Combined Application of Extracorporeal Shock Wave Therapy, Core Stability Exercise, and Anti-Inflammatory Drug Therapy in the Management of Chronic Low Back Pain: A Clinical Study

Effects of Adding Respiratory Exercises to Core Stability Training in Office Workers With Chronic Low Back Pain: A Randomized Controlled Trial.

Background: Chronic low back pain (CLBP), defined as pain persisting for more than three months, is associated with disability, functional limitations, musculoskeletal issues, and sleep disturbances in many individuals worldwide. Objective: The main objective of this study was to determine the effect of hamstring tightness, pain intensity, and disability on sleep quality in patients with chronic low back pain. Methods: This cross-sectional study included 387 individuals aged 25-55 years, recruited from various orthopedic units. Data were collected using the Roland-Morris Questionnaire (RMQ) for disability, the Pittsburgh Sleep Quality Index (PSQI) for sleep quality, the Active Knee Extension (AKE) test for hamstring tightness, and the Numeric Pain Rating Scale (NPRS) for pain intensity. Statistical analysis was conducted using SPSS version 25. Descriptive statistics, including means and standard deviations, were calculated for quantitative variables, while frequencies and percentages were calculated for qualitative variables. Chi-square tests were performed to examine the associations between NPRS, RMQ, AKE scores, and PSQI scores, with a p-value of less than 0.05 considered statistically significant. Results: The mean age of the 387 participants was 41.67 ± 13.38 years; 233 were females (60.2%), and 154 were males (39.8%). The mean RMQ score was 11.45 ± 2.34, the mean PSQI score was 8.58 ± 2.60, and the mean NPRS score was 4.97 ± 1.37. The AKE test was positive in 34.6% of participants. Chi-square tests showed a significant positive association between NPRS and PSQI scores (p = 0.001), and between RMQ and PSQI scores (p = 0.048). However, the association between AKE scores and PSQI scores was not significant (p = 0.400). Conclusion: This study highlights the significant association between pain intensity, disability, and sleep quality in patients with chronic nonspecific low back pain. Pain and disability adversely affect sleep quality, while hamstring tightness does not appear to have a significant impact. These findings underscore the importance of addressing pain and disability to manage sleep disturbances in this patient population.

Background:Chronic low back pain is both a public health issue with significant economic and social impact and a patient-specific health problem that can exacerbate other comorbidities.Objectives:The objective of our study...

Purpose: To review and summarise the prevalence of chronic back pain (CBP), chronic low back pain (CLBP) and chronic musculoskeletal pain (CMSKP) in people with spinal cord injury (SCI) and evaluate how pain is assessed. Method: A systematic literature review between 1990 and 2012 in English language journals. Twelve databases were searched including CINAHL, Cochrane, Embase, PubMed and Science direct. Data were analysed using descriptive statistics and 95% confidence interval (CI). Results: Eight studies fulfilled the inclusion criteria. Four reported on CMSKP, four on CBP and only two on CLBP. Among people with SCI and pain, the prevalence of CMSKP was 49% (95% CI: 44–55%), CBP was 47% (95% CI: 43–50%) and CLBP was 49% (95% CI: 44–55%). There were variations in both the pain classification systems used and the data collected. The type of pain reported in the back and low back areas could not be established due to insufficient evidence. Conclusion: The main finding is that the prevalence of CMSKP, and more particularly CBP and CLBP are not sufficiently reported in SCI literature.Implications for RehabilitationThere is sufficient evidence, though modest in quality and quantity, to indicate that chronic musculoskeletal pain (CMSKP), back pain (CBP) and low back pain (CLBP) are common in people with spinal cord injury (SCI). This deserves consideration by health professionals treating such patients.Pain assessment, including BP and LBP, for people with SCI should become part of the overall clinical assessment and it is preferable that standardised pain assessment tools are used.Where people with SCI suffer from CMSKP, and particularly CBP and CLBP, further consideration should be made, likely to include posture, strengthening and seating as is referral for pain medication.

BackgroundNon-specific chronic low back pain (NCLBP) has a high incidence, which has a significant impact on a patient’s body and mind and is a common condition affecting people’s quality of life. Core stability exercise (CSE) is a modestly effective treatment for NCLBP; however, CSE has only been shown to be a useful treatment option in the short term. Many clinical practice guidelines recommend the use of a biopsychosocial framework to guide the management of NCLBP. Self-compassion training (SCT) is a promising psychotherapy treatment option for NCLBP; however, there is still a lack of research on CSE combined with SCT. In this study, we will seek to determine whether CSE combined with SCT is an effective treatment option for patients with NCLBP compared to CSE alone.MethodsIn this study, we will randomize 166 adults with NCLBP to a combined SCT and CSE arm or a CSE alone arm (83 participants per group). Both interventions will consist of four weekly 1.5-h group sessions of CSE supplemented by home practice. The combined group protocol also includes 2 h of SCT before CSE. Interviewers masked to the treatment assignments will assess the outcomes at 4 and 16 weeks post-randomization. The primary outcomes are back pain disability (based on the Roland-Morris Disability Questionnaire) and pain intensity (NRS; average pain, worst pain, average pain) at 16 weeks.DiscussionIf SCT is found to enhance the effectiveness of CSE for patients with chronic back pain, the results of the study may promote the development of mind-body therapies for chronic low back pain.Trial registrationChinese Clinical Trial Registry ChiCTR2100042810. Registered on 21 January 2021

Exercise and manual therapy are used with pharmacological interventions to manage low back pain and prevent work-related musculoskeletal disorders. However, the potential benefits of incorporating exercise and ergonomics training for factory workers experiencing low back pain have not been definitively established. The objective of this study was to assess the impact of ergonomics training with exercises on pain, functionality, sleep, and fatigue among factory employees experiencing low back pain. This research was conducted as a randomized controlled trial involving workers with back pain employed in a plastic molding factory in Gebze, Kocaeli. Both groups received ergonomics training, but only the experimental group was given exercise training inclusive of stretching and core stabilization exercises. The workers in the experimental group were instructed to perform the exercises regularly for three days a week over a period of eight weeks. The McGill Pain Questionnaire (MPQ), the Visual Analogue Scale (VAS), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the Oswestry Disability Index (ODI) were used for pre-and post-treatment assessment. The ODI, FSS, PSQI, and MPQ scores were significantly reduced in both groups. In the intergroup comparison, the exercise group showed a significantly greater decrease in all test scores compared to the control group. The exercise group showed a statistically significant decrease in ODI, FSS, MPQ, and PSQI scores compared to the control group. This study demonstrated that exercise is a more effective practice than ergonomic training for factory workers suffering from chronic low back pain.

Objectives: The objective of this study was to test the reliability and validity of the Turkish version of the Quebec Back Pain Disability Scale (QBPDS) and Pain Disability Index (PDI) as well as the retainment of the psychometric properties of the original versions. The importance of the region-specific functional measures on patients with chronic low back pain was also assessed. Methods: Eighty-three patients with chronic low back pain were enrolled in the study. The QBPDS, the PDI and The Hospital Anxiety and Depression Scale (HADS) were filled by all subjects. Reliability was determined by internal consistency. Internal consistency was measured by calculating Cronbach's alpha and item-total correlation. Validity was examined by correlating the QBPDS and PDI scores to external criteria scores at a single point in time, defined as cross-sectional construct validity. Results: Cronbach's alpha value for QBPDS and PDI was found 0.93 and 0.84 respectively, which were both statistically significant ( p< 0.0001). The item-total correlations of QBPDS varied between 0.28 and 0.76, and that of PDI varied between 0.30 and 0.73. The cross-sectional construct validity coefficients of QBPDS were 0.63 for PDI, 0.46 for Visual Analogue Scale (VAS), 0.28 and 0.16 for HADS. Correlation coefficients of PDI were 0.49, and those of VAS and HADS were 0.36 and 0.24 respectively. Conclusion: Our results are in accordance with the previous findings of the English and French versions of the QBPDS and English version of the PDI, indicating that these functional scales are valid and reliable. However, due to the considerable overlap between generic and region-specific functional instruments, the use of both scales is not necessary. We conclude that the QBPDS and PDI both measure predominantly functional status in patients with chronic low back pain.

Intriduction: Aim of this research was investigate of 8 week core stability and endurance exercise on backe pain and CRP serum levels in the male workers with chronic low back pain. Method: This research was a semi-expreimental study and male workers 30-40 years Pars Khodro factory in 1394 that formed the statistical population. 30 person selected from among volunteers, and were divided into two groups of combined training (core stability, endurance) (n = 15) and control group (n = 15). In the baseline stage evaluated the amount of back pain with McGill pain questionnaire and also CRP levels through brachial blood samples. The members of the experimental group participated in 8-week exercise that included three days a week training core stability exercises and three days a week endurance exercise, and the control group were barred from participating in regularly exercise. After eight weeks, the amount of pain and the level of CRP were measured in both groups. Result: Our findings showed that 8 week core stability and enduance exercise leads to a signifiance reduction of back pain and CRP levels (P=0.001). Also, there was a significant association between CRP level and the amount of back pain in workers men as a result of participating in the training program (P=0.018). Conclusion: Due to the combined effects of core stability exercises and aerobic exercises to reduce pain and inflammation, people working in different professions can be used to reduce back pain or prevent it, to participate in this type of training.

To investigate physical activity level in patients with chronic low back and neck pain. 32 preoperative patients, 32 outpatients with low back or neck pain and 32 healthy controls were included in study. The physical activity level of the participants was evaluated with the International Physical Activity Questionnaire. The Oswestry Disability Index and Neck Pain Disability Index, Short Form-36, Pittsburgh Sleep Quality Index and Beck Depression Inventory were used for assessment of disability, quality of life, sleep quality and depression. Statistical significant differences was found in disability, sleep quality, depression, physical activity level and quality of life scores between three groups (p < 0.05). All scores of preoperative patients were significantly lower than outpatients except sleep parameter (p < 0.05). Sleep quality, disability and depression scores of patients with chronic neck pain were significantly lower and physical activity level and quality of life scores were significantly higher than patients' with chronic low back pain (p < 0.05). Physical activity modification was found in patients with chronic low back and neck pain. Physical activity level, disability, sleep, depression and quality of life scores of preoperative patients with low back pain more affected than neck patients.

BackgroundGastroesophageal reflux disease (GERD) often coexists with anxiety, depression, and poor sleep quality, which worsen symptom perception and reduce quality of life. While each factor has been linked to GERD, their combined effects have rarely been examined, especially in sleep clinic populations. This study aimed to assess the individual and combined associations of anxiety, depression, and sleep quality with probable GERD in patients at a tertiary hospital sleep center.MethodsThis retrospective cross-sectional study examined patient data from the Sleep Center of National Cheng Kung University Hospital collected between July 2020 and July 2021. All included patients completed the Gastroesophageal Reflux Disease Questionnaire (GERDQ), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to determine associations between elevated HADS-A (anxiety), HADS-D (depression), PSQI scores, and probable GERD (GERDQ score ≥ 9), adjusting for relevant confounders.ResultsAmong 877 patients, 93 (10.6%) had probable GERD. Elevated HADS-A (adjusted odds ratio [aOR]: 2.18, 95% confidence interval [CI]: 1.40–3.39, p < 0.001), HADS-D (aOR: 2.10, 95% CI: 1.34–3.29, p = 0.001), and PSQI (aOR: 3.32, 95% CI: 2.10–5.27, p < 0.001) scores were significantly associated with probable GERD. Patients with both high HADS-A and PSQI scores had a stronger association (aOR: 4.74, 95% CI: 2.62–8.60), and those with both high HADS-D and PSQI scores had the greatest odds (aOR: 5.09, 95% CI: 2.72–9.41).ConclusionResults reaffirm that anxiety, depression, and poor sleep quality are significantly associated with probable GERD. However, given the cross-sectional design, causal relationships cannot be established. The combined use of HADS and PSQI may enhance GERD risk identification, suggesting that individuals with psychological and/or sleep disturbances should consider gastroenterological evaluation.

Functional dyspepsia (FD) is one of the most common reasons for medical visits. Patients with FD incur large direct and indirect expenditures and may have significant financial burdens that affect quality of life. Our study aimed to assess the effectiveness of meditation as an adjuvant to the standard treatment in individuals diagnosed with FD. This will explore more cost-effective therapeutic management in diseases like FD, which is believed to be related to the gut-brain axis. Meditation is a nonpharmacological therapy, safer and economical, and its adjuvant use can minimize or avoid the adverse effects of long-term use of proton pump inhibitors (PPI) and tricyclic antidepressants (TCA). We wanted to comprehensively assess the role of meditation as an adjuvant therapy in patients with FD and compare it with the control arm receiving standard treatment alone. The primary objective was the change in gastrointestinal quality of life index (GIQLI) score, and the secondary objective was to assess the changes in the hospital anxiety and depression scale (HADS) score and Pittsburgh sleep quality index (PSQI) score before and after the intervention. Patients fulfilling the inclusion criteria were divided equally into two arms (experimental and control groups). The experimental group received standard treatment for dyspepsia (PPI, domperidone, TCAs) and Vaishvanara Agni meditation (VAM), while the control group received standard treatment alone. Both groups were compared at weeks 0, 4, and 8 in terms of change in GIQLI score, HADS (HADS-A and HADS-D score), and PSQI score. Our study showed that both groups experienced significant changes in GIQLI, HADS-A, HADS-D, and PSQI scores at 4 and 8 weeks when compared with the baseline time point. However, when both groups were directly compared, it was observed that the experimental group exhibited notable variations in the GIQLI score after 8 weeks, the HADS-D score after 8 weeks, and the PSQI score after 4 weeks when contrasted with the control group. These differences were found to be statistically significant. FD does not have an identified structural or biochemical cause, making it a functional gastrointestinal (GI) disorder that requires a tailored treatment approach. Our pilot randomized controlled trial (RCT) investigated the impact of meditation as adjuvant therapy for FD, revealing improvements in GI health, mental well-being, and sleep quality compared to standard treatment alone. The study recommends incorporating meditation into the management of FD and similar conditions, highlighting its holistic nature that addresses not only specific symptoms but also overall well-being. This study pioneers the examination of meditation as a complementary approach for FD, offering promising results in improving GIQLI, HADS, and PSQI scores and thus adding value to preexisting literature.

Erectile dysfunction (ED) refers to an inability to achieve or maintain a firm penile erection sufficient for satisfactory sexual intercourse. Insufficient, irregular sleep and sleep disorders adversely affect human health, including sexual function. Significant differences between biological rhythms (chronotypes) have been reported. In the present study we examine the effect of sleep quality and chronotype differences on ED patients and a control group. The study included 69 patients who presented with ED and 64 healthy controls. The respondents completed a sociodemographic data form, and disease severity in the ED group was measured using the International Index of Erectile Function (IIEF). The participants were further administered the Hospital Anxiety and Depression Scale (HADS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Morningness-Eveningness Questionnaire (MEQ), and the scale scores were compared statistically between the patient and control groups. There was no difference in the age, body mass index (BMI), alcohol use and smoking of the ED and healthy control groups, while the IIEF score was significantly lower in the ED group than in the control group. The PSQI subscale scores other than for sleep duration subscale, the PSQI global score and the HADS score were higher in the ED group than in the control group, while there was no difference between the groups in the MEQ and ISI scores. The IIEF score was correlated with the PSQI and HADS scores, and the PSQI score with the ISI and HADS scores. It would be useful to evaluate sleep quality in addition to anxiety and depression while evaluating patients with ED. Our study found no relationship between chronotype differences and ED.

Core stabilization training utilizes principles of motor learning to retrain control of the trunk muscles and lead to improvements in chronic non-specific low back pain (CNLBP).To compare the effects of biofeedback sensor and conventional physiotherapist (PT) feedback during core stabilization and activity training in patients with CNLBP.Thirty-eight patients with CNLBP were randomly assigned to Biofeedback (n = 19) or PT feedback (n = 19) groups. Patients continued 12 sessions of combined core stabilization and activity training. An auditory and tactile biofeedback was given using a validated tilt sensor integrated with an application in the Biofeedback group. An experienced PT provided verbal and tactile feedback to maintain the neutral position in the PT Feedback group. The outcomes were; disability (Revised Oswestry Disability Index-RODI), muscle activity (m.transversus abdominis and m.multifidus), pain (Visual Analog Scale-VAS), proprioception error of the trunk, patient beliefs (Fear Avoidance Beliefs Questionnaire-FABQ) and presence of depressive symptoms (Beck Depression Index-BDI), and quality of life (Short Form (SF)-36).The main effect of time were statistically significant on VAS, RODI, m.transversus abdominis and m.multifidus muscle activities, flexion, and extension proprioception error of the trunk, FABQ, BDI, and SF-36 scores in Biofeedback and PT feedback groups (p < 0.05 for all). The time X group interaction was significant on flexion and extension proprioception error of the trunk PT feedback group (consecutively; p = 0.004, p = 0.022).Biofeedback sensor or PT feedback during core stabilization training equally improves pain, disability, muscle activity, depressive symptoms, patient beliefs, and quality of life in patients with CNLBP.

The impact of hospitalization on sleep in late-life is underexplored. The current study examined patterns of sleep quality before, during, and following hospitalization, investigated predictors of sleep quality patterns, and examined predictors of classification discordance between two suggested clinical cutoffs used to demarcate poor/good sleep. This study included older adults (n = 163; mean age 79.7 ± 6.9 years, 31% female) undergoing inpatient post-acute rehabilitation. Upon admission to inpatient post-acute rehabilitation, patients completed the Pittsburgh Sleep Quality Index (PSQI) retrospectively regarding their sleep prior to hospitalization. They subsequently completed the PSQI at discharge, and 3 months, 6 months, 9 months, and 1 year post discharge. Patient demographic and clinical characteristics (pain, depression, cognition, comorbidity) were collected upon admission. Using latent class analysis methods, older adults could be classified into (1) Consistently Good Sleepers and (2) Chronically Poor Sleepers based on patterns of self-reported sleep quality pre-illness, during, and up to 1 year following inpatient rehabilitation. This pattern was maintained regardless of the clinical cutoff employed (> 5 or > 8). Logistic regression analyses indicated that higher pain and depressive symptoms were consistently associated with an increased likelihood of being classified as a chronic poor sleeper. While there was substantial classification discordance based on clinical cutoff employed, no significant predictors of this discordance emerged. Clinicians should exercise caution in assessing sleep quality in inpatient settings. Alterations in the cutoffs employed may result in discordant clinical classifications of older adults. Pain and depression warrant detailed considerations when working with older adults on inpatient units when poor sleep is a concern.

POS0031 THE PREVALENCE OF INFLAMMATORY BACK PAIN AND HLA-B27 IN A LARGE POPULATION-BASED COHORT IN THE NETHERLANDS