Doctor of Philosophy

dissertationAlthough the prognosis of patients with a lumbar disc herniation (LDH) diagnosis is generally favorable, 20% to 30% continue reporting pain, disability, and unfavorable outcome regardless of treatment received. The Fear Avoidance Model (FAM) is one among the most known models in low back pain (LBP) to explain chronic pain and disability. However, factors in this model have been mostly examined in nonspecific LBP to describe the development of chronic symptoms. The purpose of this dissertation was to study the influence of FAM factors on patients' poor outcomes following LDH surgery. We systematically searched for studies that measured any FAM factors to prospectively assess LDH surgical outcomes. We identified 13 prospective studies that used different FAM measures to predict LDH postoperative pain, disability, or sick leave. Quality assessment of the included studies was performed and reported. Heterogeneity between studies in terms of FAM predictors, outcome measures, analyses, and in other aspects were found. While pain and depression were the most measured FAM factors, some factors were not adequately assessed. There seems to be different prognostic value between preoperative leg pain and back pain. Fear, avoidance, anxiety, and pain coping seem to have negative impact on LDH surgical outcomes. We also analyzed prospective data for LDH patients undergoing discectomy surgery to study specific FAM measures and their impact on post discectomy leg pain, back pain, and disability. Fear-avoidance, pain catastrophizing, physical activity level, functional disability, and other FAM factors were measured preoperatively. The FAM measures demonstrate significant associations with each other and with preoperative functional disability. These FAM measures also explained significant amounts of the 10- week outcomes' variances. The most influential FAM factors in our data were depression and work-related fear. Many findings in this analysis were supported by previous research. In general, FAM factors seem to have a similar impact on LDH patients (pre- and postoperatively) as on nonspecific LBP patients. LDH patients with preoperative higher levels of back pain, fear-avoidance beliefs, anxiety, pain catastrophizing, passive pain coping, and depression were more likely to have unfavorable surgical outcomes. Screening for FAM factors in LDH patients and managing them accordingly during conservative therapy, before surgery, and throughout the postoperative rehabilitation is, therefore, needed to improve outcomes and minimize health care costs. i'

El perfil neuromuscular de los músculos extensores y flexores de rodilla en jugadores de fútbol profesionales en la Arabia Premier League

Purpose: The neuromuscular system of soccer players is a key factor in their competitive performance, as it determines a player's immediate force response, reactivity and running speed during matches. The neuromuscular system has recently begun to be analyzed by tensiomyography (TMG). This study's primary aim was to generate normative data of the mechanical and neuromuscular profile for the knee extensor and flexor muscles. Method: This study used a cross-sectional study of 83 professional soccer players from three Saudi Premier League teams at the start of the preseason period. TMG was used to measure the radial muscle belly displacement in the knee extensor and flexor muscles in both legs. Results: The results suggest that the highest degree of symmetry corresponded to the vastus medialis (83.7 ± 14.3%) and the lowest to the biceps femoris (76.1 ± 10.9%). No statistical difference was found between the dominant and non-dominant muscles, or between on-field player positions across all four tested muscles. Conclusion:  The study presented normative data of a convenience sample of Saudi professional soccer players and observed that the highest asymmetry was seen in the vastus medialis and the lowest asymmetry in the biceps femoris.Propósito: El sistema neuromuscular de los jugadores de fútbol es un factor clave en su desempeño competitivo, ya que determina la respuesta de fuerza inmediata de un jugador, la reactividad y la velocidad de carrera durante los partidos. Recientemente se ha comenzado a analizar el sistema neuromuscular mediante tensiomiografía (TMG). El objetivo principal de este estudio fue generar datos normativos del perfil mecánico y neuromuscular de los músculos extensores y flexores de la rodilla. Método: Este estudio utilizó un estudio transversal de 83 futbolistas profesionales de tres equipos de la Liga Premier de Arabia Saudita al comienzo del período de pretemporada. La TMG se utilizó para medir el desplazamiento del vientre del músculo radial en los músculos extensores y flexores de la rodilla en ambas piernas. Resultados: Los resultados sugieren que el mayor grado de simetría correspondió al vasto medial (83,7 ± 14,3%) y el menor al bíceps femoral (76,1 ± 10,9%). No se encontraron diferencias estadísticas entre los músculos dominantes y no dominantes, o entre las posiciones del jugador en el campo en los cuatro músculos evaluados. Conclusión: El estudio presentó datos normativos de una muestra de conveniencia de futbolistas profesionales sauditas y observó que la mayor asimetría se observó en el vasto interno y la menor asimetría en el bíceps femoral

Pain neurophysiology knowledge among physical therapy students in Saudi Arabia: a cross-sectional study

Abstract Background Pain is a leading cause of disability and accounts for many hospital and physical therapy visits. Current pain science understanding has evolved and changed substantially in the past 20 years; however, university health science curricula may not have progressed at the same rate. This study aimed to examine knowledge about pain neurophysiology among physical therapy students in Saudi Arabia, and to compare their knowledge across different education levels and by gender. Methods A cross-sectional study conducted to examine the pain neurophysiology knowledge among college physical therapy students in Saudi Arabia. The Revised Neurophysiology of Pain Questionnaire (12 items) was used. Descriptive statistics including frequencies and percentages were used to describe the sample. Analysis of variance and t-test were also used to examine the significant differences between scores. Results Physical therapy students (n = 202) from 18 different universities in Saudi Arabia participated in this study. The mean score of the participants on the questionnaire was 6.20 ± 2.07 (i.e., 52% ± 17%) and there was no significance difference between males and females. There was a statistically significant incremental increase in total score through the educational process (P < 0.05); however, this increase was very small comparing early- and final educational-level students (8% in RNPQ). Conclusion While final year physical therapy students showed higher levels of pain science knowledge than those at the beginning of their course, the magnitude of the difference was small and likely of little meaningful relevance. This may reflect the need for more emphasis on pain science in the physical therapy curriculum in Saudi Arabia

Adding A Structured Educational Session to the Rehabilitation Program of Soccer Players Following Anterior Cruciate Ligament Reconstruction: A Feasibility Study

# Background While a lack of psychological preparedness and fear of movement may be linked with the anterior cruciate ligament (ACL) re-injury, these variables are rarely addressed throughout the therapy stages via educational sessions. Unfortunately, in terms of reducing fear, increasing function, and returning to play, no research has been done yet on the efficacy of adding organized educational sessions to the rehabilitation programs of soccer players post-ACL reconstruction (ACLR). Therefore, the study's aim was to assess the feasibility and acceptability of adding organized educational sessions to the rehabilitation programs post-ACLR. # Methods A feasibility randomized controlled trial (RCT) was conducted in a specialized sports rehabilitation center. Participants post ACL reconstruction were randomized to either usual care with a structured educational session (intervention group) or usual care alone (control group). This feasibility study investigated three aspects: recruitment, intervention acceptability and randomization, and retention. The outcome measures included Tampa Scale of Kinesiophobia, ACL-Return to Sport after Injury, and International Knee Documentation Committee for knee function. Measurements were done at baseline and one week after the intervention. # Results All of the 36 players who were undergoing rehabilitation post-ACLR at the center at the time of the study were invited to participate in the study. Thirty-five players (97.2%) agreed to participate in the study. The participants responded to some questions about the acceptability of the intervention and randomization and most of them thought they were appropriate. 30 (85.7%) participants completed the follow-up questionnaires one week after the randomization. # Conclusion This feasibility research found that adding a structured educational session to the rehabilitation program for soccer players after ACLR is feasible and acceptable. Full-scale RCTs with longer follow-ups and multiple locations are recommended

Does Telerehabilitation Help in Reducing Disability among People with Musculoskeletal Conditions? A Preliminary Study

Introduction: During the coronavirus pandemic, an initiative was launched in Saudi Arabia to provide telerehabilitation for people with musculoskeletal conditions who were unable to access in-person physiotherapy due to the associated lockdown. The purpose of this study was to explore the therapeutic impact and acceptability of telerehabilitation among the Saudi population. Methods: Ninety-five participants were recruited through an online advertisement and received a physiotherapy consultation and interventions via an online video conference platform (Google Meet). Following screening for red flags, participants received tailored education and conditioning exercises 2&ndash;3 times a week for 6 weeks. Outcome measures were recorded at baseline and 6 weeks and comprised the Pain Self-Efficacy Questionnaire, Patient-Specific Functional Scale, Musculoskeletal Health Questionnaire and a satisfaction survey. Results: The most frequent musculoskeletal conditions reported were lower back (37%), knee (14%) and neck (10%) pain and post-operative conditions (15%). Participants showed significant improvements in outcomes at the end of the program (p &lt; 0.001) with effect sizes ranging from 0.6 to &minus;1.9 and reported a high level of satisfaction with the telerehabilitation intervention. Conclusion: This study showed that telerehabilitation was an acceptable method of providing physiotherapy interventions for patients with musculoskeletal conditions in Saudi Arabia

Development of a Logic Model for a Programme to Reduce the Magnetic Resonance Imaging Rate for Non-Specific Lower Back Pain in a Tertiary Care Centre

Tertiary care centres continue to experience over-utilisation of diagnostic imaging services for lower back pain cases that may not be required. Moreover, these services may require additional time and consequently delay access to services that offer conservative management, i.e., physiotherapy, and hence, increase the direct and indirect costs with no added quality of care. A logic model was developed based on qualitative and quantitative studies that explains the plan and process evaluation strategies to reduce imaging for lower back pain in tertiary hospitals. Logic models are useful tools for defining programme components. The delivery of the components is ensured by well-defined process evaluations that identify any needed modifications. The proposed logic model provides a road map for spine clinics in tertiary care hospitals to decrease the number of patient referrals for magnetic resonance imaging and waiting times for consultations and services and promote early access to physiotherapy services

The Fear Avoidance Model predicts short-term pain and disability following lumbar disc surgery.

To examine the prognostic value of the Fear Avoidance Model (FAM) variables when predicting pain intensity and disability 10-weeks postoperative following lumbar disc surgery.We recruited patients scheduled for first-time, single level lumbar disc surgery. The following aspects of the FAM were assessed at preoperative baseline and after 10 postoperative weeks: numeric pain rating scale (0-10) for leg and back pain intensity separately, Pain Catastrophizing Scale (PCS), Fear Avoidance Beliefs Questionnaire (FABQ), Beck Depression Inventory (BDI), Oswestry Disability Questionnaire (ODI), and the International Physical Activity Questionnaire (IPAQ). Multivariate regression models were used to examine the best combination of baseline FAM variables to predict the 10-week leg pain, back pain, and disability. All multivariate models were adjusted for age and sex.60 patients (30 females, mean [SD] age = 40.4 [9.5]) were enrolled. All FAM measures correlated with disability at baseline. Adding FAM variables to each of the stepwise multiple linear regression model explained a significant amount of the variance in disability (Adj. R2 = .38, p < .001), leg pain intensity (Adj. R2 = .25, p = .001), and back pain intensity Adj. R2 = .32, p < .001 at 10-weeks). After adjusting for age and gender, BDI and FABQ-work subscale were the only significant predictors added to each of the prediction models for the 10-week clinical outcome (leg pain, back pain, and ODI).BDI and FABQ-work subscale variables are associated with baseline pain intensity and disability and predict short-term pain and disability following lumbar disc surgery. Measuring these variables in patients being considered for lumbar disc surgery may improve patient outcome

Prevalence and Risk Factors Associated with Low Back Pain in the Saudi Adult Community: A Cross-Sectional Study

Worldwide, low back pain is common and linked with many risk factors. There is a lack of studies in the Saudi Arabian community on low back pain prevalence and risk factors. Therefore, the present research will investigate the prevalence of low back pain in the middle-aged and elderly community population and examine the risk factors contributing to low back pain in Saudi Arabia. The present paper is a cross-sectional study of the community living in Riyadh and the surrounding areas in Saudi Arabia. Data were collected between October 2019 and April 2020 via trained research assistants. A total of 276 participants were included in the analysis. The prevalence of low back pain was 27.9% (n = 77) among the participants included in this study. All participants reported low back pain severity with a mean of 4.35 &plusmn; 2.19 on the pain rating scale. Older age, arthritis, hypertension, anemia, osteoporosis, and a history of fractures were all associated with having LBP. Low back pain is highly prevalent in the Saudi community adult population living in Riyadh and its surrounding areas. More than a fourth of the sample reported experiencing back pain. The study outlines several modifiable risk factors (BMI, education, employment status, marital status, and smoking status) and unmodifiable risk factors (arthritis, hypertension, anemia, osteoporosis, and a history of fractures) associated with low back pain in the study sample

The use of active learning strategies in healthcare colleges in the Middle East

Abstract Background Multiple studies have explored the use of active learning strategies among faculty members in different healthcare colleges worldwide, however, very few have described the use of these strategies in the Middle East. The aim of this study was to evaluate the extent of the implementation of active learning and its various techniques across different fields of healthcare education in various countries in the Middle East. Methods A Web-based questionnaire was developed to obtain information on the use of active learning methods. This survey was disseminated among faculty members in healthcare colleges in 17 Middle Eastern countries. Results Out of 22,734 online invitations that were sent to faculty members in different healthcare colleges, 2085 (9.17%) accepted the invitations, however, only 722 (34.63%) of those who agreed to participate filled out the questionnaire. Eighty-seven percent of the responders utilized at least one technique of active learning. Active learning was used more frequently by female responders. For example, 54.30% of the female responders reported using learning by teaching as one of their teaching methods compared to 41.30% of their male counterparts (p = 0.0005). The various forms of active learning were used at similar levels in both public and private healthcare colleges. Only minor differences were seen among different age groups or academic positions of the responders, but significant variabilities were noted among the several fields of healthcare education. For example, 61.54% of responders from the nursing faculty reported using reaction to videos as one of their teaching methods compared to 31.11% of their counterparts in the faculty of dentistry (p = 0.0021). The most frequently reported obstacles interfering with the effectuation of active learning include the lack of technical support and time constraints. Conclusions Although some barriers to the implementation of active learning exist, it is extensively used by faculty members in healthcare colleges in the Middle East

Stepwise multiple linear regression to predict the 10-week leg pain.

<p>Stepwise multiple linear regression to predict the 10-week leg pain.</p