Rehabilitation Of Musculoskeletal Disorders Research Articles

Reducing electrocardiographic interference in the multichannel electromyogram to help muscle fatigue assessment in low-intensity contractions.

Surface electromyography (EMG) can be used in the rehabilitation of musculoskeletal disorders, for evaluating the coordination of muscles that stabilize a joint, or as an objective tool in assessing muscle fatigue. This latter may be achieved by evaluating the low-frequency content of the EMG. However, the electrocardiogram (ECG) interference is also recorded when EMG is acquired close to the heart. It may mask or even modify the information of interest in the EMG. Different signal processing techniques have been proposed to eliminate ECG artifacts from the EMG signals, the high-pass filter being the most used one. Nevertheless, this classic filtering approach would also attenuate EMG activities below 30 Hz, which contain information from low-intensity muscle contractions. This work addresses the automatic ECG attenuation when multichannel EMG is collected on the left pectoralis major muscle during a muscle fatigue test. The proposed ECG artifact mitigation extends a successful automatic template subtraction (TS) approach, which does not require an extra reference channel and is now applied to independent EMG source signal components extracted using a blind source separation technique (ICA, Independent Component Analysis). The automatic detection of ECG components was performed through two alternative measures: entropy and Kullback-Leibler divergence. While the ECG interference seems to hamper the detection of muscle fatigue in the low-contraction regime, the association ICA+TS preserved better the EMG low-frequency content, and the entropy-based automatic detection was found to be more suitable, avoiding possible errors that might arise from manual detection procedures.

Rehabilitation of Musculoskeletal Disorders: A Systematic Review of Effective Interventions in Physically Demanding Workplaces

Background: Musculoskeletal disorders have become the most common health issue in physically demanding workplaces, causing severe pain and functional impairments that significantly reduce the affected employees’ quality of life. As a result, this systematic review aims to evaluate the workplace interventions implemented for rehabilitating musculoskeletal disorders in this population. Methods: A systematic literature search was conducted in various databases, including PubMed, Cochrane Library, Scopus, Web of Science, and CINAHL, following the PRISMA guidelines. Only randomized controlled trials involving employees in physically demanding jobs, where workplace rehabilitation interventions were measured, were considered. A standardized form was used to extract data, including study design, sample size, intervention details, and outcomes. Results: The review included five randomized controlled trials demonstrating various rehabilitation strategies, including ergonomic training, physical therapy, and emerging approaches such as AI-based health programs. Due to these interventions, the study observed significant reductions in pain levels and improvements in functional outcomes among employees with musculoskeletal disorders. Conclusion: Workplace interventions targeting musculoskeletal disorders in physically demanding jobs have effectively reduced pain and improved functional capacity. Customized approaches that integrate ergonomic strategies with innovative technologies can significantly enhance rehabilitation outcomes. Keywords: Ergonomics, Musculoskeletal Disorders, Occupational Health, Rehabilitation.

Nanotechnology and Biomaterials in Orthopaedic Medical Applications

The convergence of nanotechnology and biomaterials has heralded a transformative era in orthopaedics, revolutionizing the diagnosis, treatment, and rehabilitation of musculoskeletal disorders. This paper explores the profound impact of this synergy, focusing on innovations in implant design, regenerative therapies, targeted drug delivery, and advanced diagnostics. Nanotechnology's precision engineering has enabled the creation of implants that mimic natural bone, facilitating integration and improving mechanical stability. The fusion with biomaterials has led to scaffolds that foster tissue regeneration and implants with enhanced biocompatibility and longevity. The paper also delves into the challenges of this convergence, such as ensuring biocompatibility, navigating regulatory landscapes, and translating laboratory innovations into clinical practice. The research found that the strategic integration of nanotechnology and biomaterials holds immense promise for reshaping orthopaedic care, enhancing patient outcomes, and elevating the standards of treatment. This research signifies a critical exploration of the convergence of nanotechnology and biomaterials within orthopaedics, offering a comprehensive analysis that not only elucidates the transformative potential of this fusion but also provides insights and guidance for future research and clinical applications, thereby contributing to the advancement of personalized and effective treatments in the field.

Myths and truths on biophysics-based approach in rehabilitation of musculoskeletal disorders.

Musculoskeletal disorders (MSD) are a crucial issue in current literature due to their impact on physical function, social, and economic costs. Rehabilitation plays a pivotal role in the therapeutic management of these disabling conditions with growing evidence underlining positive effects in improving functional outcomes. However, to date, several questions are still open about the mechanisms underpinning functional improvements while recent research is now focusing on a deeper understanding of the biophysical processes underpinning the macroscopical effects of these treatments. Thus, this narrative review aims at providing a comprehensive overview about the state of the art of biophysical dimensions of currently available treatments for MSD. PubMed, Scopus, CENTRAL, PEDro, and Web of Science were searched between March 2022 and October 2022 for in vitro and in vivo studies, clinical trials, systematic reviews, and meta-analysis addressing the issue of biophysics-based approach in rehabilitation of MSD. Our findings showed that a biophysical approach might be integrated into regenerative rehabilitation, aiming at enhancing regenerative processes by mechanical and biophysical stimuli. In addition, a biophysical-based approach has been proposed to improve knowledge about several instrumental physical therapies, including shock wave therapies, low-level laser therapy, ultrasound, short-wave diathermy, electrical stimulation, pulsed electromagnetic field, and vibration therapy. In accordance, emerging research is now focusing on the biophysical properties of several medical procedures to improve pain management in patients with MSD. Taken together, our results showed promising results of the integration of a biophysical-based approach in rehabilitation, albeit several limitations currently limit its implementation in routine clinical setting. Unfortunately, the state of the art is still inconclusive, and the low quality of clinical studies based on the biophysical approach did not provide clear treatment protocols. Further studies are needed to promote a precise rehabilitation approach targeting biological modification and enhancing the functional improvement of patients with MSDs.

Efficacy of biofeedback in rehabilitation of musculoskeletal disorders: a systematic review

Efficacy of biofeedback in rehabilitation of musculoskeletal disorders: a systematic review

Body Mass Index and Musculoskeletal Pain: A Cross-Sectional Study.

IntroductionWith obesity reaching pandemic proportions, its detrimental influence on many health-related conditions has recently become a focus of research. Musculoskeletal (MSK) pain is one of several disorders associated with obesity.Materials and methodsThis study was designed to identify MSK pain in individuals with severe obesity, recruited from a specialized obesity clinic, and to evaluate the correlation between the MSK symptoms and some individual criteria.ResultsIn 466 patients (342 females and 124 males), with a mean BMI of 42,77 ± 5.64 kg/m², 90,3% reported MSK pain. Severe pain was reported by 57,8% of female vs 26,6% of male patients. Female patients showed higher mean pain level when compared with males. Body sites with a higher prevalence of pain were: knee (63.5%), lumbar region (46.8%), hip (29%) and ankle (23%), with a predominance of severe pain. BMI have shown a positive correlation to numeric rating scale score in female participants in three body regions: shoulder (P = 0.010), knee (P = 0.042) and ankle (P = 0.024). Body sites with higher pain prevalence were especially in areas of increased mechanical load.ConclusionsUnderstanding the relationship between obesity and pain may provide insights into preventive measures and therapeutic strategies for MSK pain. Persistent MSK pain is a significant problem in obese patients that can have a negative relationship with quality of life and function. This fact highlights the importance that patients with obesity may have access to interdisciplinary care, for the prevention and rehabilitation of MSK disorders. To further understand this association, more robust studies are needed.

What Physiotherapists Specialized in Orthopedic Manual Therapy Know About Nocebo-Related Effects and Contextual Factors: Findings From a National Survey.

ObjectiveThe aim of this study was to investigate the knowledge of orthopedic manual therapists (OMTs) regarding context factors (CFs) capable of triggering nocebo effects during the treatment and how this knowledge is related to their socio-demographic features.DesignA cross-sectional online survey.SettingNational.Main Outcome MeasuresA 20 items questionnaire composed by open-ended and closed single-choice questions was administered to explore: (a) socio-demographic variables (10 questions); (b) the relation between different CFs and nocebo-related effects (2 questions); and (c) the knowledge of participants about nocebo-related effects and how they managed them in the clinical practice (8 questions).Participants1288 OMTs were recruited from the database of the Master in Rehabilitation of Musculoskeletal Disorders (MRDM) of the University of Genova from March to May 2019. Inclusion criteria were: (a) to possess a valid email account; (b) to understand and use as a native language the Italian; (c) to be graduated as OMTs; and (d) to be employed as physiotherapists specialized-OMTs during the survey.Results791 responses were received (61.4%); 473 of them were male (59.8%), with an average age of 31.0 ± 7.1 years. OMTs defined nocebo-related effects as the psychosocial context effects around therapy and patient with specific biological bases (72.2%). OMTs know that their clinical practice is pervaded by nocebo-related effects (42.5%), triggered by CFs. Participants communicated nocebo-related effects balancing the positive features of the therapy with the negative ones (50.9%), during the decision of the therapeutic plan (42.7%). They reported associative learning as the main mechanism involved in nocebo-related effects (28.8%). OMTs taught and trained patient’s strategies to manage nocebo-related effects (39.6%) through an evaluation and correction of patient’s anxieties, doubts and expectations (37.7%). OMTs most frequently considered themselves to have a “medium” education about nocebo-related effects (48.2%) and that their management should be taught during bachelor (78.6%).ConclusionOMTs believed that nocebo-related effects were present in their clinical practice and that they can be triggered by CFs.

Digital Home-based Rehabilitation for Musculoskeletal Disorders

Digital Home-based Rehabilitation for Musculoskeletal Disorders

Psychometric properties of the Zephyr bioharness device: a systematic review

BackgroundTechnological development and improvements in Wearable Physiological Monitoring devices, have facilitated the wireless and continuous field-based monitoring/capturing of physiologic measures in healthy, clinical or athletic populations. These devices have many applications for prevention and rehabilitation of musculoskeletal disorders, assuming reliable and valid data is collected. The purpose of this study was to appraise the quality and synthesize findings from published studies on psychometric properties of heart rate measurements taken with the Zephyr Bioharness device.MethodsWe searched the Embase, Medline, PsycInfo, PuMed and Google Scholar databases to identify articles. Articles were appraised for quality using a structured clinical measurement specific appraisal tool. Two raters evaluated the quality and conducted data extraction. We extracted data on the reliability (intra-class correlation coefficients and standard error of measurement) and validity measures (Pearson/Spearman’s correlation coefficients) along with mean differences. Agreement parameters were summarised by the average biases and 95% limits of agreement.ResultsA total of ten studies were included: quality ratings ranged from 54 to 92%. The intra-class correlation coefficients reported ranged from 0.85–0.98. The construct validity coefficients compared against gold standard calibrations or other commercially used devices, ranged from 0.74–0.99 and 0.67–0.98 respectively. Zephyr Bioharness agreement error ranged from − 4.81 (under-estimation) to 3.00 (over-estimation) beats per minute, with varying 95% limits of agreement, when compared with gold standard measures.ConclusionGood to excellent quality evidence from ten studies suggested that the Zephyr Bioharness device can provide reliable and valid measurements of heart rate across multiple contexts, and that it displayed good agreements vs. gold standard comparators – supporting criterion validity.

Effectiveness of vocational rehabilitation on work participation in adults with musculoskeletal disorders: an umbrella review

Purpose: Vocational rehabilitation (VR) has been identified as a solution to address the impact of musculoskeletal disorders (MSD) in working age adults. Vocational rehabilitation is a multi-component approach that includes different interventions specific to a condition which should begin early and address the physical musculoskeletal problem, any psychological disorders and employment factors to facilitate a sustained return to work. As a number of systematic reviews relating to work outcomes and rehabilitation for MSDs have been published, it was identified that an umbrella review (systematic review of existing reviews) would provide the highest level of evidence synthesis on the effectiveness of VR for MSDs.

Head and trunk 3D orientation during heading and pointing tasks

Both heading and pointing tasks may affect head and trunk since head rotation contributes to orient the gaze and trunk rotation participates to arm movement. The aim of the present study is to evaluate head and trunk 3D orientation during heading and pointing tasks. Right arm pointing and heading tasks toward eight visual targets placed in a wide frontal workspace were studied in ten healthy, right handed subjects. Three-dimensional orientation of the head and trunk (flexion-extension, lateral bending and axial rotation) and upper arm were measured using an electromagnetic tracking system. For both heading and pointing tasks, the orientation of the head in space was closely related to the target with a coupling between rotation and contralateral bending. The trunk was stable during heading but showed large leftward axial rotation during pointing as a function of target direction, coupled with right head rotation relative to the trunk. Our results suggest that the global rotations within the cervical spine compensated for trunk rotation in order to maintain an adapted orientation of the head toward the visual target. In the future, this should be taken into account for the prevention and the rehabilitation of musculoskeletal disorders.

Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life.

This study was designed to identify the major musculoskeletal symptoms of individuals with obesity, to assess their health-related quality of life, and to evaluate the correlation between the musculoskeletal symptoms and the individuals' health-related quality of life. Cross-sectional study. "Nordic Musculoskeletal Questionnaire" and "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)". In total, 41 subjects were evaluated, of which 90.15% were female. The mean age of the subjects was 40.78 ± 9.85 years and their mean body-mass index was 46.87 ± 8.08. All subjects reported musculoskeletal pain in at least one anatomical region and 80.49% had pain in three or more regions. The activity limitations due to pain were reported by 75.61% of them. The most affected regions by pain were the ankles and/or feet, lower back, knees and wrists/hands/fingers. The most associated regions with activity limitations due to pain were the ankles and/or feet, knees and lower back. The presence of pain showed a negative correlation with the domains physical functioning (PF), role-physical (RP) and body pain (BP). The activity limitations showed a negative correlation with the domains PF, BP, social functioning (SF) and role-emotional (RE). Our data showed a high prevalence of musculoskeletal pain and limitation in activities due to pain in obese subjects. The musculoskeletal symptoms had negative correlations with physical and mental components of the health-related quality of life, highlighting the importance of ensuring that patients with obesity have access to interdisciplinary care, for the prevention and rehabilitation of musculoskeletal disorders.

The Pilates method in the rehabilitation of musculoskeletal disorders: a systematic review

Abstract Introduction: Joseph Pilates created an authentic method of physical and mental conditioning, which he called Contrology and defined as the complete coordination of body, mind and spirit. Recent studies indicate that the Pilates Method is a useful tool in rehabilitation can improve overall health, sports performance and help in the prevention and attenuation of injuries and disorders of the musculoskeletal system. Musculoskeletal disorders are prevalent and costly conditions that develop gradually, presenting a chronic course and often remain untreated. Objective: This study aimed to identify the effects of the Pilates Method in the rehabilitation of musculoskeletal disorders through a systematic review. Methods: An active search was performed in the PubMed, PEDro, Scielo and Bireme databases. A total of 24 studies were pre-selected and their methodological quality was evaluated based on the PEDro scale. Of these, 14 fulfilled the selection criteria. Results: The studies analyzed indicate that Pilates can be effective both for the treatment of conditions such as scoliosis, back pain, ankylosing spondylitis and breast cancer, and for preventing injuries in adults, elderly people and athletes. Conclusion: The high methodological variability requires that these studies be viewed with caution. It indicates the need for the performance of new studies with high methodological quality and standardization of evaluation instruments.

Sling Suspension Therapy Utilization in Musculoskeletal Rehabilitation

The development of an effective and inexpensive device to restore and enhance the human musculoskeletal functions is of particular interest. Sling exercise therapy (SET) is one of the most effective developed tools in rehabilitation of musculoskeletal disorders, which has been successfully used in various applications ranging from diagnosis to treatment. To the best of our knowledge, SET has never been comprehended and reviewed previously. Therefore, it was highly required to further understand the role of SET in various therapeutic applications. Inspired by this herein, this study is dedicated to emphasize the advancement in utilization of the SET in both diagnosis and treatment as well as their related challenges. This would be concluded by future perspectives of the SET.

Therapist Perceptions of the Utility of Sonographic Imaging in the Rehabilitation of Musculoskeletal Disorders

Abstract Date Presented 4/16/2015 Sonography is a relatively inexpensive imaging modality that provides real-time, dynamic views of anatomical structures. This session will discuss the results of a qualitative descriptive study that revealed a wide range of uses for sonography by occupational therapists.

Staged Approach for Rehabilitation Classification: Shoulder Disorders (STAR-Shoulder).

Shoulder disorders are a common musculoskeletal problem causing pain and functional loss. Traditionally, diagnostic categories are based on a pathoanatomic medical model aimed at identifying the pathologic tissues. However, the pathoanatomic model may not provide diagnostic categories that effectively guide treatment decision making in rehabilitation. An expanded classification system is proposed that includes the pathoanatomic diagnosis and a rehabilitation classification based on tissue irritability and identified impairments. For the rehabilitation classification, 3 levels of irritability are proposed and defined, with corresponding strategies guiding intensity of treatment based on the physical stress theory. Common impairments are identified and are used to guide specific intervention tactics with varying levels of intensity. The proposed system is conceptual and needs to be tested for reliability and validity. This classification system may be useful clinically for guiding rehabilitation intervention and provides a potential method of identifying relevant subgroups in future research studies. Although the system was developed for and applied to shoulder disorders, it may be applicable to classification and rehabilitation of musculoskeletal disorders in other body regions.

Quality of life and maintenance of improvements after early multimodal rehabilitation: A 5-year follow-up

Purpose. There is a paucity of long-term evaluations on rehabilitation of musculoskeletal disorders, e.g., neck, shoulder or back pain. The aim of this study was to assess quality of life and the effect of early multimodal rehabilitation on 91 patients with musculoskeletal pain and disability at a 5-year follow-up.Method. The follow-up assessment, which included questions on pain, function, quality of life, perceived health, sick leave and psychosomatic symptoms, was performed 5 years after the assessment of baseline status.Results. Improvements in pain, perceived health and psychosomatic symptoms were maintained at the 5-year follow-up. In addition, improvements in function, quality of life, and level of acceptable pain were significant in comparison to baseline. At the time of the baseline assessment all patients were on sick leave (13% were on partial sick leave). At the 5-year follow-up, 58% of the patients were at work part or full time. The results show that those working differed significantly from those not working at the 5-year follow-up on almost all variables, indicating that those working enjoy better health. The most salient prognostic factors for return to work were perceived health and educational level at the time of the baseline evaluation.Conclusions. These results show that treatment improved quality of life and the effects were basically maintained at 5 years. Work capacity as reflected in return to work increased greatly (81%) at a 1-year follow-up and was substantial (58%) at the 5-year follow-up. Moreover, perceived health and educational levels were important prognostic factors. Finally, the fact that patients working reported better health underscores the probable importance of return to work. Our results imply that it may be feasible to obtain long-term benefits from such a primary care-based intervention.

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders

Purpose. This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital.Methods. In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members.Results. Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them.Conclusions. This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.