Morris Disability Questionnaire Research Articles

Effects of Gluteal Muscle Strengthening Exercise-Based Core Stabilization Training on Pain and Quality of Life in Patients with Chronic Low Back Pain

Background: The World Health Organization reports that back pain is a major cause of disorder worldwide. It is the most common musculoskeletal disorder with limited pain, muscle tension, and stiffness, and 70–80% of all individuals experience it once in their lifetime, with higher prevalence in women than in men. This study aimed to investigate the effects of gluteal muscle strengthening exercise- based core stabilization training (GSE-based CST) on pain, function, fear-avoidance patterns, and quality of life in patients with chronic back pain. Methods: This study included 34 patients with non-specific chronic low back pain. Seventeen individuals each were included in GSE-based CST and control groups. The GSE-based CST group performed GSE and CST for 15 min, three times a week for four weeks, and the control group performed CST for 30 min a day, three times a week for four weeks. The numeric pain rating scale was used to evaluate pain before and after treatment, Roland–Morris disability questionnaire was used to evaluate function, fear-avoidance beliefs questionnaire was used to evaluate fear-avoidance patterns, and quality of life was measured using the short form-36. Results: In this study, pain, function, and fear-avoidance pattern decreased significantly in both groups (All p < 0.05). During the evaluation of quality of life, both groups showed significant increase in physical and mental factors (p < 0.05). There were significant differences in pain and quality of life (p < 0.05) between the GSE-based CST and control groups. Conclusions: Therefore, GSE-based CST can be used as a basis for effective intervention to enhance pain, function, fear-avoidance patterns, and quality of life, emphasizing the need for gluteal muscle strengthening exercises in patients with non-specific chronic back pain in the future.

Unilateral biportal endoscopy vs. open decompression for lumbar epidural lipomatosis-cohort study using a prospective registry.

This study aimed to compare the outcomes of unilateral biportal endoscopy, unilateral laminectomy bilateral decompression (UBE-ULBD), and open lumbar decompression (OLD) in patients with lumbar epidural lipomatosis (LEL). This prospective observational study was conducted from March 2019 to May 2022 and encompassed 33 patients with LEL who underwent lumbar decompression. The study included 15 cases of UBE-ULBD decompression and 18 cases of open decompression, which were followed up for 1 year. The baseline characteristics, initial clinical manifestations, and surgical details [including estimated blood loss (EBL) and preoperative complications] of all patients were recorded. Radiographic evaluation included the cross-sectional area (CSA) of the thecal sac and paraspinal muscles on MRI. Clinical results were analyzed using the Short Form-36 Score (SF-36), the Numeric Pain Rating Scale (NRS) for lumbar and leg pain, creatine kinase, the Roland and Morris Disability Questionnaire (RMDQ), and the Oswestry Disability Index (ODI). The dural sac CSA increased considerably at the 1-year postoperative follow-up in both groups (p < 0.001). The operative duration in the OLD group (48.2 ± 7.2 min) was shorter than that in the UBE-ULBD group (67.7 ± 6.3 min, p < 0.001). The OLD group (97.2 ± 19.8 mL) was associated with more EBL than the UBE-ULBD group (40.6 ± 13.6 mL, p < 0.001). The duration of hospitalization in the OLD group (5.4 ± 1.3 days) was significantly longer compared with the UBE-ULBD group (3.5 ± 1.2 days, p < 0.01). The SF-36, NRS, RMDQ, and ODI scores improved in both groups postoperatively (p < 0.001). Serum creatine kinase values in the UBE-ULBD group (101.7 ± 15.5) were significantly lower than those in the OLD group (330.8 ± 28.1 U/L) 1 day after surgery (p < 0.001). The degree of paraspinal muscle atrophy in the UBE-ULBD group (4.81 ± 1.94) was significantly lower than that in the OLD group (12.15 ± 6.99) at 1 year (p < 0.001). UBE-ULBD and OLD demonstrated comparable clinical outcomes in treating LEL. However, UBE-ULBD surgery was associated with shorter hospital stays, lower rates of incision infection, lighter paravertebral muscle injury, and lower EBL than OLD surgery. Consequently, UBE-ULBD can be recommended in patients with LEL if conservative treatment fails.

Long-term impact of self-compassion training with core stability exercise on patients with nonspecific chronic low back pain: A randomized controlled trial

ObjectiveTo compare the long-term effectiveness of self-compassion therapy (SCT) combined with core stability exercise (CSE) versus CSE alone in managing nonspecific chronic low back pain (NCLBP). MethodsThe combined group received SCT and CSE, while the exercise group only received CSE. Treatment was administered once weekly for four weeks, followed by one year of follow-up. The primary outcomes were changes in functional limitations (measured by Roland and Morris Disability Questionnaire scores[RMDQ]) and self-reported back pain (measured by the Numeric Pain Rating Scale[NRS]) at 52 weeks, with assessments also conducted at 2, 4, and 16 weeks. Results52 (83.9%) completed the follow-up assessments and were included in the analysis (42 women [80.8%]; mean [SD] age,35.3 [10.0] years). In the combined group, the baseline mean (SD) RMDQ score was 9.3 (4.1),5.7 (5.8) at 2 weeks, 3.8 (3.4) at 4 weeks, 3.8 (3.7) at 16 weeks, and 2.4 (2.7) at 52 weeks. For the exercise group, the RMDQ scores were 8.2 (3.3) at baseline, 6.2 (4.2) at 2 weeks, 5.5 (4.7) at 4 weeks, 4.4 (4.5) at 16 weeks, and 5.2 (5.6) at 52 weeks. The estimated mean difference between the groups at 52 weeks was −3.356 points (95% CI, −5.835 to −0.878; P = 0.009), favoring the combined group. NRS scores showed similar changes. ConclusionThe addition of self-compassion therapy enhances the long-term efficacy of core stability training for NCLBP (Preregistered at chictr.org.cn:ChiCTR2100042810).

Short-Term Clinical and Radiographic Evaluation of Patients Treated With Expandable and Static Interbody Spacers Following Lumbar Lateral Interbody Fusion

ObjectiveThe goal of this study was to evaluate, using computed tomography (CT) and magnetic resonance imaging (MRI), patients who underwent oblique lateral interbody fusion (OLIF) using either expandable or static interbody spacers. MethodsThirty-five patients with degenerative disc disease were surgically treated with one-level OLIF and were followed up for more than six months. The Static group consisted of 22 patients, and 13 patients were in the Expandable group. Intraoperative findings included operative time (min), blood loss (ml), and cage size.Low back pain, leg pain, and leg numbness were measured using the Japanese Orthopedic Association score, visual analogue score, and the Roland–Morris Disability Questionnaire. Radiological evaluation using CT and MRI allowed measurement of cage subsidence, cross-sectional area (CSA) of the dural sac, disc height, segmental lordosis, foraminal height, and foraminal CSA preoperatively and six months postoperatively. ResultsThe Expandable group had significantly larger cage height and lordosis than the Static group (p < 0.05). The Expandable group also had greater dural sac area expansion and enlargement of the intervertebral foramen, as well as better correction of vertebral body slip (p < 0.05). Cage subsidence was significantly lower in the Expandable group (p < 0.05). JOA score and VAS for leg numbness were significantly better in the Expandable group (p < 0.05). ConclusionsCompared with static spacers, expandable spacers significantly enlarged the dural sac area, corrected vertebral body slippage, expanded the intervertebral foramen, and achieved good indirect decompression while reducing cage subsidence, resulting in improvement in clinical symptoms.

Efficacy of Individualized Homeopathic Medicines in the Treatment of Sciatica Pain: Double-Blind, Randomized, Placebo-Controlled Trial.

Objectives: Sciatica is a debilitating condition that causes pain in its distribution or in the lumbosacral nerve root that is connected to it. Although there are claims that homeopathy can reduce sciatica pain, systematic scientific proof is currently lacking. The objective of the trial was to determine whether individualized homeopathic medicines (IHMs) were as effective as identical-looking placebos in treating sciatica pain. Design: This is a double-blind, randomized (1:1), two parallel arms, placebo-controlled trial. Setting: The study was conducted at Mahesh Bhattacharyya Homoeopathic Medical College and Hospital, Howrah, West Bengal, India. Subjects: Sixty participants with sciatica pain were included in this study. Interventions: Verum (n = 30; IHMs plus concomitant care) versus control (n = 30; placebos plus concomitant care). Outcome measures: Primary-Sciatica Bothersome Index (SBI) and Sciatica Frequency Index (SFI) scores and secondary-Roland Morris Pain and Disability Questionnaire (RMPDQ), Short Form McGill Pain Questionnaire (SF-MPQ), and Oswestry Low Back Pain Questionnaire (OLBPQ) scores: all of them were measured at baseline, and every month, up to 3 months. Results: Intention-to-treat sample (n = 60) was analyzed. Group differences were examined by two-way (split-half) repeated measure analysis of variance, primarily accounting for between groups and time interactions, and additionally, by unpaired t tests comparing the estimates obtained individually every month. The level of significance was set at p < 0.025 and <0.05 two tailed for the primary and secondary outcomes, respectively. Group differences could not achieve significance in SBI (p = 0.044), SFI (p = 0.080), and RMPDQ scores (p = 0.134), but were significant for SF-MPQ (p = 0.007) and OLBPQ (p = 0.036). Gnaphalium polycephalum (n = 6; 10%) was the most frequently prescribed medicine. No harm, serious adverse events, or intercurrent illnesses were recorded in either of the groups. Conclusions: The primary outcome failed to demonstrate evidently that homeopathy was effective beyond placebo, and the trial remained inconclusive. Independent replications are warranted to confirm the findings. Clinical Trial Registration Number: CTRI/2020/10/028617.

THE EFFECT OF LUMBAR STABILIZATION EXERCISES ON CHRONIC LOW BACK PAIN PATIENTS

Objective&#x0D; The aim of this study is to investigate the effect&#x0D; of lumbar stabilization exercises (LSE) on pain,&#x0D; functional capacity, quality of life, and balance in&#x0D; patients with chronic low back pain (CLBP), and also&#x0D; to evaluate the effect on the cross-sectional area of&#x0D; the lumbar multifidus muscle.&#x0D; Material and Method&#x0D; Sixty-six patients with CLBP were enrolled,&#x0D; randomized, and divided into two groups. LSE,&#x0D; transcutaneous electrical nerve stimulation (TENS),&#x0D; and hot pack treatments were performed in Group&#x0D; 1 (n=28). In Group 2 (n=37), TENS and hot pack&#x0D; treatments were performed only. Pre and 8-week&#x0D; post-treatment assessments were made. Visual&#x0D; Analog Scale (VAS) was used to evaluate pain.&#x0D; Modified Oswestry Disability Index (ODI) and Roland&#x0D; Morris Disability Questionnaire (RMDQ) were used&#x0D; to evaluate the functional disability. Short Form-36&#x0D; (SF-36) was used to measure the quality of life. In&#x0D; the assessment of balance, a Tetrax® posturography&#x0D; device (Sunlight Medical Ltd, Israel) was used and fall&#x0D; index (FI) was calculated. The cross-sectional area of&#x0D; multifidus muscles was measured by ultrasonography.&#x0D; Results&#x0D; Significant improvements regarding the crosssectional&#x0D; area of multifidus musclesand subparameters&#x0D; of SF-36 named physical role, pain,&#x0D; mental health, and energy/vitality were determined in&#x0D; Group 1 compared to Group 2 (p˂0.05). No significant&#x0D; difference was present between the groups regarding&#x0D; FI, VAS score, RMDQ, ODI, and balance.&#x0D; Conclusion&#x0D; Lumbar stabilization exercises in patients with chronic&#x0D; low back pain multifidus positively affects crosssectional&#x0D; area and quality of life. For our sample,&#x0D; the addition of lumbar stabilization exercises to&#x0D; the conventional physical therapy program does&#x0D; not provides an additional contribution in terms of&#x0D; balance, pain and disability.

Structural and Criterion Validity of a New 6-item Roland–Morris Disability Questionnaire (RMDQ-6) on Patients with Chronic Lower Back Pain Receiving Integrative Medicine

Background: Lower back pain (LBP) is a leading cause of disability worldwide. The Roland–Morris Disability Questionnaire (RMDQ) has been widely used to assess functional impairment in patients with LBP. However, its length and redundancy calls for a more concise and optimized version.Methods: We conducted a secondary analysis of data from two randomized controlled trials comparing pharmacopuncture and physical therapy for chronic LBP. We focused on 132 patients with moderate-to-severe symptoms and analyzed their baseline data to evaluate the structural validity of the RMDQ. We used R packages lavaan and semPlot for confirmatory factor analysis (CFA). Model fit were assessed through various indices, including comparative fit index, Tucker–Lewis index, root mean square error of approximation, and standardized root mean squared residual.Results: A total of 18 items were ultimately removed to produce a streamlined 6-item structure. Our model met the fit index criteria, yielding a one-domain, 6-item RMDQ structure. While the relative indices fell slightly short of the ideal values, the RMDQ-6 derived through CFA correlated well with the original version.Conclusion: This study developed a more concise version of RMDQ through CFA to optimize its structural configuration. This concise instrument can be proposed as an efficient tool to assess the functionality of patients with LBP.

A trial-based economic evaluation of the CaFaSpA referral strategy for axial spondyloarthritis

Objective To assess the cost–utility from healthcare and societal perspectives of the digital CaFaSpA referral strategy (CS) for axial spondyloarthritis (axSpA) in primary care patients with chronic low back pain (CLBP). Method A cluster randomized controlled trial was performed in the Netherlands. General practice units were randomized into CS or usual care (UC). Economic evaluation was performed from the healthcare and societal perspectives within a 12-month time horizon. Outcome measures encompassed disability [Roland–Morris Disability Questionnaire (RMDQ)] and health-related quality of life (EQ-5D-3L). Direct medical (iMTA Medical Consumption Questionnaire) and indirect costs (iMTA Productivity Cost Questionnaire), including productivity loss, were evaluated. Incremental cost–utility ratios (ICURs) were calculated. Results The study included 90 GP clusters with 563 patients (CS: n = 260; UC: n = 303) (mean ± sd age 36.3 ± 7.5 years; 66% female). After 12 months, no minimal important differences in outcomes were observed for RMDQ (−0.21, 95%CI −1.52 to 1.13) or EQ-5D (−0.02, 95%CI −0.08 to 0.05). However, total costs were significantly lower in the CS group owing to lower productivity loss costs. The ICUR for RMDQ was €18,059 per point decrease and €220,457 per quality-adjusted life year increase. Conclusions Digital referral did not decrease the overall healthcare status of patients after 1 year of follow-up and appears to be more cost-effective than UC. Therefore, CS can be used as an appropriate primary care referral model for CLBP patients at risk for axSpA. This will accelerate timely provision of care by the right caregiver.

Kinesiotherapy in chronic back pain and combined tension type headache

Kinesiotherapy is eff ective in the treatment of chronic nonspecific back pain (CNBP), but its eff ectiveness in tensiontype headache (TTH) is unclear. The effectiveness of kinesiotherapy in patients with CNBP and comorbid TTH has been little studied.The aim of the study was to evaluate the effectiveness of kinesiotherapy in patients with CNBS and comorbid TTH. Patients and methods. 52 patients (22 men and 30 women, mean age 32.4 ± 7.5 years) with CNBP and combined TTH were included in the study. All patients received standard treatment, of which 28 patients received kinesiotherapy (Group 1) and 24 patients were included in the comparison group (Group 2). All patients used pain diaries. All patients were tested by using the Beck Anxiety Inventory, the Beck’s Depression Inventory, the Pain Catastrophization Scale, the Kinesiophobia Scale, the Oswestry Disability Index, the Roland–Morris Disability Questionnaire, the Headache Impact Test 6, numerical pain rating scale before treatment and 3, 6 months after treatment. Clinical effcacy was assessed by reducing the frequency and intensity of headache (by ≥ 50%), back pain (by ≥ 30%), and by increasing functional activity during the day (by ≥ 30%).Results. At 6 months follow-up signifiantly more patients in group 1 than in group 2 achieved a clinical effect on TTH and CNBP: 78.5% (n = 22) compared to 41.7% (n = 10); OR (95% CI) = 1.99. In 9 patients (32%) of group 1, a complete remission of TTH and CNBP was noted, in group 2 there were no such patients. At 6 months follow-up group 1 showed a significant improvement (p &lt; 0.05) in comparison with group 2 in terms of functional activity and emotional state.Conclusion. Kinesiotherapy for CNBP and combined TTH is effective both for back pain and headache. It increases functional activity and improves the emotional state of patients.

An Assessment of the Longitudinal Construct Validity of the Pain Behavioral Scale (PaBS) in a Saudi Population with Chronic Low Back Pain: A Preliminary Study.

Background: The Pain Behavioral Scale (PaBS) measures the presence and severity of pain behavior. We examine the longitudinal construct validity of the PaBS using convergent and known-groups approaches on a population of 23 participants with chronic lower back pain (LBP) undergoing routine physiotherapy care and pain neuroscience education. Methods: Participants who satisfied study inclusion and exclusion criteria were recruited from patients who attended two testing sessions at physiotherapy clinics in Saudi Arabia. Participant pain behavior was initially measured using the PaBS scale; participants performed standardized physical tests (e.g., repeated trunk flexion) and provided baseline demographic, clinical data, and self-reported measurements using the Modified Roland and Morris disability questionnaire (MODI), fear-avoidance questionnaire (FABQ), and pain catastrophizing scale (PCS). In subsequent visits, a physiotherapist provided usual care to participants, and weekly sessions were established for online pain-neuroscience education. During week six, participants repeated the same questionnaires and physical performance tests with the PaBS. Paired t-tests are used to compare changes in health characteristics from baseline responses to those in week six. Correlations between changes in PaBS from baseline to week six, with changes in outcome measures (i.e., disability, pain intensity, fear-avoidance beliefs, catastrophizing), were determined. To assess known-group validity, we also used a general linear model. Results: A total of 23 participants completed the PNE and follow-up data collection. The mean change from baseline in the PaBS score was statistically significant, as were changes in MODI, FABQ, and PCS. Almost 70% of participants improved their PaBS scores over the six-week period, with PaBS scores of almost 40% of them improving by three units or more. The change in PaBS score correlated significantly with changes in the PCS-rumination subscale, supporting a proposed approach to estimate convergent validity (r = 0.44, 95% CI = 0.04-0.72, p = 0.035). Conclusions: The mean change from baseline in the PaBS score is statistically significant, as are changes in MODI, FABQ, and PCS, supporting its convergent validity. According to our STarT Back groups, the medium to low-risk group had a lower PaBS score, and high-risk group had a higher PaBS score, indicating that PaBS use in clinical assessment may identify people according to pain-behavior severity, or those at increased risk of developing disability.

The influence of comorbidities on outcomes for older people with back pain: BACE-D cohort study

BackgroundComorbidities are common in older people with back pain but little is known about the influence of comorbidities on outcomes. ObjectivesTo explore the influence of the most prevalent comorbidities, and the number of comorbidities, on short (at 3 months) and long-term (at 12 months) outcomes of back pain in older people. MethodsWe analyzed data from the ‘Back Complaints in the Elders’ Dutch study cohort (BACE-D) and included participants aged >55 years. We used the modified Self-Administered Comorbidities Questionnaire (SCQ), the Numeric Rating Scale (NRS) and the Roland–Morris Disability Questionnaire (RMDQ) to assess the number of comorbidities, pain intensity and back-related physical functioning, respectively. We conducted separate linear regression models to analyze the association between comorbidities and outcomes including potential confounders of age, sex, body mass index, smoking and alcoholic drinking status, back pain history, and baseline NRS and RMDQ scores. ResultsOur study included 669 participants with a mean age of 66.5 (SD 7.7) years of whom 394 were female. More comorbidities were positively associated with higher pain intensity (3-month regression coefficient (β) =0.27, 95% CI 0.14–0.39; 12-month β = 0.31, 95% CI 0.17–0.45) and worse physical functioning (3-month β = 0.54, 95% CI 0.31–0.77; 12-month β = 0.64, 95% CI 0.37–0.92). Four of the 5 commonest comorbidities were musculoskeletal problems. Older participants with musculoskeletal comorbidities had higher pain intensity (3-month β = 0.89 95% CI 0.41–1.37; 12-month β = 1.17, 95% CI 0.65–1.69), and worse physical functioning (3-month β = 1.61, 95% CI 0.71–2.52; 12-month β = 1.85, 95% CI 0.82–2.89, P-value < 0.001) compared to participants without musculoskeletal comorbidities. ConclusionsMore comorbidities are associated with worse back pain outcomes in older adults. Participants with musculoskeletal comorbidities had worse back pain outcomes than those without.

CAUDAL BLOCK AS A TREATMENT MODALITY TO AVOID LUMBAR SPINE SURGERY IN PATIENTS WITH CHRONIC BACK PAIN

Introduction: Chronic Lower back pain is the most common cause of functional disability in an adult due to prolonged sitting, ageing society, obesity &amp; sedentary lifestyle, the number of Chronic Lower back pain patients can be expected to increase in the coming decades. Caudal Pain Block is one of the procedures to avoid lumbar spine surgery in patients with chronic low back pain. Main aim of this study is to analyse weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain. Aims And Objectives: To find out that weather the effect of caudal pain block can avoid lumbar spinal surgery in patients with chronic low back pain.To review the literature. Material and Methods: A prospective study was done on 55 patients with chronic low back pain who were given caudal pain block and followed up at 1,2, 3, and 6 months and outcomes measured using visual analogue scale and The Roland–Morris Disability Questionnaire. Observations: Caudal pain block was given in 55 patients, 51 patients got relieved of their pain and were able to avoid spine surgery and 4 out of 55 patients went for the spine surgery despite given caudal pain block. Results:According to VAS score 12 patients had excellent results, 21 had good results, 18 had fair and 4 had poor results. According to Roland–Morris Disability Questionnaire - 10 patients had excellent results, 20 patients had good results, 21 had fair results and 4 had poor results. Conclusion:Chronic low back pain managed with Caudal pain block is a good treatment modality with excellent results and good alternative to avoid operative procedures.

Substantiating the Therapeutic Effects of Simultaneous Heat Massage Combined with Conventional Physical Therapy for Treatment of Lower Back Pain: A Randomized Controlled Feasibility Trial

There are various therapeutic options for the conservative management of lower back pain (LBP). A combination of two or more treatment options may be more effective in the clinical management of non-specific LBP. In this study, we compared the effects of simultaneous heat massage with conventional physical therapy in patients with subacute LBP. A single-center randomized controlled trial in which 40 participants with LBP were allocated to one of two groups: a heat massage group (HMG) and physical therapy group (PTG). The HMG received simultaneous heat massage therapy using a mechanical device (CGM MB-1401, Ceragem, Republic of Korea). The PTG received conventional physical therapy. Both groups received 40 min of therapy once daily, five times a week, for a total of four weeks. Changes in serum cortisol, epinephrine (EP), and norepinephrine (NE) were assessed. The outcomes were measured using the pain numeric rating scale (PNRS), the Oswestry disability index (ODI), the Roland-Morris disability questionnaire (RMDQ), the short-form McGill pain questionnaire (SF-MPQ), the multidimensional fatigue inventory (MFI-20), the Beck depression inventory (BDI), surface EMG (sEMG), and sympathetic skin response (SSR) at baseline (PRE), at 2 (2 W) and 4 weeks (4 W) following the intervention. The serum EP and NE levels in the HMG decreased after treatment. The PNRS, ODI, RMDQ, and SF-MPQ scores improved without significance in both groups. The BDI score showed improvement in the HMG before the PTG. The MFI-20 score improved in both groups, but the results were better in the HMG than in the PTG at 4 W. All the activities of sEMG were significantly decreased in both groups. However, the improvement of the %MVIC in the HMG was better than that in the PTG at 4 W. The SSR latency on sEMG decreased while the amplitude increased in the HMG at 2 W and 4 W, respectively. Following 4 weeks of combined therapies, heat massage was not superior to conventional physical therapy alone. Both treatments were shown to be effective in improving LBP and pain-related disability. However, heat massage was shown to have a better effect on the control of autonomic nerve function and underlying moods.

Efficacy of surgical treatment on polypharmacy of elderly patients with lumbar spinal canal stenosis: retrospective exploratory research

BackgroundPolypharmacy is a growing public health problem occurring in all healthcare settings worldwide. Elderly patients with lumbar spinal canal stenosis (LSS) who manifest low back and neuropathic pain and have a high frequency of comorbidity are predicted to take many drugs. However, no studies have reported polypharmacy in elderly patients with LSS. Thus, we aimed to review the polypharmacy among elderly LSS patients with elective surgeries and examine how the surgical treatment reduces the polypharmacy.MethodsWe retrospectively enrolled all the patients aged ≥ 65 years who underwent spinal surgery for LSS between April 2020 and March 2021. The prescribed drugs of participants were directly checked by pharmacists in the outpatient department preoperatively and 6-month and 1-year postoperatively. The baseline characteristics were collected beside the patient-based outcomes including Roland–Morris Disability Questionnaire, Zurich Claudication Questionnaire, and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The cutoff number of drugs for polypharmacy was defined as 6. The prescription drugs were divided into 9 categories: drugs for neuropsychiatric, cardiovascular, respiratory, digestive, endocrine metabolic, and urinary renal diseases; blood products; pain relief medication; and others.ResultsA total of 102 cases were finally analyzed, with a follow-up rate of 78.0%. Of the participants, the preoperative polypharmacy prevalence was 66.7%. The number of drugs 6-month and 1-year postoperatively was significantly less than the preoperative one. The proportions of polypharmacy at 6 months and 1 year after surgery significantly decreased to 57.8% and 55.9%, respectively. When the prescribed drugs were divided into 9 categories, the number of drugs for pain relief and digestive diseases was significantly reduced after surgery. The multi-variable analysis revealed that a higher score in the psychological disorder of JOABPEQ was associated with 3 or more drugs decreased 1-year postoperatively (OR, 2.5; 95% CI: 1.0–6.1).ConclusionPolypharmacy prevalence was high among elderly LSS patients indicated for lumbar spinal surgery. Additionally, our data showed that lumbar spinal surgery was effective in reducing polypharmacy among elderly LSS patients. Finally, the multi-variable analysis indicated that better psychological condition was associated with the reduction of prescribed drugs after lumbar spinal surgery.

Autologous Platelet-Rich Plasma Administration on the Intervertebral Disc in Low Back Pain Patients with Modic Type 1 Change: Report of Two Cases.

Background and Objectives: Modic type 1 is known to be associated with lower back pain (LBP), but at present, a treatment has not been fully established. Meanwhile, platelet-rich plasma (PRP) has been used for tissue regeneration and repair in the clinical setting. There is no clinical PRP injection trial for the intervertebral disc of LBP patients with Modic type 1. Thus, this study aimed to verify PRP injection safety and efficacy in LBP patients with Modic type 1. As a preliminary experiment, two LBP cases with Modic type 1 are presented. Materials and Methods: PRP was administered intradiscally to two LBP patients with Modic type 1. PRP was obtained from the patients' anticoagulated blood. Primary endpoints were physical condition, laboratory data, and X-ray for safety evaluation. Secondary endpoints were pain scores using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Roland-Morris Disability Questionnaire (RDQ) to evaluate PRP efficacy. The observation period was 24 weeks after the PRP injection. In addition, changes in Modic type 1 using MRI were evaluated. Results: This study assessed two LBP patients with Modic type 1. There were no adverse events in physical condition, laboratory data, or lumbar X-rays after injection. Follow-up MRI showed a decrease of high signal intensity on T2WI compared to before PRP administration. The pain scores tended to improve after the injection. Conclusions: PRP injection into the intervertebral disc of LBP patients with Modic type 1 might be safe and effective. This analysis will be continued as a prospective study to establish the efficacy.

Association of Fear-avoidance Belief with Dynamic Balance, Functional Performance, and Disability in Chronic Low Back Pain Patients: A Cross-sectional Study

Context: Chronic low back pain is a common musculoskeletal condition in the community. According to fear-avoidance beliefs model, the anticipation of increased pain or reinjury further evokes the avoidance behavior causing disability. Aim: The study aimed to correlate fear-avoidance beliefs with dynamic balance, functional performance, and disability in chronic low back pain patients. Settings and Design: A cross-sectional study was conducted in 75 chronic low back pain patients in a tertiary care hospital. Subjects and Methods: Pain, fear-avoidance beliefs, dynamic balance, and disability were assessed in chronic low back pain patients. Pain was evaluated using the numerical pain rating scale, fear avoidance using the fear-avoidance belief questionnaire (FABQ), disability using the Roland–Morris disability questionnaire, dynamic balance using the MiniBest test, and functional performance using the Back Performance Scale. Statistical Analysis Used: Statistical measures such as median and interquartile ranges were calculated. The Spearman’s correlation test was used. Results: There was a low correlation between FABQ and pain (r = 0.431, P = 0.000), dynamic balance (r = −0.425, P = 0.000), and functional performance (r = 0.482, P = 0.000) and moderate positive correlation with disability (r s = 0.538, P = 0.000) in chronic low back pain patients. Conclusions: Fear-avoidance beliefs are significantly associated with pain, dynamic balance, functional performance, and disability in chronic low back pain patients.

Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain.

Acupuncture and myofascial meridians show great anatomical and clinical compatibility. We aimed to compare the effects of myofascial meridian stretching exercises and acupuncture in patients with low back pain. We randomized 81 subjects with acute/subacute low back pain into three groups: an acupuncture (A) group, a myofascial meridian stretching (MMS) group, and a control (C) group. We recorded the Numerical Rating Scale (NRS) and Roland- Morris Disability Questionnaire (RMQ) scores at baseline and weeks two and six. We evaluated posterior pelvic tilt and transversus abdominis muscle strenghth with a pressure biofeedback unit, back extensor muscle strength by the Sorenson test, and lumbar range of motion (ROM) with an inclinometer. Group A received acupuncture (BL 57 and BL 62 acupoints) and stretching exercises according to the posterior superficial line were applied to the MMS group. Improvements in the NRS score were more prominent in group A than in group C (p = 0.004). The RMQ score improvement between baseline and weeks two and six was more prominent in groups A and MMS (p < 0.001, p = 0.001, respectively). The Sorenson test showed significant improvement between the baseline and week two in groups A and MMS (p = 0.004, p < 0.001, respectively). The increase in lumbar ROM measurement in the MMS group between baseline and week two was significantly higher than in groups A and C (p = 0.009, p < 0.001, respectively). Stretching exercises according to the myofascial meridian system and acupuncture contributed to improved symptoms in the first two weeks in patients with acute/subacute low-back pain.

A novel physical functioning test to complement subjective questionnaires in chronic low back pain assessments

BACKGROUND CONTEXTLifting disability commonly affects patients with chronic low back pain (CLBP) and may not correlate with the existing lifting-related physical assessment tests, such as the loaded forward reach (LFR) test. PURPOSEThe Lift and Place (LAP) test was developed to assess lifting disability in CLBP based on known risk factors. The LAP test was compared with established physical assessment test, including the LFR test and self-reported disability questionnaires. STUDY DESIGN/SETTINGThis cross-sectional study measured self-reported disability questionnaires along with LAP and other physical assessment test results PATIENT SAMPLEEighty three CLBP and 82 asymptomatic participants aged 18 to 55 with normal BMI according to WHO classification. OUTCOME MEASURESOswestry disability index (ODI), Roland–Morris disability questionnaire (RMDQ), Numerical Pain Rating Scale, Trunk Extensor Endurance test, 5 Repetition Sit-To-Stand test, LAP and LFR test. METHODSPhysical assessment test scores were compared between the two groups. The correlation of assessment test scores with ODI and RMDQ in patients with CLBP was calculated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) of each assessment tests. Assessment tests, ODI, and RMDQ were measured twice for CLBP patients on separate days to calculate the test-retest intraclass correlation (ICC) reliability. Two researchers scored the assessment tests independently to calculate the inter-rater ICC. RESULTSPatients with CLBP were slower in the LAP test (CLBP vs asymptomatic: 21.6±4.9 s vs 18.6±3.6 s) and had shorter reach in the LFR test (CLBP vs asymptomatic: 33.6±6.0 cm vs 36.3±6.6 cm). The LAP was correlated with both ODI (r=0.418) and RMDQ (r=0.390), while the LFR was not. In the ROC analysis, the LAP and LFR bore AUCs of 0.685 and 0.379, respectively. Their test-retest ICCs were 0.913 and 0.858, and their inter-rater ICCs were 0.997 and 0.969, respectively. CONCLUSIONSThe LAP test demonstrated higher reliability and significant correlation with the ODI and RMDQ, indicating its potential as performance assessment for lifting disability in CLBP. Further studies should investigate the use of LAP and other physical assessments for rapid CLBP screening.

Impact of Digital Device Use on Neck and Low Back Pain Intensity among Nursing Students at a Saudi Government University: A Cross-Sectional Study.

As digital technology and online activities have become more widely accessible over the past few years, information and communication technology have grown in importance in all students' lives. Most of them routinely use digital devices for a range of activities, primarily for online learning, activities, assignments, conversing, and Internet browsing. This study elucidated the relationship between neck and low back pain intensity and the use of digital devices among Saudi nursing students. A cross-sectional descriptive exploratory research design was applied using a convenience sample of 120 nursing students enrolled in an undergraduate nursing program at a Saudi government university located in Riyadh, the capital city of Saudi Arabia. A valid and reliable self-administered survey was employed. Data about sociodemographic characteristics, the Neck Disability Index and the Roland-Morris Disability Questionnaire were collected. The participants reported 9.1 ± 4.6 study hours on average per week. A total of 82.5% of them do not receive enough exercise, and 87.5% indicated daily use of digital devices. Around half (54.2%) of participants reported having neck pain of a mild intensity. About 60% of the participants regularly shift positions to rest their backs, 39.2% are only able to stand for limited periods due to back issues, and 39.2% expressed concern for others about what might happen to their health. Although there was an association between neck pain intensity and the age or gender of all research participants, there was a significant association between neck pain severity and marital status (χ2 = 15.226, p = 0.019). Our findings suggest that nursing students should maintain neutral neck and back postures on a regular basis to reduce pain, which could be attributed to extensive reading on digital devices.

Differences in pain, disability, and psychological function in low back pain patients with and without anxiety

Objectives: Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Chronic low back pain (LBP) reduces working hours, increases comorbidities, and increases rehabilitation needs. The aim of this study was to evaluate whether there were differences in pain, dysfunction, and psychological factors between two groups. The supplementary demonstrated the relationship between these influencing factors and anxiety. Methods: A cross-sectional study was designed to analyze the differences in pain, disability, and psychological function in non-specific LBP patients with and without anxiety. In total, 60 subjects were divided into two groups based on self-rated anxiety scores: 30 patients with SAS score ≥50 were in the low back pain with anxiety group, and 30 for the LBP without anxiety group with SAS score <50. The pain intensity was assessed using the Visual Analog Scale; psychological function, using the Pain Anxiety Symptoms Scale, the Tampa Scale for Kinesiophobia, and the Fear Avoidance Beliefs Questionnaire; functional disability, using the Oswestry Disability Index and the Roland-Morris Disability Questionnaire; quality of life using 36-Item Short-Form Health Survey questionnaire; and the quality of sleep using Pittsburgh Sleep Quality Index, and the relationships between variables and anxiety scores were estimated using Spearman correlation analysis. Results: A total of 60 participants were enrolled after self-rated anxiety was assessed and the full investigation was finished. The analyses showed significant differences of pain intensity (p = 0.034, disability (ODI, p = 0.007; RMDQ, p = 0.012) and psychological function (TSK, p = 0.000; PASS, p = 0.009; FABQ, p = 0.000; SF-36, p = 0.000; and PSQI, p = 0.000) between the two groups. Spearman correlation analysis showed that the anxiety score had significant positive correlations with functional disability (ODI, p = 0.004 and 95% CI = 0.112-0.573; RMDQ, p = 0.003, 95% CI = 0.135-0.586) and psychological function (TSK, p = 0.001, 95% CI = 0.174-0.612), excellent positive correlation with quality of sleep (PASS, p = 0.025, 95% CI = 0.031-0.512), and strongly negative correlations with the quality of life (SF-36, p = 0.000, 95% CI = 0.761-0.433). Conclusion: We recognized that anxiety in low back pain patients was mainly due to interaction with the intensity of pain, disability level, and a mass of psychological function. The future research direction could be to alleviate the anxiety on the comprehensive efficacy of patients with low back pain.