RESUMEN
BACKGROUND: 'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability. OBJECTIVE: This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP). METHODS: Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks. RESULTS: WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR. CONCLUSION: Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.
Asunto(s)
Dolor Crónico , Terapia por Ejercicio , Miedo , Dolor de la Región Lumbar , Equilibrio Postural , Humanos , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/terapia , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/rehabilitación , Masculino , Femenino , Persona de Mediana Edad , Terapia por Ejercicio/métodos , Anciano , Dolor Crónico/fisiopatología , Dolor Crónico/terapia , Dolor Crónico/rehabilitación , Dolor Crónico/diagnóstico , Dolor Crónico/psicología , Resultado del Tratamiento , Dimensión del Dolor , Agua , Estudios de Factibilidad , Factores de Tiempo , Evaluación de la Discapacidad , Factores de Edad , Recuperación de la Función , Accidentes por Caídas/prevención & controlRESUMEN
BACKGROUND: Patients with chronic low back pain (CLBP) frequently present with kinesiophobia. Though large body of evidence reported the impact of kinesiophobia in patients with CLBP, there are paucity of studies in associating kinesiophobia to muscle endurance and position sense in patients with CLBP. The primary aim of the study is to compare the impact of kinesiophobia on lumbar extensor endurance, position sense in patient with CLBP, and asymptomatic individuals. Secondarily, we aim to examine the association between kinesiophobia and lumbar extensor endurance, position sense, pain intensity, and functional ability in patients with CLBP. Thirdly, we aim to assess the degree of association of various factors on CLBP, lumbar endurance, and position sense. MATERIAL AND METHODS: This case-control study will have 200 patients with CLBP and 400 controls. Kinesiophobia, lumbar endurance, and lumbar position sense will be assessed with Tampa Scale, Soren's lumbar extensor test, and lumbar repositioning test respectively. Secondarily, the pain intensity will be assessed with visual analog scale and functional ability with Patient-specific Functional Scale in patients with CLBP. Lumbar endurance and joint position sense will be compared between subjects with and without kinesiophobia. Kinesiophobia scores will be compared with lumbar extensor endurance and proprioception joint position errors, pain intensity, and functional ability. Simple and multiple binary logistic regression will be used to determine crude and adjusted odd's ratio for kinesiophobia, lumbar position sense and kinesiophobia, and lumbar endurance. DISCUSSION: The finding from this study can be generalized as this study has adequate sample size and subgroup analysis by adjusting the variables to draw a valid conclusion. The finding of this study will help the working physician to include assessment of kinesiophobia as part of musculoskeletal evaluation for patient with CLBP in a prospective diagnostic intervention. TRIAL REGISTRATION: ClinicalTrials.gov NCT05079893 . Registered on 14 October 2021.
Asunto(s)
Dolor Crónico , Dolor de la Región Lumbar , Estudios de Casos y Controles , Dolor Crónico/diagnóstico , Evaluación de la Discapacidad , Humanos , Dolor de la Región Lumbar/diagnóstico , Músculos , Dimensión del Dolor , Propiocepción , Estudios ProspectivosRESUMEN
INTRODUCTION: Distinguishing intraarticular lesion from extraarticular lesion need a thorough clinical evaluation in case of atraumatic knee pain. The main objective of this case report was to describe about the clinical course of a patient with unrelenting symptoms with suspected lateral meniscus lesion. CASE DESCRIPTION: A 48-year old man was diagnosed with suspected lesion in the anterior horn of lateral meniscus for 9 months had received pharmacological and physiotherapy interventions. Yet the patient did not respond favourably to former symptomatic treatment. As the history and objective evaluation consistently matched with abnormal neurodynamics, in the similar line, the patient was treated with neural mobilization in a modified slump position, 15 repetitions per session for three consecutive days combined with postural correction exercises. RESULT: The outcomes were measured with numeric pain rating scale (NPRS) and knee society scale (KSS). The patient responded very well to neural mobilization combined with postural correction exercises. The NPRS (4 at rest; 7 on activity) before our intervention reduced to (0 at rest, 1 on activity) at the end of 3 rd consecutive day intervention and the KSS improved to 75 from 55 in pain score & 90 from 80 on function score. At 2-months follow-up, the patient completely recovered from pain and knee dysfunction. CONCLUSION: This case report signifies that abnormal neurodynamics can be a factor for lateral knee pain. Neural mobilization with postural correction exercises may be recommended as an appropriate treatment for patient with lateral-knee-pain due to abnormal neurodynamics.