Oswestry Disability Questionnaire Research Articles

Effect of Vitamin-D supplementation in adults presenting with chronic lower back pain

Background: Chronic pain in the lower back of adults is a common problem and mostly associated with Vitamin D deficiency. Along with standard treatment, vitamin D supplementation can help in early and better relief from back pain.
 Objective: To assess the effectiveness of vitamin D supplementation in patients with chronic lower back pain.
 Study Design & Methods: This Quasi-experimental trial was conducted at Department of Orthopaedics, Benazir Bhutto Hospital for 6 months. The patients aged between 15 to 55 years with chronic low back pain were included and pain score was noted by using a visual analogue scale (VAS). Patients were prescribed with oral vitamin D3 with a dose of 50,000 IU weekly for eight weeks (induction phase) and oral vitamin D3 with a dose of 50,000 IU once monthly for 6 months (maintenance phase). Outcome parameters included pain measured by VAS, functional disability by modified Oswestry disability questionnaire scores, and Vitamin-D3 levels at baseline,2, 3 and 6 months post-supplementation.
 Results: Mean age of patients was 44.21± 11.92 years.There were 337 (56.2%) male patients while 263 (43.8%) female patients. Baseline mean vitamin-D levels were 13.32 ± 6.10 ng/mL and increased to 37.18 ± 11.72 post supplementation (P < 0.0001). There was a significant decrease in the pain score after 2nd, 3rd& 6th months (61.7 ± 4.8, 45.2 ± 4.6 & 36.9 ± 7.9, respectively) than 81.2 ± 2.4 before supplementation (P < 0.001). The modified Oswestry disability score also showed significant improvement after 2nd, 3rd& 6thmonths (35.5 ± 11.4, 30.2 ± 9.4 & 25.8 ± 10.6, respectively) as compared to baseline 46.4 ± 13.2 (P < 0.001). About 418 (69.7%) patients attained normal levels after 6 months.
 Conclusion: Prescription of Vitamin D in addition to standard therapy for chronic lower back pain can be beneficial in getting relief from pain and improving the functional ability of the patient.

Correlation Analysis Between Oswestry Disability Questionnaire and Abdominal Flexor Endurance among Non-Specific Low Back Pain Patients

Correlation Analysis Between Oswestry Disability Questionnaire and Abdominal Flexor Endurance among Non-Specific Low Back Pain Patients

Scapular and Pelvic PNF Pattern for Female Physical Education Students with Low Back Pain

Background: - Physical education students are at greater risk of low back pain due to physical activity thatput a lot of stress on the lumbar spine, such as gymnastics, wrestling, rowing, diving, and football. PNFtraining is one of the interventions that are less investigated in the management of LBP.Purpose: - The purpose of this study was to determine whether exercises using proprioceptive neuromuscularfacilitation (PNF) scapular and pelvic patterns might decrease the pain index and increase the lumbarflexibility of female physical education students with low back pain.Subjects & Methods: - A total of 40 female undergraduates with low back pain who meets the inclusion andexclusion criteria are recruited for the study.Methodology: - 20 were allotted to Experimental group who received scapular and pelvic pattern of PNFalong with conventional strengthening exercises and another 20 was allotted to Control group who receivedconventional strengthening exercises alone.Outcome Measures: - Numerical Pain Rating Scale (NPRS), Modified-Modified Schober Scale (MMST)and Oswestry Disability Questionnaire (ODI).Results: - results showed that both the groups improved almost equally in lumbar flexion and extensionranges but the improvement was considerably significant on NPRS and Modified Oswestry Disability Indexwas found to be significantly effective in experimental group which was p<0.001.Conclusion: - This study showed that PNF can be used to improve pain index rating and lumbar flexibility.The findings indicate that the experimental group experienced greater improvement than the control groupby participating in the PNF lumbar stabilization

Managing pain and stiffness through individualized homoeopathy in lumbar spondylosis: Results of a prospective consecutive case series

Background: Low back pain affects approximately 60 – 85% of adults during some point in their lives and LS is responsible for about 10 % of all the back-pain. Common conventional treatments like NSAIDS and Epidural steroid injections (ESI) deleterious side effects. Objectives: This case series of lumbar spondylosis presented here tries to show response to individualized homoeopathic medicine in context of pain, stiffness through Visual Analog Scale (VAS) and RODQ. Method: Patients with spondylotic changes in lumbar spine were included in this case series. Individualized homoeopathic medicines were prescribed in singledose in each case and followed up every 2 weeks for eight months. Pain and stiffness in every case was assessed using Visual Analog Scale (VAS)at baseline and every two weeks for eight months. Revised Oswestry disability questionnaire (RODQ) scoresto assess quality of life was used at baseline and at the end of 8 months. Results: Mean VAS score for pain reduced from 78.07 ± 13.72mm (baseline)to 38 ± 25.55 mm (end); 95% CI: 22.05 - 58.09; P

Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study.

Background:Facet joint is a potential structure to be the source of chronic low back pain (LBP) affecting lumbar motion, pain, and disability. Other than the recommended treatment of lumbar stabilization exercise (LSE), several manual procedures including muscle energy technique (MET) are commonly used in physical therapy clinic. However, little evidences of the effects of MET have been reported.Objective:This study aimed to compare the immediate effects of MET and LSE in patients with chronic LBP with suspected facet joint origin.Methods:Twenty-one patients with low back pain were recruited and randomly assigned to receive treatment either MET or LSE. The outcomes were kinematic changes, pain intensity, and disability level. Lumbar active range of motion (ROM) of flexion, extension, left and right lateral flexion, and left and right rotation were evaluated using the three-dimension motion analysis system at baseline and immediately after treatment. Pain intensity was evaluated using visual analogue scale (VAS) at baseline, immediately after, and two days after treatment. Thai version of the modified Oswestry disability questionnaire (ODQ) was utilized at baseline and two days after treatment. The mixed model analysis of variance was used to analyze all outcomes.Results:The results showed that all outcomes were not different between groups after treatments. Although there were statistically significant improvements after the treatments when collapsing the groups, the minimal clinically important change was found only for pain but not for lumbar movements and disabilities scores.Conclusion:The effect of MET and LSE alone in single session might not be intensive enough to improve movements and decrease disability in patients with chronic LBP with suspected facet joint origin.

Assessment of disability levels in patients with low back pain based on the type of lumbar spinal disorder.

Low back pain (LBP) is a common health condition and the leading cause of activity limitation and absenteeism in most parts of the world. One-fifth of patients with LBP develop chronic pain disability. This study investigated the disability levels in patients with different types of lumbar spinal disorders. A total of 528 patients visiting spine clinics between June 2017 and February 2018 were enrolled in this study. A demographic checklist, the patients' medical records, the Oswestry Disability Questionnaire, and the Visual Analog Scale (VAS) were used to collect the data. Non-specific LBP (29.5%) and discopathy (27%) were the most common final diagnoses. The obtained Oswestry Disability Index (ODI) was significantly higher in older patients, those with higher body mass index, more work experience, and smokers. Lower ODI was found in individuals with a history of regular exercise. Most individuals in all diagnostic groups were categorized into the high ODI group (p⩽ 0.001). In patients with lumbar spine lesions, ODI is significantly correlated with age, BMI, work experience, smoking, and the type of disorder (discopathy, spondylolysis, and spondylolisthesis). Regular exercise is associated with lower levels of disability.

Management of low back pain with a combination of static and dynamic Yogasanas and Siddha Medicine- A Case Series

Background: Siddha philosophical concepts reveal that the disruptions in the flow of life force (Prana) are the cause of dysfunctions in a particular part of the body. As per this fact, chronic low back pain is due to the disruptions in the flow of life force in and around the spine. Objective: was to evaluate whether the regular practice of a specific set of static and dynamic Yogasanas along with Siddha Medicine would reduce chronic low back pain by regulating the flow of Prana. Material & Methods: The clinical trial was undertaken in Santhigiri Siddha Medical College & Hospital, Pothencode, Thiruvananthapuram, Kerala, with a sample size of 10 patients. As per the inclusion, exclusion criteria, after obtaining consent to participate and to follow yoga therapies this study was carried out. The degree of illness and prognosis is quantitatively assessed with the Revised Oswestry Disability Questionnaire (Revised ODI) and pain is assessed by Visual Analog Scale (VAS). Results: The clinical outcome of ODI score revealed marked improvement in range of movements. Out of 10 patients, 8 patients showed good improvement (Minimal Disability) and 2 patients had moderate pain relief (Moderate Disability). Pain assessment by VAS and the score plot also revealed remarkable pain relief. Conclusion: The outcome of this case series suggests that a combination of static and dynamic Yogasanas with suitable internal medicines of Siddha system gives a marked improvement in chronic low back pain.

Effect of sciatic nerve neurodynamic sustained natural apophyseal glides on individuals with pelvic crossed syndrome: A randomized controlled trial

Background: Pelvic crossed syndrome (PCS) is a common predisposing factor of low back pain. If left untreated, PCS could result in various spinal and lower-limb pathologies which would hinder an individual's functional abilities and affect their quality of life. Aims: The study aimed to evaluate the effect of sciatic nerve neurodynamic sustained natural apophyseal glides (SNAGs) along with a stretching-strengthening protocol on individuals with symptomatic PCS. Settings and Design: This study was conducted in a tertiary care center; this was a randomized controlled trial. Materials and Methods: Forty-two individuals were randomly allocated to control group (conventional physical therapy) and experimental group (sciatic nerve neurodynamic SNAGs along with conventional physical therapy) using envelope method. The outcome measures – pressure pain threshold, degree of lumbar lordosis, modified Thomas test, finger-to-floor test, and Modified Oswestry Disability Questionnaire (MODQ) were obtained from the participants on day 1 and posttreatment on day 6, respectively. Both the groups received the treatment for 45 min per session for 6 consecutive days. Statistical Analysis Used: Parametric dependent t-test was applied through R software 3.5.1. Results: Intragroup analysis revealed statistically significant changes in all outcome measures in both the groups. Statistically significant changes were observed in the intergroup analysis of all the outcome measures (P Conclusion: Sciatic nerve neurodynamic SNAGS when given along with conventional therapy resulted in significant and superior improvement as compared to conventional therapy alone in patients with symptomatic PCS in terms of pain sensitivity and flexibility.

Combination of Rehabilitative Therapy with Ultramicronized Palmitoylethanolamide for Chronic Low Back Pain: An Observational Study.

IntroductionChronic low back pain (LBP) caused by intervertebral disc herniation was reported in the 2010 Global Burden of Disease study to be the main reason for years lived with disability. It causes significant personal, social, and economic burdens. Many of those who suffer from LBP find conventional medical treatments to be unsatisfactory for treating their pain, so they are increasingly resorting to complementary and alternative medicine (CAM) therapies. Given that the population is aging, there is an urgent need to characterize the combinations of complementary therapies that yield the best outcomes and treatments, even for prolonged periods. This observational study aimed to evaluate the effect of ultramicronized palmitoylethanolamide (umPEA) + CAM (daily functional rehabilitation + decontracting massage) therapies on chronic pain in patients suffering from multiple herniated discs in the lumbar spine.MethodsEligible patients received 600 mg of umPEA twice a day in combination with a daily functional rehabilitation session according to the McKenzie Method of Mechanical Diagnosis and Therapy plus a decontracting massage for 20 consecutive days, followed by 600 mg of umPEA once a day for 40 days in addition to standard therapy.ResultsThe results showed that the average pain intensity score, evaluated via the Numeric Rating Scale, progressively decreased during the study period, reaching a value that was not clinically relevant at the end of the observation period. Pain relief was paralleled by improvements in the physical and mental components of quality of life as evaluated with the SF-36 questionnaire as well as in disability for low back pain as evaluated with the Oswestry Disability Questionnaire. Collectively, the results demonstrate that umPEA in combination with CAM therapies could be an important strategy for combating LBP.ConclusionsThe multiple action of PEA in combination with CAM therapies may represent the multitarget approach needed to tackle the as-yet unsolved problem of chronic pain resistant to conventional therapies.

77 Comparison between Swiss Ball Exercise and Sling Exercise on Lumbar Stability and Postural Stability in Patients with Non-Specific Chronic Low Back Pain: A Pilot Study

Abstract Objective This study was to comparison of level of lumbar stability and postural sway in sagittal plane and coronal plane between exercise with ball and sling in the patients with non-specific chronic low back pain (NCLBP). Methodology Twenty participants with NCLBP aged 20 to 55 years were randomly divided into exercise with ball group (BG) and exercise with sling group (SG). Both groups performed 8 exercise sessions; two times per week for four weeks. The visual analog scale (VAS), modified oswestry disability questionnaire (MODQ), modified isometric stability test (MIST) were used to measure at baseline, week 2 and week 4 after exercise. Moreover, the sway area and sway velocity were evaluated at before and after training. Both group performed exercise 15 repetitions per set for 3 sets with 1-minute resting between set. A repeated two-way ANOVA was used to analyze the difference variables between both groups. Results The results showed significant difference between pre and post treatment of pain intensity, functional disability, MIST and postural sway in both groups (p<.001). When compared between both groups, the reduction in all parameters for the BG group was significantly higher than the SG group (p<.05). Moreover, the findings represented that the postural sway in both sagittal and coronal plane showed no significant difference between both groups after complete treatment. Conclusion The core stabilization exercise with ball and with sling can provided reduction of pain and functional disability. Moreover, the BG group is more effective for decreasing of pain, disability and improving of lumbar stability may described by greater perturbation of the ball. During perform exercise on ball bring to unstable and increasing of neuromuscular control. These results can applied to clinical practice for choosing the appropriate exercise program in the patients with NCLBP.

Responsiveness of pain, functional capacity tests, and disability level in individuals with chronic nonspecific low back pain.

Background:Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP).Objective:This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP.Methods:Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM).Results:The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES −0.986, SRM −0.928) and five-time sit-to-stand test (5 TSST) (SRM −0.846).Conclusion:This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.

Short-term Effects of Thoracic Spine Thrust Manipulation, Exercise, and Education in Individuals With Low Back Pain: A Randomized Controlled Trial.

To determine the short-term effectiveness of thoracic manipulation when compared to sham manipulation for individuals with low back pain (LBP). Randomized controlled trial. Patients with LBP were stratified based on symptom duration and randomly assigned to a thoracic manipulation or sham manipulation treatment group. Groups received 3 visits that included manipulation or sham manipulation, core stabilization exercises, and patient education. Factorial repeated-measures analysis of variance and multiple regression were performed for pain, disability, and fear avoidance. The Mann-Whitney U test was used to analyze patient-perceived improvement, via the global rating of change scale, at follow-up. Ninety participants completed the study (mean ± SD age, 38 ± 11.5 years; 70% female; 72% with chronic LBP). The overall group-by-time interaction was not significant for the Modified Oswestry Disability Questionnaire, numeric pain-rating scale, and Fear-Avoidance Beliefs Questionnaire outcomes. The global rating of change scale was not significantly different between groups. Three sessions of thoracic manipulation, education, and exercise did not result in improved outcomes when compared to a sham manipulation, education, and exercise in individuals with chronic LBP. Future studies are needed to identify the most effective management strategies for the treatment of LBP. Therapy, level 1b. J Orthop Sports Phys Ther 2020;50(1):24-32. Epub 6 Dec 2019. doi:10.2519/jospt.2020.8928.

Transforaminal Versus Lateral Parasagittal Versus Midline Interlaminar Lumbar Epidural Steroid Injection for Management of Unilateral Radicular Lumbar Pain: A Randomized DoubleBlind Trial

Background: Epidural steroid injections (ESIs) are commonly used for management of lumbosacral radicular pain. Midline interlaminar (MIL) or transforaminal (TF) routes are commonly used. The TF route, although associated with higher delivery of drug to the ventral epidural space, has serious complications including spinal cord injury and permanent paralysis reported in literature. Therefore, there is a search for a technically better route with fewer complications and greater drug delivery into the ventral epidural space. Recently, a parasagittal interlaminar (PIL) approach has been defined. Objectives: We conducted this study to compare therapeutic effectiveness of 3 techniques of ESIs in patients having unilateral lumbar radiculopathy. Further, effect of ESI on bone mineral density (BMD) and serum osteocalcin levels were studied. Study Design: Randomized double-blind trial. Setting: Pain clinic of a tertiary care hospital. Methods: Sixty-five patients were randomly allocated into group MIL, group PIL, and group TF to receive epidural injection with 80 mg of methylprednisolone and 2 mL of 2% lidocaine. Effective pain relief and improvement in disability were assessed using Visual Analog Scale (VAS) and Modified Oswestry Disability Questionnaire (MODQ) scores at 2 weeks, 4 weeks, 3 months, and 6 months, respectively. Patients with < 50% relief received additional injection. Primary outcome of study was effective pain relief at 6 months. Mean change in VAS and MODQ scores, BMD, and serum osteocalcin levels were secondary outcome assessed. Results: Patients having effective pain relief were significantly higher in group PIL (16 of 20 [80%]) and group TF (15 of 20 [75%]) compared with group MIL. Patients receiving ESI in group PIL and group TF showed significantly lower VAS scores than group MIL (P = 0.02, P = 0.50 at 3 months and P = 0.00, P = 0.02 at 6 months, respectively). Mean MODQ scores in group PIL and group TF were significantly lower than group MIL. However, group PIL and group TF did not significantly differ in MODQ scores. There was no significant change in serum osteocalcin and BMD, as assessed by dual energy x-ray absorptiometry scan at 3 months. Limitations: The absence of a placebo control group, small sample size, and relatively short follow-up of 6 months were limitations. Conclusions: PIL approach is equivalent to TF and superior to MIL approach in terms of effective pain relief and decrease in disability in patients with unilateral lumbar radiculopathy. This study showed no deleterious effect on BMD. Key words: Epidural steroid, technique, efficacy, bone marrow density, serum osteocalcin

EFFECTIVENESS OF NEURAL MOBILIZATION IN THE MANAGEMENT OF CHRONIC LOW BACK PAIN WITH RADICULOPATHY: A RANDOMIZED CONTROLLED TRIAL

Background: Neural mobilization (NM) constitutes the most effective, common method for assessing and treating several neuromuscular disorders. The study at hand aims to determine the effectiveness of the NM technique compared to lumbar stabilization exercise (LSE) and Radial Extracorporeal Shock Wave Therapy (rESWT) in the physical therapy management of chronic low back pain (CLBP) with radiculopathy.Methods: Two groups comprising 30 participants and randomly chosen formed the basis of this investigation: Group A (NM, LSE, and rESWT) and Group B (LSE and rESWT). The period of three to six weeks constituted the time it took to measure the results herein reached baseline. The results of the observations focused on pain assessed by numerical pain rating scale (NPRS), Lumbar flexion range of motion (Lumbar FROM) by Schober’s method, and disability level as measured by the Modified Oswestry Disability Questionnaire (MODQ).Results: In the control group, the mean scores of pain, lumbar FROM, and MODQ at baselines showed a high level of similarity (6.47, 2.87, and 43.71 respectively in the intervention group, and 6.20, 2.93 and 44.66. Both groups showed improvement in their pain scores at three weeks (P<0.05). However, only lumbar FROM and MODQ showed statistically significant improvement in favor of the intervention group at three weeks (P<0.05). By week 6, both groups achieved a statistically significant difference in the values of all variables.Conclusion: NM with LSE and rESWT is more effective than LSE and rESWT in the third week, and was similarly effective in the sixth week of the treatment. NM with LSE and rESWT may be an alternative treatment option in the treatment of CLBP.

The Italian version of the Quebec Back Pain Disability Scale: cross-cultural adaptation, reliability and validity in patients with chronic low back pain.

Growing attention is being given to physical functioning measures to assess interventions for low back pain (LBP). The Quebec Back Pain Disability Questionnaire (QBPDS) has never been validated in Italian patients, and the aim of the study was culturally adapting and validating the Italian version of the QBPDS (QBPDS-I), to allow its use with Italian-speaking patients with chronic LBP. The QBPDS-I was developed by means of forward-backward translation, a final review by an expert committee and a test of the prefinal version to evaluate its comprehensibility. The psychometric testing included structural validity by exploratory factor analysis (EFA), reliability by internal consistency (Cronbach's alpha) and test-retest reliability (intraclass correlation coefficient, ICC 2.1), measurement error by calculating the minimum detectable change (MDC), construct validity by assessing hypotheses of QBPDS correlations with the Roland Morris Disability Scale (RMDQ), the Oswestry Disability Questionnaire (ODI) and a pain numerical rating scale (NRS) (Spearman's correlations). It took one month to develop a consensus-based version of the QBPDS-I. The questionnaire was administered to 201 subjects with chronic LBP and was well accepted. EFA suggested a one-factor 20-item solution (first factor variance explained = 54.7%). Internal consistency (α = 0.95) and test-retest reliability (ICC = 0.90) were excellent. The MDC was 12 scale points. Construct validity was good as all of the hypotheses were met; correlations: RMDQ (r = 0.40), ODI (r = 0.48) and NRS (r = 0.44). The QBPDS-I is unidimensional, reliable and valid in patients with chronic LBP. Its use is recommended for clinical and research purposes.

Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort study

BackgroundResuming walking after lumbar surgery is a common focus of early post-operative rehabilitation, however there is no knowledge about whether increased walking is associated with better functional outcomes. This study aimed to determine whether time spent walking in the week after lumbar surgery, along with co-morbidities, pre-operative pain duration, pre-operative physical activity or function, or surgical variables predict substantial improvement in physical function six months after lumbar surgery.MethodsA prospective cohort study design was utilized. Participants undergoing lumbar surgery (discectomy, decompression, fusion) were recruited between April and November 2016. Predictor variables were collected pre-operatively (age, sex, smoking status, obesity, diabetes, depression, anxiety, pre-operative pain duration, neurological deficit, physical activity levels, mobility restriction, function) and early post-operatively (post-operative walking time, surgical procedure, single/multi-level surgery). Outcome variables (physical function, back pain and leg pain severity) were measured pre-operatively and six-months post-operatively. Logistic regression analysis was used to establish prediction of substantial improvement in outcome at six months.ResultsParticipants (N = 233; 50% female; age 61 (SD = 14) years) who walked more in the first post-operative week were more likely to have substantially improved function on the Oswestry Disability Questionnaire at six months (OR 1.18, 95%CI 1.02–1.37), as were participants with < 12 months pre-operative pain (OR 2.71, 95%CI 1.28–5.74), and those with lower pre-operative function (OR 4.02, 95%CI 2.33–6.93). Age < 65 years (OR 2.36, 95%CI 1.14–4.85), and < 12 months pre-operative pain (OR 3.52 95%CI 1.69–7.33) predicted substantial improvement on the SF-36 Physical Component Summary. There were no significant predictors for substantial improvement in either leg or back pain.ConclusionsWalking time in the week after lumbar surgery is one of several predictors of substantial improvement in function at six months. Further research is required to determine whether intervention designed to increase walking early after lumbar surgery results in improved longer-term recovery of function.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), registration number 12616000747426. Retrospectively registered on the 7th of June 2016.

Transcranial direct current stimulation for nonspecific low back pain: double-blind randomized sham-controlled trial

Introduction: Low back pain is recognized as a major cause of morbidity worldwide. Between 70 and 80% of adults experience at least one occasion of low back pain with duration of 3 months or longer in their lifetime. Aside from the classic treatment methods, there are other new techniques yet to be clinically investigated. Transcranial direct current stimulation (tDCS) has been reported to alleviate pain by affecting the central nervous system. To date only a small number of studies have been published on the effects of tDCS on chronic low back pain. Some of these were pilot studies and others were low-powered in terms of their inference. Therefore the clinical application of tDCS requires further careful evaluation. Objective: To assess the efficacy of transcranial direct current stimulation for treatment of chronic nonspecific low back pain. Materials and methods: We carried out a double-blind randomized sham-controlled trial in a University Hospital. In total 70 people (15 women) with low back pain were randomized to either active or sham stimulation. The primary outcome was intensity of low back pain on the Visual Analog Scale. We also used the Oswestry Disability Questionnaire to evaluate the effects of back pain on daily activities. For the active stimulation group we administered 2 mA tDCS, 20 minutes for each session, once daily, 5 days per week for 2 weeks, totaling 10 sessions. For the sham stimulation group a similar program was followed with no stimulation. Both groups used analgesic medication. Results: Within-group analysis showed that an initial decrease in pain intensity was significant in both groups (both p &lt; 0.001). However, pain reduction became stable only in the active treatment group. There was a significant difference in the pattern of change in mean pain scores in favor of tDCS (p &lt; 0.001). Active treatment also significantly reduced disability scores (all p values &lt; 0.001), whereas participants in the sham treatment group did not experience functional recovery. Mixed ANOVA indicated that the pattern of change in mean scores of disability differed between the two groups throughout the study course, in favor of active stimulation (p &lt; 0.001). Conclusion: Transcranial direct current stimulation is an effective and safe initial treatment for chronic nonspecific low back pain, and the benefits remain for at least several months.

The influence of knee bolster on lumbar spinal stenosis parameters on MR images.

To estimate the effect of the knee bolster use during an MRI on lumbar spinal stenosis parameters and low back pain-related disability. A repeated-measurement study of 27 males and 19 females with mean age 55.78 ± 14.36, referred for an MRI of the lumbar spine due to low back pain, performed with and without standard knee bolster. A radiologist evaluated the lumbar lordosis Cobb's angle, the cross-sectional area of the right and left intervertebral foramina and spinal canal at L1-L2, L2-L3, L3-L4 spinal levels. Spinal symptoms were evaluated by the Oswestry Disability Questionnaire. The Cobb angle of lumbar lordosis was found significantly greater on an MRI performed without knee bolster than with bolster (47.30 ± 9.90 vs. 42.57 ± 10.62, p < 0.001). The cross-sectional area of the intervertebral foramina and spinal canal at all evaluated levels was smaller when performed without knee bolster than with bolster. However, differences were significant only at the L1-L2 level and in the spinal canal at all evaluated levels. The Cobb angle, measured with and without knee bolster, showed significant positive correlations with back pain while standing and walking. The spinal canal area without knee bolster showed greater correlations with the Oswestry score parameters than with knee bolster. MR images at evaluated spinal levels taken without knee bolster showed greater correlations of the spinal canal cross-sectional area with the Oswestry score than ones with knee bolster. Thus, one may prefer MR images acquired without a bolster below the knee compared to an MRI with a knee bolster.

Low Back Pain--Related Disability in Parkinson Disease: Impact on Functional Mobility, Physical Activity, and Quality of Life.

People with Parkinson disease (PD) frequently experience low back pain (LBP), yet the impact of LBP on functional mobility, physical activity, and quality of life (QOL) has not been described in PD. The objectives of this study were to describe body positions and functional activities associated with LBP and to determine the relationships between LBP-related disability and PD motor sign severity, physical activity level, and QOL. The study was a cross-sectional study. Thirty participants with idiopathic PD (mean age=64.6 years [SD=10.3]; 15 women) completed the Revised Oswestry Disability Questionnaire (RODQ), a measure of LBP-related disability. PD motor symptom severity was measured using the Movement Disorder Society-Unified Parkinson Disease Rating Scale Part III (MDS-UPRDS III). The Physical Activity Scale for the Elderly (PASE) was used to measure self-reported physical activity. The Parkinson Disease Questionnaire-39 (PDQ-39) was used to measure QOL. Descriptive statistics were used to characterize LBP intensity and LBP-related disability. Spearman correlations were used to determine relationships between the RODQ and the MDS-UPDRS III, PASE, and PDQ-39. LBP was reported to be of at least moderate intensity by 63.3% of participants. LBP most frequently impaired standing, sleeping, lifting, and walking. The RODQ was significantly related to the MDS-UPDRS III (r=0.38), PASE (r=-0.37), PDQ-39 summary index (r=0.55), PDQ-39 mobility subdomain (r=0.54), and PDQ-39 bodily pain subdomain (r=0.44). Limitations included a small sample of people with mild to moderate PD severity, the fact that RODQ is a less frequently used measure of LBP-related disability, and the lack of a non-PD control group. LBP affected walking, sleeping, standing, and lifting in this small sample of people with mild to moderate PD. Greater LBP-related disability was associated with greater motor sign severity, lower physical activity level, and lower QOL in people with PD.

Wet Cupping—Traditional Hijamah Technique versus Asian Cupping Technique in Chronic Low Back Pain Patients: A Pilot Randomized Clinical Trial

To evaluate the feasibility of comparing the effect of the traditional Hijamah and the Asian wet cupping techniques in the management of patients with chronic low back pain (CLBP), a randomized clinical trial comparing traditional and Asian wet cupping techniques for CLBP was conducted in two secondary care hospitals in Saudi Arabia. Seventy eligible participants with CLBP were randomized to receive one session of wet cupping using either Asian technique (34 patients) or traditional Hijamah technique (36 patients). Cupping was performed at four sites of the bilateral bladder meridian (BL23, BL24, and BL25). The numeric rating scale, Present Pain Intensity, and Oswestry Disability Questionnaire scores were measured immediately after intervention, at seven days, and 14 days after intervention. In both groups, there was a significant decrease in the numeric rating scale, Present Pain Intensity, and Oswestry Disability Questionnaire scores, immediately after intervention, at seven days, and 14 days after intervention. However, there was no significant difference between the two groups across all the outcome measures up to 14 days after intervention. The study did not show a superiority of one technique compared with the other. Longer follow-up periods and more than one cupping session may be needed to evaluate the difference, if any, between both the techniques. Trial RegistrationNCT02012205.