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1.
J Med Internet Res ; 23(2): e26292, 2021 02 22.
Article in English | MEDLINE | ID: covidwho-1574360

ABSTRACT

BACKGROUND: Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. OBJECTIVE: We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. METHODS: A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between-within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. RESULTS: The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre-post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. CONCLUSIONS: EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/25291.


Subject(s)
COVID-19 , Chronic Pain/therapy , Health Behavior , Low Back Pain/therapy , Pain Management/methods , Virtual Reality , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Double-Blind Method , Female , Humans , Male , Middle Aged , Pandemics , Self Report , Time Factors , Young Adult
2.
BMC Musculoskelet Disord ; 22(1): 955, 2021 Nov 15.
Article in English | MEDLINE | ID: covidwho-1526623

ABSTRACT

BACKGROUND: Globally, chronic low back pain (CLBP) is the leading cause of disability associated with economic costs. However, it has received little attention in low-and-middle-income countries. This study estimated the prevalence and risk factors of CLBP among adults presenting at selected hospitals in KwaZulu-Natal. METHODOLOGY: This cross-sectional study was conducted among adults aged ≥18 years who attended the selected hospitals in KwaZulu-Natal during the study period. A self-administered questionnaire was used to collect data on socio-demographic, work-related factors, and information about CLBP. The SPSS version 24.0 (IBM SPSS Inc) was used for data analysis. Descriptive statistics were used for demographic characteristics of participants. CLBP risk factors were assessed using multivariate logistic regression analysis. A p-value of ≤0.05 was deemed statistically significant. RESULTS: A total of 678 adults participated in this study. The overall prevalence of CLBP was 18.1% (95% CI: 15.3 - 21.3) with females having a higher prevalence than males, 19.8% (95% CI: 16.0 - 24.1) and 15.85% (95% CI: 11.8 - 20.6), respectively. Using multivariate regression analysis, the following risk factors were identified: overweight (aOR: 3.7, 95% CI: 1.1 - 12.3, p = 0.032), no formal education (aOR: 6.1, 95% CI: 2.1 - 18.1, p = 0.001), lack of regular physical exercises (aOR: 2.2, 95% CI: 1.0 - 4.8, p = 0.044), smoking 1 to 10 (aOR: 4.5, 95% CI: 2.0 - 10.2, p < 0.001) and more than 11 cigarettes per day (aOR: 25.3, 95% CI: 10.4 - 61.2, p < 0.001), occasional and frequent consumption of alcohol, aOR: 2.5, 95% CI: 1.1 - 5.9, p < 0.001 and aOR: 11.3, 95% CI: 4.9 - 25.8, p < 0.001, respectively, a sedentary lifestyle (aOR: 31.8, 95% CI: 11.2 - 90.2, p < 0.001), manual work (aOR: 26.2, 95% CI: 10.1 - 68.4, p < 0.001) and a stooped sitting posture (aOR: 6.0, 95% CI: 2.0 - 17.6, p = 0.001). CONCLUSION: This study concluded that the prevalence of CLBP in KwaZulu-Natal is higher than in other regions, and that it is predicted by a lack of formal education, overweight, lack of regular physical exercises, smoking, alcohol consumption, sedentary lifestyle, manual work, and a stooped posture.


Subject(s)
Low Back Pain , Adolescent , Adult , Cross-Sectional Studies , Female , Hospitals , Humans , Low Back Pain/diagnosis , Low Back Pain/epidemiology , Male , Prevalence , Risk Factors , South Africa/epidemiology
4.
Eur Spine J ; 30(10): 2944-2954, 2021 10.
Article in English | MEDLINE | ID: covidwho-1326826

ABSTRACT

PURPOSE: The COVID-19 pandemic and the containment measures such as social distancing, mobility restrictions and quarantine have significantly impacted the delivery of healthcare services, with possible negative effects on low back pain patients. In this study, we used an innovative agent-based model to quantify the effects of COVID-19 on the prevalence and severity of low back pain in the general population. METHODS: Epidemiological data were used to simulate the low back pain evolution in a population of 300,000 agents. Reduced access to treatment due to the containment measures was simulated with a probabilistic approach, in which 500 random scenarios (differing in: length of the lockdown, probability of having access to treatment, time before the resumption of treatment, duration of the effects of the treatment after its interruption) were simulated. RESULTS: The lockdown may increase the mean pain score higher than 1/10 points for patients suffering from acute low back pain, up to 4-5/10 points for specific individuals. The lockdown also affected the length of pain episodes, possibly impacting chronicity and disability. All the variables describing the random scenarios had a relevant impact in determining both the increase of pain intensity in the population and the length of the effects of the lockdown. CONCLUSIONS: "Optimal lockdown parameters" which minimize the impact on low back pain while preserving the effects on infection spread and mortality could not be identified. Policies favouring a prompt resumption of treatments after the lockdown may be effective in shortening the duration of its negative effects.


Subject(s)
COVID-19 , Low Back Pain , Communicable Disease Control , Humans , Low Back Pain/epidemiology , Pandemics , SARS-CoV-2
5.
Int J Environ Res Public Health ; 18(14)2021 07 06.
Article in English | MEDLINE | ID: covidwho-1323221

ABSTRACT

Chronic low back pain is one of the most common, poorly understood, and potentially disabling chronic pain conditions from which older adults suffer. The existing low back pain research has relied almost exclusively on White/Caucasian participant samples. This study examines the correlates of chronic low back pain among a sample of underserved urban African American and Latino older adults. Controlling for age, gender, race/ethnicity, education, living arrangement, and number of major chronic conditions, associations between low back pain and the following outcome variables are examined: (1) healthcare utilization, (2) health-related quality of life (HR-QoL) and self-rated quality of health; and (3) physical and mental health outcomes. METHODS: We recruited nine hundred and five (905) African American and Latino older adults from the South Los Angeles community using convenience and snowball sampling. In addition to standard items that measure demographic variables, our survey included validated instruments to document HR-QoL health status, the Short-Form McGill Pain Questionnaire-2, Geriatric Depression Scale, sleep disorder, and healthcare access. Data analysis includes bivariate and 17 independent multivariate models. RESULTS: Almost 55% and 48% of the Latino and African American older adults who participated in our study reported chronic low back pain. Our data revealed that having low back pain was associated with three categories of outcomes including: (1) a higher level of healthcare utilization measured by (i) physician visits, (ii) emergency department visits, (iii) number of Rx used, (iv) a higher level of medication complexity, (v) a lower level of adherence to medication regimens, and (vi) a lower level of satisfaction with medical care; (2) a lower level of HR-QoL and self-assessment of health measured by (i) physical health QoL, (ii) mental health QoL, and (iii) a lower level of self-rated health; and (3) worse physical and mental health outcomes measured by (i) a higher number of depressive symptoms, (ii) a higher level of pain, (iii) falls, (iv) sleep disorders, (v) and being overweight/obese. DISCUSSION: Low back pain remains a public health concern and significantly impacts the quality of life, health care utilization, and health outcomes of underserved minority older adults. Multi-faceted and culturally sensitive interventional studies are needed to ensure the timely diagnosis and treatment of low back pain among underserved minority older adults. Many barriers and challenges that affect underserved African American and Latino older adults with low back pain simply cannot be addressed in over-crowded EDs. Our study contributes to and raises the awareness of healthcare providers and health policymakers on the necessity for prevention, early diagnosis, proper medical management, and rehabilitation policies to minimize the burdens associated with chronic low back pain among underserved older African American and Latino patients in an under-resourced community such as South Los Angeles.


Subject(s)
Low Back Pain , Quality of Life , African Americans , Aged , Cross-Sectional Studies , Humans , Low Back Pain/epidemiology
6.
J Coll Physicians Surg Pak ; 31(7): S127-S129, 2021 07.
Article in English | MEDLINE | ID: covidwho-1317404

ABSTRACT

Most pregnancy-related sacral stress fractures occur after delivery. This case aims to emphasise that stress fractures can occur before delivery, and since excessive weight gain is a risk factor, pregnant women should avoid gaining excess weight, especially during quarantine. This patient, who gained 20 kgs during first pregnancy, started complaining of severe pain in the left sacral region in the 40th week of pregnancy, without any trauma. Despite conservative follow-up, her pain increased, and a caesarean section was performed. The patient continued to complain of pain in the left sacral region. Magnetic resonance imaging (MRI) identified a sacral stress fracture which was treated conservatively and resolved after 4 months. Complaints of severe back pain during the last stage of pregnancy require a detailed physical examination. When localised sensitivity is detected in the sacral region during pregnancy, a diagnosis can be made using MRI, thereby avoiding radiation exposure. Key Words: Stress fractures, COVID-19, Sacrum, Pregnancy.


Subject(s)
COVID-19 , Fractures, Stress , Low Back Pain , Spinal Fractures , Cesarean Section/adverse effects , Female , Fractures, Stress/diagnostic imaging , Fractures, Stress/epidemiology , Fractures, Stress/etiology , Humans , Magnetic Resonance Imaging , Pandemics , Pregnancy , Quarantine , SARS-CoV-2 , Sacrococcygeal Region , Sacrum/diagnostic imaging , Weight Gain
7.
BMJ Case Rep ; 13(9)2020 Sep 21.
Article in English | MEDLINE | ID: covidwho-1304172

ABSTRACT

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Subject(s)
Coronavirus Infections/complications , Guillain-Barre Syndrome/physiopathology , Low Back Pain/physiopathology , Muscle Weakness/physiopathology , Paresthesia/physiopathology , Pneumonia, Viral/complications , Analgesics/therapeutic use , Betacoronavirus , Brain/diagnostic imaging , COVID-19 , Coronavirus Infections/diagnosis , Diagnosis, Differential , Female , Gabapentin/therapeutic use , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiculopathy/diagnosis , SARS-CoV-2 , Spinal Cord/diagnostic imaging
8.
Int J Environ Res Public Health ; 18(11)2021 05 25.
Article in English | MEDLINE | ID: covidwho-1266717

ABSTRACT

Whole-body electromyostimulation (WB-EMS), an innovative training technology, is considered as a joint-friendly, highly customizable and particularly time-effective option for improving muscle strength and stability, body composition and pain relief. The aim of the present study was to determine the effect of 16 weeks of once-weekly WB-EMS on maximum isometric trunk (MITS), leg extensor strength (MILES), lean body mass (LBM) and body-fat content. A cohort of 54 male amateur golfers, 18 to 70 years old and largely representative for healthy adults, were randomly assigned to a WB-EMS (n = 27) or a control group (CG: n = 27). Bipolar low-frequency WB-EMS combined with low-intensity movements was conducted once per week for 20 min at the participants' locations, while the CG maintained their habitual activity. The intention to treat analysis with multiple imputation was applied. After 16 weeks of once-weekly WB-EMS application with an attendance rate close to 100%, we observed significant WB-EMS effects on MITS (p < 0.001), MILES (p = 0.001), LBM (p = 0.034), but not body-fat content (p = 0.080) and low-back pain (LBP: p ≥ 0.078). In summary, the commercial setting of once-weekly WB-EMS application is effective to enhance stability, maximum strength, body composition and, to a lower extent, LBP in amateur golfers widely representative for a healthy male cohort.


Subject(s)
Electric Stimulation Therapy , Low Back Pain , Adolescent , Adult , Aged , Body Composition , Humans , Male , Middle Aged , Muscle Strength , Muscle, Skeletal , Young Adult
9.
Int J Environ Res Public Health ; 18(11)2021 05 23.
Article in English | MEDLINE | ID: covidwho-1266716

ABSTRACT

Back pain is one of the most costly disorders among the worldwide working population. Within that population, healthcare workers are at a high risk of back pain. Though they often demonstrate awkward postures and impaired balance in comparison with healthy workers, there is no clear relationship between compensatory postural responses to unpredictable stimuli and the strength of related muscle groups, in particular in individuals with mild to moderate back pain. This paper presents a study protocol that aims to evaluate the relationship between peak anterior to peak posterior displacements of the center of pressure (CoP) and corresponding time from peak anterior to peak posterior displacements of the CoP after sudden external perturbations and peak force during a maximum voluntary isometric contraction of the back and hamstring muscles in physiotherapists with non-specific back pain in its early stages. Participants will complete the Oswestry Disability Questionnaire. Those that rate their back pain on the 0-10 Low Back Pain Scale in the ranges 1-3 (mild pain) and 4-6 (moderate pain) will be considered. They will undergo a perturbation-based balance test and a test of the maximal isometric strength of back muscles and hip extensors. We assume that by adding tests of reactive balance and strength of related muscle groups in the functional testing of physiotherapists, we would be able to identify back problems earlier and more efficiently and therefore address them well before chronic back disorders occur.


Subject(s)
Hamstring Muscles , Low Back Pain , Physical Therapists , Cross-Sectional Studies , Humans , Isometric Contraction , Muscle Strength , Muscle, Skeletal , Postural Balance
10.
Am J Phys Med Rehabil ; 100(4): 307-312, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1266237

ABSTRACT

OBJECTIVE: The clinical manifestations of COVID-19 range from mild symptoms to severe pneumonia and severe organ damage. When evaluated specifically for pain, the data so far have shown that myalgia, headache, and chest pain can be seen in patients at varying rates; myalgia and headache, especially, are among the initial symptoms. DESIGN: This retrospective chart review, followed by a descriptive survey design study, was carried out by examining patients afflicted with COVID-19. After discharge, patients were asked about the severity and the body region of their pain, their use of analgesics, their mood and mental health, and their overall quality of life. RESULTS: A total of 206 patients with a mean age of 56.24 ± 16.99 yrs were included in the study. Pain during COVID-19 was found to be higher compared with the preinfectious and postinfectious states. The most frequent painful areas were reported to be the neck and back before the infection, whereas the head and limbs during the infection. The most frequently used analgesic during infection was paracetamol. There was no relationship between the patients' pain and anxiety and depression; the quality of life was found to be worse in patients with persistent pain. CONCLUSIONS: This study showed that the head and limbs were the most common painful body regions during COVID-19. It was also found that pain can continue in the postinfection period.


Subject(s)
COVID-19/epidemiology , Myalgia/diagnosis , Pain Measurement/statistics & numerical data , Adult , Aged , COVID-19/complications , Female , Headache/diagnosis , Humans , Low Back Pain/diagnosis , Male , Middle Aged , Myalgia/etiology , Neck Pain/diagnosis , Physical Examination , Primary Health Care/methods , Retrospective Studies
11.
BMC Neurol ; 21(1): 202, 2021 May 19.
Article in English | MEDLINE | ID: covidwho-1236547

ABSTRACT

BACKGROUND: Spinal neuroarthropathy (SNA), also known as Charcot spine, is an uncommon aggressive arthropathy, secondary to loss of proprioceptive and nociceptive feedback from the spine. A diagnosis of SNA is frequently delayed due to the scarcity of symptoms in its early stages, leading to significant neurological deterioration. Therefore, prompt suspicion of the disease is critical to providing better outcomes. This case assembles two rare characteristics of SNA: diabetic aetiology and a precocious time of diagnosis, and aims to highlight the magnetic resonance imaging (MRI) findings that allowed for the diagnosis. CASE PRESENTATION: A 44-year-old woman, with long-term type 1 diabetes, presented with a two-month history of progressive lumbar pain, difficulty in maintaining an upright position, and discrete trunk forward-leaning. Diabetes-related vasculopathy and nephropathy were already known, and laboratory test results did not show any new abnormalities. A lumbar MRI revealed extensive signal intensity changes of the L2 and L3 vertebral bodies associated with marginal areas of enhancement and the involvement of regions adjacent to interapophyseal articulations and spinous processes from L2-L3 to L5-S1, in association with degenerative changes of the thoracolumbar spine. These findings were identified by the radiologist as suggestive of SNA. To rule out neoplastic and infectious disease, a bone biopsy at the L2-L3 level was executed. The pathology report revealed intervertebral disc material and fragments of fibrous tissue, with a complete absence of inflammatory cells. It was decided to perform a six-month MRI follow-up, which showed stability of the findings, confirming the hypothesis of Charcot spine. The patient was under clinical and radiological follow-up and did not require surgical fixation at the moment of diagnosis. After 2.5 years from the initial diagnosis, a new MRI revealed progression of the lesions with oedema and enlarged paravertebral soft tissues; these findings are compatible with the patient's latest complaints of lumbar pain recurrence. CONCLUSION: To the best of our knowledge, this is the first case report of an MRI-based early diagnosis of diabetic SNA, a rare disease with nonspecific symptoms in its initial stages and a wide spectrum of differential diagnoses. The MRI findings, distinctly the involvement of both anterior and posterior spinal elements, were the key to allowing for the proper diagnosis. A precocious diagnosis, although challenging, is fundamental to providing early intervention and to preventing further neurological impairment.


Subject(s)
Arthropathy, Neurogenic , Magnetic Resonance Imaging , Spinal Diseases/diagnostic imaging , Adult , Arthropathy, Neurogenic/diagnostic imaging , Arthropathy, Neurogenic/etiology , Diabetes Mellitus, Type 1/complications , Diagnosis, Differential , Female , Humans , Low Back Pain , Lumbar Vertebrae/diagnostic imaging
12.
J Osteopath Med ; 121(7): 625-633, 2021 03 29.
Article in English | MEDLINE | ID: covidwho-1154107

ABSTRACT

CONTEXT: The novel coronavirus 2019 (COVID-19) pandemic has impacted the delivery of health care services throughout the United States, including those for patients with chronic pain. OBJECTIVES: To measure changes in patients' utilization of nonpharmacological and pharmacological treatments for chronic low back pain and related outcomes during the COVID-19 pandemic. METHODS: A pre-post study was conducted within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) using data in the 3 months before and 3-6 months after the declaration of a national emergency related to COVID-19. Participants 21-79 years old with chronic low back pain were included in the study and provided self reported data at relevant quarterly encounters. Use of exercise therapy, yoga, massage therapy, spinal manipulation, acupuncture, cognitive behavioral therapy, nonsteroidal antiinflammatory drugs, and opioids for low back pain was measured. The primary outcomes were low back pain intensity and back related functioning measured with a numerical rating scale and the Roland Morris Disability Questionnaire, respectively. Secondary outcomes included health related quality of life scales measured with the Patient Reported Outcomes Measurement Information System, including scales for physical function, anxiety, depression, low energy/fatigue, sleep disturbance, participation in social roles and activities, and pain interference with activities. RESULTS: A total of 476 participants were included in this study. The mean age of participants at baseline was 54.0 years (standard deviation, ±13.2 years; range, 22-81 years). There were 349 (73.3%) female participants and 127 (26.7%) male participants in the study. Utilization of exercise therapy (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.23-0.57), massage therapy (OR, 0.46; 95% CI, 0.25-0.83), and spinal manipulation (OR, 0.53; 95% CI, 0.29-0.93) decreased during the pandemic. A reduction in NSAID use was also observed (OR, 0.67; 95% CI, 0.45-0.99). Participants reported a significant, but not clinically relevant, improvement in low back pain intensity during the pandemic (mean improvement, 0.19; 95% CI, 0.03-0.34; Cohen's d, 0.11). However, White participants reported a significant improvement in low back pain intensity (mean improvement, 0.28; 95% CI, 0.10-0.46), whereas Black participants did not (mean improvement, -0.13; 95% CI, -0.46 to 0.19; p for interaction=0.03). Overall, there was a significant and clinically relevant improvement in pain interference with activities (mean improvement, 1.11; 95% CI, 0.20-2.02; Cohen's d, 0.20). The use of NSAIDs during the pandemic was associated with marginal increases in low back pain intensity. CONCLUSIONS: Overall, decreased utilization of treatments for chronic low back pain did not adversely impact pain and functioning outcomes during the first 6 months of the pandemic. However, Black participants experienced significantly worse pain outcomes than their White counterparts.


Subject(s)
COVID-19/epidemiology , Chronic Pain/therapy , Low Back Pain/therapy , Acupuncture Therapy/statistics & numerical data , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , COVID-19/prevention & control , COVID-19/transmission , Cognitive Behavioral Therapy/statistics & numerical data , Exercise Therapy/statistics & numerical data , Female , Humans , Male , Manipulation, Spinal/statistics & numerical data , Massage/statistics & numerical data , Middle Aged , Outcome Assessment, Health Care , Pain Measurement , Procedures and Techniques Utilization , Quality of Life , United States , Yoga , Young Adult
13.
J Med Internet Res ; 23(3): e22548, 2021 03 18.
Article in English | MEDLINE | ID: covidwho-1140611

ABSTRACT

BACKGROUND: The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services. OBJECTIVE: This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP. METHODS: A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability. RESULTS: Approximately 93.03% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0% (188/988) and 21.5% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59% (61/1090) of participants reporting opioid use at the end of their treatment. CONCLUSIONS: Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896.


Subject(s)
Exercise Therapy/methods , Low Back Pain/rehabilitation , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Humans , Internet , Male , Middle Aged , Prospective Studies , Treatment Outcome , Young Adult
14.
J Am Board Fam Med ; 34(Suppl): S77-S84, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1100003

ABSTRACT

INTRODUCTION: This study was conducted to determine if limited access to health care during the COVID-19 pandemic impacted utilization of recommended nonpharmacological treatments, nonsteroidal anti-inflammatory drugs, and opioids by patients with chronic low back pain and affected clinical outcomes relating to pain intensity and disability. METHODS: Participants within the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation were eligible if they provided encounter data in the 3 months immediately before and after the national emergency proclamation date (NEPD). RESULTS: The mean age of the 528 study participants was 53.9 years and 74.1% were women. Utilization of exercise therapy, massage therapy, and spinal manipulation decreased during the pandemic. Increasing age was associated with decreased utilization of all nonpharmacological treatments except exercise therapy, and with increased opioid use during the pandemic. African American participants reported decreased utilization of yoga and spinal manipulation during the pandemic. Overall, mean change scores for pain intensity and disability before and after the NEPD were not significant. However, African American participants consistently reported worse pain intensity and disability outcomes during the pandemic. Marginally worse outcomes were observed less consistently for pain intensity with increasing age and for disability among women. DISCUSSION: Social distancing during the pandemic impacted the uptake of recommended nonpharmacological treatments for chronic low back pain that require visiting community-based facilities or interacting closely with providers. CONCLUSIONS: The pandemic threatens to exacerbate the impact of chronic low back pain, particularly among African American patients and the older population, by impeding access to guideline-informed noninvasive treatments.


Subject(s)
Chronic Pain/therapy , Low Back Pain/therapy , Adult , Aged , COVID-19 , Demography , Female , Guideline Adherence/organization & administration , Guideline Adherence/trends , Health Services Accessibility/statistics & numerical data , Health Services Accessibility/trends , Humans , Male , Middle Aged , Pandemics , Quality of Life , Registries , SARS-CoV-2 , United States
15.
Am J Phys Med Rehabil ; 100(4): 307-312, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1066489

ABSTRACT

OBJECTIVE: The clinical manifestations of COVID-19 range from mild symptoms to severe pneumonia and severe organ damage. When evaluated specifically for pain, the data so far have shown that myalgia, headache, and chest pain can be seen in patients at varying rates; myalgia and headache, especially, are among the initial symptoms. DESIGN: This retrospective chart review, followed by a descriptive survey design study, was carried out by examining patients afflicted with COVID-19. After discharge, patients were asked about the severity and the body region of their pain, their use of analgesics, their mood and mental health, and their overall quality of life. RESULTS: A total of 206 patients with a mean age of 56.24 ± 16.99 yrs were included in the study. Pain during COVID-19 was found to be higher compared with the preinfectious and postinfectious states. The most frequent painful areas were reported to be the neck and back before the infection, whereas the head and limbs during the infection. The most frequently used analgesic during infection was paracetamol. There was no relationship between the patients' pain and anxiety and depression; the quality of life was found to be worse in patients with persistent pain. CONCLUSIONS: This study showed that the head and limbs were the most common painful body regions during COVID-19. It was also found that pain can continue in the postinfection period.


Subject(s)
COVID-19/epidemiology , Myalgia/diagnosis , Pain Measurement/statistics & numerical data , Adult , Aged , COVID-19/complications , Female , Headache/diagnosis , Humans , Low Back Pain/diagnosis , Male , Middle Aged , Myalgia/etiology , Neck Pain/diagnosis , Physical Examination , Primary Health Care/methods , Retrospective Studies
16.
Pediatr Infect Dis J ; 40(2): e87-e98, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1062923

ABSTRACT

We report first viral meningitis associated with coronavirus disease 2019 (COVID-19) in a patient hospitalized at Imam Hassan Hospital in Bojnurd. The patient was a 9-year-old child with no history of internal disease who referred to the emergency with a complaint of fever, headache and low back pain, about 3 days after the onset of symptoms. finally, viral meningitis was diagnosed with COVID-19.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Meningitis, Viral/complications , Meningitis, Viral/physiopathology , COVID-19/diagnosis , Child , Emergency Service, Hospital , Female , Fever , Hospitalization , Humans , Iran , Low Back Pain , Meningitis, Viral/diagnosis , Meningitis, Viral/virology , SARS-CoV-2/isolation & purification , Thorax/diagnostic imaging
17.
Am J Phys Med Rehabil ; 100(4): 307-312, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1041878

ABSTRACT

OBJECTIVE: The clinical manifestations of COVID-19 range from mild symptoms to severe pneumonia and severe organ damage. When evaluated specifically for pain, the data so far have shown that myalgia, headache, and chest pain can be seen in patients at varying rates; myalgia and headache, especially, are among the initial symptoms. DESIGN: This retrospective chart review, followed by a descriptive survey design study, was carried out by examining patients afflicted with COVID-19. After discharge, patients were asked about the severity and the body region of their pain, their use of analgesics, their mood and mental health, and their overall quality of life. RESULTS: A total of 206 patients with a mean age of 56.24 ± 16.99 yrs were included in the study. Pain during COVID-19 was found to be higher compared with the preinfectious and postinfectious states. The most frequent painful areas were reported to be the neck and back before the infection, whereas the head and limbs during the infection. The most frequently used analgesic during infection was paracetamol. There was no relationship between the patients' pain and anxiety and depression; the quality of life was found to be worse in patients with persistent pain. CONCLUSIONS: This study showed that the head and limbs were the most common painful body regions during COVID-19. It was also found that pain can continue in the postinfection period.


Subject(s)
COVID-19/epidemiology , Myalgia/diagnosis , Pain Measurement/statistics & numerical data , Adult , Aged , COVID-19/complications , Female , Headache/diagnosis , Humans , Low Back Pain/diagnosis , Male , Middle Aged , Myalgia/etiology , Neck Pain/diagnosis , Physical Examination , Primary Health Care/methods , Retrospective Studies
18.
Int J Environ Res Public Health ; 17(19)2020 10 06.
Article in English | MEDLINE | ID: covidwho-1000280

ABSTRACT

This study aimed to estimate the effect of the coronavirus disease 2019 (COVID-19) quarantine on low back pain (LBP) intensity, prevalence, and associated risk factors among adults in Riyadh (Saudi Arabia). A total of 463 adults (259 males and 204 females) aged between 18 and 64 years and residing in Riyadh (Saudi Arabia) participated in this cross-sectional study. A self-administered structured questionnaire composed of 20 questions regarding demographic characteristics, work- and academic-related aspects, physical activity (PA), daily habits and tasks, and pain-related aspects was used. The LBP point prevalence before the quarantine was 38.8%, and 43.8% after the quarantine. The LBP intensity significantly increased during the quarantine. The low back was also the most common musculoskeletal pain area. Furthermore, during the quarantine, a significantly higher LBP intensity was reported by those individuals who (a) were aged between 35 and 49 years old, (b) had a body mass index equal to or exceeding 30, (c) underwent higher levels of stress, (d) did not comply with the ergonomic recommendations, (e) were sitting for long periods, (f) did not practice enough physical activity (PA), and (g) underwent teleworking or distance learning. No significant differences were found between genders. The COVID-19 quarantine resulted in a significant increase in LBP intensity, point prevalence, and most associated risk factors.


Subject(s)
Coronavirus Infections/prevention & control , Coronavirus , Disease Outbreaks/prevention & control , Low Back Pain/epidemiology , Pneumonia, Viral/prevention & control , Quarantine , Adolescent , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology , Prevalence , Risk Factors , SARS-CoV-2 , Saudi Arabia/epidemiology , Young Adult
19.
Musculoskeletal Care ; 19(3): 384-395, 2021 09.
Article in English | MEDLINE | ID: covidwho-959220

ABSTRACT

BACKGROUND: With an ongoing move towards more management of patients within the community setting, demand for magnetic resonance imaging (MRI) is increasing and commonly used in lower back conditions. There is well recorded overuse of MRI in this scenario which goes against evidence-based practice and adds to rising healthcare costs. METHODS: The study was a retrospective review of lumbar spine MRI scans performed within a community-based setting over an 18-month period. The review took a randomised purposive sample of patients (n = 450); looking at adherence to, and relevance of, guidelines in managing lower back conditions. Data extracted provided information on demographics and prevalence of clinical presentation and report observations. RESULTS: There is variation in practice and utlisation of MRI with this patient group which warrants further exploration. Results support inappropriate use, lacking adherence to guidelines and pathways, leading to unnecessary imaging. 46% of referrals were considered clinically justified with 38% of report findings considered abnormal and of clinical relevance. Chi-square and binomial logistic regression were used to assess the significance and relationship of any factors on referral justification and report outcome. No difference was found between type of referrer, with patient age and leg symptoms being significant factors. CONCLUSION: The study highlights the opportunity to integrate better referral criteria to improve referral quality, its suitability and the relevance of final reports. In the current climate this would help manage appropriate use of imaging resources during the post COVID-19 pandemic recovery phase, as well as support recommendations regarding diagnostic reform and a move towards more community-based diagnostics.


Subject(s)
Low Back Pain/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging/methods , COVID-19 , England/epidemiology , Female , Guideline Adherence , Humans , Male , Middle Aged , Retrospective Studies , SARS-CoV-2
20.
Work ; 67(1): 11-19, 2020.
Article in English | MEDLINE | ID: covidwho-890319

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused global adoption of stay-at-home mandates in an effort to curb viral spread. This lockdown has had the unintended consequence of decreasing physical activity, and incidence of low back pain (LBP) is likely to rise as sedentary behavior increases. OBJECTIVE: In this article, we aim to provide a fundamental, novel approach to alleviate LBP including desk worker associated LBP exacerbated during the COVID-19 pandemic. METHODS: Individuals can alleviate their LBP through a simplistic, self-therapeutic approach: myofascial release and stretching of key musculature involved in LBP following a simple technique and associated time domain, as well as a 360-degree strengthening of the muscles surrounding the lower back. Additional muscular strength will support the lower back and lend resilience to aid in the mitigation of pain caused by poor work-related postural positions. RESULTS: We demonstrate several exercises and movements aimed at alleviating LBP. Additionally, we provide a summary graphic which facilitates ease of use of the exercise plan and represents a novel methodology for simple distribution of evidence-based pain reduction strategies. CONCLUSIOS: Through mitigation of sedentary behavior and adoption of the techniques described herein, LBP can be decreased and, in some cases, cured.


Subject(s)
Low Back Pain/therapy , Massage , Muscle Stretching Exercises , Occupational Diseases/therapy , Resistance Training , Sedentary Behavior , Workplace/psychology , Back Muscles/physiopathology , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Humans , Low Back Pain/physiopathology , Occupational Diseases/physiopathology , Pain Management/methods , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telecommunications
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