Lumbar Bracing for Chronic Low Back Pain: A Randomized Controlled Trial.

PURPOSE: We performed this study to evaluate the effect of back bracing to treat patients with chronic low back pain. METHODS: This was a prospective, unblinded, randomized controlled trial of 61 adults with uncomplicated chronic low back pain (>12 wks) and imaging findings of degenerative spondylosis, to assess the effectiveness of a semirigid back brace. All study participants received back school instruction. The treatment group also received a lumbar orthosis and was instructed to wear it as needed for symptom relief. At baseline, 6 wks, 12 wks, and 6 mos after intervention, we collected: Numerical Rating Scale to measure pain intensity, Pain Disability Questionnaire, Patient-Reported Outcome Measurement Information System, and EuroQol 5-Dimension (EQ-5D) to measure patient-reported function and quality of life. RESULTS: An interim analysis at the halfway point in enrollment (61 of 120 planned participants) revealed the Pain Disability Questionnaire, Patient-Reported Outcome Measurement Information System, and EQ-5D scores in the treatment group to be worse than in the control group, but no significant group differences in Numerical Rating Scale scores. Outcome differences between groups analyzed over time revealed (effect [P]): Pain Disability Questionnaire = 0.84 (0.04); Patient-Reported Outcome Measurement Information System = 0.78 (0.005); EQ-5D = 0.06 (0.01); and Numerical Rating Scale = 0.02 (0.6). We halted the study because continuation was unlikely to produce significant changes to the results. CONCLUSIONS: In patients with uncomplicated chronic low back pain, a back brace when combined with education and exercise instruction did not provide any pain relief compared with education and exercise instruction alone. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the effect of lumbar back bracing on pain intensity in patients with chronic low back pain; (2) Discuss the effects of lumbar back bracing on pain-related disability, function, and quality of life in patients with chronic low back pain; and (3) Understand the role of lumbar back bracing in the treatment of patients with chronic low back pain. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Heterotrophic Ossification in Patient With Prosthetic Leg.

Heterotrophic ossification (HO) is a well-described phenomenon in patients with spinal cord injury, head injury, burns, hip replacement, and general trauma. However, it has also been described through a relative paucity of case reports that repeated microtrauma from the use of weight-bearing leg prostheses is an additional possible cause of HO. In our case, we examine a patient who developed an extreme case of HO after he began an exercise regimen with assistance from a running limb. This abnormal formation was actually advantageous because it created a more snug fit of the prosthetic device and improved the patient's ability to run.

Complex Abdominal Wall Reconstruction: A Novel Approach to Postoperative Care Using Physical Medicine and Rehabilitation.

BACKGROUND: Abdominal wall defects remain a significant cause of morbidity and mortality in the United States. Postoperative rehabilitation programs have been used consistently in many surgical subspecialties with exceptional results. Such programs have proven to decrease the total time patients require to resume daily activities. The authors describe a systematic rehabilitation protocol developed with the physical medicine and rehabilitation department that has significantly decreased recurrence rates in patients undergoing complex abdominal wall reconstruction. METHODS: A retrospective analysis was carried out on patients presenting for open repair of an abdominal wall defect performed by a single surgeon. Over a 5-year period, there were 275 consecutive patients divided into two similar groups: one group consisted of 137 patients that received abdominal wall rehabilitation; a second group of 138 patients did not. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and postoperative complications including recurrence were collected. RESULTS: Patients enrolled in the abdominal wall rehabilitation program were found to have fewer recurrences at follow-up, with statistical significance compared with those that were not enrolled in the program. CONCLUSIONS: The implementation of the abdominal wall rehabilitation program has resulted in a decrease in recurrence rates following complex abdominal wall hernia repair and reconstruction. This is an innovative system that uses rehabilitation and physical therapy to enhance the psychosocial and occupational status of patients by improving recurrence rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.