Journal of Back and Musculoskeletal Rehabilitation最新文献

Background: Chronic low back pain (cLBP) is a global health complaint. Acupuncture is an effective therapy for cLBP; however, evidence for an optimal acupuncture practice scheme is limited.

Objective: This study aimed to determine the feasibility of conducting a randomized controlled trial (RCT) to assess the effectiveness of two acupuncture regimes (sensitized-points acupuncture and routine integrative acupuncture package) for cLBP.

Methods: This was a two-arm, assessor-blind, randomized-controlled feasibility study. Thirty adult participants with cLBP were randomly assigned into two groups. Each group received 8 sessions of either sensitized-points acupuncture or routine integrative acupuncture package, respectively. Treatments were conducted twice per week. Outcomes were assessed at baseline (week 0), on a weekly basis for four weeks (week 1, 2, 3, 4), and follow-up (week 12). Student's t-tests, Mann-Whitney U tests, Fisher's exact tests, descriptive analyses, and power analyses were used for statistics.

Results: Participants were recruited over 10 weeks with a recruitment rate of 12 participants per month. The treatment plan in both groups was well accepted and tolerated. Besides, the study was characterized by low adverse event rates (8.0% in Group A, 11.7% in Group B), high completion of the outcome measures (97.8% in Group A, 94.3% in Group B), and high participant retention rate (100% in Group A, 93.8% in Group B). Furthermore, preliminary analyses showed that both regimes of acupuncture were potentially efficacious and safe.

Conclusions: Conducting a fully powered RCT to evaluate efficacy and safety of two acupuncture regimes in the management of cLBP is feasible.

Background: Prior studies showing the effectiveness of extracorporeal shock wave therapy (ESWT) in patients with plantar fasciitis are mostly based on patient-reported measurements.

Objective: The aim of this study was to demonstrate the effectiveness of ESWT with ultrasonographic and pedobarographic measurements.

Methods: A total of 50 patients were included in the study. All patients were evaluated before and six weeks after ESWT treatment. Pain was evaluated with the Visual Analogue Scale (VAS), functional status with Foot Function Index (FFI), and quality of life with Short Form-36 (SF-36). Plantar pressure measurements were made with a pedobarography device, and plantar fascia thickness was measured with ultrasonography.

Results: After treatment, VAS-Pain decreased significantly. There was a statistically significant improvement in FFI scores after treatment. Similarly, a statistically significant improvement was seen in SF-36 scores. There was a significant decrease in ultrasonographic measurements of the plantar fascia thickness in the origo and midsection regions. There was a statistically significant decrease only in medial heel pressure measurements.

Conclusion: The results of this study showed that ESWT provides symptomatic and functional improvements in patients with plantar fasciitis as well as ultrasonographic plantar fascia thickness and pedobarographic medial heel pressure measurements.

Background: Supracondylar humerus fractures are the most common type of elbow fractures in children. Nerve injuries, primarily neuropraxia, are frequent complications and are often managed with a "wait-and-see" approach. Electroneuromyography (ENMG) is the standard method for evaluating peripheral nerve injuries, while ultrasound (US) is valuable for localizing lesions.

Objective: This case report aims to highlight the beneficial role of US in the follow-up and rehabilitation of nerve injuries following pediatric supracondylar humerus fractures.

Case presentation: A 4-year-old boy presented with a supracondylar humerus fracture that was treated with closed reduction and K-wire fixation. He exhibited weakness in the first two fingers of his left hand, difficulty grasping, and nail changes. Ultrasound revealed a median nerve lesion adjacent to the fracture site. ENMG indicated an acute severe axonal injury involving the branch innervating the flexor carpi radialis muscle. Following rehabilitation, there was improvement in hand grip strength, measured using a JAMAR hand dynamometer, and in health-related quality of life (QoL), assessed by the Pediatric Outcomes Data Collection Instrument (PODCI) score. Follow-up ENMG showed signs of mild reinnervation.

Conclusion: Pre-ENMG ultrasound provides crucial information regarding which nerve should be examined with a nerve conduction study and identifies the initial muscle to be evaluated during needle EMG. This aids in accurately localizing nerve damage and guiding effective treatment.

Background: Quality of life in patients receiving knee arthroplasty is crucial for rehabilitation. Even if the validity of the 36-Item Short Form (SF-36) was already confirmed, the Substantial Clinical Benefit (SCB) and Patient Acceptable Symptom Score (PASS) values of this score remain unknown for both Total Knee Arthroplasty (TKA) and Unicompartmental Knee Arthroplasty (UKA).

Objective: The purpose of this research was to compute the Minimal Clinically Important Difference (MCID) of the SF-36 after UKA, and the SCB and PASS of SF-36 after TKA and UKA, in order to assess post-surgery quality of life in knee osteoarthritis.

Methods: Overall, 59 patients (40 women and 19 men, mean age 60.3 ± 13.1 years) completed the questionnaire until six months follow-up. Of these patients, 22 underwent the TKA procedure, while 37 patients underwent the UKA procedure. The anchor question for computing the MCID and SCB thresholds was "How would you describe your health condition in relation to your previous state?". The PASS scores were determined using the ROC curve and the 75th percentile of the cumulative percentage curve of respondents who believe their symptoms are under control.

Results: The MCID values of global SF-36, Physical Component Summary (PCS) and Mental Component Summary (MCS) after UKA were 11.3, 14.5 and 11.4, respectively. The SCB values of global SF-36, PCS and MCS after UKA were 23.5, 23.1 and 15, respectively. The PASS values of global SF-36, PCS and MCS after TKA were 71.2, 75 and 69.3, respectively. The PASS values of global SF-36, PCS and MCS after UKA were 70.4, 72.1 and 67.5, respectively.

Conclusion: The SF-36 score represents a valid score for quality of life in patients with knee osteoarthritis. Taken together, the results showed a statistically significant improvement between inception and latest follow-up after TKA and UKA.

Background: Forward head posture (FHP) is a common malalignment affecting the cervicothoracic spine. This deviation is associated with neck disability and muscle imbalance.

Objective: This study aimed to investigate the efficacy of FHP correction using regional versus comprehensive spinal programs on the craniovertebral (CV) angle, neck disability, and spinal muscle activity.

Methods: Sixty participants with FHP were randomly assigned to receive either a cervicothoracic correction program (control group) or a cervicothoracic plus lumbopelvic program (experimental group). The CV angle, neck disability index (NDI), and normalized electromyography as a percentage of maximum voluntary isometric contraction (%MVIC) from spinal muscles were measured before and after the intervention.

Results: Post-intervention, both groups showed significant improvement across time in CV angle and NDI (p < 0.001, p = 0.002). However, the between-group comparison was not statistically significant. The NDI showed significant improvement only in the experimental group (p = 0.005). The minimal clinical important difference (MCID) obtained was 6.44 for the NDI. A reduction in %MVIC over time was observed in both groups for cervical erector spinae (Right, p = 0.006, Left, p = 0.001). The between-group comparison of spinal muscle activation was not significantly different.

Conclusion: The study suggested that FHP management using a cervicothoracic or cervicothoracic plus lumbopelvic protocol could improve cervical posture and lower cervical muscle demand. Incorporating a lumbopelvic into the cervicothoracic protocol was more effective in reducing short-term neck pain and disability than a cervicothoracic protocol alone. A comprehensive spine program may be a clinically beneficial rehabilitation protocol for FHP to improve neck pain and disability.

Background: Shoulder pain can be caused by structures within the shoulder joint or external structure to shoulder and the prevalence of shoulder pain is high.

Objective: The purpose was to investigate the ultrasonographic characteristics of patients with shoulder pain and to study the association between age groups (less than 60 years vs. 60 years and above) and commonly found abnormal ultrasonographic findings.

Methods: A retrospective study was conducted on 253 patients experiencing shoulder pain over a month. Data included gender, age, side of pain, pain duration, painful area, previous treatments, clinical assessment of shoulder pain. The abnormal findings in shoulder ultrasound images were reported, and the association between age group with common ultrasound abnormalities were analyzed using the chi-square test.

Results: Common abnormal ultrasound findings included subdeltoid bursitis (82.7%), biceps tendon effusion (48.7%), and supraspinatus tendinosis (44.2%). Moreover, patients aged 60 years and above had a significantly higher prevalence of biceps tendon effusion (53.6% vs 36.0%), supraspinatus tendon tear (19.3% vs 8.6%) and subscapularis tendon tear (6.1% vs 1.4%) compared to those aged less than 60 years.

Conclusion: The common abnormal ultrasound findings in patients with shoulder pain were subdeltoid bursitis, biceps tendon effusion and supraspinatus tendinosis. Patients aged 60 years and above had a significantly higher prevalence of biceps tendon effusion and tears in the supraspinatus and subscapularis tendons.

Background: Abnormal gait dynamics are an important risk factor responsible for the high incidence of traumatic knee osteoarthritis in patients undergoing anterior cruciate ligament (ACL) reconstruction.

Objective: To evaluate the effect of neuromuscular electrical stimulation (NMES) superimposed quadriceps training on gait dynamics.

Methods: A total of 32 postoperative patients were randomly allocated to the NMES and conventional training (CT) groups, with 16 patients per group. Patients in the CT group received the standardized conventional training for 60 min per day, 3 days per week for 6 weeks, while those in the NMES group received the same conventional training, but with NMES superimposed on the conventional open chain training of the quadriceps. The amount of time for training was equal between the two groups. Patients were evaluated at 8 and 14 weeks after surgery. The outcome measurements were maximum voluntary isometric contraction (MVIC) of the quadriceps used to assess the quadriceps strength, Lysholm score used to assess knee function and peak vertical ground reaction force (PvGRF), heel medial (HM) peak pressure and heel lateral (HL) peak pressure used to assess gait dynamics.

Results: Compared to the CT group, the NMES group had greater improvements in quadriceps strength (p<0.001, effect size = 2.93), knee function (p = 0.049, effect size = 2.06), and gait loading (including HL peak pressure (P = 0.007, effect size = 0.89) and PvGRF (P = 0.019, effect size = 0.62)). After the intervention, participants in both groups had a significantly lower rearfoot impulse and significantly higher forefoot impulse.

Conclusions: The NMES superimposed on conventional quadriceps open chain training has shown additional improvements in gait loading in patients after ACL reconstruction, which suggests it may contribute to delaying the onset of early postoperative traumatic knee osteoarthritis. In addition, changes in foot impulse may suggest a progressive trend in quadriceps avoidance gait in the early postoperative period.

Background: Individuals with adult degenerative lumbar scoliosis (ADLS) have underlying biomechanical alterations along the trunk muscles. However, few studies have evaluated trunk muscles in ADLS.

Objective: To quantify and evaluate the symmetry, thickness, and stiffness (shear modulus) of the abdominal and back muscles in ADLS participants.

Methods: This was a case-control study with participants aged 60-79 years with ADLS (n = 37) and without ADLS (n = 37). Radiographic examination data were collected from the participants. Ultrasound thickness and shear modulus measurements were performed to compare differences in the rectus abdominis, external oblique, internal oblique, transversus abdominis (TrA), multifidus, erector spinae, and quadratus lumborum muscles in the supine, prone and standing positions in the ADLS (n = 37) and control groups (n = 37). Thicknesses and shear modulus were compared.

Results: The absolute thickness of the TrA in ADLS group was significantly greater on the convex side than on the concave side in both the supine (2.978 ± 0.552 vs. 2.556 ± 0.513, p = 0.041) and standing positions (2.671 ± 0.475 vs. 2.054 ± 0.401, p = 0.034). The percentage changes in both sides of the shear modulus of the TrA were significantly greater in the ADLS group than in the control group for the supine position (p = 0.019), and standing position (p = 0.039).

Conclusions: Compared with those in the control group, only the absolute muscle thicknesses and percent change in the shear modulus of the TrA in the ADLS participants were more asymmetric.