The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to investigate the effect of adding the cognitive behavioral treatment (CBT) component to routine physical therapy (PT) on pain and depression reduction, improvement in quality of life, and enhanced function in patients with chronic low back pain (CLBP). TYPE: Systematic review. LITERATURE SURVEY: Google Scholar, PubMed, Ovid, ScienceDirect, ProQuest, Scopus, Cochrane Library, and Embase electronic databases were explored for the key terms of "behavioral (or behavioural) treatment" OR "behavior (behaviour) treatment" OR "behavior (behaviour) therapy" OR "cognitive behavior (or behaviour) treatment" OR "cognitive treatment" OR "cognitive therapy" OR "operant behavior (or behaviour) treatment" OR "respondent behavior (or behaviour) treatment" AND "physical therapy" OR "physiotherapy" OR "exercise therapy" OR "electrotherapy" OR "electrical therapy" OR "manual therapy" OR "myofascial therapy" OR "rehabilitation" AND "low back pain" OR "lower back pain" OR "back pain" OR "chronic back pain" OR "chronic lower back pain", with no limitation on language, through January 2018. METHODOLOGY: All randomized controlled trials that statistically compared the effectiveness of CBT + PT and PT were included for quality analysis. Studies were rated by high to poor quality, using Hailey's classification, based on their design and performance. SYNTHESIS: Of the 10 included studies, 7 were rated as high quality and 3 as good quality. Although CBT + PT was found to be superior to PT for pain, disability, quality of life, and functional capacity variables in some of the included studies, no extra benefit from CBT was documented in other investigations. The included studies also failed to show any advantage of CBT + PT over PT in reducing depression, and PT was even found to be superior to CBT + PT in one high-quality study. CONCLUSIONS: Although appearing to be advantageous by reducing pain and disability and enhancing functional capacity and quality of life, CBT effects on depression cannot be teased out from the effects of PT. LEVEL OF EVIDENCE: I.

Ultrasound Measurement of Abdominal Muscle Thickness With and Without Transducer Fixation During Standing Postural Tasks in Participants With and Without Chronic Low Back Pain: Intrasession and Intersession Reliability.

BACKGROUND: Ultrasound (US) imaging can be used for the measurement of trunk muscle activity. The displacements of US transducer, especially during more dynamic situations, however, may disturb the measurement results. To control this variable, some studies have used transducer fixator (TF), but no study evaluated the effect of using TF on US reliability in dynamic situations. The present study discriminated this issue. OBJECTIVE: To investigate the intrasession and intersession reliability of lateral abdominal muscle thickness measurement in dynamic standing postural tasks by using US with and without TF in participants with and without chronic low back pain (CLBP). DESIGN: An intersession and intrasession reliability study. SETTING: Biomechanics laboratory, Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran. PARTICIPANTS: Twenty-three patients with CLBP and 23 healthy matched individuals. METHODS: Abdominal muscle thickness of all the subjects was evaluated with use of US imaging with the patient in the supine position and double-leg stance at different levels of platform stability of BBS (static, levels 6 and 3), with and without using TF. Intraclass correlation coefficients (ICCs), standard errors of measurement, minimal metrically detectable changes, and coefficients of variation were calculated to determine intersession and intrasession reliability of muscle activity measure. MAIN OUTCOME MEASUREMENTS: Lateral abdominal muscle thickness. RESULTS: The intersession ICCs in the conditions with TF ranged from 0.93 to 0.98 and 0.97 to 0.99 in CLBP and healthy individuals, respectively. The intersession ICCs in the conditions without TF ranged from 0.67 to 0.79 and 0.7 to 0.86 in CLBP and healthy groups, respectively. In addition, smaller standard errors of measurement and minimal metrically detectable change values were observed with US measurement in both the groups when TF was used. CONCLUSION: US imaging appears to have acceptable reliability for the assessment of abdominal muscle thickness during dynamic standing tasks in individuals with and without CLBP. The use of TF results in greater levels of reliability during US measurement of abdominal muscle. LEVEL OF EVIDENCE: III.

Uphill and Downhill Walking in Multiple Sclerosis: A Randomized Controlled Trial.

BACKGROUND: Various exercise protocols have been recommended for patients with multiple sclerosis (MS). We investigated the effects of uphill and downhill walking exercise on mobility, functional activities, and muscle strength in MS patients. METHODS: Thirty-four MS patients were randomly allocated to either the downhill or uphill treadmill walking group for 12 sessions (3 times/wk) of 30 minutes' walking on a 10% negative slope (n = 17) or a 10% positive slope (n = 17), respectively. Measurements were taken before and after the intervention and after 4-week follow-up and included fatigue by Modified Fatigue Impact Scale; mobility by Modified Rivermead Mobility Index; disability by Guy's Neurological Disability Scale; functional activities by 2-Minute Walk Test, Timed 25-Foot Walk test, and Timed Up and Go test; balance indices by Biodex Balance System; and quadriceps and hamstring isometric muscles by torque of left and right knee joints. Analysis of variance with repeated measures was used to investigate the intervention effects on the measurements. RESULTS: After the intervention, significant improvement was found in the downhill group versus the uphill group in terms of fatigue, mobility, and disability indices; functional activities; balance indices; and quadriceps isometric torque (P < .05). The results were stable at 4-week follow-up. CONCLUSIONS: Downhill walking on a treadmill may improve muscle performance, functional activity, and balance control in MS patients. These findings support the idea of using eccentric exercise training in MS rehabilitation protocols.