Low Back Pain Research Articles

Use of machine learning to identify prognostic variables for outcomes in chronic low back pain treatment: a retrospective analysis

ABSTRACT Objectives Most patients seen in physical therapy (PT) clinics for low back pain (LBP) are treated for chronic low back pain (CLBP), yet PT interventions suggest minimal effectiveness. The Cochrane Back Review Group proposed ‘Holy Grail’ questions, one being: ‘What are the most important (preventable) predictors of chronicity’ for patients with LBP? Subsequently, prognostic factors influencing outcomes for CLBP have been described, however results remain conflicting due to methodological weaknesses. Methods This retrospective observational cohort study examined prognostic risk factors for PT outcomes in CLBP treatment using a sub-type of AI. Bootstrap random forest supervised machine learning analysis was employed to identify the outcomes-associated variables. Results The top variables identified as predictive were: FOTO™ predicted functional status (FS) change score; FOTO™ predicted number of visits; initial FS score, age; history of jogging/walking, obesity, and previous treatments; provider education level; medication use; gender. Conclusion This article presents how AI can be used to predict risk prognostic factors in healthcare research. Improving predictive accuracy helps clinicians predict outcomes and determine most appropriate plans of care and may impact research attrition rates.

Work-Related Muscluskeletal Disorders and Work Ability Among Hospital Employees in Southeast of Iran

Background: The Work Ability Index (WAI) evaluates how well workers cope with the physical and mental demands of their jobs. Objectives: This study aims to explore how demographic factors and work-related musculoskeletal disorders (WMSDs) influence work ability among employees at the largest specialized hospital in southeast Iran. Methods: This cross-sectional study was conducted at the largest specialized hospital in Zahedan. A sample of 194 clinical staff and support personnel, including nurses, nursing assistants, patient transporters, and cleaning staff, were randomly selected through a stratified random sampling method. Work ability and musculoskeletal discomfort were assessed using the Persian versions of the WAI and Cornell Questionnaires. Quantitative data were presented as mean ± SD, while qualitative data were expressed as numbers and percentages. Pearson correlation, Kruskal-Wallis, Mann-Whitney U, and one- and multi-factor General Linear Models were used for data analysis in SPSS version 19. Results: Work ability decreased with age (P < 0.001). Significant associations were found between work ability and age, job category, education, and Body Mass Index (BMI) (P < 0.05). After adjusting for age, job, education, and BMI, lower back pain (P = 0.002), thigh pain (P = 0.004), and knee pain (P = 0.026) were significantly linked to work ability. There was a notable negative correlation between work ability and discomfort score (r = -0.337, P < 0.001), with nursing assistants reporting higher discomfort scores compared to nurses, cleaning staff, and patient transporters (P < 0.05). Conclusions: Our findings suggest a potential link between musculoskeletal disorders (MSDs) and work ability. Therefore, it is recommended to implement a program focused on identifying and addressing the risk factors associated with MSDs.

Fear of movement interacts with trunk mobility, and pain intensity to predict disability in patients with chronic low back pain: a classification and regression tree (CART) analysis.

Low back pain significantly impacts global health, particularly in low-income areas where primary care challenges are prevalent. Assessing both biophysical and psychological factors associated with low back pain-related disability is crucial for developing effective screening and management strategies. This study aimed to examine the association between fear of movement, trunk mobility, pain intensity, physical activity, and low back pain-related disability, and to identify key factors contributing to higher disability levels in patients with chronic low back pain. This cross-sectional study analyzed data from 381 chronic low back pain patients aged over 18, collected at a primary care ambulatory between 2015 and 2019. Variables measured included pain intensity, fear of movement, physical activity, trunk mobility, and disability. A Classification and Regression Tree approach was used to model disability predictors. Fear of movement was the main driver of high disability (OR = 17.3, 95%CI 8.9-33.7). Two profiles were particularly prone to higher disability: patients with high fear of movement (>47.5) and pain intensity > 1.5; and those with lower fear of movement but poor trunk mobility (>36.5 cm). Patients with better trunk mobility and low pain intensity (≤3.5) showed significantly less disability (OR = 0.06, 95%CI 0.02-0.17). The findings highlight the need for integrating better psychological and biophysical assessments in managing chronic low back pain. Understanding how fear of movement, trunk mobility, and pain interaction can improve screening accuracy and optimize care in resource-limited settings, using valid and feasible tools for these scenarios.

Thermal Annuloplasty for the Treatment of Discogenic Low Back Pain With a High-Intensity Zone After Full Endoscopic Discectomy

Thermal Annuloplasty for the Treatment of Discogenic Low Back Pain With a High-Intensity Zone After Full Endoscopic Discectomy

Shear wave elastography based analysis of changes in fascial and muscle stiffness in patients with chronic non-specific low back pain

BackgroundThe quantitative assessment of individual muscle and fascial stiffness in patients with low back pain remains a challenge. This study aimed to compare the stiffness of the thoracolumbar fascia (TLF), erector spinae (ES), and multifidus (MF) in patients with and without chronic non-specific low back pain (CNLBP) using shear wave elastography (SWE). It also sought to explore the relationship between muscle and fascial stiffness and the levels of pain and dysfunction in patients with CNLBP.MethodsIn this cross-sectional study, 30 patients with CNLBP (age 27.40 ± 4.57 years, 19 males, 11 females, BMI 22.96 ± 2.55 kg/m2) and 32 healthy controls (age 27.94 ± 4.94 years, 15 males, 17 females, BMI 22.52 ± 2.26 kg/m2) were enrolled. Stiffness of the TLF, ES, and MF was measured using SWE, and Young’s modulus values were recorded. The numeric rating scale (NRS) for quantifying pain intensity and the Oswestry Disability Index (ODI) scores were recorded for the case group to examine their correlations with the resilience index.ResultsThe CNLBP group exhibited significantly higher shear modulus values at the L4-5 bilateral TLF (left: p = 0.014, d = 0.64; right: p = 0.002, d = 0.86), ES (left: p = 0.013, d = 0.66; right: p = 0.027, d = 0.58), and MF (left: p = 0.009, d = 0.69; right: p = 0.002, d = 0.85) compared to the control group. Comparable findings were observed for the right ES (p = 0.026, d = 0.59) and left MF (p = 0.020, η2 = 0.09) at L1-2. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.57, p = 0.001; right: r = 0.65, p < 0.001) at L4-5 and the NRS scores. Moderate correlations were noted between the shear modulus of the ES (left: r = 0.42, p = 0.022; right: r = 0.48, p = 0.007) and MF (left: r = 0.50, p = 0.005; right: r = 0.42, p = 0.023) at L4-5 and the NRS scores. Additionally, the shear modulus of the MF (r = 0.50, p = 0.005) on the left side of L1-2 showed similar correlations. Strong correlations were observed between the shear modulus of the bilateral TLF (left: r = 0.60, p < 0.001; right: r = 0.58, p < 0.001) at L4-5 and the ODI scores. Moderate correlations were observed between the shear modulus of the right TLF (r = 0.43, p = 0.017), ES (r = 0.38, p = 0.037), and MF (r = 0.44, p = 0.015) at L1-2, as well as the bilateral MF (left: r = 0.46, p = 0.011; right: r = 0.45, p = 0.012) at L4-5, and the ODI scores. No significant correlations were found at other measurement sites.ConclusionIn patients with CNLBP, the stiffness of the lumbar fascia and muscles is generally higher than in individuals without LBP. However, this increase is not uniform across all lumbar regions, with the most significant changes observed in the L4-5 segments. In addition, higher stiffness may be associated with pain and dysfunction, primarily manifested in the TLF.

Early effectiveness of unilateral biportal endoscopy technique for migrated lumbar intervertebral disc herniation

To explore early effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of migrated lumbar intervertebral disc herniation. A retrospective analysis was conducted on 87 patients with migrated lumbar intervertebral disc herniation, who were treated with UBE technique between May 2021 and December 2022 and met the selection criteria. There were 55 males and 32 females, with an average age of 48.8 years (range, 29-74 years). The disease duration ranged from 2 to 23 months, with an average of 9.1 months. The surgical segments included 17 cases of L 3, 4, 32 cases of L 4, 5, and 38 cases of L 5, S 1. According to Lee's classification criteria, there were 12 cases of type 1, 17 cases of type 2, 37 cases of type 3, and 21 cases of type 4. The operation time, length of hospital stay, and complications were recorded. The visual analogue scale (VAS) score was used to assess the degree of low back and leg pain before operaion and at 3 days, 3 months, 6 months, and 12 months after operation. The Oswestry disability index (ODI) was used to evaluate the lumbar spine function. At last follow-up, the modified MacNab criteria was used to evaluate the effectiveness. According to the preoperative migrated intervertebral disc classification, the patients were allocated into groups Ⅰ to Ⅳ. The differences in VAS score and ODI were compared. All 87 patients successfully completed the operations. There was no nerve root injury, dural sac injury, or dural tear during operation. The operation time was (58.6±14.6) minutes and the length of hospital stay was (4.0±0.8) days. All incisions healed by first intention after operation. No symptomatic epidural hematoma occurred. All patients were followed up for 12 months. There were significant differences in VAS scores and ODI at each time point after operation when compared with those before operation ( P<0.05). There were significant differences in VAS score at 3 days after operation when compared with that at 3, 6, and 12 months after operation ( P<0.05). For ODI, except that there was no significant difference between 6 and 12 months after operation ( P>0.05), there were significant differences between other time points after operation ( P<0.05). At last follow-up, the effectiveness was rated as excellent in 66 cases, good in 13 cases, and fair in 8 cases according to the modified MacNab criteria, and the excellent and good rate was 90.8%. There was no intervertebral disc herniation recurred during follow-up period. There was no significant difference in VAS score and ODI among groups Ⅰ -Ⅳ before operation and at each time point after operation ( P>0.05). The UBE technique is safe and effective in the treatment of migrated lumbar intervertebral disc herniation, with a low complication rate and satisfactory early effectiveness.

Factors associated with pain-related functional interference in people with chronic low back pain enrolled in a physical exercise programme: the role of pain, sleep, and quality of life.

To identify the factors associated with the pain-related functional interference level in people with chronic low back pain. Cross-sectional. Chronic low back pain patients. Sociodemographic data, pain intensity, pain-related functional interference, physical functioning and fitness, sleep quality, anxiety and depression, social support, and health-related quality of life were recorded. Descriptive and bivariate analyses were performed. A linear regression model was carried out to identify the factors associated with the pain-related functional interference level. 99 participants were involved (mean age: 54.37 SD: 12.44; women: 67.7%). 37.4%, 27.3%, and 35.4% were classified into low, moderate, and high pain-related functional interference level groups, respectively. Higher pain-related functional interference was associated with higher pain intensity (β: 0.724; p = 0.026), worse sleep quality (β: 0.077; p = 0.012), worse quality of life (physical (β: -0.539; p < 0.001) and mental (β: -0.289; p < 0.001), and lower consumption of weak opioids (β: -3.408; p = 0.037). Beyond the pain experience and intensity among people with chronic low back pain, several biopsychosocial factors associated with this condition has been identified. Furthermore, higher pain intensity, worse sleep quality, worse quality of life, and weak opioids' consumption have been related to the pain-related functional interference of this population.

Effectiveness of Maximum Voluntary Contraction Using Surface Electromyography on Erector Spinae and Tensor Fascia Latae Muscle Along With Muscle Energy Technique in Chronic Non-Specific Low Back Pain

Background: Low Back Pain (LBP) one of the major health issues over the world. It affects quality of life and work absentness leads to disability. Non-specific Low Back Pain (NSLBP) does not have specified problem. In this type, muscle imbalance, distributed muscle strength, endurance, movement co-ordination impairment, poor posture might enhance the nociceptor stimuli.Muscle energy technique (MET) is an active manual technique focused over muscle stretching, strengthening, relaxing. Aims to restore normal joint mobility and reduce pain.Aim: To determine the effect of muscle energy technique in chronic non-specific low back pain.To study the effectiveness of muscle energy technique in subjects with chronic non-specific low back pain on pain, functional disability and Surface electromyography (SEMG) measures.Material and Method: A total of 40 subjects were included in the study. 20 subjects with CNSLBP were allocated in a group A. whereas group B was allocated with Core Muscle Strengthening exercises (CMSE) for three weeks. All the participants were clearly explained about the procedure and informed consent attained.In group A, MET was applied over four muscle groups namely quadratus Lumborum (QL), erector spinae (ES), iliopsoas, tensor fascia latae (TFL). SEMG study was done over the two muscles, ES and TFL. At rest period measurement was done after their maximum voluntary contraction was recorded. Results: Pre-post-test comparison was analysed by Wilcoxon’s matched pair test. Between group analysis done by Mann Whitney U test, the experimental groups exhibit VAS, ODI, SEMG-ES (Rt and Lt), TFL (t and Lt) shown significance at p value = 0.001. Conclusion: MET was effectively reducing functional disability, decreases pain, muscle strength improved in ES and TFL muscles of both sides evaluated through SEMG.

Working conditions, health status, and musculoskeletal disorders among hospital cleaning workers: a cross-sectional study in Turkey.

Cleaning workers face many workplace risk factors and may experience many health problems. In this context, this study aimed to evaluate the musculoskeletal disorders, the health status of hospital cleaning workers, and the working conditions and risk factors affecting the workplace environment. This cross-sectional study was conducted in a university hospital of Turkey. All the cleaning workers who have been working for ≥1 year were participants. The participants' socio-demographic and occupational characteristics, health complaints, workplace risk factors, occupational accidents, and ergonomic nonconformities were observed and questioned. Four hundred thirty-eight cleaning employees participated in the study. In the past year, 19.6% of participants had an occupational accident. Of those, 24.4% did not report it, and 30.2% were absent from work. No pre-employment examination was reported by 36.8% of the participants, and periodic medical examinations were never undergone by 98.4%. Low back pain was experienced by 42.0% of the participants, while 29.5% reported shoulder pain and 28.8% knee pain. While working, 83.1% of the participants bent frequently, 82.2% repeated the same movement, and 73.2% stood for a long time. Chemical substances were the most common workplace risk factors. There were significant differences according to age and gender in almost all musculoskeletal disorders. Gender differences were observed also in various health outcomes and occupational complaints. Repeated bending and prolonged standing were associated with hip/leg and foot/ankle pains; heavy lifting with low back, back, wrist/hand, and ankle/foot pains; and failure to the breaks with shoulder, knee and hip/leg pains. This research investigated the health issues and occupational safety challenges faced by hospital cleaning personnel. Specifically, it examined musculoskeletal disorders and work-related accidents, emphasizing gaps in regular health screenings for these workers. The findings underscore gender variations in these challenges and propose strategies to mitigate ergonomic risks encountered by cleaning staff. Med Pr Work Health Saf. 2024;75(5).

Global burden of low back pain and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

BackgroundThis study aimed to examine the evolving trends in the global burden of low back pain (LBP) from 1990 to 2021 and predicted disease burden until 2035.Materials and methodsLBP-related data were obtained from the Global Health Data Exchange (GHDx) query tool. All estimates and their 95% uncertainty intervals (UIs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool in Global Burden of Disease, Injury, and Risk Factor Study (GBD) 2021. Data processing and visualization were conducted using The R Programming Language software version 4.3.2 and Joinpoint 4.7.ResultsIn 2021, approximately 628.8 million people worldwide were affected by LBP, with approximately 266.9 million new incident cases and age-standardized incidence rate (ASIR) of 3176.6 per 100,000. Compared with 1990, although the ASIR and age-standardized disability-adjusted life years rate (ASDALYsR) decreased, absolute numbers increased significantly. Projections for 2035 reveal a continued decline in ASIR and ASDALYsR for LBP. The LBP burden varied by the sociodemographic index quintile and GBD region, with the highest ASIR and ASDALYsR observed in Central Europe and the greatest decrease in East Asia. Globally, women bear a higher burden of LBP than men, with middle-aged populations experiencing the heaviest burden. Occupational ergonomic factors, high body mass index, and smoking remain the primary risk factors for LBP, with occupational ergonomic factors contributing the most to the overall burden.ConclusionDespite a projected decline in incidence, the global burden of LBP persists, exhibiting significant regional and gender disparities. To mitigate its future burden, precise and effective prevention and control strategies targeting high-risk factors are imperative.

Physiotherapists’ knowledge, attitude and practice of clinical prediction rules in low-back pain

Abstract Background and aim Clinical prediction rules (CPRs) are mathematical tools that are intended to guide clinicians in clinical decision making or predict a future outcome, but they seem rather unknown, under-utilized, or avoided by clinicians. This study aimed to assess knowledge, attitude, and practice of CPRs in low-back pain (LBP) among physiotherapists. Methods A cross-sectional study involving 45 consenting specialist musculoskeletal physiotherapists from three public-funded teaching hospitals in Nigeria was carried out. An adapted validated questionnaire on facilitators and barriers to CPRs utilization, and a socio-demographic proforma were used to collect data. Descriptive and inferential statistics were employed to analyze data. Alpha level was set at p &lt; 0.05. Results Respondents were mostly males (71.1%), married (64.4%) and first-degree holders (55.6%). Twenty-eight (62.2%) of the respondents had above-average knowledge of CPRs in LBP. Rates for positive attitude towards, and utilization of CPRs were 37.8% and 15.6%. Knowledge and attitude about CPRs in LBP were not significantly influenced by socio-demographic factors (p &gt; 0.05). However, there was a significant association between the utilization of CPRs and years of experience (χ2 = 10.339 p = 0.016). Conclusion Most Nigerian physiotherapists had above-average knowledge, but a negative attitude and low utilization of CPRs in LBP. Clinicians’ years of clinical experience influence the usage of CPR. There is a need to incorporate training in CPRs into undergraduate and continuous professional development programmes.

About Distress in Chronic Pain Conditions: A Pre–Post Study on the Effectiveness of a Mindfulness-Based Intervention for Fibromyalgia and Low Back Pain Patients

Chronic pain (CP) affects about 30% of the global population and poses significant challenges to individuals and healthcare systems worldwide. The interactions between physiological, psychological, and social factors are crucial in the onset and development of CP conditions. This study aimed to evaluate the effectiveness of mindfulness-based intervention, examining its impact on perceived stress (PSS), depression and anxiety (BDI-II, PGWBI/DEP, SAS, STAI Y), sleep quality (PSQI), and mindfulness abilities (MAAS) in individuals with CP. Participants (N = 89, 84.3% female) underwent one of two diagnoses [fibromyalgia (FM) or low back pain (LBP)] and took part in an MBSR intervention. The mindfulness program proved effective in reducing PSQI scores (F = 11.97; p &lt; 0.01) over time, independently of the type of diagnosis. There was also a marginal increase in trait mindfulness as measured by MAAS (F = 3.25; p = 0.07) in both groups. A significant difference between the two groups was found for the effect on PSS: F (1,87) = 6.46; p &lt; 0.05. Mindfulness practice also reduced anxiety in FM and depressive symptoms in LBP, indicating a reduction in psychological distress among participants. Our findings suggest that mindfulness-based interventions may offer promising avenues for personalized pain management in clinical settings.

Percutaneous endoscopic lumbar discectomy versus open fenestration discectomy for lumbar disc herniation: a retrospective propensity score-matched study with more than 5 years of follow-up.

We compared the long-term outcomes of percutaneous endoscopic lumbar discectomy (PELD) with those of open fenestration discectomy (OFD) in treating lumbar disc herniation (LDH). 281 patients were included from January 2013 to December 2018, of whom 228 underwent PELD and 53 underwent OFD. General information of patients was collected and imbalances in covariates between groups were corrected using propensity score matching (PSM). Then, the clinical function scores, imaging data, and complications were compared. Among participants, 102 patients were successfully matched and were followed for 62-128 months. Compared to the OFD group, the PELD group indicated greater improvements in visual analog scale score of low back pain (VAS-BP), Japanese orthopedic association (JOA), and Oswestry disability index (ODI) at 7 days postoperatively and the last follow-up (P < 0.05). At 24 months postoperatively and the last follow-up, the disc height index (DHI), ratio of grays (RVG), and range of motion (ROM) were higher and the compass value was lower (P < 0.05) in the PELD group compared to the OFD group, suggesting that the PELD procedure better maintained the mobility and stability of the responsible segment after surgery. The recurrence rates between the PELD (9.80%) and OFD (7.84%) groups did not reveal statistical differences (P > 0.05). PELD and OFD both provide acceptable clinical outcomes for LDH. However, PELD is superior to OFD in terms of relieving low back pain, delaying disc degeneration, and maintaining segmental stability.

Pregnancy after amputation: A national survey of prosthetic and mobility outcomes in women with lived experience

Background: In pregnancy, women with limb loss or deficiency or lower extremity amputations (LEAs) may experience physiologic changes affecting mobility, prosthesis use, and/or pain. However, little is known about the pregnancy-related experiences of these women. Objective: The objective of this research was to characterize pregnancy-related experiences including complications, impact on prosthesis use, gait aid use, and mobility for women with LEAs. Study Design: A national, self-administered online survey. Data were analyzed using descriptive statistics. Thematic analyses were performed on open-ended questions. Participants were women with 1 or more LEA(s) who had been pregnant within the last 5 years and were recruited via social media, LEA clinics, and word of mouth. Results: Sixteen women from 4 Canadian provinces completed the survey describing 31 pregnancies. A total of 9 had acquired LEAs and 7 had congenital LEAs. All but 1 respondent had unilateral LEAs; most common level was transfemoral (38%). All wore a prosthesis daily and were K-level 4 ambulators. Five (31%) had to decrease or stop prosthesis use, and 6 (25%) required a gait aid or wheelchair during pregnancy. The most common pregnancy-associated complications were low back pain (64%), changes to limb size/prosthesis comfort (64%), reduced balance (44%), falls (38%), and postpartum depression (25%). Conclusion: This survey is the first to describe the many unique challenges women with LEAs may experience in pregnancy and highlights important information for women with LEAs, their health care providers, their rehabilitation team, and avenues for future research.

Comparison of results among UBE-TLIF, MIS-TLIF and open TLIF for Meyerding grade I lumbar spondylolisthesis: a retrospective study.

The unilateral biportal endoscopic (UBE) technique has garnered significant attention for its little paraspinal iatrogenic damage, expedited recovery, and low complication rates. This method is also applicable to open transforaminal lumbar interbody fusion (TLIF). Therefore, this study aimed to conduct a comparative analysis of the outcomes associated with unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and TLIF for Meyerding grade I lumbar spondylolisthesis. The study examined the outcomes of 79 patients with Meyerding grade I lumbar spondylolisthesis who underwent single-level intervertebral fusion. Clinical assessments included the measurement of pain levels using the Visual Analogue Scale (VAS) for low back and leg pain, the Oswestry Disability Index (ODI), surgical data, and demographic information. Imaging techniques were utilized to evaluate the fusion rate. The VAS-Back demonstrated a statistically significant improvement in Group UBE-TLIF compared to the other groups at the one-week postoperative evaluation (p < .05). Additionally, the UBE-TLIF group exhibited a significantly longer total operative time compared to the other groups (p < .05). However, it was noted that the Postop Hemovac drain were significantly greater in the MIS-TLIF and TLIF groups compared to the UBE-TLIF group (p < .05). The present research demonstrated the effectiveness of UBE-TLIF, MIS-TLIF, and TLIF as surgical approaches for treating Meyerding grade I lumbar spondylolisthesis. Among these methods, UBE-TLIF demonstrated a reduction in Postop Hemovac drain, and an increase in operative duration.

Meta-Analysis of the Efficacy of Rapid Rehabilitation Surgical Nursing in Lumbar Disc Herniation

Background: Lumbar disc herniation (LDH) is a common cause of lower back pain and radiculopathy. In recent years, the enhanced recovery after surgery (ERAS) concept has been increasingly applied in orthopedics and gastrointestinal surgery. Purpose: To investigate the effect of using rapid rehabilitation surgical care for lumbar disc herniation by meta-analysis. Data source: Google Scholar, PubMed Medical, Cochrane and Embase databases were used for the analysis. Research selection: An initial search yielded a total of 322 relevant articles. Duplicate pieces of literature were screened using Endnote. In addition, non-randomized controlled trials and studies with a sample size of less than 30 were excluded. A total of seven papers were included in this study. Main outcomes: The Rapid Rehabilitation Surgical Nursing (RRSN) group showed significantly higher patient satisfaction (RR = 1.24; 95% CI: 1.06, 1.26; p &lt; 0.01) and self-assessed health (Total MD = 5.67; 95% CI: 4.27, 7.06; p &lt; 0.01) compared to the Normal Nursing (NN) group. Pain levels (MD = −0.66; 95% CI: −0.97, −0.36; p &lt; 0.01), disability levels (MD = −18.64; 95% CI: −32.53, −4.76; p &lt; 0.01), anxiety risk (SAS-MD = −4.33; 95% CI: −6.23, −2.44; p &lt; 0.01), and depression risk (SDS-MD = −4.29; 95% CI: −7.50, −1.07; p &lt; 0.01) were significantly lower in the RRSN group compared to the NN group. According to the GRADE classification, the certainty for patient satisfaction is high, while the certainty for post-care pain, functional capacity, risk of psychological disorders, and self-assessed health status is moderate. Conclusions: Rapid recovery surgical nursing can significantly improve postoperative recovery of lumbar disc herniation, increase patient satisfaction, reduce the risk of psychological disorders, improve lumbar function, and alleviate patient pain.

Melatonin attenuates degenerative disc degression by downregulating DLX5 via the TGF/Smad2/3 pathway in nucleus pulposus cells.

Intervertebral disc degeneration (IVDD) is the leading cause of low back pain, and apoptosis plays a key role in its pathogenesis. Distal-less homeobox 5 (Dlx5) has been reported to induce cell apoptosis. Melatonin, as a powerful antiapoptotic agent, has been widely reported. This study aimed to investigate the role of DLX5 in the pathogenesis of IVDD and the potential therapeutic role of melatonin in targeting DLX5 in IVDD. Western blotting, RT-qPCR, immunohistochemistry, si-DLX5, Ex-DLX5, flow cytometry, and immunofluorescence were used to examine the regulatory effect of DLX5 on apoptosis. Therapeutic efficacy was assessed by the intraperitoneal injection of melatonin into IVDD mice. The expression level of DLX5 is significantly increased in IVDD, and the expression levels were positively correlated with the grade of IVDD. DLX5 was significantly upregulated in TNF-α-induced degenerative NP cells. Degenerative NP cells transfected with si-DLX5 exhibited significantly less apoptosis than control cells. Melatonin significantly alleviated IVDD in surgically induced IVDD model mice. The results revealed that the expression of DLX5 was positively correlated with the severity of IVDD and that melatonin ameliorated DLX5-induced apoptosis and extracellular matrix imbalance by inhibiting the TGF-β/Smad signaling pathway. This study may provide therapeutic strategies to alleviate inflammation-induced apoptosis IVDD-associated inflammation-induced apoptosis. DLX5 plays an important role in IVDD progression by promoting apoptosis, and melatonin represents a promising therapeutic strategy for alleviating IVDD-associated inflammation and apoptosis.

Evaluation of V-type titanium cable internal fixation for the treatment of young adult fifth lumbar spondylolysis: technical notes and a retrospective clinical study.

Various strategies, each with its own set of limitations, are available for managing lumbar spondylolysis. In response, our department has developed an innovative solution: a V-shaped titanium cable integrated with a pedicle screw internal fixation system specifically designed for lumbar spondylolysis in young adults. The objective of this study was to thoroughly investigate the long-term efficacy of V-type titanium cable internal fixation for the management of spondylolysis, especially in young adults. Twenty-one patients with fifth lumbar spondylolysis were treated using V-shaped titanium cables and pedicle screw internal fixation at the General Hospital Xinjiang Military Command. The duration of low back pain before surgery was 6 ~ 48 (15.85 ± 11.57) months. The Medtronic (S7) navigation system was used during surgery to guide the placement of pedicle screws, aiming to avoid damaging the L4-5 facet joint by positioning the screws lower and further to the side. Intraoperative indices (operative time and intraoperative blood loss) were recorded. The visual analog scale (VAS), Oswestry Disability Index (ODI), pelvic incidence (PI), and intraoperative imaging measurements of screw accuracy were meticulously recorded and assessed in a comprehensive manner. This thorough evaluation was conducted both intraoperatively and throughout the follow-up period, which lasted for at least one year.The Macnab efficacy criteria were used to assess postoperative outcomes during the final follow-up period. All patients successfully completed the 1-year follow-up on time. Two patients experienced postoperative wound liquefaction and successfully recovered after undergoing dressing changes. The average duration of the surgical procedure was 113.09 ± 6.97min, and an intraoperative blood loss of 50.47 ± 21.32 millilitres was observed. Significant differences were noted in visual analog scale (VAS) scores before and after surgery at various time intervals, indicating improvement with the progression of rehabilitation exercises. No significant changes were found in the pelvic incidence (PI), and there were no notable differences between the preoperative and postoperative periods. No loosening, breakage, or failure of the internal fixation was found during the long-term follow-up. Furthermore, there were no serious complications, such as infection or vascular or nerve injuries. occurred during the procedure. A patient who presented with a considerable cryptic fissure of sacrum 1 experienced dural injury during the surgical procedure. Intraoperatively, dural sutures were skillfully applied, and the adjacent muscles were fortified. Remarkably, the patient achieved successful healing in a single stage. On the first day postsurgery, a gradual improvement in mobility was noted. The use of a V-shaped titanium cable in conjunction with a pedicle screw internal fixation system for the management of fifth lumbar spondylolysis in young individuals is characterized by its ease of execution and ability to yield favorable outcomes. This approach relies on the prerequisite that patients with minimal intervertebral disc injury or mild lumbar spondylolisthesis demonstrate high overall success rates but experience low failure rates associated with internal fixation. Most significantly, this technique involves segmental internal fixation, which safeguards the functional spinal unit (FSU).

IMPACTOS DA FISIOTERAPIA NA REDUÇÃO DAS DORES MUSCULOESQUELÉTICAS EM MULHERES ADULTAS COM LOMBALGIA, UMA REVISÃO DE LITERATURA

Introduction: Low back pain is defined as one of the leading causes of disability in adult women, primarily affecting functionality and well-being. Physiotherapy aims to provide comfort and improve quality of life through strategies that seek to minimize the discomfort caused by this condition. This paper analyzes and presents physiotherapy techniques for reducing musculoskeletal pain in adult women with low back pain. Objective: The objective was to identify the most effective approaches for symptom relief and functional rehabilitation of these patients. Methodology: The structure is a literature review, composed of articles published between 2018 and 2024 from databases such as PubMed, BVS, Lilacs, and Scielo. Descriptors in both Portuguese and English were used according to DeCS/MeSH (Health Sciences Descriptors). Keywords were applied with filters for language (Portuguese and English), publication year (2018-2024), article type (clinical trial, observational study), and full-text availability. Results: The search highlighted the results of physiotherapy, particularly through specific stability exercises and pain neuroscience education. These interventions significantly reduced pain and improved the quality of life in women with low back pain, as the overall prevalence of low back pain was notably higher in women compared to men. Discussion: Various techniques were examined to evaluate the main evidence on the impacts of physiotherapy in reducing musculoskeletal pain in adult women with low back pain. There was some complexity in finding evidence that specifically addressed the topic. Conclusion: Physiotherapists are trained to rehabilitate and prevent, playing a crucial role in pain reduction, functional improvement, and improving lives. They hold an essential and indispensable role in this context.

Redesign of work facilities at the tofu pressing station with a participatory ergonomic approach

Tahu Palda is a small and medium-sized micro business in the food industry that produces tofu. This factory has been producing tofu since 2005, located in North Aceh. The workers in this tofu usually five workers, with an average of 7 working hours per day. Based on the observations at several workstations, initial data indicate that the dominant work posture is standing, bending, and lifting heavy loads such as a 20 kg weight for pressing and lifting a mold holder with a 15 kg load. This is done continuously for 7 working hours each day. Based on the results of the distribution of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), it was found that workers at the station experience complaints such as back pain, lower back pain, and upper arm pain due to the high frequency of lifting heavy loads. If this continues to be neglected, it can lead to work-related diseases such as musculoskeletal disorders. The assessment of workers' posture using the Rapid Entire Body Assessment (REBA) method shows that the score obtained for the job of pouring soybean paste is 7, which means a moderate risk, the job of lifting the press weight is 5, which means a moderate risk, and the job of flipping molds has a score of 10, which falls into the high-risk category and needs improvement. Improvements were made using a participatory ergonomics approach, resulting in the decision to redesign the tofu press tool to fit the workers' body anthropometry. The anthropometric calculations for the height range of the press support tool and cutting tool are 141.1 cm, the press support range is 68.78 cm, the width of the press tool is 49.4 cm, the height of the tray is 4.54 cm, and the height of the tray holder is 103.85 cm.