Cross-cultural adaptation and validation of the Dutch version of the core outcome measures index for low back pain.

PURPOSE: The core outcome measures index (COMI) is a validated multidimensional instrument for assessing patient-reported outcome in patients with back problems. The aim of the present study is to translate the COMI into Dutch and validate it for use in native Dutch speakers with low back pain. METHODS: The COMI was translated into Dutch following established guidelines and avoiding region-specific terminology. A total of 89 Dutch-speaking patients with low back pain were recruited from 8 centers, located in the Dutch-speaking part of Belgium. Patients completed a questionnaire booklet including the validated Dutch version of the Roland Morris disability questionnaire, EQ-5D, the WHOQoL-Bref, the Numeric Rating Scale (NRS) for pain, and the Dutch translation of the COMI. Two weeks later, patients completed the Dutch COMI translation again, with a transition scale assessing changes in their condition. RESULTS: The patterns of correlations between the individual COMI items and the validated reference questionnaires were comparable to those reported for other validated language versions of the COMI. The intraclass correlation for the COMI summary score was 0.90 (95% CI 0.84-0.94). It was 0.75 and 0.70 for the back and leg pain score, respectively. The minimum detectable change for the COMI summary score was 1.74. No significant differences were observed between repeated scores of individual COMI items or for the summary score. CONCLUSION: The reproducibility of the Dutch translation of the COMI is comparable to that of other validated spine outcome measures. The COMI items correlate well with the established item-specific scores. The Dutch translation of the COMI, validated by this work, is a reliable and valuable tool for spine centers treating Dutch-speaking patients and can be used in registries and outcome studies.

Musculoskeletal ultrasound for interventional physiatry.

More and more physiatrists are interested in learning how to use musculoskeletal ultrasonography in their clinical practice. The possibility of high resolution, dynamic, comparative and repeatable imaging makes it an important diagnostic tool for soft tissue pathology. There is also growing interest to use sonography for guiding interventions such as aspirations and infiltrations. In daily practice these are often done blindly or palpation-guided. To improve the accuracy of interventions, fluoroscopy or computed tomography were traditionally used for guidance. Since sonography is non-ionizing, readily available and relatively low cost, it has become the first choice to guide many musculoskeletal interventions. Ultrasound allows real-time imaging of target and needle as well as surrounding vulnerable structures such as vessels and nerves. Many different techniques are proposed in the literature. Interventions under ultrasound guidance have been proven to be more accurate than unguided ones. Further studies are required to prove better clinical results and fewer complications. Infection is the most dreaded complication. This review wants to highlight technical aspects of ultrasound guidance of interventions and give a survey of different interventions that have been introduced, with emphasis on applications in Physical Medicine and Rehabilitation. Results and complications are discussed. Finally training requirements and modalities are presented.

Functional reorganization of cervical flexor activity because of induced muscle pain evaluated by muscle functional magnetic resonance imaging.

There is mounting evidence of an association between chronic neck pain and impaired cervical flexor muscle performance. It is likely that the deep cervical flexors demonstrate changes very early after the onset of pain, but evidence is currently lacking. This study investigated the effect of experimental neck muscle pain on the activation of the cervical flexor muscles during the performance of craniocervical flexion (CCF) by use of muscle functional magnetic resonance imaging. Activity of the longus colli (Lco), longus capitis (Lca) and sternocleidomastoid (SCM) muscles were investigated bilaterally and at three cervical levels (C0-C1, C2-C3 and C6-C7) in 14 healthy subjects. Measurements were performed at rest and after the performance of CCF without and with induced pain of the upper trapezius (intramuscular injection of hypertonic saline). In the non-pain condition, the Lca (p = 0.005) and Lco (p = 0.029) were significantly more active during CCF compared to SCM. In the pain condition, the activity of the Lco and Lca was reduced bilaterally and at multiple levels (p ≤ 0.009), whereas the left SCM showed increased activity at only the C6-C7 level (p ≤ 0.001). The results suggest that local excitation of nociceptive afferents causes an immediate reorganization of the cervical flexor muscle activity similar to that identified in clinical populations.

The effect of unilateral muscle pain on recruitment of the lumbar multifidus during automatic contraction. An experimental pain study.

Changes in control of the multifidus muscle are a likely contributor to low back pain (LBP), however, the underlying mechanisms of these changes are not well understood. To date it remains uncertain if pain has a selective effect on the multifidus muscles, in line with the observations of the selective changes in structure in acute LBP, or a more generalized effect. The objective of this study is to help to elucidate whether acute unilateral muscle pain alters the activation of the multifidus specific at the level and side of the pain or has a more widespread effect. An experimental pain protocol using hypertonic saline was applied to induce unilateral low back muscle pain. Automatic activity of the multifidus muscle during arm lifts was evaluated with dynamic ultrasound measurement, by assessing muscle thickness change during contraction. Multifidus activity of 15 healthy subjects was compared in a non-pain and in a pain condition, at different spinal levels (L3-L4-L5) and at both body sides. Unilateral induced pain at one segmental level reduced muscle thickness increase during contraction, at both body sides and at different lumbar levels. These results do suggest that unilateral pain may have a more widespread effect on multifidus muscle recruitment, affecting the left and right muscles, at different lumbar levels.