for the transcultural adaptation of questionnaires. Thirty-five patients with non-specific CLBP and 48 healthy participants were recruited. Assessor one administered the FreBAQ-G to each patient with CLBP on two separate days to quantify intra-observer reliability. Assessor two administered the FreBaQ-G to each patient on day 1. The scores were compared to those obtained by assessor one on day 1 to assess inter-observer reliability. Known-groups validity was quantified by comparing the FreBAQ-G score between patients and healthy controls. To assess convergent validity, patient\u27s FreBAQ-G scores were correlated to their two-point discrimination (TPD) scores. Results: Intra- and Inter-observer reliability were both moderate with ICC3.1 = 0.88 (95%CI: 0.77 to 0.94) and 0.89 (95%CI: 0.79 to 0.94), respectively. Intra- and inter-observer limits of agreement (LoA) were 6.2 (95%CI: 5.0±8.1) and 6.0 (4.8±7.8), respectively. The adjusted mean difference between patients and controls was 5.4 (95%CI: 3.0 to 7.8, p\u3c0.01). Patient\u27s FreBAQ-G scores were not associated with TPD thresholds (Pearson\u27s r = -0.05, p = 0.79). Conclusions: The FreBAQ-G demonstrated a degree of reliability and known-groups validity. Interpretation of patient level data should be performed with caution because the LoA were substantial. It did not demonstrate convergent validity against TPD. Floor effects of some items of the FreBAQ-G may have influenced the validity and reliability results. The clinimetric properties of the FreBAQ-G require further investigation as a simple measure of disrupted self-perception of the back before firm recommendations on its use can be made

Efficacy of movement control exercises versus general exercises on recurrent sub-acute nonspecific low back pain in a sub-group of patients with movement control dysfunction. protocol of a randomized controlled trial

Background: Practice guidelines recommend various types of exercise for chronic back pain but there have been few head-to-head comparisons of these interventions. General exercise seems to be an effective option for management of chronic low back pain (LBP) but very little is known about the management of a sub-acute LBP within sub-groups. Recent research has developed clinical tests to identify a subgroup of patients with chronic non-specific LBP who have movement control dysfunction (MD). Method/Design: We are conducting a randomized controlled trial (RCT) to compare the effects of general exercise and specific movement control exercise (SMCE) on disability and function in patients with MD within recurrent sub-acute LBP. The main outcome measure is the Roland Morris Disability Questionnaire. Discussion: European clinical guideline for management of chronic LBP recommends that more research is required to develop tools to improve the classification and identification of specific clinical sub-groups of chronic LBP patients. Good quality RCTs are then needed to determine the effectiveness of specific interventions aimed at these specific target groups. This RCT aims to test the hypothesis whether patients within a sub-group of MD benefit more through a specific individually tailored movement control exercise program than through general exercises

Motor performance in chronic low back pain: is there an influence of pain-related cognitions? A pilot study

Background: Chronic low back pain (CLBP) is often accompanied by an abnormal motor performance. However, it has not been clarified yet whether these deviations also occur during motor tasks not involving the back and whether the performance is influenced by pain and pain-related cognitions. Therefore, the aim of the present study is to get insight in the contribution of both pain experience and pain-related cognitions to general motor task performance in CLBP. Methods. 13 CLBP patients and 15 healthy subjects performed a hand-function task in three conditions: sitting, lying prone (lying) and lying prone without trunk support (provoking). The last condition was assumed to provoke pain-related cognitions, which was considered successful when a patients' pain expectancy on a numeric rating scale was at least 1 point higher than actual pain experienced. Subjects' performance was expressed in reaction time and movement time. Repeated measures analysis of variance was performed to detect main effect for group and condition. Special interest was given to group*condition interaction, since significant interaction would indicate that patients and healthy subjects performed differently throughout the three conditions. Results: Patients were slower throughout all conditions compared to healthy subjects. With respect to the provoking condition, patients showed deteriorated performance compared to lying while healthy subjects' performance remained equal between these two conditions. Further analysis of patients' data showed that provocation was successful in 54% of the patients. Especially this group showed deteriorated performance in the provoking condition. Conclusion: It can be concluded that CLBP patients in general have worse motor task performance compared to healthy subjects and that provoking pain-related cognitions further worsened performanc