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1.
Phys Ther ; 102(5)2022 05 05.
Article in English | MEDLINE | ID: covidwho-1873986

ABSTRACT

OBJECTIVE: The aims of this study were to examine associations between frequency of telerehabilitation (TR) and outcomes of functional status (FS), number of visits, and patient satisfaction during COVID-19 and to compare FS outcomes by TR delivery mode for individuals with low back pain. METHODS: Propensity score matching was used to match episodes of care with or without TR exposure by the probability of receiving TR. FS, visits, and satisfaction were compared for individuals without TR and those who received care by TR for "any," "few," "most," or "all" frequencies (4 matched samples), and FS was compared for individuals receiving synchronous, asynchronous, and mixed TR modes (3 matched samples). Standardized differences were used to compare samples before and after matching. Outcomes between matched samples were compared using z tests with 95% CI. RESULTS: The sample consisted of 91,117 episodes of care from 1398 clinics located in 46 states (58% women; mean age = 55 [SD = 18]). Of those, only 5013 episodes (5.5%) involved any amount of TR. All standardized differences between matched samples were <0.1. There was no significant difference in FS points (range = 0-100, with higher representing better FS) between matched samples, except for episodes that had ``few'' (-1.7) and ``all'' (+2.0) TR frequencies or that involved the asynchronous (-2.6) TR mode. These point differences suggest limited clinical importance. Episodes with any TR frequency involved significantly fewer visits (0.7-1.3) than episodes with no TR, except that those with the "most" TR frequency had non-significantly fewer visits (0.6). A smaller proportion of individuals with TR (-4.0% to -5.0%) than of individuals with no telerehabilitation reported being very satisfied with treatment results, except for those with the "all" TR frequency. CONCLUSIONS: A positive association between TR and rehabilitation outcomes was observed, with a trend for better FS outcomes and fewer visits when all care was delivered through TR. Satisfaction tended to be lower with TR use. Overall, this observational study showed that for people with low back pain, physical therapy delivered through TR was equally effective as and more efficient than in-person care, with a trend of higher effectiveness when used for all visits during the episode of care. No differences in FS outcomes were observed between care delivered with synchronous and mixed TR delivery modes and care delivered with no TR. However, the asynchronous mode of TR was associated with worse functional outcomes than no TR. Although the majority of people were very satisfied with their treatment results with and without TR, very high satisfaction rates were reported by a slightly smaller proportion of individuals with TR versus those without TR. Our results suggest that TR is a viable option for rehabilitation care for individuals with low back pain and should also be considered in the post-COVID-19 era.


Subject(s)
COVID-19 , Low Back Pain , Telerehabilitation , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Patient Satisfaction , Telerehabilitation/methods
2.
JMIR mHealth and uHealth ; 10(5), 2022.
Article in English | ProQuest Central | ID: covidwho-1871103

ABSTRACT

Background: Artificial intelligence–assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years;n=27, 56.3% male patients) and 46.9 years (SD 12.3 years;n=28, 54.9% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method;0.062 vs 0.114;difference between groups −0.053, 95% CI −0.184 to 0.079;P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8;difference between groups −0.5, 95% CI −1.1 to 0.0;P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006;difference between groups 0.061, 95% CI 0.008 to 0.114;P=.03), and fear of movement at week 12 (−2.3 vs 0.5;difference between groups −2.8, 95% CI −5.5 to −0.1;P=.04). Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037;https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046866

3.
Int J Infect Dis ; 122: 144-151, 2022 May 25.
Article in English | MEDLINE | ID: covidwho-1867236

ABSTRACT

OBJECTIVES: Pain is a significant complaint of patients with postacute COVID-19 syndrome; however, little is known about the association between SARS-CoV-2 infection and pain. This study aimed to (1) examine the association between SARS-CoV-2 infection and low back pain (LBP) and (2) identify independent predictors of LBP among survivors of COVID-19. METHODS: This case-control study involved 878 participants aged ≥18 years. Data were collected from February 24 to April 7, 2022, in Bangladesh. LBP was measured using the musculoskeletal subscale of subjective health complaints produced by Eriksen et al. Descriptive analysis was performed to compute LBP prevalence and compare the prevalence across groups. Multiple logistic analyses helped to identify the predictors of LBP for survivors of COVID-19. RESULTS: Overall, 20% of participants reported LBP; however, the prevalence of LBP was significantly high among patients with postacute COVID-19 compared with their counterparts (24.4% vs 15.7%, P = 0.001). Regression analysis for all participants suggested that SARS-CoV-2 infection was independently associated with LBP (adjusted odds ratio 1.837, 95% confidence interval 1.253-2.692). However, moderate COVID-19 symptom (adjusted odds ratio 1.754, 95% confidence interval 0.984-3.126) was the only statistically significant predictor of LBP among postacute COVID-19 patients. CONCLUSION: SARS-CoV-2 infection was associated with LBP, and moderate COVID-19 symptom was an independently associated factor of LBP. The health care facilities must be prepared to deal with the burden of LBP among patients with postacute COVID-19.

4.
BMJ Open ; 11(8), 2021.
Article in English | ProQuest Central | ID: covidwho-1843109

ABSTRACT

ObjectivesThe COVID-19 pandemic has forced many people to stay at home and to maintain social distancing. This study aimed to assess the association of reduced physical activity during the COVID-19 pandemic with new onset of neck pain (katakori) among a rural Japanese population living in areas damaged by the Great East Japan Earthquake (GEJE).Design, setting and participantsThis prospective cohort study has been conducted continuously since 2011 after the GEJE. This study used longitudinal data from 1608 adults who responded to the self-reported questionnaire before and during the COVID-19 pandemic. Changes in physical activity due to the COVID-19 pandemic were categorised into four groups: ‘no change’, ‘decreased by 20%–30%’, ‘decreased by half’ and ‘almost never go out’. Multiple logistic regression analysis was used to estimate the OR and 95% CI of the association between COVID-19 pandemic-related physical inactivity and new-onset neck pain.ResultsIn total, ‘no change’, ‘decreased by 20%–30%’, ‘decreased by half’, and ‘almost never go out’ were reported by 9.2%, 27.7%, 31.2% and 21.9% of respondents, respectively. Among them, 9.8% reported new-onset neck pain. A significantly higher rate of new-onset neck pain was observed in participants who reported ‘decreased by half’ (adjusted OR 1.85, 95% CI 1.04 to 3.30) and who ‘almost never go out’ (adjusted OR 2.13, 95% CI 1.16 to 3.91), compared with those who reported ‘no change.’ConclusionsDecreased physical activity has increased due to the COVID-19 pandemic and was significantly associated with new-onset neck pain among GEJE survivors.

5.
International Journal of Environmental Research and Public Health ; 19(9):5223, 2022.
Article in English | ProQuest Central | ID: covidwho-1837188

ABSTRACT

Health-related quality of life (HRQoL) concerns satisfaction with life and happiness with regard to physical, mental, and social factors. RAND-36 is a publicly available, self-administered questionnaire that examines eight health dimensions. This study evaluated the HRQoL of the South Korean population using the RAND-36 questionnaire and compared HRQoL across sociodemographic characteristics. From May 2015 to May 2019, South Koreans who visited public places aged 19–80 years were recruited and the RAND-36 questionnaire was administered. Overall, 1002 participants were recruited (mean age 45.34 years, 52% men). Men scored better than women in both physical and mental health (p < 0.05). There were significant differences in bodily pain (p < 0.05), general health perception (p < 0.05), and energy/fatigue (p < 0.05) dimensions according to the participants’ health condition. The HRQoL of South Koreans was lower than average in most dimensions compared with other countries. As the first study to assess this, its data can be used in future studies that apply RAND-36 to evaluate the HRQoL of diseased individuals, as they can compare their findings with those of our study population.

6.
Journal of Musculoskeletal Research ; 25(1), 2022.
Article in English | EMBASE | ID: covidwho-1816790

ABSTRACT

Purpose: The sudden lockdown due to COVID-19 in India led to closure of schools and colleges. This resulted in an increased usage of online mode of study, with a more sedentary lifestyle. The survey study aimed to analyze the prevalence of any musculoskeletal problem in students and teachers due to the same. Methodology: A Google Form was distributed by a snowball sampling technique using various social media platforms. A total of 715 responses were received. Results: Maximum respondents were in the age range of 18-25 years. Eighty eight percent of participants in the survey were involved in the online mode of education, with 60.8% experiencing some form of musculoskeletal pain or discomfort;71% of people believed that the cause of pain was online working. Neck pain (51.3%) followed by low back pain (33.4%) and headaches (29.8%) were commonly reported. University teachers reported maximum pain followed by university students, school teachers and school students. Of all the respondents, 60.8% people admitted to adopting awkward postures while at work, whereas only 27.6% of them exercised to relieve pain and discomfort. Conclusion: There is an urgent need to develop appropriate intervention strategies for people involved in sedentary online work to prevent the occurrence of musculoskeletal pain and discomfort. Physical therapy can play a major role in managing this lifestyle hazard.

7.
Pain Physician ; 24(S1):S209-S232, 2021.
Article in English | ProQuest Central | ID: covidwho-1813052

ABSTRACT

BACKGROUND: Transforaminal epidural injections have been used since the late 1990s to treat lumbar radicular pain. They have been the subject of considerable attention, with varying conclusions from systematic reviews as to their efficacy. Transforaminal injections have been associated with rare but major complications. Further, the use of transforaminal injections has increased since the passage of the Affordable Care Act. Finally, with the SARS-CoV-2 pandemic, there has been heightened concern regarding the risk associated with steroid injections. OBJECTIVES: To evaluate and update the effectiveness of transforaminal injections for 4 indications: radicular pain;from spinal stenosis;from failed back surgery syndrome;and for axial low back pain;and to evaluate the safety of the procedure. STUDY DESIGN: A systematic review and meta-analysis of the efficacy of transforaminal injections. METHODS: The available literature on transforaminal injections was reviewed and the quality assessed. The level of evidence was classified on a 5-point scale based on the quality of evidence developed by the US Preventive Services Task Force (USPSTF) and modified by the American Society of Interventional Pain Physicians (ASIPP). Data sources included relevant literature from 1966 to April 2020, and manual searches of the bibliographies of known primary and review articles. Pain relief and functional improvement were the primary outcome measures. A minimum of 6 months pain relief follow-up was required. RESULTS: For this systematic review, 66 studies were identified. Eighteen randomized controlled trials met the inclusion criteria. No observational studies were included. Eleven randomized controlled trials dealt with various aspects of transforaminal injections for radicular pain owing to disc herniation. Based on these studies, there is Level 1 evidence supporting the use of transforaminal injections for radicular pain owing to disc herniation. A meta-analysis showed that at both 3 and 6 months, there was highly statistically significant improvement in both pain and function with both particulate and nonparticulate steroids. For radicular pain from central stenosis there is one moderate quality study, with Level IV evidence. For radicular pain caused by failed back surgery syndrome there is one moderate quality study, with Level IV evidence. For radicular pain from foraminal stenosis and for axial pain there is Level V evidence, opinion-based/consensus, supporting the use of transforaminal injections. Transforaminal injections are generally safe. However, they have been associated with major neurologic complications related to cord infarct. Causes other than intraluminal injection of particulates appear to be at play. The use of an infraneural approach and of blunt needles appear to offer the greatest patient safety. Because of concern over the role of particulate steroids, multiple other injectates have been evaluated, including nonparticulate steroids, tumor necrosis factor alpha (TNF-a) inhibitors, and local anesthetics without steroids. No injectate has been proven superior. If there is concern about immunosuppression because of risk of COVID-19 infection, either the lowest possible dose of steroid or no steroid should be used. LIMITATIONS: The study was limited by the paucity of literature for some indications. CONCLUSIONS: There is Level I evidence for the use of transforaminal injections for radicular pain from disc herniations.

8.
Pain Physician ; 24(5):319-325, 2021.
Article in English | ProQuest Central | ID: covidwho-1812623

ABSTRACT

BACKGROUND: The COVID-19 infection poses a serious threat to global health for millions of people. In addition to therapeutic treatment methods, preventive measures are also important in controlling the pandemic. As a result, billions of people are quarantined in their homes to prevent the spread of coronavirus. However, social isolation may result in immobility, which can lead to musculoskeletal problems and an increased level of pain, depending on the weakness of the muscles. OBJECTIVES: To examine the effect of social isolation during the recent COVID-19 pandemic on patients with chronic low back pain. STUDY DESIGN: A total of 145 patients who underwent a spine intervention within the past year were enrolled in this prospective and cross-sectional study. SETTING: The study was performed in the interventional pain unit of a tertiary rehabilitation center in Turkey. METHODS: Patient data were obtained by telephone interview and included information pertaining to demographics, pain history, an assessment of pain, analgesic use, activity levels, and an evaluation of stress and sleep habits. Additionally, the International Physical Activity Questionnaire (IPAQ) was used to evaluate patient activity levels. RESULTS: It was detected that social isolation has increased the intensity of low back pain experienced by patients during the COVID-19 pandemic. We also found that patients who benefited from spinal injections administered in the prepandemic period experience less severe low back pain (P = 0.000) and took fewer analgesics (P = 0.000) during the pandemic. The findings of our study revealed that there was a significant reverse correlation between IPAQ walking scores and the prepandemic Visual Analog Scale (VAS) scores (P = 0.015, r = -0.201) and the pandemic VAS scores (P = 0.000, r = -0.313).By contrast, the level of benefit from injections decreased (P < 0.05) and the duration of spinal intervention was shortened in patients with high IPAQ sitting scores (P < 0.05). LIMITATIONS: The limitations of the study are the small number of patients and the fact that our results are based on patients’ self-reported data. CONCLUSIONS: Social isolation has had an increasing effect on low back pain during the COVID-19 pandemic. The results of our study showed a significant relationship between activity level and pain intensity. We also found that patients who have benefited from spinal injections administered in the prepandemic period experience less severe low back pain during the pandemic.

9.
J Occup Health ; 64(1): e12329, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1800405

ABSTRACT

OBJECTIVES: This study examined the relationship between frequency of working from home and low back pain (LBP), considering the quality of work environment. METHODS: The study was based on a cross-sectional internet-based survey. Of 33 302 respondents, data from 12 774 desk workers were retained for analysis. We used a 0-10 numerical rating scale to assess LBP. Work environment was assessed using five subjective questions. Mixed-effects logistic regression nested by city level was used to analyze the relationship between frequency of working from home and LBP, stratified by work environment condition. RESULTS: The prevalence of LBP was 21.0%. Among those reporting a poor work environment, as opposed to almost never working from home, the multivariate odds ratio (OR) of LBP were as follows: working from home less than 1 day per week: OR = 1.25, 95% CI: 0.89-1.76, p = .190; 2-3 days per week: OR = 1.58, 95% CI: 1.16-2.16, p = .004; and 4 or more days per week: OR = 1.82, 95% CI: 1.38-2.40, p < .001. By contrast, among those reporting a good work environment, the OR of LBP did not increase as the frequency of working from home increased. CONCLUSIONS: The relationship between LBP and frequency of working from home was found to vary with the quality of the work environment; more specifically, LBP was associated with frequency of teleworking in a poor work environment. This study suggests that employers should give more support to their employees in promoting a good work environment to prevent LBP. (Words: 240/250).


Subject(s)
Low Back Pain , Occupational Diseases , Cross-Sectional Studies , Humans , Japan/epidemiology , Low Back Pain/epidemiology , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Risk Factors , Surveys and Questionnaires , Teleworking
10.
Int J Environ Res Public Health ; 19(8)2022 04 11.
Article in English | MEDLINE | ID: covidwho-1785696

ABSTRACT

In March 2019, the World Health Organization (WHO) recognized the COVID-19 pandemic as a global issue. To reduce the spread of this disease, health safety pathways were implemented worldwide. These extraordinary measures changed people's lifestyles, e.g., by being forced to isolate, and in many cases, to work remotely from home. Low back pain (LBP), the most common cause of disability worldwide, is often a symptom of COVID-19. Moreover, it is often associated with different lifestyle features (type of job, physical activity, body weight). Therefore, the purpose of this systematic review and meta-analysis was to estimate the effect of the COVID-19 lockdown on LBP intensity and prevalence compared with LBP rates before the pandemic. A systematic search was performed on Scopus, PubMed, and Cochrane Central. Overall, eight studies with 2365 patients were included in the analysis. We used the Joanna Briggs Institute (JBI) critical appraisal tool to evaluate the risk of bias: six studies (75%) were at moderate risk of bias and two studies (25%) were at low risk of bias. These studies showed an increase in both the prevalence and intensity of LBP during the COVID-19 lockdown.


Subject(s)
COVID-19 , Low Back Pain , COVID-19/epidemiology , Communicable Disease Control , Humans , Low Back Pain/epidemiology , Pandemics , Prevalence
11.
Pain Physician ; 25(2):193-207, 2022.
Article in English | Web of Science | ID: covidwho-1776968

ABSTRACT

Background: Regenerative medicine interventions are applied to assist in the repair, and to potentially replace or restore damaged tissue through the use of autologous/allogenic biologics and it continues to expand. The anti-inflammatory, immunomodulatory, and regenerative properties of bone marrow mesenchymal stem cells (BM-MSCs), and investigation into their therapeutic efficacy and safety in patients with severe chronic low back pain, have not been demonstrated in controlled studies. Multiple pain generators have been hypothesized to be responsible in severe spinal degeneration and it is difficult to identify a single pain generator;consequently, resulting in inadequate therapeutic results. Objectives: The study was undertaken to evaluate the effectiveness of autologous bone marrow MSCs in the treatment of chronic low back pain due to severe lumbar spinal degeneration with involvement of multiple structures. Study Design: Prospective, open-label, nonrandomized, parallel-controlled, 2-arm exploratory study. Setting: A private, specialized, interventional pain management and regenerative medicine clinic. Methods: The treatment group patients received a one-time bone marrow concentrate injection into spinal structures (i.e., discs, facets, spinal nerves, and sacroiliac joints), along with conventional treatment, whereas, the control group received conventional treatment with nonsteroid antiinflammatory drugs, over-the-counter drugs, structured exercise programs, physical therapy, spinal injections and opioids, etc., as indicated. Outcomes Assessment: Outcomes were assessed utilizing multiple instruments, including the Oswestry Disability Index (ODI), Numeric Rating Scale (NRS-11), EuroQOL 5-Dimensional Questionnaire (EQ-5D-3L), Global Mental Health (GMH), and Global Physical Health (GPH). Multiple outcomes were assessed with primary outcomes being minimal clinically important differences (MCID) in ODI scores between the groups and/or a 2-point reduction in pain scores. In the study group, total nucleated cells, colony forming units-fibroblast, CD34-positive cell numbers and platelets were also recorded, along with post-procedure magnetic resonance imaging changes. Outcomes were assessed at 1, 3, 6, and 12 months. Results: Significant improvement was achieved in functional status measured by ODI, pain relief measured by NRS-11, and other parameters measured by EQ-5D-3L, GMH, and GPH, in the study group relative to the control group at all time periods. The results showed significant improvements at 12-month follow-up with 67% of the patients in the study group achieving MCID utilizing ODI when compared to 8% in the control group. Greater than 2-point pain reduction was seen in 74% of the patients at 3 months, 66% of the patients at 6 months, and 56% of the patients at 12 months. Both MCID and pain relief of 2 points were significantly different compared to the control group. Opioid use decreased in the investigational group, whereas, there was a slight increase in the control group. Age, gender, opioid use, and body mass index did not affect the outcomes in the stem cell group. Limitations: Single center, nonrandomized study. Conclusions: The first available controlled study utilizing BM-MSCs in severe degenerative spinal disease with interventions into multiple structures simultaneously, including disc, facet joints, nerve roots, and sacroiliac joint based on symptomatology, showed promising results.

12.
Front Public Health ; 9: 744601, 2021.
Article in English | MEDLINE | ID: covidwho-1775912

ABSTRACT

Objectives: Low back pain (LBP) has negative implications for the military's combat effectiveness. This study was conducted to determine the prevalence and risk factors of LBP among pilots through a questionnaire and physical function assessments. Methods: Data on the demographic and occupational characteristics, health habits, physical activity, and musculoskeletal injuries of 217 male pilots (114 fighter, 48 helicopter, and 55 transport pilots) were collected using a self-reported questionnaire and physical function assessments. Results: LBP prevalence was 37.8% in the total cohort and 36.0, 45.8, and 34.5% among fighter, helicopter, and transport pilots, respectively. Multivariate regression analysis revealed that the risk factors significantly associated with LBP were neck pain [odds ratio (OR): 3.559, 95% confidence interval (CI): 1.827-6.934], transversus abdominis activation (OR: 0.346, 95% CI: 0.172-0.698), and hip external rotator strength (OR: 0.001, 95% CI: 0.000-0.563) in the total cohort; neck pain (OR: 3.586, 95% CI: 1.365-9.418), transversus abdominis activation (OR: 0.268, 95% CI: 0.094-0.765), hip external rotator strength (OR: 0.000, 95% CI: 0.000-0.949), and weekly flying hours (OR: 3.889, 95% CI: 1.490-10.149) in fighter pilots; irregular strength training (OR: 0.036, 95% CI: 0.003-0.507) and hip external rotator strength (OR: 0.000, 95% CI: 0.000-0.042) in helicopter pilots; and neck pain (OR: 6.417, 95% CI: 1.424-28.909) in transport pilots. Conclusions: High volume flight schedules and weak core muscle functions have significant negative effects on pilots' back health. LBP is commonly associated with high weekly flying hours, worsening neck pain, transversus abdominis insufficient activation, and reduced hip extensor/rotator strength. Risk factors vary among pilots of different aircraft. Thus, specific core muscle training would be especially important for military pilots.


Subject(s)
Low Back Pain , Military Personnel , Humans , Low Back Pain/epidemiology , Low Back Pain/etiology , Male , Prevalence , Risk Factors , Surveys and Questionnaires
13.
Trauma Monthly ; 27:76-81, 2022.
Article in English | EMBASE | ID: covidwho-1772148

ABSTRACT

The new coronavirus disease, which started in Wuhan, quickly transformed into a pandemic and a life-threatening global infection. Understanding Covid-19-specific views can facilitate defining more accurate CT scan diagnostic criteria for this disease. These views include ground-glass opacity (GGO), consolidation, interlobular septal thickening, reticular, and crazy paving. This case series aimed to assess six Covid-19 patients displaying the target sign view in lung CT scans.

14.
BMJ : British Medical Journal (Online) ; 376, 2022.
Article in English | ProQuest Central | ID: covidwho-1769894

ABSTRACT

The same applies to widening health inequalities doi:10.1136/bmj.o607).7 That’s clear when the government claims that poverty has declined, although our fact check explains why it hasn’t (doi:10.1136/bmj.o814),8 and the latest measures to help people on low incomes at a time of rising costs of living will plunge 1.5 million more people into poverty according to the government’s preferred poverty metric (doi:10.1136/bmj.o794).9 When a ministry of health tots up the impact of its measures, does it consider the effects on health and wellbeing? Take the earlier diagnosis of lung cancer and its possible effect on all cause survival (doi:10.1136/bmj-2021-069008, doi:10.1136/bmj.o666),1718 and the benefit of psychological interventions for chronic, non-specific low back pain (doi:10.1136/bmj-2021-067718).19 Or the solace that one doctor found in DJing, which led to a thriving second career (doi:10.1136/bmj.o647).20 Where there is outrage, we attempt to bring solutions and hope. Association of computed tomography screening with lung cancer stage shift and survival in the United States: quasi-experimental study.

15.
British Journal of Surgery ; 109(SUPPL 1):i6-i7, 2022.
Article in English | EMBASE | ID: covidwho-1769188

ABSTRACT

Aim: Approximately 2.6 million people see their GP for lower back pain (LBP) each year. Referrals for spinal surgery are increasing with varying effectiveness. Screening for neurosurgical red flags is critical to quickly identify the rare but serious causes of LBP, such as CES. The primary aim was to explore what effect COVID-19 had on the management pathway of these patients in primary care to investigate causes of LBP including ruling out CES. Method: A service evaluation of all patients presenting to a large primary care provider in West Yorkshire with lower back pain who underwent MRI lumbar/sacral spine investigation between March 2020 and March 2021 was conducted. Results: A total of 105 patients with matched MRI scans were included. Neurosurgical red flag screening was performed by virtual appointment only in 32 (30.5%) of patients. In 10 cases (9.5%), red flag screening was not documented. Radiological outcomes revealed three (2.9%) cases of CES. Thirty (28.6%) required onward referral to neurosurgery. The majority (n=56;53%) had demonstrated radiological pathology amenable to conservative management. Conclusions: During the pandemic, almost a third of patients in primary care did not receive a face-to-face examination to rule out red flags in lieu of virtual appointments and history alone. The majority of imaging revealed pathology that was amenable to conservative management. The safety of virtual consultations including telephone appointments to screen for neurosurgical pathology needs further investigation. If deemed safe, virtual patient pathways may be optimised to achieve effective recognition patients at risk of CES requiring neurosurgical intervention.

16.
Health Expect ; 25(2): 721-731, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1764936

ABSTRACT

BACKGROUND: There is a need for effective health service solutions to provide greater structure and support for implementing evidence-based practice in back pain care. Patient involvement in developing these solutions is crucial to increase relevance, acceptability and uptake. OBJECTIVES: To determine patients' perceived needs and barriers to best-practice back pain care, and potential solutions to better address care needs. The study is the third in a series of needs assessment studies feeding into the 'idea generation' for service design in a large teaching hospital in a culturally and linguistically diverse community in metropolitan Sydney, Australia. DESIGN: We conducted a combination of focus groups and in-depth interviews using an interpretive description approach. We used inductive thematic analysis to identify the main themes. SETTING AND PARTICIPANTS: We purposively sampled patients with diverse characteristics from the neurosurgery and physiotherapy outpatient clinics, in particular those whose primary language was English, Arabic, Persian or Mandarin. Non-English audio recordings were translated and transcribed by bilingual researchers. RESULTS: There were 24 participants (focus groups = 9; individual interviews = 15) when data saturation was reached. The analysis identified three key themes with several subthemes around what service designers needed to understand in helping people with back pain in this setting: (1) This is who I am; (2) It's not working for me; and (3) What I think I need. DISCUSSION AND CONCLUSION: This study highlights that perceived unmet needs of patients are underpinned by unhelpful beliefs about the causes of and solutions for back pain, misaligned care expectations, unclear expectations of the hospital role and fragmentations in the health system. To design and implement a service that can deliver better back pain care, several solutions need to be integrated around: developing new resources that challenge unhelpful beliefs and set realistic expectations; improving access to education and self-management resources; focusing on individualized care; using a collaborative multidisciplinary approach within the hospital; and better connecting with and directing primary health care services. PATIENT OR PUBLIC CONTRIBUTION: A consumer representative of the Western Sydney Local Health District provided input during study conceptualisation and is duly recognized in the Acknowledgements section.


Subject(s)
Back Pain , Self-Management , Back Pain/therapy , Hospitals , Humans , Needs Assessment , Qualitative Research
17.
Russian Journal of Pain ; 20(1):42-47, 2022.
Article in Russian | Scopus | ID: covidwho-1761329

ABSTRACT

The article describes a clinical case of a patient with pain in the lower back after suffering a coronavirus infection COVID-19. The purpose of the observation was to study the association of COVID-19 with pain in the lower back, as well as the compliance of complaints and the clinical picture with the criteria for diagnosing postcoid syndrome. Possible therapy strategy developed. The use of NSAID Meloxicam (Amelotex), myoreraxant Tolperisone (Calmirex), and the antioxidant Cytoflavin contributed to a rapid regression of symptoms and an improvement in the patient’s general condition. There were no reported side effects or complications of therapy. Additionally, no correction of antihypertensive therapy was required. © 2022, Media Sphera Publishing Group. All rights reserved.

18.
Osteoporosis International ; 32(SUPPL 1):S142, 2022.
Article in English | EMBASE | ID: covidwho-1748503

ABSTRACT

Objective: COVID-19 pandemic was associated with increased risk of hypovitaminosis D due to lockdown regulations and limited outdoor activities, while young adult patients with autoimmune conditions may associated decreased values of 25-hydroxyvitamin D due to copresence of celiac disease, glucocorticoid exposure, malabsorption, overtreatment of autoimmune hypothyroidism, etc. (1-5).We aim to introduce a female case known with autoimmune conditions who was admitted for vitaminD deficiency related symptoms during pandemic. Case report: A 41-year-old, nonsmoker female is admitted for nonspecific muscle cramps, and joints pain, asthenia which is persistent for the last several months in addition to chronic low back pain (which required chronic use of nonsteroid anti-inflammatory medication). Her personal medical background reveals a diagnosis of HLA-B27-positive ankylosing spondylitis that was established seven years before current admission. She is also known with autoimmune thyroiditis with negative antibodies, a diagnostic that was based on suggestive ultrasound features with highly hypoechoic pattern of relative small thyroid gland (and normal thyroid function). She is also confirmed with thrombophilia. She has a negative personal history of confirmed COVID-19 infection and she followed the lockdown restrictions for several weeks. The family medical history is irrelevant. On admission, clinical examination of the thyroid is within normal limits on amenstruated normal weighted female. Biochemistry data points out normal total calcium of 9.45 mg/dL (normal: 8.4-10.3 mg/dL). Endocrine panel shows TSH=1.28 μUI/mL (normal: 0.5-4.5 μUI/mL), free levothyroxine=11.65 pmol/L (normal: 9-19 pmol/L), anti-thyroperoxidase antibodies=10.88 UI/mL (normal: 0-35), anti-thyroglobulin antibodies=10 UI/mL (normal: 0-115 UI/mL). 25-hydroxyvitamin D=10 ng/mL (normal >30 ng/mL) with increased PTH levels and negative antibodies for celiac disease. Supplementation with daily 2000 UI of vitamin D for 12 weeks followed by daily 1000 UI was recommended. Conclusion: The association thrombophilia-hypovitaminosis D has been reported in some patients, but it is rather incidental. Chronic use of antiinflammatory medication may cause malabsorption, and also the potential of a second autoimmune disease at intestinal level may cause this deficiency, but the current pandemic reality has become a new cause of it.

19.
Int J Ther Massage Bodywork ; 15(1): 15-22, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1742778

ABSTRACT

Background: Many studies have shown that changes in lumbar flexion angle and the pelvic inclination angle can be affected by the shortening of the lumbar muscles, which can cause low back pain. Decreased lumbar flexion angle and pelvic inclination angle can cause or exacerbate low back pain by disrupting the lumbo-pelvic rhythm. Purpose: This study aimed to use myofascial release techniques as a specialized treatment on muscle tissue to cause muscles to reach the optimal length and improve lumbar flexion angle and pelvic inclination angle, and thus improve low-back pain. Setting: Non-specific low back pain patients, Tarbiat Modares University, Iran. Participants: 30 chronic non-specific low back pain participants were randomly assigned into two groups. Research Design: This is a randomized control trial. Interventions: The myofascial release group (n=15) underwent 4 sessions of myofascial release treatment based on Myer's techniques, and the control group (n=15) underwent 10 sessions of routine electrotherapy for two weeks. Main Outcome Measures: Before starting the intervention and after the last treatment session, both groups were evaluated by the lumbar flexion angle with a flexible ruler, calculating the pelvic inclination angle by a trigonometric formula, and VAS measured the pain score of the participants. Results: The results of the paired t test showed that, after treatment in both groups, the severity of pain and lumbar flexion angle changed significantly (p ≤ .001). However, the pelvic inclination angle was changed considerably only in the myofascial release group, and we did not see significant changes in the control group (p = .082). Also, the independent sample t test results to examine the between-group changes showed that changes in the myofascial release group were significantly different from the control group (p ≤ .000). Also, the effect size shows the large effect of the myofascial release technique compared to the control group (effect size ≥ 1.85). Conclusion: The present study results showed that myofascial release techniques in patients with low back pain could help decrease pain intensity and increase lumbar flexion and pelvic inclination angle. Based on the present study results, myofascial release can be a treatment to correct posture in patients with chronic non-specific, low back pain. Due to the prevalence of the COVID-19 pandemic, it was not possible to evaluate the long-term effects of treatment.

20.
Applied Sciences ; 12(5):2501, 2022.
Article in English | ProQuest Central | ID: covidwho-1736822

ABSTRACT

This study aimed to investigate the effect of core stabilization exercises on the contractile properties and isokinetic muscle function of adult females with a sedentary lifestyle. We enrolled 105 adult females. Tensiomyography was performed on the erector spinae, and the isokinetic muscular functional test was performed on the trunk at an angular velocity of 60°/s and 90°/s. All participants performed the exercise for 60 min per day, 3 times a week, for 7 weeks. A Wilcoxon signed-rank test was performed at a significance level of 0.05. Tensiomyography (TMG) of the erector spinae revealed no significant post-exercise change in the contraction time;however, there was a significant post-exercise increase in the maximum radial displacement and mean velocity until 90% of the TMG was displaced. Additionally, the isokinetic muscular functional test of the trunk revealed a significant post-exercise increase in almost all variables. Our findings demonstrated that the core stabilization exercise reduced stiffness in the erector spinae, increased the velocity of erector spinae contraction, and effectively improved the isokinetic muscular function of the trunk.

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