Journal of Back and Musculoskeletal Rehabilitation最新文献

Background: Randomized controlled trials (RCTs) represent the highest level of evidence in guiding the management of clavicle fractures. They are conducted to ensure that evidence drives the basis of treatment algorithms. Relying solely on P values to assess orthopedic RCTs may be deceptive and challenge the validity of the studies.

Objective: To evaluate the degree of statistical fragility in the clavicle fracture literature using the fragility index (FI) and fragility quotient (FQ).

Methods: A systematic search strategy using the Medline, PubMed, and Embase databases was used to find all dichotomous data for randomized controlled trials (RCTs) in clavicle fracture research from 2000 to 2024. The FI of each outcome was calculated by reversing a single outcome event until significance was reversed. The FQ was calculated by dividing each fragility index by the study sample size. The interquartile range (IQR) was also calculated for the FI and FQ.

Results: Of the 3646 articles screened, 81 met the search criteria, with 30 RCTs evaluating clavicle fractures included for analysis. There were 250 total outcomes, where 62 significant and 188 nonsignificant outcomes were identified. The overall FI and FQ were 4 (IQR 3-5) and 0.045 (IQR 0.024-0.080). Statistically significant and nonsignificant outcomes had an FI of 3.5 (IQR 2-7) and 4 (IQR 3-5), respectively. Regarding loss to follow-up (LTF), 63.3% (19) reported LTF greater or equal to the overall FI of 4.

Conclusion: When scrutinizing management algorithms relying on statistical analysis, we recommend including the FI and FQ alongside the P value.

Background: Femoral intertrochanteric fractures are a prevalent type of hip fracture among the elderly population. And proximal femoral nail anti-rotation (PFNA) is the leading surgical technique for managing femoral intertrochanteric fractures in this patient population.

Objective: This study aimed to evaluate the clinical efficacy of proximal femoral nail anti-rotation (PFNA) in managing intertrochanteric fractures in elderly patients with negative medial cortical support. Additionally, the outcomes associated with two different nail positioning techniques were investigated.

Methods: Elderly patients with femoral intertrochanteric fractures with negative medial cortical support, treated between January 2017 and January 2021, were included. A retrospective analysis of their clinical data was conducted. Patients were categorized into two groups based on the positioning technique: lithotomy position group (n = 40) and scissor position group (n = 40). Baseline characteristics, perioperative indicators, hidden blood loss, and Harris hip scores were compared.

Results: The groups exhibited no significant differences in baseline characteristics, incision length, or postoperative tip-apex distance. The scissor position group experienced fewer fluoroscopies, shorter surgical durations, and lower Visual Analogue Scale (VAS) scores for the unaffected limb on postoperative day 1 compared to the lithotomy position group. No significant differences in hidden blood loss were observed between the groups. The Harris hip score for the unaffected side showed no significant differences between the scissor position group on postoperative day 1 and postoperative month 1. However, in the lithotomy position group, the Harris hip score of the unaffected side on postoperative day 1 was significantly lower than that at postoperative month 1. Additionally, the Harris hip score for the unaffected side on postoperative day 1 was substantially higher in the scissor position group compared to the lithotomy position group, although there were no significant differences between the two groups at postoperative month 1.

Conclusion: PFNA in the scissor position demonstrated advantages over the lithotomy position, including reduced fluoroscopy usage, shorter surgical duration, and less trauma to the unaffected limb. These findings indicate its effectiveness in managing intertrochanteric fractures in elderly patients with negative medial cortical support.

Background: In recent years, the femoral neck system (FNS) has become increasingly widely used for Pauwels type III femoral neck fractures.

Objective: We performed a meta-analysis to investigate the safety and efficacy of FNS and the mainstream internal fixation method, cannulated screw (CS), in the treatment of Pauwels type III femoral neck fractures.

Methods: We systematically searched all research studies from PubMed, Embase, Web of Science, Cochrane, WANFANG, and the Chinese Academic Journal Full-Text Database (CNKI) from 2018 to July 2024 and conducted data extraction. The study was conducted on July 26, 2024. We used the PRISMA guidelines to assess the quality of the results of all included studies. In addition, we searched for references to relevant articles. After completing the literature search, we performed a manual literature screening to obtain studies that met the inclusion criteria. The outcomes were Harris Hip Score, operation duration, intraoperative blood loss, hospital stay, healing time, and postoperative complications.

Results: This meta-analysis ultimately included nine studies (n = 524) and conducted quality evaluations. All nine articles were retrospective cohort studies. The study exhibited statistically significant variations between the FNS and CS groups in relation to total complications (95% confidence interval (CI)= [0.11, 0.40], odds ratio (OR) = 0.21, P < 0.001), Harris Hip Score (95%CI = [2.14, 3.65], mean difference (MD) = 2.89, P < 0.001), Femoral head necrosis (95%CI = [0.17, 0.86], OR = 0.38, P = 0.02), Internal fixation failure (95%CI = [0.06, 0.50], OR = 0.17, P = 0.001), Medium femoral neck shortening (95%CI = [0.17, 0.53], OR = 0.30, P < 0.001), intraoperative blood loss (95%CI = [11.57, 26.80], MD = 19.19, P < 0.001), Operation duration (95%CI = [-15.20, -2.17], MD = -8.69, P = 0.009), and healing time (95%CI = [-1.30, -0.32], MD = -0.81, P = 0.001).

Conclusion: This meta-analysis showed that in Pauwels type III femoral neck fractures, the femoral neck system has a shorter operative time, a lower rate of postoperative complications, a shorter healing time, less shortening of the femoral neck, and a higher Harris Hip Score compared with cannulated screws, but increases intraoperative blood loss. However, more clinical studies are needed to confirm our conclusions due to our small sample size and lack of randomized controlled trials.

Background: Osteoarthritis is the third leading risk factor for disability in older adults.

Objective: To compare the efficacy of different traditional Chinese exercises on knee osteoarthritis by network meta-analysis, and to provide a reference basis for patients to choose the best method.

Methods: Seven databases, including Pubmed, Embase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and China Science and Technology Journal Database were searched for literature on traditional Chinese exercise to improve the symptoms of patients with knee osteoarthritis. The search period was from inception of the database until February 14, 2024. Literature screening and data extraction were carried out independently by 2 investigators, and the quality of the included studies was evaluated using the Cochrane Risk of Bias 2.0 assessment tool. R4.2.3 and Stata 15.0 were used for analysis.

Results: Forty-two studies involving 2843 patients were ultimately included, encompassing 4 kinds of traditional Chinese exercise. The surface under the cumulative ranking curve (SUCRA) showed that Baduanjin was the best traditional Chinese exercises for Western Ontario and McMaster University Osteoarthritis Index scores including pain score (SUCRA = 0.85), stiffness score (SUCRA = 0.87), physical function score (SUCRA = 0.88) and overall score (SUCRA = 0.83). For Visual Analog Scale pain score, the most effective traditional Chinese exercise was Tai Chi (SUCRA = 0.93).

Conclusion: The efficacy of Tai Chi, Baduanjin, Yijinjing, and Wuqinxi on knee osteoarthritis patients is superior to that of usual care. Baduanjin had the best effect in improving stiffness, physical function and overall score, and both Baduanjin and Tai Chi were the best options for improving pain.

Background: Interprofessional rehabilitation programs are recommended by practice guidelines based on their effectiveness in improving health-related quality of life, pain, and function for people with chronic low back pain (CLBP). However, the most appropriate program characteristics are poorly described in the literature.

Objective: This scoping review aimed to synthesize the characteristics of interprofessional rehabilitation programs for people living with CLBP.

Methods: The scoping review was guided by the framework developed by Arksey and O'Malley, which has been further enhanced by the Joanna Briggs Institute (JBI). Electronic databases, including Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, SCOPUS, PubMed, Web of Science, and Cochrane Library, were searched to identify relevant published studies.

Results: Out of 13370 articles identified through our search, seventy-nine studies fulfilled our eligibility criteria. In the majority of the studies (n = 75), interprofessional rehabilitation programs for people with CLBP consisted of two or more of the following interventions: physical activity and exercise (n = 68), education (n = 61), psychotherapy (n = 52), and vocational support/advice (n = 31). In a few studies describing the underlying theories, the biopsychosocial model, which emphasizes the need to address social, psychological, and physical components in the management of CLBP, was the most often cited theoretical framework.

Conclusion: There is substantial variation in how interprofessional rehabilitation programs for people with CLBP are conceptualized and evaluated. A detailed description of the intervention evaluated, and the underlying theoretical frameworks was also lacking in most studies. We recommend the use of a consistent term and components aligned with practice guidelines.

Background: Heel spurs, caused by inflammation and overstretching of the plantar fascia, are a common source of heel pain. Although various conservative and invasive treatments are used, evidence on their effectiveness remains limited.

Objective: This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) and magnetic field application on pain levels in heel spur patients.

Methods: The files of 80 patients diagnosed with heel spurs were accessed. Patients with missing demographic information in the files, incomplete Visual Analogue Scale (VAS) values, and patients with heel pain complaints for less than 5 months were excluded from the study. A total of 39 patients who met the study criteria were included in the study. While ESWT was applied to 21 of these patients (ESWT group), magnetic field was applied to 18 patients (MA group). All patients were given plantar fascia stretching exercises as a home program. Pain scores before and after treatment were evaluated with VAS.

Results: A significant decrease was found in VAS values after the 5th session and 2 months later in both the ESWT group and the magnetic field group (p < 0.001). On the other hand, neither treatment method was found to be superior to each other (p > 0.05).

Conclusion: It was observed that the pain of the patients decreased in both the early and late periods in both applications.

Background: Chronic nonspecific low back pain (CNLBP) is a leading cause of disability and remains a major burden for many public health systems. Acupuncture is a nonpharmacological treatment for CNLBP that can be effective in improving low back pain; nevertheless, its effect on improving back muscle endurance in patients with CNLBP and its duration of effect have not been studied.

Objective: The goal of this study was to assess the impact of acupuncture on lower back muscle activity in CNLBP patients.

Methods: This was a single-blind, randomized, crossover experimental study. Thirty female patients were randomized into Group A (15 patients) or Group B (15 patients). Patients in Group A were assigned to receive real acupuncture (RA) in the first phase and sham acupuncture (SA) in the second phase, while those in Group B received SA first and then RA, with a 1-week washout period between phases. Two-way repeated ANOVA was used to evaluate the effect of group and time on isokinetic parameters, Surface electromyography (sEMG) data, and blood data.

Results: Significant interaction effects were identified between group * time on the isokinetic parameters of the lumbar extensor muscles, sEMG values of the erector spinae, blood lactate levels, and blood ammonia levels (all p< 0.05). Compared with those of the SA group, the isokinetic parameters of the lumbar extensor muscles, sEMG values of the erector spinae, blood lactate levels, and blood ammonia levels of the RA group were significantly different (all p< 0.05).

Conclusion: RA improves lumbar extensor endurance in patients with CNLBP and lasts approximately 9 minutes. RA can improve blood circulation to reduce blood lactic acid and blood ammonia produced during exercise.

Background: Chronic low back pain can severely affect quality of life. While several treatments are available, the combination of therapies often results in better outcomes.

Objective: This study delves into the comparative effectiveness of combining monopolar dielectric diathermy radiofrequency (MDR) with supervised therapeutic exercise against the latter treatment alone.

Methods: A randomized single-blind controlled trial was conducted. The intervention group (n= 30) received MDR with supervised therapeutic exercises for eight weekly sessions for four weeks. The control group (n= 30) received only the same exercise protocol. The following self-report measures were assessed before the first treatment session, at four, and 12 weeks: disability, pain, kinesiophobia, quality of life, sleep quality, emotional distress, isometric trunk strength, and trunk flexion range.

Results: Repeated ANOVA measures revealed significant time*group interactions for the McQuade test (p= 0.003), the physical role (p= 0.011), vitality (p= 0.023), social function (p= 0.006), and mental health subscales (p= 0.042). Between-group analyses showed significant differences for all outcomes at each follow-up: RMDQ (post-treatment, p= 0.040), ODI (post-treatment and 12-week, p= 0.040), VAS (p< 0.001), TSK (p< 0.001), and McQuade Test (p< 0.020).

Conclusion: The combination of diathermy radiofrequency with supervised therapeutic exercise significantly surpasses the efficacy of supervised therapeutic exercise alone, showcasing improvements in pain, disability, kinesiophobia, lumbar mobility in flexion, and overall quality of life in patients with chronic low back pain.

Background: Severe osteoporotic vertebral compression fracture (SOVCF) is frequently complicated by endplatedisc complex (EDC) injury. While percutaneous kyphoplasty (PKP) can offer rapid analgesia and facilitate early activity, it does not restore vertebral height and may result in intervertebral leakage and untreated EDC injury.

Objective: This study aimed to evaluate the clinical outcomes of percutaneous functional spinal unit cementoplasty (PFSUP) for SOVCF complicated by EDC injury and compare its clinical and imaging outcomes with PKP.

Methods: This was a retrospective case-control study. Patients with SOVCF complicated with EDC injury between January 1, 2018, and December 31, 2019, were recruited and assigned to the PKP group and PFSUP group based on their treatment procedures Back pain was evaluated using the visual analog scale (VAS) and daily life activities were assessed using the Oswestry disability index (ODI). X-rays were employed to observe the presence and location of cement leakage, as well as to measure the sagittal vertical axis (SVA) and local kyphosis angle (LKA). Loss of correction was calculated by subtracting the LKA after surgery from that at the final follow-up visit Subsequent vertebral fracture (SVF) was confirmed using the Genant semi-quantitative method and/or MRI.

Results: A total of 64 patients were included in this study. Among them 41 cases were assigned to the PKP group (28 females, 74.8 years on average), while the remaining 23 cases were assigned to the PFSUP group (15 females, 76.3 years on average). All surgical interventions were successfully completed without major complications. Compared to the PKP group, the PFSUP group had longer operation time (70.28 ± 11.44 vs 44.5 ± 10.12, P< 0.001) higher frequencies of radiation exposure (97.6 ± 19.85 vs 38.6 ± 9.53, P< 0.001), and a lower cement leakage rate (26.1% vs. 41.5%, P< 0.001). One day after surgery and at the final follow-up the PFSUP group had lower VAS and ODI scores, as well as lower LKA and Sva values compared with the PKP group (all P< .001). At the final follow-up visit, the PFSUP group demonstrated a lower loss of correction (4.38 ± 2.71 vs. 10.19 ± 3.41 P< 0.001) and a lower SVF rate compared to the PKP group (21.7% vs. 31.7%, P< 0.001).

Conclusion: PFSUP outperformed PKP in alleviating pain restoring and maintaining sagittal balance, and lowering the incidence of cement leakage and SVF for SOVCF with EDC injury However, PFSUP was associated with longer operation time and high radiation exposure frequencies.