Morris Disability Questionnaire Research Articles

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.

Effectiveness of a Group-Based Rehabilitation Program Combining Education with Multimodal Exercises in the Treatment of Patients with Nonspecific Chronic Low Back Pain: A Retrospective Uncontrolled Study.

Simple SummaryLow back pain is a major and worldwide cause of global disability. It is not rare that an acute episode of low back pain evolves towards a chronic status without any specific cause. While many clinicians focus their treatment on low-value -care interventions (e.g., massage or electrotherapy), best clinical practice guidelines now recommend a mixed approach combining exercises and education. Furthermore, owing to the potential advantages that confer patient interactions with others (support, motivation, and program compliance), we decided to launch such an intervention program in a group setting (MyBack program) and aimed to evaluate its effectiveness through this study. Following this 8-week intervention program, approximately three-quarters of the patients reported a relevant reduction in pain intensity (78%), catastrophic thinking (78%), functional disability (74%), and fear of movement and work-related activities (74%). Only a quarter of the patients (26%) reported a relevant improvement in quality of life, probably because this outcome was already high before treatment. The MyBack program combining education with multimodal group exercises led to satisfactory clinical, functional, and psychosocial outcomes.Currently, there is no consensus on the best rehabilitation program to perform for nonspecific chronic low back pain (NSCLBP). However, multimodal exercises, education, and group-based sessions seem to be beneficial. We, therefore, launched such a treatment program and aimed to evaluate its effectiveness in improving patient health status. We retrospectively analyzed the records of 23 NSCLB patients who followed the MyBack program at La Tour hospital from 2020 to 2022 (25 sessions, 8 weeks). Patients were evaluated before and after intervention using pain on a visual analog scale (pVAS), Roland–Morris Disability Questionnaire (RMDQ), Pain Catastrophizing Scale (PCS), Tampa Scale of Kinesiophobia (TSK), and the EuroQol-5D-3L (EQ-5D-3L). Responder rates were calculated using minimal clinically important differences. Patients reported a significant reduction (p < 0.05) in the pVAS (5.3 ± 1.2 vs. 3.1 ± 1.6), RMDQ (8.8 ± 3.3 vs. 4.0 ± 3.7), PCS (24.5 ± 9.4 vs. 11.7 ± 7.9) and TSK (41.5 ± 9.2 vs. 32.7 ± 7.0). The EQ-5D-3L also statistically improved (score: 0.59 ± 0.14 vs. 0.73 ± 0.07; and VAS: 54.8 ± 16.8 vs. 67.0 ± 15.2). The responder rates were 78% for the pVAS and PCS, 74% for the RMDQ and TSK, and only 26% for the EQ-5D-3L. The MyBack program combining education with multimodal group exercises led to satisfactory clinical, functional, and psychosocial outcomes.

Disease-Specific Knowledge, Physical Activity, and Physical Functioning Examination among Patients with Chronic Non-Specific Low Back Pain.

Physical activity, physical functioning, and pain are some of the most critical factors of low back pain (LBP) treatment and prevention, but it was unknown that the back school program (BSP) influences the physical activity level of the patients with LBP. Data from 306 healthy patients and patients with chronic non-specific low back pain (cnsLBP) were used. We used the Global Physical Activity Questionnaire (GPAQ), the Low Back Pain Knowledge Questionnaire (LKQ), the visual analog scale, and the Roland–Morris Disability Questionnaire (RMDQ). The significance level was set at p < 0.05. The amount of sedentary time in cnsLBP patients enrolled in the BSP was significantly lower compared to the other two groups (p < 0.001). Significantly higher moderate-intensity activities, leisure time activities, and active transportation were observed in the cnsLBP patients enrolled in the BSP than in the other two groups (p < 0.001). RMDQ scores and the pain intensity of the cnsLBP patients enrolled in the BSP were significantly lower than in patients with LBP receiving only exercise therapy (p < 0.001). The physical activity level and low-back-pain-specific knowledge was significantly higher, while back-related disability and pain intensity were significantly lower among patients with low back pain syndrome who participated in a back school program.

The best structure of the Tampa Scale for Kinesiophobia for patients with chronic low back pain has two domains and nine items

Purpose To identify the best internal structure of the Tampa Scale for Kinesiophobia in chronic low back pain patients. Design Questionnaire validation study was designed for this study. Setting This study was conducted in physical therapy facility. Subjects Respondents reporting chronic low back pain (≥3 points on the 11-point Numerical Pain Rating Scale). Main measures We included participants of both sexes, with a self-report of low back pain ≥3 months and with pain intensity ≥3 on the 11-point Numerical Pain Rating Scale; participants also answered the Roland–Morris Disability Questionnaire and the Pain-Related Catastrophizing Thoughts Scale for low back pain disability and catastrophizing, respectively. The dimensionality and number of items of the Tampa Scale for Kinesiophobia were evaluated using the confirmatory factor analysis. Criterion validity was assessed using Spearman’s correlation coefficient using the original version of the 17-item Tampa Scale for Kinesiophobia as the gold standard. Results A total of 122 participants were included, with mean values of low back pain duration ≥48 months, pain intensity >5 and disability >8. Tampa Scale for Kinesiophobia structure with two domains and nine items was the most suitable, with adequate values in all fit indices (Chi-square/degree of freedom <3, Comparative Fit Index and Tucker–Lewis Index >0.90, and root mean square error of approximation <0.08) and lower Akaike information criterion and Bayesian information criterion values. We observed a high correlation between the 17-item Tampa Scale for Kinesiophobia and the activity avoidance domain (rho = 0.850, P < 0.001) and somatic focus domain (rho = 0.792, P < 0.001) of the nine-item Tampa Scale for Kinesiophobia. Conclusion Tampa Scale for Kinesiophobia structure with two domains (activity avoidance and somatic focus) and nine items is the most suitable for patients with chronic low back pain.

Effectiveness and Safety of Pharmacopuncture Therapy for Chronic Low Back Pain: A Protocol for a Pragmatic Randomized Controlled Trial.

PurposeChronic low back pain (LBP) is a common musculoskeletal disorder that affects everyday life; moreover, it occasionally causes disability and increases medical expenditure. This pragmatic randomized clinical trial aims to investigate the effects of pharmacopuncture on chronic LBP by comparing the effectiveness of pharmacopuncture and physiotherapy strategies.Patients and MethodsIn this two-armed, parallel, multi-center randomized controlled study, the participants will randomly undergo 10 sessions of pharmacopuncture therapy or physiotherapy over five weeks based on the randomization outcomes. The primary outcome will be the numeric rating scale (NRS) score of LBP. The secondary outcomes will include the NRS score of radiating leg pain, visual analog scale (VAS) score of LBP and radiating leg pain, Oswestry disability index, the Korean version of the Roland–Morris disability questionnaire, patient global impression of change (PGIC), short Form-12 health survey version 2, and 5-level EuroQol-5 dimension (EQ-5D-5L).ConclusionThis protocol aims to examine the comparative effectiveness of pharmacopuncture, which is a widely used therapy in Korean medicine, with respect to the standard therapy through a pragmatic randomized controlled trial to present useful data to facilitate clinical or policy decision making.Trial RegistrationClinicaltrials.gov (NCT04833309); Clinical Research Information Service (KCT0006088).

Outcomes of minimally invasive spine decompression in lumbar spinal stenosis and intervertebral disc prolapse: A prospective study

Introduction: Lumbar spinal stenosis and intervertebral disc prolapse are the most common cause of back pain and sciatica. Both conditions are traditionally treated by a midline lumbar incision, after which the paraspinous muscles are elevated from the spinous processes and lamina and retracted laterally and extensively. Minimally invasive lumbar decompression is a procedure designed to debulk hypertrophied ligamentum flavum and removal of the herniated disc with a goal of relieving neural compression. Our study aimed to assess the outcome in terms of improvement in neurology, extent of pain relief in the postoperative period and complications in patients undergoing minimally invasive spine decompression.Methodology: The present study was conducted in a tertiary care hospital. A total of 16 patients who satisfied both the inclusion and exclusion criteria and gave informed consent were recruited for the study from January 2020 to March 2021. All patients underwent minimally invasive spine decompression by tubular retractors. Outcome measures used are Visual analog score for leg pain and back pain, Modified Oswestry Disability Index (MODI), Roland Morris Disability Questionnaire (RMDQ) and neurological examination preoperatively and postoperatively at 6 weeks, 3 months and 6 months.Results: Out of 16 patients, ten patients had intervertebral disc prolapse and six had lumbar spinal stenosis. L4L5 was the most common level seen in our patients. Mean pre-operative VAS score was 6.88 and 4.44 for leg pain and back pain, there was significant reduction at the end of 6 months. Mean preoperative MODI score was 66.38, preoperatively 13 patients (81%) had crippling back pain, 3 patients (18.75%) had severe disability. At the end of 6 months, all 16 patients had less than minimal disability. Mean preoperative roland morris disability score was 11.31+ 0.61. There was a significant mean improvement at 6 months postoperatively from the preoperative baseline score. Nine patients (43.8%) had a motor deficit of which 4 patients had a significant motor power improvement. Two patient had complications, one patient had CSF leak intraoperatively and the other patient developed a superficial wound infection.Conclusion: Minimally invasive spine surgery is an excellent surgical option in patients with lumbar spinal stenosis and prolapsed intervertebral disc. Patients who underwent minimally invasive spine decompression had satisfactory functional outcome in terms of pain relief, minimal hospital stay and early return to day to day activities.

Magnitude of Dural Tube Compression Still Does Not Show a Predictive Value for Symptomatic Lumbar Spinal Stenosis for Six-Year Follow-Up: A Longitudinal Observation Study in the Community.

Background: Lumbar spinal stenosis (LSS) is a clinical syndrome based on anatomic narrowing of the spinal canal. It is well known that anatomic narrowing of the spinal canal is essential for manifestation, but not all of them cause symptoms. There are many studies assessing the relationship between dural tube compression on MRI and clinical symptoms; however, most of them are cross-sectional. The purpose of this study was to reveal the magnitude of dural tube compression’s influence on the presence or development of LSS symptoms at the six-year follow-up and the occurrence of surgery during the follow-up period or not in the community setting. Methods: This was a longitudinal observational study of 459 participants who were assessed for typical LSS symptoms, and whose Roland–Morris Disability Questionnaire and numerical rating scale of leg pain and numbness was recorded using a questionnaire and conventional MRI of the lumbar spine. Typical LSS symptoms were judged using an LSS diagnostic support tool, which was a self-administered, self-reported history questionnaire (LSS-SSHQ). After six years, 232 subjects (follow-up rate 50.5%) were followed-up with typical LSS symptoms using LSS-SSHQ by mail. The relationship between the magnitude of dural tube compression evaluated by dural tube cross-sectional area (DCSA) in the initial assessment and the time course of typical LSS symptoms for the six-year duration were analyzed. In addition, predictors of the presence of typical LSS symptoms at the six-year follow-up were assessed. Furthermore, we investigated the relationship between typical LSS symptoms and DCSA during the initial assessment of patients who underwent surgery during the follow-up period. A multivariate logistic regression analysis was performed for statistical analysis. Results: (1) Severe dural tube compression did not show that LSS symptoms continued after six years. (2) Severe dural tube compression could not detect development of LSS-symptoms and surgery during the six-year period. Conclusion: Severe dural tube compression could not detect typical LSS symptom development and occurrence of surgery during the six-year period.

Efficacy of Transcutaneous Electrical Nerve Stimulation and Interferential Current on Tactile Acuity of Individuals With Nonspecific Chronic Low Back Pain

ObjectivesTranscutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) are pain electrotherapies with questioned efficacy. Studies of their effects on tactile acuity of individuals with nonspecific chronic low back pain (NSCLBP) are limited, hence, this study. Materials and MethodsThirty-three individuals with NSCLBP randomly allocated into three groups completed this study. Data collected from participants included age, gender, and anthropometric characteristics of height, weight, body mass index, and percentage body fat measured with standard instruments. Also, participants' tactile acuity, pain intensity, and disability were assessed before and after interventions with digital caliper, numerical pain rating scale, and Roland–Morris Disability Questionnaire, respectively. Interventions consisted of stretching, strengthening, and stabilization exercises to all three groups in addition of TENS to group 1 and IFC to group 2, respectively, for five weeks. Descriptive statistics of mean and standard deviation summarized the data. Inferential statistics of paired t-test, independent t-test, and analysis of variance tested the level of significance among variables at p ≤ 0.05. ResultsTactile acuity was significantly (p < 0.05) increased after TENS intervention only, while pain intensity was significantly (p < 0.05) reduced after the three interventions. The result showed no gender difference in tactile acuity values among the participants. ConclusionsTENS increases the tactile acuity of individuals with NSCLBP, whereas IFC demonstrated no significant change in tactile acuity.

A New Educational Program could Reduce Disability and Improve Quality of Life in Patients with Chronic Low Back Pain

This randomized clinical trial examined the efficacy of a designed educational program versus oral drug treatment in Iran. A total of 197 patients with chronic low back pain were randomized into either intervention group (n = 97) receiving a five 2 hour– session educational program followed by continued monthly booster sessions and telephone counseling plus medication or to control group (n = 100) receiving just medication. At baseline and 3 months of follow up, participants completed demographic characteristic questionnaires as well as three other questionnaires including Short – form General Health Survey (SF-36 item), Quebec Disability Scale (QDS) and Ronald – Morris Disability Questionnaire (RDQ). Data were analyzed by SPSS 18. The two groups were comparable at baseline in terms of all baseline characteristics and the mean scores of the scales. However, after three months, the intervention group was significantly different from control group in all subscales of SF-36, QDS and RDQ (P values &lt; 0.05). Furthermore, this study showed a statistically significant difference between two groups (P&lt; 0.05) in terms of mean difference scores for SF -36, RDQ and QDS over time. The findings revealed that the designed educational program could improve all quality of life domains and reduce disability in chronic low back pain patients during a period of 3 months.

Clinical Efficacy of Melon GliSODin® for the Treatment of Aging-Related Dysfunction in Motor Organs-A Double Blind, Randomized Placebo-Controlled Study.

Background: Locomotive syndrome is a concept proposed in Japan involving decreased mobility due to osteoarthritis, osteoporosis, and sarcopenia. This double-blind, randomized study aimed to investigate the effects of superoxide dismutase (SOD)-rich melon extract (Melon GliSODin®) on locomotive syndrome. Methods: For 6 months, we administered oral Melon GliSODin® (500.4 mg/day) or a placebo to 24 and 22 women, respectively (aged 50–80 years), with knee or lower back discomfort or pain. Using baseline and 6-month data, changes in the Verbal Rating Scale and in subjective symptoms (determined using the Japanese Knee Osteoarthritis Measure, Locomo 25, the Roland–Morris Disability questionnaire, and the Chalder Fatigue Scale) were assessed, along with various oxidative markers, antioxidants, inflammatory markers, renal and liver function biochemical markers, bone metabolism markers, body composition, and motor function. Results: Oral Melon GliSODin® administration tended to be associated with a larger improvement in subjective symptom scores, a reduction in oxidative markers (malondialdehyde and diacron reactive oxygen metabolites) and tumor necrosis factor-α, and a significant increase in non-fat mass between baseline and 6 months. However, no statistically significant differences were observed between the groups for outcomes at 6 months. Conclusions: Melon GliSODin® tended to improve the subjective symptoms of participants who had knee or lower back pain or discomfort. Melon GliSODin® administration may help to prevent the progression of locomotive syndrome. Future studies involving larger sample sizes and more stringent randomization protocols are needed to determine differences between the placebo and Melon GliSODin® groups.

Does m-health-based exercise (guidance plus education) improve efficacy in patients with chronic low-back pain? A preliminary report on the intervention’s significance

BackgroundThe utilization of mobile health (m-health) has rapidly expanded during the COVID-19 pandemic, and there is still a lack of relevant clinical data pertaining to chronic low-back pain (CLBP) management. This study was designed to compare the effectiveness of m-health-based exercise (via guidance plus education) versus exercise (via guidance) during CLBP management.MethodsParticipants (n = 40) were randomly assigned to intervention and control groups. The intervention group received m-health-based exercise (via guidance plus education), whereas the control group received m-health-based exercise (via guidance). The exercise prescription video and educational content were sent to participants by the application (app), Ding Talk. Repeated-measures analysis of variance was used to test the baseline’s intervention effects, 6-week follow-up, and 18-week follow-up. We selected function (Roland and Morris Disability Questionnaire) and pain intensity (current, mean, and most severe Numeric Rating Scale in the last 2 weeks) as the primary outcomes, changes of negative emotion (depression, anxious), and quality of life as the secondary outcomes.ResultsTime’s significant effect was found in pain, function, and health-related quality of life in both groups, but time did not show significant interaction effects. Participants were able to use m-based education with their anxiety and depression after treatment, but the relief only lasted until week 6. No differences were found on the aspect of mental health-related quality of life.ConclusionPreliminary findings suggest that m-health-based exercise (via guidance) may be a convenient and effective method to treat CLBP. However, additional health education didn't help more. More rigorous controlled trials are needed to improve the therapeutic effect in future studies.Trial registrationChinese Clinical Trials Registry Number ChiCTR2000041459. Registered on December 26, 2020.

Effect of platelet-rich plasma injections for chronic nonspecific low back pain: A randomized controlled study.

Background:Patient with chronic nonspecific low back pain is weakened ligament, and prolotherapy is the effective treatment but their use remains controversial. These ligaments can be strengthened by platelet-rich plasma injection. We hypothesized that the effectiveness of platelet-rich plasma injection and prolotherapy may decrease pain and improved disability of patient with chronic low back painMethods:This study was a prospective, double-blind, randomized controlled trial and was conducted for 3 years for patient enroll and follow-up. Thirty-four patients with chronic nonspecific low back pain (duration of at least 3 months) refectory to conventional management were randomized to platelet-rich plasma injection and lidocaine injection. Patients were treated with weekly platelet-rich plasma or lidocaine injections at the lumbopelvic ligaments for 2 weeks and then weekly prolotherapy with 15% glucose for 2 weeks and followed up 6 months. Visual analog scale, Oswestry Disability Index, and Roland–Morris Disability Questionnaire were evaluated at initial, 4 weeks, 3 months, and 6 months. Four patients did not complete this trial. Three were in the platelet-rich plasma injection and 1 was in the lidocaine injection.Results:The intensity of pain was significantly decreased in platelet-rich plasma injections at 6 months as compared lidocaine injections; between-group differences were 0.9 (95% confidence interval 0.10–1.75 [P = .027]). All participants were significantly decreased pain and disability index at 4 weeks, 3 months, and 6 months but there were no significant differences between groups except for visual analog scale at 6 months. The baseline parameters were no significant differences in both groups.Conclusions:In chronic nonspecific low back pain, the platelet-rich plasma injection in combination with prolotherapy is an effective intervention and either lidocaine or platelet-rich plasma injection significantly reduced disability. And injection at the lumbopelvic ligaments using the platelet-rich plasma and prolotherapy is also an effective treatment for pain.

Electrical Properties of Lumbar Paraspinal Muscles in Young Adults With and Without Chronic Low Back Pain Based on Electrical Impedance Myography: A Cross-Sectional Study.

BackgroundLumbar paraspinal muscle (LPM) is important in spinal stabilization in patients with chronic low back pain (CLBP). However, the electrical properties of LPM in patients with CLBP remain unclear. Electrical impedance myography (EIM) is a novel and non-invasive technique that provides a simple quantitative evaluation of electrical properties of the LPM.PurposeThis study aimed to apply EIM to assess the electrical properties of the LPM between patients with CLBP and healthy control (HC).MethodsThirty participants (15 CLBP participants; 15 healthy controls) were enrolled in the study. Participants in the CLBP group were asked to complete the visual analog scale (VAS), Oswestry Disability Index (ODI), and Roland–Morris Disability Questionnaire (RDQ) to assess the pain intensity and disability in daily life. Independent sample t-tests were adopted to analyze the basic characteristics between the two groups. At 5, 50, 100, and 200 kHz current frequencies, the electrical properties were measured on each side of the LPM. The EIM parameters of resistance (R), reactance (X), phase angle (PA), and Z value were analyzed by one-way analysis of variance (ANOVA), with age as covariate. Spearman's rank correlation coefficient analysis was applied to explore the relationships between the questionnaires and the EIM parameters.ResultsThe R and Z values of bilateral LPM in the CLBP group were significantly larger than those in the HC group; the PA decreased and the X did not change at these four tested current frequencies. At 5 kHz, Z and R on the right side were non-significantly different between patients and HCs. Correlation analysis showed that at 50 kHz, ODI and RDQ scores correlated negatively with the R of the bilateral LPM (r = 0.523, r = 0.581, respectively; p < 0.05). RDQ scores correlated positively with the PA of the right LPM (r = 0.521, p < 0.05).ConclusionThe electrical properties of the bilateral LPM differed between CLBP participants and healthy individuals, regardless of the different frequencies used. These altered electrical properties of the LPM in the patients with CLBP correlated to some extent with disability in daily life.

Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial.

Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain.

The reliability of patient-reported outcomes in patients with chronic low back pain when answered in online, telephone, and face-to-face interview format

ABSTRACT&#x0D; Purpose: Patient-reported outcomes (PROs) are unique indicators of disease and treatment impact on patients that help in the selection of the correct interventions for their treatment. The aim of our study was to investigate the reliability of PROs that are frequently used in patients with chronic low back pain in face-to-face interview, online, and telephone formats.&#x0D; Methods: The participants were randomized into groups until there were at least 120 participants each in the face-to-face interview, online, and telephone groups. All participants completed the Oswestry Disability Index, the Roland–Morris Disability Questionnaire, and the Fremantle Back Awareness Questionnaire according to the format characteristics of their group.&#x0D; Results: Among the 364 patients, in the online group (n=120) the completion time for all three questionnaires was significantly shorter than that in the face-to-face interview (n=121) (ODI: p=0.002, RMDQ: p=0.003 and FreBAQ: p=0.032) and telephone (n=123) (ODI: p=0.007, RMDQ: p=0.001 and FreBAQ: p=0.024) groups. When the test–retest reliability was examined, the ODI (ICC: 0.86), RMDQ (ICC: 0.93), and FreBAQ (ICC: 0.81) showed an excellent correlation in the face-to-face interview group. In the telephone group, the ODI, RMDQ, and FreBAQ showed good correlations. In the online group, there was a good correlation in the RMDQ (ICC: 0.74) and FreBAQ (ICC: 0.65), while there was a moderate correlation in the ODI (ICC: 0.59). &#x0D; Conclusion: Although the ODI, RMDQ, and FreBAQ for chronic low back pain patients had lower reliability correlations in both the online and telephone versions compared to the face-to-face interview, mostly they had adequate reliability. Moreover, the online version was a more useful and quicker evaluation method than the telephone version. However, we do not recommend using the online version of the ODI due to its lower reliability.

Thread embedding acupuncture for herniated intervertebral disc of the lumbar spine: A multicenter, randomized, patient-assessor-blinded, controlled, parallel, clinical trial

Backgroundand purpose: Although several studies have reported that thread embedding acupuncture (TEA) is effective for lumbar herniated intervertebral disc (LHIVD), the evidence remains limited because previous studies had a high risk of bias. This study aimed to investigate the efficacy and safety of TEA for LHIVD through a rigorously designed trial. Materials and methodsThis was a randomized, patient-assessor-blinded, sham-controlled trial. Participants were screened according to eligibility criteria, and 70 patients with LHIVD were randomly allocated to the TEA and sham TEA (STEA) groups in a 1:1 ratio. Both groups received TEA or STEA treatment at 23 acupoints once per week for eight weeks. Changes in low back pain, radiating pain, Oswestry disability index, Roland–Morris disability questionnaire, EuroQol 5–Dimensions 5–Levels, and global perceived effect were measured at baseline and at 4, 8, 12, and 16 weeks after screening and compared between the two groups. ResultsTEA showed no significant difference in all outcomes compared to STEA immediately after eight weeks of treatment. After an additional eight weeks of follow-up, TEA showed a more significant effect on the low back pain than STEA (p < 0.05) and showed a better tendency in maintaining or enhancing the improvement of radiating pain, function, and quality of life even after the end of treatment. No serious adverse events were observed. ConclusionTEA is effective in improving low back pain in patients with LHIVD and may help improve function and quality of life, especially in the long term.

Effectiveness of a training program on the low back pain and functional disability in industrial workers

ABSTRACT Low back pain (LBP) as a common musculoskeletal disorder is a well-known complaint of industrial workers. This study was performed to determine the effect of back school training program on quality of life in workers with chronic low back pain. Two hundred and fifty workers with chronic LBP (identified through interviews in a factory), were randomly divided into two groups of control and intervention and then the intervention group received the back school training course. In this study, Back School was a multi-purpose, multi-dimensional, patient-centred team training program in which the participants received the necessary training in five groups of 25 workers with 4 training sessions. Data were collected at two intervals before and after the intervention by using the SF-36 questionnaire, LBP visual analogue scale and the Roland–Morris Disability Questionnaire (RMDQ). Statistics analysis such as descriptive statistics, t-test and analysis of variance were used to analyse the data. The results showed that the psychological component and the physical component of quality of life after intervention were significantly different between the two groups. In addition, after the intervention, a decrease in the functional disability and LBP scores were observed in the intervention group. The results showed that a structurally strong and well-organized training schedule such as back school program could be practically useful for reducing and relieving pain and also improving functional ability in workers of industrial settings.

Proprioceptive neuromuscular facilitation exercises versus lumbar stabilization exercises for chronic low back pain patients: A randomized interventional study

Background: Chronic low back pain causes discomfort and disturbance in the mechanoreceptor and proprioception centers. Exercises improve muscle strength, flexibility, endurance, and ability to perform life activities. Proprioceptive neuromuscular facilitation (PNF) involves stretching, resisted movements which improves muscle disharmony, atrophy, and joint movement limitation. Lumbar stabilization exercises (LSE) develop the awareness of muscle contraction and control from simple to complex patterns. Both exercises are effective individually in chronic low back pain patients. This study was conducted to find out which technique is better. Objectives: The objective of the study is to determine the efficacy of PNF versus LSE program in chronic low back pain patients. Study Design: A Randomized study was conducted. Methods: A prospective, interventional study was conducted on patients with mechanical low back pain of more than 3 months, in both males and females, of age 20–45 years. Patients having systemic illness, central or peripheral neurologic signs, and specific causes of low back pain were excluded. Individuals having systemic illness and psychiatric illness were also excluded from the study. Twenty-two patients were selected and divided into two groups. Patients were assessed on the Visual Analog Scale (VAS), modified Schober's test, Modified Oswestry Low Back Pain Disability Questionnaire (ODI), Roland and Morris Low Back Pain and Disability Questionnaire (RMDQ). Patients in the PNF Group received concentric and eccentric contractions of agonist and antagonist muscles, patterns such as chopping, lifting, bilateral leg, and trunk lateral flexion. LSE Group received core strengthening exercises. Both group received 3 treatment sessions per week for 4 weeks, each session lasting for 45 min. Results: PNF group showed significant improvement in pain on VAS (P = 0.003; 95% confidence interval [CI[, 2.15–3.01), in disability on ODI (P = 0.001, 95% CI, 12.09–20.1), and in lumbar flexibility Modified Schober's test (P = 0.000, 95% CI, 5.15–5.93) On RMDQ, there was no statistically significant difference between PNF and LSE groups (P = 0.061, 95% CI, 6.87–8.97). Conclusion: There was a significant improvement seen in the pain and disability which was assessed on VAS and ODI in the PNF group over LSE. Hence, PNF exercises can be incorporated with LSE in the treatment of LBP.