Non-specific Low Back Pain Patients Research Articles

The effect of adding hip strengthening exercises to lumbar stabilizing exercises on gait for the treatment of non-specific low back pain: a randomized controlled trial

IntroductionTo evaluate the impact of adding hip strength exercises to lumbar stabilizing exercises on pain, disability, and spatio-temporal parameters of gait in the treatment of non-specific low back pain (NSLBP).MethodsIn this randomized controlled trial, 60 patients diagnosed with NSLBP were randomized into two equal groups. The subjects were randomly allocated to either group A, the control group (<i>n</i> = 30), performing lumbar stabilizing exercises, or group B, the study group (<i>n</i> = 30), receiving lumbar stabilizing exercises and a progressive hip strengthening exercise program. The frequency of intervention was 3 sessions per week for six weeks. In this trial, the Visual Analogue Scale for pain intensity, Modified Oswestry Disability Index for disability, and Kinovea 2D motion analysis for spatio-temporal parameters were evaluated pre-treatment and after six weeks.ResultsThere were statistically significant differences between groups in changes in pain scores (<i>p</i> = 0.035), the disability index (<i>p</i> = 0.012), and COG vertical displacement (<i>p</i> = 0.017). There were no statistically significant differences in stride length, stride time, stride speed, or cadence between the control and study groups (<i>p</i> > 0.005).ConclusionsAdding hip strengthening exercises to a lumbar stabilization exercise program can reduce pain and disability and decrease COG vertical displacement more than a lumbar stabilization exercise program alone in NSLBP patients. However, no differences were found in gait speed, cadence, stride length, and stride time.

The effect of dynamic neuromuscular stabilization technique combined with Kinesio Taping on neuromuscular function and pain self-efficacy in individuals with chronic nonspecific low back pain: A randomized trial.

This study investigates the therapeutic efficacy of dynamic neuromuscular stabilization (DNS) technology paired with Kinesio Taping in patients with persistent nonspecific low back pain, as well as the effect on neuromuscular function and pain self-efficacy. A randomized controlled clinical study was conducted to collect clinical data on DNS combined with KT for the treatment of chronic nonspecific low back pain from November 2023 to April 2024. The inclusion criteria were patients with chronic nonspecific lower back pain, aged between 18 and 30 years old, and without serious underlying medical conditions, such as cardiac disease, hypertension, and diabetes. The control group received Kinesio Tape therapy, and the experimental group received a combination of Kinesio Tape therapy and DNS technology. The treatment lasted for 6 weeks, 3 times a week. Patients were examined before and after treatment using the Visual Analog Rating Scale, Oswestry Dysfunction Score, and Pain Self-Efficacy Questionnaire. Multifidus and transversus abdominis muscle strength was tested using surface electromyography signals, and the patient's joint mobility, maximal isometric muscle strength, and muscular endurance were tested using the Davy Spine Rehabilitation System. Internal lumbar and abdominal pressures were assessed using stabilizer pressure biofeedback. A total of 32 subjects (17 males and 15 females) were enrolled, of which 16 were in the experimental group and 16 in the control group. After the treatment, the patients in both groups showed significant improvements in the visual analogue scale, Oswestry disability index, Chinese version of Pain Self-Efficacy Questionnaire (PSEQ), joint mobility, maximum isometric strength, muscle endurance, abdominal pressure, transverse abdominal muscle and multifidus muscle scales compared with the pretreatment results. (Chinese version of Pain Self-Efficacy Questionnaire) scales were significantly improved compared with the pretreatment; joint mobility, maximal isometric muscle strength, muscular endurance, intra-abdominal pressure, transversus abdominis and multifidus AEMG (average electromyography) were more significantly improved, and the differences were statistically significant (P < .05). The experimental group showed more significant improvement than the control group (P < .05). DNS technology paired with Kinesio Taping can considerably improve neuromuscular function and enhance pain self-efficacy in chronic nonspecific low back pain patients, reducing discomfort and improving dysfunction.

Comparison of cognitive functional therapy and neurofeedback training on kinetic gait in patients with chronic non-specific low back pain: a randomised controlled trial

Purpose of the article Walking disorders are a significant issue for patients with low back pain. The aim of clinical trials is to compare the effects of cognitive functional therapy (CFT) and neurofeedback training (NFBT) on gait kinetics in chronic non-specific low back pain (CNSLBP) patients. Materials and Methods Sixty females with chronic non-specific low back pain were recruitment for clinical trials. They were randomly divided into experimental and one control groups (Each group 20 patients). The experimental group received the relevant interventions for eight weeks. The primary outcome was pain, kinesiophobia and disability. The secondary outcome was vertical ground reaction force (VGRF) parameters. Two-Way Repeated Measures ANOVA statistical method was used for data analysis. Results Within-group comparisons showed that neurofeedback training and cognitive functional therapy groups experienced significant improvement in pain intensity, disability and kinesiophobia after eight-week (p < 0.05). However, the cognitive functional therapy group improved the vertical ground reaction force parameters better than the neurofeedback training group (p < 0.05). Conclusions cognitive functional therapy intervention had a greater effect on the vertical ground reaction force parameters. The reason for the greater effect of cognitive functional therapy intervention on vertical ground reaction force parameters can be partially explained due to the multimodal therapy used through cognitive exercises and motor control.

Variations in pain, disability, and psychosocial functioning among non-specific chronic low back pain patients with and without anxiety

Variations in pain, disability, and psychosocial functioning among non-specific chronic low back pain patients with and without anxiety

Effectiveness of dry needle therapy in patients with chronic nonspecific low back pain

Background: Low back pain is a prevalent symptom worldwide, with various underlying causes, making differential diagnosis essential. This study aims to investigate the efficacy of dry needling treatment added to exercise in patients with chronic Nonspecific Low Back Pain (NLBP). The McKenzie exercise program was applied to all participants.Materials and Method: The study comprised sixty participants, randomly allocated into two groups: the dry needling (DNG) and the exercise group (EG). The participants in DNG received a total of six sessions of dry needling treatment, two days a week, to the gluteus medius and quadratus lumborum and multifidus muscles. All participants were given a McKenzie exercise program two sets per day for three weeks.Results: A significant difference was noted in the VAS-night values of the patients within the DNG before treatment (p: 0.004), and the EG also exhibited a significant difference in the VAS-activity (p: 0.017) and VAS-resting (p: 0.024) values following the treatment. A statistically significant decrease was observed in favor of DNG in VAS-rest, VAS-night, VAS-activity values (p&gt;0.001) in the comparions of the groups.Conclusions: Dry needling treatment added to exercise therapy in chronic NLBP patients is effective on activity and rest pain severity in the shortterm results. However, no additive efficacy of dry needling treatment was found on the number of trigger points, disability, and depression.

Hip joint kinematic assessment in chronic non-specific low back pain patients. A Delphi study

BackgroundChronic nonspecific low back pain (CNSLBP) has been associated with movement impairment (MI) of the hip joint. However, evidence supporting this is inconsistent.Agreement from experts may provide rationale and recommendations for the assessment of the hip joint in the management of CNSLBP patients. ObjectiveGain expert consensus on whether hip MIs are related to CNSLBP, whether they should be assessed and which movement types and directions they recommend. MethodsThrough a three-round e-Delphi process, international experts in the field rated levels of agreement for generated themes pertaining to assessing proposed hip joint MI in individuals with CNSLBP and underlying rationales. Consensus was defined a priori as ≥75% ratings on Likert scales with an IQR≤ 1. ResultsInternational expert panel consisted of a mix of researchers and clinicians with the majority involved in both. Response for round I was 27, round 2 was 21 and round III was 26 individuals.Consensus was achieved for the association of active and passive hip joint MI in CNSLBP and their assessment. 100% agreement was achieved for the rationale regarding compensatory movement of the lumbar spine, and the assessment of passive hip movements, in particular extension. Consensus was also achieved for assessing hip passive flexion, extension, rotations, and abduction, active flexion, extension, and abduction. No agreement was attained regarding passive accessory movement. ConclusionThe assessment of active and passive hip joint MI is regarded by experts as appropriate and informative in the management of and research pertaining to CNSLBP.

CULTURAL adaptation and validation of the Indonesian version of the Roland-Morris disability questionnaire: A psychometric analysis

BACKGROUND: Epidemiological evidence underscores low back pain (LBP) as a prevalent and consequential musculoskeletal disorder, posing a significant public health challenge. Patient-reported outcome measures (PROMs) play a crucial role in the diagnostic process for LBP, with the Roland-Morris Disability Questionnaire (RMDQ) being a commonly utilized tool in evaluating LBP. OBJECTIVE: This cross-sectional study aimed to cross-culturally adapt and validate the Indonesian version of the 24-item-RMDQ among nonspecific LBP (NSLBP) patients. METHODS: The RMDQ scales underwent forward-backwards translation, readability, and content validity assessments with NSLBP patients (n = 137), with a mean age of 38.6±11.8 years (59% female). Psychometric testing included assessments of internal consistency and 1-week test-retest reliability, convergent validity with pain numeric rating scale (PNRS), and the Physical Component Summary (PCS) and Mental Component Summary (MCS) of quality of life (Short Form 12). The construct validity using confirmatory factor analyses (CFA). RESULTS: The findings of this study indicated a good internal consistency (Cronbach α= 0.80) of the translated instrument. Moderate to good repeatability estimates of all RMDQ items were demonstrated with the total ICC of the total RMDQ score of 0.90 [95%CI (0.85–0.94)]. The instrument correlations with PNRS, PCS, and MCS were 0.54, 0.60, and 0.23, respectively. The goodness-of-fit test further affirmed an acceptable fit of the data, although low factor loadings were found in several RMDQ items. CONCLUSION: Although the factor structure of the RMDQ scale warrants further investigation, the overall findings support its suitability for clinical application in Indonesian NSLBP patients.

Exploring temporal congruence in motor imagery and movement execution in non-specific chronic low back pain

Chronic non-specific low back pain (NSCLBP) is linked to sensorimotor dysfunctions and altered motor planning, likely due to neuroplastic changes. Motor imagery (MI) and movement execution share neural pathways, but the relationship between imagined and executed movements in NSCLBP patients remains underexplored. This study aimed to assess the temporal congruence between imagined and executed movements in NSCLBP sufferers, with secondary goals of investigating group differences in movement chronometry, psychological well-being, and disability, as well as possible correlations among these factors. Fifty-six participants, including 28 NSCLBP patients and 28 asymptomatic subjects (AS), performed lumbar flexion and Timed Up and Go (TUG) tasks. NSCLBP patients showed significant temporal incongruence in both tasks, executing movements more slowly than imagined, whereas AS displayed incongruence only in the TUG task. NSCLBP patients also took longer to imagine and execute lumbar flexion movements compared to AS, with correlations observed between execution delays, higher disability, and greater fear of movement. The findings highlight a lack of temporal congruence in NSCLBP patients, especially in lumbar flexion, emphasizing the complex relationship between chronic pain, motor ability, and psychological factors. These results suggest that integrated treatment approaches addressing cognitive and emotional aspects are crucial for managing NSCLBP.

Relationship between the flexion relaxation phenomenon and kinematics of the multi-segmental spine in nonspecific chronic low back pain patients

The flexion relaxation phenomenon (FRP) is characterized by the reduction of paraspinal muscle activity at maximum trunk flexion. FRP is reported to be altered (persistence of spinal muscle activity) in more than half of nonspecific chronic low back pain (NSCLBP) patients. Little is known about how the multi-segmental spine affects FRP. The aim of this observational study was to investigate the relationship between FRP and kinematic parameters of the multi-segmental spine in NSCLBP patients. Forty NSCLBP patients and thirty-five asymptomatic participants performed a standing maximal trunk flexion task. Surface electromyography was recorded along the erector spinae longissimus. The kinematics of the spine were assessed using a 3D motion analysis system. The investigated spinal segments were upper thoracic, lower thoracic, thoracolumbar, upper lumbar, lower lumbar, and lumbopelvic. Upper lumbar ROM, anterior sagittal inclination of the upper lumbar relative to the lower lumbar in the upright position, and ROM of the upper lumbar relative to the lower lumbar during full trunk flexion were significantly correlated with the flexion relaxation ratio (Rho 0.42 to 0.58, p < 0.006). The relative position and movement of the upper lumbar segment seem to play an important role in the presence or absence of FRP in NSCLBP patients.

Risk factors Associated with Pain Severity in Syrian patients with non-specific low back Pain

BackgroundLow back pain (LBP) majorly contributes to activity limitations and work absences worldwide. Therefore, a comprehensive knowledge of the risk factors linked to non-specific low back pain (NSLBP) can enable early and timely interventions to achieve long-term improvements. Current study aimed to assess the risk factors associated with the severity of NSLBP patients in Syria.MethodsThis study used a cross-sectional design and a self-assessment questionnaire to collect data on NSLBP, as well as personal and physical factors, across four provinces in Syria (Damascus, Aleppo, Homs, and Latakia) from November 2021 to September 2022. The assessments incorporated the Short Form 36-Item Health Survey (SF-36), the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Then we examined the relationship between the severity of NSLBP and these potential risk factors. Descriptive statistics were employed to summarize the demographic characteristics of the participants. Additionally, multiple logistic regression analysis was performed to evaluate the risk factors for non-specific low back pain.ResultsThe study included a total of 875 patients with NSLBP. The results indicated that patients with primary school education, a high body mass index (BMI), prolonged driving and sitting durations, smoking habits, and recurrent low back pain had higher VAS and ODI scores, as well as lower SF-36 scores (p < 0.01). Additionally, workers and drivers had higher VAS and ODI scores and lower SF-36 scores compared to waiters and patients who lifted objects heavier than 10 kg for more than a quarter of their work time for over 10 years (p < 0.01). The multiple logistic regression analysis revealed that lower education levels, low back pain lasting 1–7 days, chronic low back pain in the past year, smoking, driving for prolonged time, and higher BMI were associated with more severe VAS scores.ConclusionThe severity of NSLBP is related to lower education levels, poor living conditions, strenuous physical labor, inactive lifestyle, and driving for a long time. Additionally, patients with recurrent NSLBP experience more intense pain. To manage these issues, potential interventions could include reducing obesity rates, limiting the duration of hard physical work, limiting driving duration and reducing sedentary behaviors and smoking. These measures may help alleviate the overall burden of NSLBP.

The effect of cognitive functional therapy on the plantar pressure distribution symmetry in patients with chronic non-specific low back pain: A randomized controlled trial

ObjectiveThis study aimed to evaluate the effect of Cognitive functional therapy (CFT) on plantar pressure distribution symmetry in chronic non-specific low back pain (CNSLBP) patients. Methodforty females with NSCLBP (age range 30–50 years) were recruited for clinical trials. They were randomly divided into experimental and control groups (Each group had 20 patients). The patients in the experimental group received CFT for 8 weeks. The primary outcome was psychological variables inclusive of pain, kinesiophobia and disability. The secondary outcome was plantar pressure distribution symmetry which assessment in standing condition. The Covariance statistical method was used for data analysis. ResultsThe results of covariance analysis for primary outcome showed a significant difference (p < 0.05) with a reduction of 52 % in pain (p = 0.001), 12 % in kinesiophobia (p = 0.001) and 41% in disability (p = 0.001). Also, the results of covariance analysis for secondary outcome showed a significant difference in plantar pressure distribution symmetry of inter-limbs foot (p = 0.007), forward and backward in the right foot (p = 0.002) and forward and backward in the left foot (p = 0.001). ConclusionCFT reduces of pain, kinesiophobia and disability. In addition significant difference in the plantar pressure distribution symmetry was observed, which it is argued the plantar pressure asymmetric can be influenced by psychological factors.

Understanding the flexion-relaxation phenomenon in non-specific chronic low back pain patients throught immersive virtual reality feedback approach

The flexion-relaxation phenomenon (FRP) is frequently absent among non-specific chronic low back pain (NSCLBP) patients. However, it is unknown whether this absence is intrinsic to their pathology or merely a consequence of reduced trunk flexion. Immersive virtual reality (IVR) can create a patient avatar whose range of motion can be modulated to differ from the real movement. The present study enrolled 15 NSCLBP patients and 15 asymptomatic participants with similar characteristics to disentangle the relationship between range of motion and the FRP in NSCLBP using IVR. Trunk kinematics and lumbar muscle electromyography were assessed. The IVR environment was combined with a motion capture system to create avatars that moved like each participant. The IVR display showed a closed room and a mirror reflecting the subject’s avatar with a target line to be reached by trunk flexion. The avatar’s trunk movements were modulated from reality, leading the participants to flex their trunk more than their voluntary maximum trunk flexion. Under IVR conditions, NSCLBP patients significantly increased their trunk flexion angle, which was coupled with a significant improvement in the FRP. The absence of the FRP among the NSCLBP population appeared to be primarily related to reduced trunk flexion.

Effectiveness of Virtual Reality on Rehabilitation of Chronic Non-Specific Low Back Pain Patients.

Virtual reality (VR) is used extensively for musculoskeletal conditions, but its efficacy in chronic low back pain still needs more investigation. To discuss the effectiveness of VR on selected outcomes in Chronic Non-Specific Low Back Pain (CNSLBP). Thirty-five patients with CNSLBP joined this study. Postural correction exercises using the TBed VR gaming system in addition to hamstring stretching were employed, and moist heat on the low back was applied. Pre- and post-intervention values of pain, ROM, function, and balance (overall stability index) were obtained using the numerical rating pain scale (NPRS), Oswestry Disability Index, back range of motion (BROM), and Biodex system. Satisfaction level on a 1-10 scale and the degree of commitment to the exercise sessions were assessed after the intervention. The patients completed the intervention period and outcome measures sessions. Paired t-tests reported statistically significant improvements and high effect size in pain, ROM, function, and balance after the end of the treatment (p < 0.001, Cohen's d > 0.69). The level of satisfaction was 9.25 ± 0.766, and the commitment to exercise sessions was high (98.75% attendance rate). Applying postural correction using TBed VR gaming in addition to heat and stretching may improve pain, range of motion, function, and balance in patients with chronic low back pain.

Maitland Mobilization versus Core Stability Exercises in Management Chronic Nonspecific LBP

Background: Low back pain (LBP) is one of the main causes that affect mechanical function in human bodies worldwide, 90% of the cases with non-specific LBP. Different options are available for the management of non-specific LBP. While Maitland mobilization and core stability exercises are usually utilized in clinical practice for managing Chronic Nonspecific Low Back Pain, there is now a lack of research examining their comparative effectiveness. Objective: The objective of this study is to assess and compare the efficiency of Maitland mobilization and core stability exercise as treatment modalities for adults suffering from chronic non-specific low back pain. Methods: A total of 36 Non-specific low back pain (NSLBP) patients with ages 18 to 45 years were inducted and given their Informed consent. Subjects were allocated into two groups through simple random sampling. Group A (N=18) received central posterior-anterior vertebral mobilization while group B (N=18) received core stability exercises. Pain and functional disability were assessed using the Visual Analogue scale (VAS) and Oswestry Disability Index (ODI) respectively. Pre &amp; post-treatment scores were documented and compared to achieve the aim of this study. Results: T-test indicated that the results pre- and post-treatment were showed a statistically positive significant difference by applying Maitland mobilization technique with non-specific LBP to improve functional disability (ODI) and reduce pain intensity (VAS) with (p = 0.001), respectively. On the other hand, results for the application of core stability exercises in management NSLBP also showed positive signs in reducing VAS and improving ODI with (p= 0.001) respectively. The findings suggest that there was no statistically significant difference between the Maitland mobilization technique and core stability exercises in treating NSLBP for pain reduction with (p = 0.312) and improvement in ODI with (p = 0.055). For applying Maitland mobilization in NSLBP, Pearson correlation results indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.034) and pain severity (VAS) with (p = 0.808). For core stability exercises, the results of Pearson's correlation indicated that there was no relationship between body mass index (KG/M2) and functional disability (ODI) with (p = 0.959) and pain intensity (VAS) with (p = 0.987). By gender, the results showed there were no statistically significant role for Maitland mobilization and core stability exercises in improving function and reducing pain among patients with chronic non-specific low back pain. Conclusion: Both core stability exercises and Maitland method have demonstrated effectiveness in reducing pain and improving functional disability in patients with chronic nonspecific low back pain.

BACK-to-MOVE: Machine learning and computer vision model automating clinical classification of non-specific low back pain for personalised management.

Low back pain (LBP) is a major global disability contributor with profound health and socio-economic implications. The predominant form is non-specific LBP (NSLBP), lacking treatable pathology. Active physical interventions tailored to individual needs and capabilities are crucial for its management. However, the intricate nature of NSLBP and complexity of clinical classification systems necessitating extensive clinical training, hinder customised treatment access. Recent advancements in machine learning and computer vision demonstrate promise in characterising NSLBP altered movement patters through wearable sensors and optical motion capture. This study aimed to develop and evaluate a machine learning model (i.e., 'BACK-to-MOVE') for NSLBP classification trained with expert clinical classification, spinal motion data from a standard video alongside patient-reported outcome measures (PROMs). Synchronised video and three-dimensional (3D) motion data was collected during forward spinal flexion from 83 NSLBP patients. Two physiotherapists independently classified them as motor control impairment (MCI) or movement impairment (MI), with conflicts resolved by a third expert. The Convolutional Neural Networks (CNNs) architecture, HigherHRNet, was chosen for effective pose estimation from video data. The model was validated against 3D motion data (subset of 62) and trained on the freely available MS-COCO dataset for feature extraction. The Back-to-Move classifier underwent fine-tuning through feed-forward neural networks using labelled examples from the training dataset. Evaluation utilised 5-fold cross-validation to assess accuracy, specificity, sensitivity, and F1 measure. Pose estimation's Mean Square Error of 0.35 degrees against 3D motion data demonstrated strong criterion validity. Back-to-Move proficiently differentiated MI and MCI classes, yielding 93.98% accuracy, 96.49% sensitivity (MI detection), 88.46% specificity (MCI detection), and an F1 measure of .957. Incorporating PROMs curtailed classifier performance (accuracy: 68.67%, sensitivity: 91.23%, specificity: 18.52%, F1: .800). This study is the first to demonstrate automated clinical classification of NSLBP using computer vision and machine learning with standard video data, achieving accuracy comparable to expert consensus. Automated classification of NSLBP based on altered movement patters video-recorded during routine clinical examination could expedite personalised NSLBP rehabilitation management, circumventing existing healthcare constraints. This advancement holds significant promise for patients and healthcare services alike.

Prevalence of Disability in Chronic Non-Specific Low Back Pain Patients

Background: Lower back pain (LBP) is the most frequent medical condition requiring rehabilitation in most countries, and it is also the most common medical issue among individuals with disabilities. Numerous illnesses, such as nephrolithiasis, endometriosis, tumors, fibromyalgia, and psychological disorders, can induce back pain that is not related to the spine. Objective: To determine the disability prevalence among patients with chronic non-specific low back pain Materials and Methods: The cross sectional observational study was conducted in the Department of Physical Medicine and Rehabilitation, Dhaka Medical College &amp; Hospital, Dhaka. Total 103 cases diagnosed individuals with chronic non-specific low back pain after fulfilling enrollment criteria was enrolled in this study. Question about sex life (ODI-8) was asked at the end of the interview. Disability refers to impairment, activity limitation and participation restrictions that may occur with a health condition. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds with or without referred leg pain. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 23.0 for Windows (SPSS Inc., Chicago, Illinois, USA). Results: Prevalence of the disability more than half (52.4%) of the patients had severe disability, 27(26.2%) had moderate, 14(13.6%) had crippled and 8(7.8%) had minimal disability. Conclusion: The prevalence of severe disability in Chronic Non-Specific Low Back Pain was 52.4%. The duration and severity of pain are significantly correlated with impairment.

Clinical and Biochemical Changes Among Nonspecific Low Back Pain Patients Treated with Wet Cupping Therapy: A Prospective Interventional Study

Clinical and Biochemical Changes Among Nonspecific Low Back Pain Patients Treated with Wet Cupping Therapy: A Prospective Interventional Study

Effect Of Triamcinolone Trigger Point Injection On Changes In TNF-α Levels And Oswestry Disability Index (ODI) Scores Non-Specific Low Back Pain (LBP) Patients

Background: Low back pain (LBP) is the most common musculoskeletal problem and a major cause of worldwide disability causing increased health costs and indirect costs associated with reduced or lost productivity. One of the therapeutic management of LBP is Triamcinolone trigger point injection. Until now, research on the effect of Triamcinolone trigger point injection on changes in TNF-α levels and Oswestry Disability Index (ODI) scores in Non-Specific LBP patients is still limited. Objective: To analyze the effect of Triamcinolone trigger point injection on changes in TNF-α levels and ODI scores before and after Triamcinolone trigger point injection in Non-Specific LBP patients. Methods: This is a quasi-experimental analytic observational study with a pre and post-test group design approach. Subjects were diagnosed with Non-Specific LBP who had met the inclusion criteria (acute pain less than 3 months, patient age 30-55 years, moderate-severe pain intensity, had never received a Triamcinolone trigger point injection) with the exclusion criteria patients experiencing severe pain. not only caused by NPB. The study subjects were checked for TNF-α levels and ODI scores before and after the Triamcinolone trigger point injection. Then a paired T-test was carried out. Results: During the study period September - November 2022 at the Neurology Outpatient Polyclinic, RSUP Dr. Kariadi Semarang obtained 32 subjects. There was a significant difference between changes in TNF-α levels before and after Triamcinolone trigger point injection (p=0.000). There was a significant difference in ODI scores before and after the Triamcinolone trigger point injection (p=0.000). There was no significant relationship between the risk factors for gender, occupation, BMI, physiotherapy, and changes in TNF-α levels with changes in the ODI score. Conclusion: There is a significant difference in changes in TNF-α levels and ODI scores before and after Triamcinolone trigger point injection.

Validity and Reliability of the Greek Version of Pittsburgh Sleep Quality Index in Chronic Non-Specific Low Back Pain Patients.

The purpose of this study was to investigate psychometric properties of the Greek translation of Pittsburgh Sleep Quality Index (GR-PSQI) in a Greek chronic non-specific low back pain (CNSLBP) sample, thus, providing insight on its clarity and acceptability as a widely used sleep assessment tool in clinical practice. Asymptomatic volunteers (n = 73) and CNSLBP volunteers (n = 47), participated in the study. For the assessment of construct validity, the known-groups method was used. Thus, all the participants (asymptomatic and CNSLBP) completed the GR-PSQI. For the assessment of concurrent validity, the CNSLBP participants additionally completed the following validated questionnaires for depression, insomnia and sleep quality: Beck Depression Inventory Questionnaire (BDI), Insomnia Severity Index (ISI), and Sleep Quality Numeric Rating Scale (SQNRS). For the assessment of test-retest reliability, the CNSLBP participants completed the GR-PSQI a second time, one week after the first time. The results showed excellent test-retest reliability (ICC = 0.969, SEM = 0.90, SDD = 2.49%) and internal consistency (Cronbach α = 0.985), moderate to good concurrent validity (from r = 0.556 to r = 0.860) among PSQI, BDI, SQNRS, and ISI, as well as excellent construct validity (p = 0.000) between the two groups. The Greek translation of PSQI could be a valuable tool for Greek healthcare professionals in both clinical and research environments.

Acute effect of dry needling on trunk kinematics and balance of patients with non-specific low back pain

BackgroundLimited knowledge exists about the effectiveness of dry needling (DN) concerning the torso kinematics in patients with non-specific low back pain (NS-LBP). Acute effects of DN in NS-LBP patients from a functional perspective were investigated. MethodsSixteen NS-LBP patients and 11 healthy individuals (HG) were examined. NS-LBP patients received a single session of DN at the lumbar region. Baseline and immediate post-treatment measurements during flexion-extension and lateral bending of the trunk were conducted for the NS-LBP patients. HG were measured only at baseline to be used as a reference of NS-LBP patients' initial condition. Algometry was applied in NS-LBP patients. Centre of pressure, range of motion of the trunk and its’ derivatives were obtained. FindingsHG performed significantly faster, smoother and with greater mobility in the performed tasks compared to the pre intervention measurements of the NS-LBP patients. For the NS-LBP patients, significant greater angular velocity in frontal plane and significant lower jerk in the sagittal plane were demonstrated post intervention. DN alleviated pain tolerance significantly at the L5 level. Regarding the effectiveness of the DN upon spine kinematics, their derivatives were more sensitive. InterpretationIt appeared that the pathological type of torso movement was acutely affected by DN. NS-LBP patients showcased smoother movement immediately after the intervention and better control as imprinted in the higher derivative of motion although range of motion did not improve. This quantitative variable may not be subjected to acute effects of DN but rather need additional time and training to be improved.