Prevalence and risk factors of restless legs syndrome in patients of migraine without aura

Background: An association between migraine and Restless Legs Syndrome (RLS) has been proposed due to shared dopaminergic dysfunction. Both have substantial effects on the quality of life. Identifying co morbidities of migraine helps in optimizing patient management. Objectives To study the prevalence of RLS in patients of migraine without aura, and associated co morbidities of RLS.Methods: This was a hospital based prospective observational study. All patients diagnosed as Migraine without aura as per ICHD-3 criteria completed the questions regarding migraine headache, Migraine Disability Assessment (MIDAS) questionnaire, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index (PSQI) and International RLS Study Group (IRLSSG) Rating Scale. RLS was diagnosed using the IRLSSG criteria. Serological investigations were done to look for secondary causes of RLS.Results: Out of 200 consecutive patients of migraine without aura were included in the study over a period of 18 months. Frequency of RLS was 13.5% (n=27). All patients had primary RLS. Mean PSQI score was higher in the patients of migraine without aura with RLS than in non RLS patients of migraine without aura (3.30±2.66 vs 2.24±2.03 p≤0.0168). Poor sleep quality, anxiety, depression was found in 9%, 8% and 2.5% respectively in patients of migraine without aura.Conclusions: An association between migraine without aura and RLS was demonstrated. Migraine without aura was associated with increased frequency of poor sleep quality, anxiety and depression.

Ayurvedic Management Of Lumbar Spondylolisthesis (kati Shoola) With Special Reference To Chincha Lavana Sweda- A Case Report

Spondylolisthesis is described as a translation of a vertebra with respect to the vertebra below without any modification or notable lesion to the pars interarticularis. Lumbar spondylolisthesis can be considered as various conditions like Kati shoola, Kati Graha, Trika Graha, Prushta Graha, Trika Shoola, Prushta Shoola, Grudrasi in Ayurveda. The present article deals with a case of diagnosed Grade 1 lumbar spondylolisthesis of L4 over L5 and got advised for surgery. The Ayurvedic diagnosis of Kati soola was made. Management included Abhyanga, Kativasti, Kshira vasti, Virechana, Vaitarana vasti and Chincha lavana sweda along with internal medications. Chincha lavana sweda is a very simple and effective Swedana procedure to cure pain in low back, especially due to Spondylolisthesis. But it is not widely used. This case report also wants to introduce the technique to Ayurvedic practitioners who are unaware of it. Before treatment, total score on Oswestry low back pain disability questionnaire was 34 (68%) and at the time of discharge, the score was 8 (16%). On Roland-Morris low back pain and disability questionnaire, the before treatment score was 17 and at the time of discharge it was reduced to 4. That means the patient showed an improvement of 76% on Roland-Morris low back pain and disability questionnaire. The present case report substantiates effectiveness of classical Ayurvedic Management in spondylolosthesis.

Effectiveness of back school exercises in non specific low back pain.

Background: Worldwide, 65–80% of the population experience low back pain at some stage of their lives. The most common cause of disability is related to the musculoskeletal system; particularly low back pain and spinal disorders. It is convenient to classify low back pain into two group’s i.e. specific and nonspecific low back pain. Aim: To study effectiveness of back school exercises in nonspecific low back pain. Methods: A sample size of 50 between age group of 20 – 60 years was selected. Pre intervention VAS and RMDQ score was noted with back school intervention for four weeks followed by post intervention VAS and RMDQ score. Results: After back school intervention the VAS score for pain intensity was reduced at rest and on activity, the RMDQ scores was also reduced significantly, it shows the low back pain disabilities was reduced in all age groups. Conclusion: From the study it is concluded that the back school exercises are effective in nonspecific low back pain. The back school interventions can improve workability of patient.

Cross-Cultural Adaptation, Validation, and Reliability Testing of the Modified Oswestry Disability Questionnaire in Persian Population with Low Back Pain

STUDY DESIGN: Prospective study. PURPOSE: We aimed to validate the Persian version of the modified Oswestry disability questionnaire (MODQ) in patients with low back pain. OVERVIEW OF LITERATURE: Modified Oswestry low back pain disability questionnaire is a well-known condition-specific outcome measure that helps quantify disability in patients with lumbar syndromes. METHODS: To test the validity in a pilot study, the Persian MODQ was administered to 25 individuals with low back pain. We then enrolled 200 consecutive patients with low back pain to fill the Persian MODQ as well as the short form 36 (SF-36) questionnaire. Convergent validity of the MODQ was tested using the Spearman's correlation coefficient between the MODQ and SF-36 subscales. Intraclass correlation coefficient (ICC) and Cronbach's α coefficient were measured to test the reliability between test and retest and internal consistency of all items, respectively. RESULTS: ICC for individual items ranged from 0.43 to 0.80 showing good reliability and reproducibility of each individual item. Cronbach's α coefficient was 0.69 showing good internal consistency across all 10 items of the Persian MODQ. Total MODQ score showed moderate to strong correlation with the eight subscales and the two domains of the SF-36. The highest correlation was between the MODQ and the physical functioning subscale of the SF-36 (r=–0.54, p<0.001) and the physical component domain of the SF-36 (r=–0.55, p<0.001) showing that MODQ is measuring what it is supposed to measure in terms of disability and physical function. CONCLUSIONS: Persian version of the MODQ is a valid and reliable tool for the assessment of the disability following low back pain.

Cross-Cultural Adaptation, Validation, and Reliability Testing of the Modified Oswestry Disability Questionnaire in Persian Population with Low Back Pain

STUDY DESIGN: Prospective study. PURPOSE: We aimed to validate the Persian version of the modified Oswestry disability questionnaire (MODQ) in patients with low back pain. OVERVIEW OF LITERATURE: Modified Oswestry low back pain disability questionnaire is a well-known condition-specific outcome measure that helps quantify disability in patients with lumbar syndromes. METHODS: To test the validity in a pilot study, the Persian MODQ was administered to 25 individuals with low back pain. We then enrolled 200 consecutive patients with low back pain to fill the Persian MODQ as well as the short form 36 (SF-36) questionnaire. Convergent validity of the MODQ was tested using the Spearman's correlation coefficient between the MODQ and SF-36 subscales. Intraclass correlation coefficient (ICC) and Cronbach's α coefficient were measured to test the reliability between test and retest and internal consistency of all items, respectively. RESULTS: ICC for individual items ranged from 0.43 to 0.80 showing good reliability and reproducibility of each individual item. Cronbach's α coefficient was 0.69 showing good internal consistency across all 10 items of the Persian MODQ. Total MODQ score showed moderate to strong correlation with the eight subscales and the two domains of the SF-36. The highest correlation was between the MODQ and the physical functioning subscale of the SF-36 (r=–0.54, p<0.001) and the physical component domain of the SF-36 (r=–0.55, p<0.001) showing that MODQ is measuring what it is supposed to measure in terms of disability and physical function. CONCLUSIONS: Persian version of the MODQ is a valid and reliable tool for the assessment of the disability following low back pain.

The Association of Each Disability Based on the Three Sub-Categories of the Roland-Morris Disability Questionnaire during Hospitalization with Itself at 1 Year Postoperatively in Patients with Degenerative Lumbar Spinal Stenosis

STUDY DESIGN: A prospective study in a hospital. PURPOSE: To investigate whether each disability based on the three sub-categories of the Roland-Morris disability questionnaire (RDQ) during hospitalization is associated with itself at 1 year postoperatively in patients with degenerative lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: Although the total score of the RDQ represents whole pain-related disabilities or health-related quality of life, it is a shortcoming that multi-dimensional changes in disabilities are difficult to understand when only using the RDQ. METHODS: Fifty-seven patients with LSS (men, 28; women, 29; 63.0+/-12.1 years) were included. Disabilities, pain intensity and depressive feelings were assessed at preoperation, discharge and 1 year postoperatively. RESULTS: The range of "mental and physical activities (MPA)," "functional movements on/around a bed (FM)" and "walking function (WF)" scores were 0 to 13 (median, 8), 0 to 6 (median, 6) and 0 to 4 (median, 3) at preoperation; 0 to 12 (median, 0), 0 to 6 (median, 0), and 0 to 4 (median, 0) at discharge; and 0 to 8 (median, 0), 0 to 5 (median, 0), and 0 to 4 (median, 0) at 1 year postoperatively, respectively. The following significant multiple regression equations were obtained: MPA at 1 year postoperatively=0.56 (MPA at discharge)-0.10 (depression at discharge)+0.90 (adjusted r2=0.41), FM at 1 year postoperatively=0.35 (MPA at discharge)-0.06 (depression at discharge)+0.40 (adjusted r2=0.45) and WF at 1 year postoperatively=0.59 (WF at discharge)-0.08 (depression at discharge)+0.63 (adjusted r2=0.29). CONCLUSIONS: In our LSS population, each disability based on MPA and WF at discharge is associated with itself in the future. Therefore, disabilities excluding functional movements are longitudinally independent.

Reliability and Validity of the Korean Version of the Pain Disability Questionnaire

OBJECTIVE: To translate the English version of the Pain Disability Questionnaire (PDQ) into Korean and to investigate the reliability and validity of the Korean version of the PDQ (K-PDQ) in patients suffering chronic disabling musculoskeletal disorders (CDMDs). METHODS: The English version of the PDQ was translated into Korean. Ten patients with CDMDs were randomly selected for a pilot study to assess the comprehensibility of the pre-final version. One hundred and thirty-nine patients suffering from CDMDs for more than 3 months were enrolled in this study. Follow-up questionnaires were obtained to examine the test-retest reliability. Concurrent validity was evaluated by comparing the K-PDQ with the visual analogue scale (VAS). Construct validity was evaluated by comparing the K-PDQ with the brief form of the World Health Organization quality of life assessment instrument (WHOQOL-BREF) using Pearson correlation coefficient. Reliability was assessed using the intraclass correlation coefficient (ICC), and internal consistency was determined by Cronbach's alpha. RESULTS: Test-retest reliability was assessed in 70 patients, with an average time interval of 12 days. The ICC was 0.958 (p<0.001). Internal consistency reached Cronbach's alpha of 0.933 for the functional component and 0.870 for the psychosocial component. The correlation coefficient for the K-PDQ when compared with the VAS was 0.834 in the first assessment and 0.831 in the second assessment. All domains of the WHOQOL-BREF showed a significant negative correlation with the K-PDQ. CONCLUSION: The K-PDQ is a reliable and valid instrument for measuring disability and can be used to assess disability and treatment outcomes in Korean patients with CDMD.

Psychometric Characteristics of the Korean Version of the Roland-Morris Disability Questionnaire

The aims of this study were; 1) to develop the final version of the Korean Roland-Morris Disability Questionnaire (RDQ), and 2) to compare the responsiveness between the RDQ and the Oswestry Disability Index (ODI) scores in patients having low back pain. The psychometric properties of the final Korean RDQ were evaluated in 221 patients. Among them, 30 patients were reliability tested. Validity was evaluated using an 11-point numerical rating scale (NRS) and the Korean ODI. The receiver operating characteristic (ROC) curve analysis of the RDQ and the ODI was compared in 54 patients with lumbar zygapophyseal (facet) joint pain. There was a moderate relationship between the RDQ and NRS (r = 0.59, P < 0.01) and a strongly positive correlation between the RDQ and the ODI (r = 0.76, P < 0.001). The Korean RDQ with the higher area under the ROC curve showed a better overall responsive performance than did the ODI in patients with lumbar facet joint pain after medial branch radiofrequency neurotomy (P < 0.01). The results of the study present the final version of the Korean RDQ is valid for assessing functional status in a Korean population with chronic low back pain.

Effect of trigger point acupuncture treatment in older patients with chronic low back pain: randomized controlled trial / 全日本鍼灸学会雑誌

[Objective]To compare the efficacies of three types of acupuncture modalities on the pain magnitude and disability of chronic low back pain (LBP).<BR>[Design]Single blind randomized controlled trial, three parallel arms.<BR>[Setting]Outpatients of the Meiji University of Integrative Medicine Hospital.<BR>[Subjects]Thirty-nine elderly patients (24 females, 15 males;age 71.2 ± 7.7) who suffered from LBP for at least six months.<BR>[Interventions]Subjects were randomly allocated to one of three groups. Tender point group (TeP, n = 13) received to the tender point. Trigger point acupuncture group (TrP, n = 13) received to the trigger points. Sham acupuncture group (SM, n = 13) mimicked needling without insertion of the needle in the trigger point. Acupuncture sessions were performed once a week for five weeks. <BR>[Main Outcome Measures]Pain intensity (visual analogue scale:VAS) and QOL (Roland-Morris Disability Questionnaire:RDQ). <BR>[Results]At the end of the treatment period, significant improvement was observed on pain intensity and QOL in the TrP group alone (p < 0.01). However, there were significant differences in pain at the three month follow-up.<BR>[Conclusion]These results suggest that trigger point acupuncture has a long-term effect on treatment for low back pain in aged patients.

The Effect of Acupuncture Treatment on Patient with Vertigo / 日本東洋医学雑誌

We evaluated the clinical effects of acupuncture/moxibustion therapy in 7 patients with vertigo that was uncontrollable with western medicine. The observation period was 6-15 months. The 7 patients consisted of 1 male and 6 females aged 29-73 years (mean, 44.7 years). More than 4 courses or more of acupuncture/moxibustion treatment (acupuncture + warm moxibustion) were performed in each patient, and the effects were evaluated based on the results of a daily living disability questionnaire before and after treatment. In practice, these effects were classified into 4 grades (cure, improvement, no change, aggravation). Cure was observed in1patient, improvement in 5 patients, and no change in1patient, indicating this therapy was effective in 85% of the patients. None of the patients showed aggravation of their condition. In addition, no adverse effects were observed.Our results suggest that acupuncture/moxibustion therapy has certain effects on intractable vertigo. Therefore, in patients with vertigo who do not respond to western medical care, such as the administration of anti-vertigo drugs, a beneficial effect of acupuncture/moxibustion as a complementary therapy can be expected.

Effects of Bed Rest on Acute Nonspecific Low Back Pain / 中国康复理论与实践

@#Objective To investigate the effect of bed rest on acute nonspecific low back pain(ANLBP).Methods87 cases were randomly divided into bed rest group (42 cases) and free activity group (45 cases).The bed rest group would be proper activity indoor and step up activity outdoor after absolute in bed for a week.The free activity group would be prescribed free activity.At the same time,all of them received physiotherapy and non-steroidal anti-inflammatory drugs (NSAIDs).The visual analogous scale (VAS) were measured before and 2 weeks after treatment.The Roland-Morris disability questionnaire (RMDQ) were measured before and 2,6 weeks after treatment.ResultsThe difference of VAS and RMDQ scores between these 2 groups were not significant before treatment (P>0.05),but were significant 2 weeks after treatment(P<0.05).Further more,the difference of RMDQ scores between these 2 groups were not significant 6 weeks after treatment (P>0.05).ConclusionThe bed rest about patients could not promote,but delay the improvement of the pain and disability in the early period or later period recovery of ANLBP.

Effects of Bed Rest on Acute Nonspecific Low Back Pain / 中国康复理论与实践

@#Objective To investigate the effect of bed rest on acute nonspecific low back pain(ANLBP).Methods87 cases were randomly divided into bed rest group (42 cases) and free activity group (45 cases).The bed rest group would be proper activity indoor and step up activity outdoor after absolute in bed for a week.The free activity group would be prescribed free activity.At the same time,all of them received physiotherapy and non-steroidal anti-inflammatory drugs (NSAIDs).The visual analogous scale (VAS) were measured before and 2 weeks after treatment.The Roland-Morris disability questionnaire (RMDQ) were measured before and 2,6 weeks after treatment.ResultsThe difference of VAS and RMDQ scores between these 2 groups were not significant before treatment (P>0.05),but were significant 2 weeks after treatment(P<0.05).Further more,the difference of RMDQ scores between these 2 groups were not significant 6 weeks after treatment (P>0.05).ConclusionThe bed rest about patients could not promote,but delay the improvement of the pain and disability in the early period or later period recovery of ANLBP.

A Controlled Clinical Trial Comparing Trigger Point Acupuncture with Tender Point Acupuncture Treatments for Chronic Low Back Pain-A Pilot Study on 9 Elderly Patients- / 全日本鍼灸学会雑誌

[Objective] Although there is some evidence for the efficacy of trigger point acupuncture and tender point acupuncture treatments for chronic low back pain, differences between the therapeutic effect of trigger point needling and that of tender point needling remain unclear. We compared the therapeutic effects of trigger point acupuncture and tender point acupuncture treatment for chronic low pack pain in elderly patients.<BR>[Design] Single-blind clinical controlled trial, quasi-randomized, 2 parallel arms.<BR>[Methods] Nine patients, aged 65 or over, with chronic low back pain for at least 6 months were alternately allocated to the trigger point needling group (n=4) or tender point needling group (n=5). Patients received treatments once a week for five weeks. Outcome measures were pain intensity (Visual Analog Scale : VAS) and pain disability (Roland-Morris Disability Questionnaire : RDQ).<BR>[Results] After the treatment period, VAS and RDQ values had improved significantly in the trigger point group, but there were no significant improvements in the tender point group.<BR>[Conclusion] Differences in improvement between the trigger point and tender point groups seem to suggest that the trigger point needling was different from tender meridian point needling in respect to the therapeutic effect. Further studies are necessary to fully assess the efficacy of this treatment for chronic low back pain using a blinded or placebo control group.

Scalability of brief disability questionnaire (BDQ) Thai version.

Psychiatric disorders lead to functional disability of the affected patients. Assessment of functional disability in psychiatric patients is important for psychiatric research. The objective of this study is to test the scalability of the Brief Disability Questionnaire and its correlation with mental health status in Thai patients. Materials and Methods: The mental health status and functional disability of 879 patients attending four primary care settings were respectively assessed by two self-report questionnaires, the General Health Questionnaire (GHQ) and the Brief Disability Questionnaire (BDQ). The internal consistency of the BDQ was assessed using Cronbach’s alpha coefficient and its scalability was ten investigated by Mokken analysis. The relationship between the score of the GHQ and the BDQ was examined by Pearson’s correlation coefficient. Results: The internal consistency of the BDQ was high with a Cronbach’s Alpha coefficient of 0.82. Each item of the BDQ showed an acceptable scalability (H >=0.3). The results showed that the BDQ satisfied the criteria for a hierarchical scale. The BDQ score was significantly correlated with the score of the GHQ-12 _r=0.45, p<0.001). Conclusion: The Brief Disability Questionnaire maintains its hierarchical scalability in Thai subjects and can be used as an outcome measurement of functional disability.

Effect of Therapeutic Exercises on Shoulder Dysfunction in VDT-related female Office Workers / 예방의학회지

Visual display terminal(VDT) is popular in majority of office in modern countries. Musculoskeletal pain due to repetitive work with VDT is a serious industrial accident at present. In recent studies, shoulder pain in VDT users is the most common problem in Korea. The purpose of this study was to evaluate and compare the effect of exercises on shoulder dysfunction in VDT-related female office workers. Of the l19 patients with shoulder dysfunction, 32 patients entered into the study. 16 patients(Group I) were not prescribed exercises, other 16 patients (Group II) performed throughout the specific shoulder exercises such as pendular exercises(forward, backward and circumduction) and sidelying external rotation exercises with weights. After 3 months of exercises, the two groups were compared in term of the pain rating scale, disability questionnaire score and range of motion score. The results were summarized as follows ; l. The pain rating scale in Group I before and after 3 months were not differenced significantly(p value=0.784) and in Group II, the scale before and after exercises were differenced significantly(p value=0.0005). 2. The disability, questionnaire scores in Group I before and after 3 months were not differenced significantly(p value=0.437) and in Group II, the scores before and after exercises were differenced significantly(p value=0.0002). 3. The ROM scores of the affected shoulder in Group I before and after 3 months were not differenced significantly(p value=0.876) and in Group II, the scores before and after exercises were differenced significantly(p value=0.0017). In conclusion, that the specific shoulder exercises on shoulder dysfunction in VDT-related female office workers are encouraged.