Segmental stabilizing exercises and low back pain: What is the evidence?

Study design: A systematic review of randomized controlled trials. Objectives: To evaluate the effectiveness of segmental stabilizing exercises for acute, subacute and chronic low back pain with regard to pain, recurrence of pain, disability and return to work. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Controlled Trials Register, PEDro and article reference lists were searched from 1988 onward. Randomized controlled trials with segmental stabilizing exercises for adult low back pain patients were included. Four comparisons were foreseen: (1) effectiveness of segmental stabilizing exercises versus treatment by general practitioner (GP); (2) effectiveness of segmental stabilizing exercises versus other physiotherapy treatment; (3) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus treatment by GP and (4) effectiveness of segmental stabilizing exercises combined with other physiotherapy treatment versus other physiotherapy treatment. Results: Seven trials were included. For acute low back pain, segmental stabilizing exercises are equally effective in reducing short-term disability and pain and more effective in reducing long-term recurrence of low back pain than treatment by GP. For chronic low back pain, segmental stabilizing exercises are, in the short and long term, more effective than GP treatment and may be as effective as other physiotherapy treatments in reducing disability and pain. There is limited evidence that segmental stabilizing exercises additional to other physiotherapy treatment are equally effective for pain and more effective concerning disability than other physiotherapy treatments alone. There is no evidence concerning subacute low back pain. Conclusion: For low back pain, segmental stabilizing exercises are more effective than treatment by GP but they are not more effective than other physiotherapy interventions

Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons

OBJECTIVES: To assess the use of prognostic patient factors and predictive tests in clinical decision making for spinal fusion in patients with chronic low back pain. DESIGN AND SETTING: Nationwide survey among spine surgeons. PARTICIPANTS: Surgeon members of the Dutch Spine Society were questioned on their treatment strategy for chronic low back pain. PRIMARY AND SECONDARY OUTCOME MEASURES: The surgeons’ opinion on the use of prognostic factors and tests for patient selection were addressed, and the degree of uniformity was assessed. In addition, the influence of surgeon specific factors, such as clinical experience and training, was determined. RESULTS: The comments from 62 surgeons (70% response rate) were analysed. Forty-four surgeons (71%) had extensive clinical experience. There was a statistically significant lack of uniformity of opinion in 7 of the 11 items on prognostic factors and 8 of the 11 items on predictive tests, respectively. Imaging was valued much higher than predictive tests, psychological screening, or patient preferences (all p<0.01). Apart from the use of discography and long multi-segment fusions, differences in training or clinical experience did not appear to be of significant influence on treatment strategy. CONCLUSIONS: The present survey showed a lack of consensus among spine surgeons on the use of predictive tests for patient selection. Prognostic patient factors were not consistently incorporated in their treatment strategy. Clinical decision making for spinal fusion to treat chronic low back pain does not have a uniform evidence base in practice. Future research should focus on identifying subgroups of patients for whom spinal fusion is an effective treatment. Only a reliable prediction of surgical outcome, combined with the implementation of individual patient factors, may enable the instalment of consensus guidelines in surgical decision making for chronic low back pain

Preliminary inconclusive results of a randomised double blinded cross-over pilot trial in long-term-care dwelling elderly assessing the feasibility of stochastic resonance whole-body vibration

Background This randomised double-blinded controlled cross-over pilot study examined feasibility and preliminary effects of stochastic resonance whole-body vibration training applied in long term care elderly. Findings Nine long term care elderly were recruited and randomized to group A (6 Hz, Noise 4 SR-WBV/ Sham) or B (Sham / 1 Hz, Noise 1 SR-WBV). Feasibility outcomes included recruitment rate, attrition, adherence and safety. Physical performance outcomes focused on the Expanded Timed Get Up-and-Go (ETGUG) test, the Short Physical Performance Battery (SPPB), and lower extremity muscle strength. Of 24 subjects initially approached 9 started and 5 completed the study resulting in 37.5 recruitment, 44.4 attrition and 81.7 % adherence rates. No adverse events were reported. There is more evidence of improved performance levels in the SR-WBV treatment group with significant differences in average change for isometric rate of force development (p = 0.016 left leg; p = 0.028 right leg). No statistical significance was reached for other parameters. Conclusions The findings of this study indicate that the used training protocol for long term care elderly is feasible, however, requires more closely monitoring of participants; e.g. needs protocol modifications that target improved compliance with the intervention in this setting. SR-WBV shows beneficial effects on physical performance for those adhering to the intervention. Trial registration U.S. National Institutes of Health NCT01543243 Physical activity (PA) for elderly is one of the major elements for general health prevention [1] and inactive or sedentary elderly should increase their PA [2]. Despite the known benefits of PA, residents living in long-term care (LTC) are relatively sedentary [3, 4]. Low baseline fitness and mobility levels in (pre-)frail elderly should be considered when starting exercise and this exercise should be adapted to the physical capabilities of these individuals [5]. Whole body vibration (WBV) seems a safe and beneficial type of balance exercise [6, 7]. Pilot studies showed that stochastic resonance WBV (SR-WBV) in (untrained) elderly is both safe and feasible [8, 9]. SR-WBV might also be valuable for (pre-)frail elderly in LTC where the neuromuscular systems of the trainees might not be able withstanding higher loading and long training sessions [8]. However, confirmatory results of such positive effects of WBV in LTC settings is not available and no evidence concerning the feasibility of SR-WBV in LTC dwelling elderly exists. This study tested the feasibility and effects of SR-WBV training in LTC elderly with the aim to (I) evaluate the intervention process and the ability to recruit and retain LTC elderly for such an intervention, and (II) assess the impact of 4-week SR-WBV on physical performance. Finding

Manual muscle testing and hand-held dynamometry in people with inflammatory myopathy : an intra- and interrater reliability and validity study

Manual muscle testing (MMT) and hand-held dynamometry (HHD) are commonly used in people with inflammatory myopathy (IM), but their clinimetric properties have not yet been sufficiently studied. To evaluate the reliability and validity of MMT and HHD, maximum isometric strength was measured in eight muscle groups across three measurement events. To evaluate reliability of HHD, intra-class correlation coefficients (ICC), the standard error of measurements (SEM) and smallest detectable changes (SDC) were calculated. To measure reliability of MMT linear Cohen`s Kappa was computed for single muscle groups and ICC for total score. Additionally, correlations between MMT8 and HHD were evaluated with Spearman Correlation Coefficients. Fifty people with myositis (56±14 years, 76% female) were included in the study. Intra-and interrater reliability of HHD yielded excellent ICCs (0.75-0.97) for all muscle groups, except for interrater reliability of ankle extension (0.61). The corresponding SEMs% ranged from 8 to 28% and the SDCs% from 23 to 65%. MMT8 total score revealed excellent intra-and interrater reliability (ICC>0.9). Intrarater reliability of single muscle groups was substantial for shoulder and hip abduction, elbow and neck flexion, and hip extension (0.64-0.69); moderate for wrist (0.53) and knee extension (0.49) and fair for ankle extension (0.35). Interrater reliability was moderate for neck flexion (0.54) and hip abduction (0.44); fair for shoulder abduction, elbow flexion, wrist and ankle extension (0.20-0.33); and slight for knee extension (0.08). Correlations between the two tests were low for wrist, knee, ankle, and hip extension; moderate for elbow flexion, neck flexion and hip abduction; and good for shoulder abduction. In conclusion, the MMT8 total score is a reliable assessment to consider general muscle weakness in people with myositis but not for single muscle groups. In contrast, our results confirm that HHD can be recommended to evaluate strength of single muscle groups

Complaints of the arm, neck and shoulder among computer office workers in Sudan: a prevalence study with validation of an Arabic risk factors questionnaire

<p>Abstract</p> <p>Background</p> <p>Complaints of the arm, neck and/or shoulders (CANS) in general and computer-related disorders in particular affect millions of computer office workers in Western developed countries. However, with the widespread use of computer systems in developing countries, the associated musculoskeletal complaints are yet to be investigated.</p> <p>Aim</p> <p>To study the prevalence of work-related CANS, among computer office workers in Sudan, and to test the psychometric properties of a translated Dutch questionnaire in Arabic language.</p> <p>Methods</p> <p>In 2005 282 computer office workers at a mobile telecommunication company and three banks in Khartoum, Sudan, received an Arabic language version of the validated Maastricht upper extremity questionnaire (MUEQ). The questionnaire holds 109 items covering demographic characteristics, in addition to six main domains (i.e. work station, body posture, break time, job control, job demands and social support) assessing potential physical and psychosocial risk factors. Forward/backward translation of the MUQE was done independently by two different translators. Prevalence over the past year were computed for CANS. Further, the psychometric properties of the Arabic questionnaire were investigated (i.e. factor structure and reliability) and cross-validation was carried out.</p> <p>Results</p> <p>The response rate of the questionnaire was 88% (n = 250). The one-year prevalence of CANS showed that 53% of the respondents could be classified as mild cases. The highest incidences were found for neck and shoulder symptoms (64% and 41% respectively). The analysis of the psychometric properties of the scale resulted in the identification of 2 factors for each of the 6 domains (i.e. office equipment, computer position, head and body posture, awkward body posture, autonomy, quality of break time, skill discretion, decision authority, time pressure, task complexity, social support, and work flow). The calculation of internal consistency and cross validation provided evidence of reliability and lack of redundancy of items.</p> <p>Conclusion</p> <p>The prevalence of CANS among the targeted population seems to correspond strongly with prevalence of CANS in Western developed countries. The Arabic translation of the MUEQ has satisfactory psychometric properties to be used to assess work-related risk factors for the development of CANS among computer office workers in Sudan.</p

Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review

QuestionWhat are the effects of strength training alone, exercise therapy alone, and exercise with additional passive manual mobilisation on pain and function in people with knee osteoarthritis compared to control? What are the effects of these interventions relative to each other?DesignA meta-analysis of randomised controlled trials.ParticipantsAdults with osteoarthritis of the knee.Intervention typesStrength training alone, exercise therapy alone (combination of strength training with active range of motion exercises and aerobic activity), or exercise with additional passive manual mobilisation, versus any non-exercise control. Comparisons between the three interventions were also sought.Outcome measuresThe primary outcome measures were pain and physical function.Results12 trials compared one of the interventions against control. The effect size on pain was 0.38 (95% CI 0.23 to 0.54) for strength training, 0.34 (95% CI 0.19 to 0.49) for exercise, and 0.69 (95% CI 0.42 to 0.96) for exercise plus manual mobilisation. Each intervention also improved physical function significantly. No randomised comparisons of the three interventions were identified. However, meta-regression indicated that exercise plus manual mobilisations improved pain significantly more than exercise alone (p = 0.03). The remaining comparisons between the three interventions for pain and physical function were not significant.ConclusionExercise therapy plus manual mobilisation showed a moderate effect size on pain compared to the small effect sizes for strength training or exercise therapy alone. To achieve better pain relief in patients with knee osteoarthritis physiotherapists or manual therapists might consider adding manual mobilisation to optimise supervised active exercise programs

Exercise- and education-based prehabilitation before total knee arthroplasty: a pilot study

OBJECTIVE To determine the feasibility and estimates of effects of a supervised exercise- and education-based prehabilitation programme aiming to improve knee functioning compared with usual care in patients awaiting total knee arthroplasty. DESIGN A randomized controlled pilot study. SUBJECTS Patients receiving primary, unilateral total knee arthroplasty. METHODS Patients randomized to the intervention group participated in a personalized 4-8-week prehabilitation programme before surgery. Feasibility of the intervention and self-reported knee functioning, pain, physical performance and hospital stay were assessed at baseline, immediately preoperatively, 6 and 12 weeks after surgery. RESULTS Twenty patients (mean age 72.7±5.95 years) were enrolled in this study. The personalized prehabilitation programme was found to be feasible and safe, with an exercise adherence of 90%. Significant medium interaction effects between groups and over time favouring prehabilitation were reported for the sport subscale of the Knee Osteoarthritis Outcome Score (F(3/54) = 2.895, p = 0.043, η² = 0.139) and Tegner Activity Scale (F(2.2/39.1) = 3.20, p = 0.048, η² = 0.151). CONCLUSION The absence of adverse events and high adherence to the programme, coupled with beneficial changes shown in the intervention group, support the conduct of a full-scale trial investigating the effectiveness of prehabilitation

Effect of preoperative neuromuscualr training (NEMEX-TJR) on functional outcome after total knee replacement : an assessor-blinded randomized controlled trial

Background: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. Methods: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation. Results: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively. Conclusions: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn't give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial

Reliability of patient-specific gait profiles with inertial measurement units during the 2-min walk test in incomplete spinal cord injury

Most established clinical walking tests assess specific aspects of movement function (velocity, endurance, etc.) but are generally unable to determine specific biomechanical or neurological deficits that limit an individual's ability to walk. Recently, inertial measurement units (IMU) have been used to collect objective kinematic data for gait analysis and could be a valuable extension for clinical assessments (e.g., functional walking measures). This study assesses the reliability of an IMU-based overground gait analysis during the 2-min walk test (2mWT) in individuals with spinal cord injury (SCI). Furthermore, the study elaborates on the capability of IMUs to distinguish between different gait characteristics in individuals with SCI. Twenty-six individuals (aged 22-79) with acute or chronic SCI (AIS: C and D) completed the 2mWT with IMUs attached above each ankle on 2 test days, separated by 1 to 7 days. The IMU-based gait analysis showed good to excellent test-retest reliability (ICC: 0.77-0.99) for all gait parameters. Gait profiles remained stable between two measurements. Sensor-based gait profiling was able to reveal patient-specific gait impairments even in individuals with the same walking performance in the 2mWT. IMUs are a valuable add-on to clinical gait assessments and deliver reliable information on detailed gait pathologies in individuals with SCI