Inter-Rater Reliability of Pain Provocation Tests for Painful Lumbar Facet Joints. A Pilot Study.

BACKGROUND: With a life-time prevalence of 39%, low back pain (LBP) is one of the most common musculoskeletal disorders. Correct diagnosis of underlying causes is commonly seen as a prerequisite for successful therapy of LBP. Currently, there is no useful, non-invasive clinical test to diagnose painful lumbar zygapophyseal joints. Clinical tests with high diagnostic accuracy are therefore desirable. Inter-rater reliability is commonly seen as a prerequisite of test validity. The objective of this pilot study was thus to evaluate inter-rater reliability of new clinical pain provocation tests for diagnosing painful lumbar zygapophyseal joints. If a clinically significant level of inter-rater reliability were to be determined, this study could constitute a first step towards establishing the clinical utility of this new set of tests in the structural diagnosis of low back disorders. MATERIAL AND METHODS: Patients participating in this study were recruited in a specialist hospital throughout June 2015 until September 2016. Both female and male patients with current LBP, with or without buttock or lower extremity symptoms were screened for inclusion. Patients had preferably to be 50 years or older in order to be included in this study. The upper age limit was set at 90 years. They also had to be fluent in German to be able to follow verbal instructions. Exclusion criteria comprised the presence of red flags, surgical spinal fusion at any level of the lumbar spine, discectomy within the past 12 months, radiculopathy and/or radicular pain, interventional treatments for the IVD, SIJs or ZAJs within the past three months, psychiatric disorders, current litigation issues concerning back pain, and central nervous system diseases. Three certified manual therapy instructors tested patients independently. Fleiss' kappa values and percent agreements were calculated. RESULTS: Subjects included a sample of 48 patients (15 males and 33 females) with a mean age of 66.48 years (range 33 - 90) presenting at a specialist hospital with low back pain. The new pain provocation tests for lumbar zygapophyseal joints showed moderate reliability (Fleiss' κ = 0.46) and an overall percent agreement of 68.8%. Separate tests for the zygapophyseal joints of L5-S1 showed fair reliability (Fleiss' κ = 0.37) and an overall percent agreement of 64.6%. Unidimensional tests that were used in the study to exclude the intervertebral disc as a nociceptive generator showed fair reliability as well (average κ of 0.28 and 0.39, respectively). Neither drop outs nor adverse events occurred. CONCLUSION: The new pain provocation tests for lumbar zygapophyseal joints showed clinically significant levels of inter-rater reliability. Validation of these tests against fluoroscopy-guided medial branch blocks is warranted.

Effects of vitamin D on patients with fibromyalgia syndrome: a randomized placebo-controlled trial.

The role of calcifediol in the perception of chronic pain is a widely discussed subject. Low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS). We lack evidence of the role of vitamin D supplementation in these patients. To our knowledge, no randomized controlled trial has been published on the subject. Thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to treatment group (TG) or control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20weeks via oral supplementation with cholecalciferol. The CG received placebo medication. Re-evaluation was performed in both groups after a further 24weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised. A marked reduction in pain was noted over the treatment period in TG: a 2 (groups)×4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. Optimization of calcifediol levels in FMS had a positive effect on the perception of pain. This economical therapy with a low side effect profile may well be considered in patients with FMS. However, further studies with larger patient numbers are needed to prove the hypothesis.

[Motivation for physical activity - a survey in a Central European state]. / Motivation zur Bewegung - Eine Umfrage in einem zentraleuropäischen Staat.

INTRODUCTION: Physical activity has high importance in the prevention of diseases, particularly where lifestyle diseases are concerned. To motivate a person to be physically active often proves to be difficult in clinical practice. Thus it was the aim of this study to find out through interviews how to best motivate most notably the part of the population that is less active. METHODS: 500 persons aged from 15 years onwards were asked in face-to-face interviews about their leisure activities, self-assessment of their personal fitness, and about inhibiting and motivating factors in connection with their physical activity. RESULTS: Only every second interviewed person is intentionally active in order to improve his/her own fitness. The better part of the inactive population can envisage introducing more physical activity into their everyday life. There are various reasons that instigate to be more active: above all, the recommendation of doctors, but also the wish for physical wellbeing or group dynamics act as a stimulant. Would there be an advertising campaign promoting the importance of physical activity, top athletes and physicians would have the most motivating impact. CONCLUSION: A sustainable and favourable effect on health promotion could be achieved most notably by motivating people to add more physical activity to their everyday life.