In Press Articles

Validity and Reliability of the 4 Meter Walk Test in Parkinson Disease

Kristen P Barta¹, Anne H Boddy², Megan B Flores², Kathryn E Sawyer³, Lindsay A Perry⁴, Ashley H Campbell⁵

¹University of North Texas Health Science Center, 3500 Bowie Blvd, Fort Worth, TX 76107

²Baylor University, One Bear Place #97193, Waco, TX 76798

³Tufts University. 800 5^th Ave, Seattle, WA 98104

⁴Augustana University, 2001 S. Summit Ave, Sioux Falls, SD, 57197

⁵The University of St. Augustine for Health Sciences, 5401 La Crosse Ave, Austin, TX 78739

Purpose: The purpose of this study was to assess the validity and reliability of the 4-meter walk test (4MWT) in people with Parkinson disease (PD). Method: Gait velocity was measured in 25 people with PD using a computerized walkway, 10-meter walk test (10MWT), and 4-meter walk test (4MWT) under three conditions: comfortable walking speed (CWS), fast walking speed (FWS), dual task (DT). Video recording was used to assess intrarater and interrater reliability of the 4MWT. Pearson’s correlation assessed validity and the intra-class correlation coefficient (ICC (2,1)) assessed intrarater and interrater reliability. Results: There was a significant correlation between the computerized walkway and the 4MWT for all conditions, CWS (r = 0.87, p < 0.001), FWS (r = .67, p = 0.002), and DT (r = .78, p < 0.001). There was significant correlation between the 10MWT and the 4MWT for all conditions, CWS (r = 0.80, p < 0.001), FWS (r = .66, p < 0.001), and DT (r = .50, p = 0.013). All reliability tests were significant at p < 0.001. Intrarater reliability values were very high for CWS (ICC (2,1) = 0.91, [.73-.97]), FWS (ICC (2,1) = 0.99, [0.98-0.99]), and DT (ICC (2,1) = 0.96, [ 0.88-0.98]). Interrater reliability values were high for CWS (ICC (2,1) = 0.90, [0.73-0.96]), FWS (ICC (2,1) = 0.99, [0.98-0.99]), and DT (ICC (2,1) = 0.95, [0.87-0.98]). Conclusion: The 4MWT is a valid and reliable tool to measure gait velocity in individuals with PD.

Addressing Health Worker Burnout to Improve the Quality of Patient Care

Ian Batanda

Senior Orthopedic Officer and the palliative care focal person, Fort Portal Regional Referral Hospital

Burnout can contribute to poor health worker functioning, although its true impact on the quality of patient care is not well understood. The demanding nature of the healthcare environment necessitates health workers to make cognitive and behavioral efforts to cope with and ensure longevity in service. Thus, this review explored the available evidence on the mechanisms involved in addressing work stress and burnout in the healthcare workplace. Several individual coping mechanisms and institutional interventions have been identified. Further studies are needed to establish the effectiveness of documented interventions in reducing burnout and improving job performance and quality of care.

Respiratory Muscle Training and Maintenance Program Impact on Cardiopulmonary Function in Parkinson’s Disease: Pilot Study

Kristen P. Barta^1*, Germaine Ferreira², Nicole P. Borman³, Ashley H. Campbell³

¹University of North Texas Health Science Center, 3500 Bowie Blvd, Fort Worth, TX 76107.

²Baylor University, One Bear Place #97193, Waco, TX  76798.

³University of St. Augustine for Health Sciences, 5401 La Crosse Ave Austin, TX 78739.

Introduction: Parkinson’s disease (PD) leads to motor symptoms that can contribute to difficulties with traditional exercise leading to a decline in cardiopulmonary function. Research has shown that intensive inspiratory muscle training (IMT) can have a positive impact on respiratory function yet have limited long-term benefits when the training was discontinued. The purpose of this study was to determine an appropriate maintenance program to sustain improvements made after an intensive IMT. Methods: Nine people with PD completed the intensive and maintenance IMT programs. The dependent variables of maximum inspiratory pressure (MIP), maximum expiratory pressure, six-minute walk test distance, and fatigue were assessed using a one-way repeated ANOVA. Results: The results showed that the intensive IMT program significantly improved MIP F(2,16) = 7.88, p = 0.004. Post hoc analysis showed a significant change between initial testing and completion of the intensive program (p = .048) and completion of the maintenance program (p = .015). There was not a significant difference between the intensive and maintenance programs (p = .59) indicating that the improvements were maintained. Conclusion: The results of this intervention protocol support the benefits of an IMT protocol and that a maintenance program can be beneficial in keeping the gains achieved.

The study is registered at www.clinicaltrails.gov NCT05287243.

Iliopsoas Trigger Point Dry Needling and Myofascial Stretching for Treatment of Lumbar Herniated Disc and Radiculitis: Two Case Reports, An Overview and Throwing Down the Gauntlet

Reuben S. Ingber

1323 Avenue P, Brooklyn, NY 11229, USA

Research is needed to demonstrate the optimal method (s) utilized in the conservative treatment of lumbar herniated disc. At present, the comment in Judges 21,25, fits “everyone did as they pleased” or as they learned from their mentors.  The SPORT study for herniated disc treatment comparing results of surgical care to conservative care, described methodology of conservative care as “the usual care”, and not any specific, organized, scientifically based methodology.  Two more cases of lumbar radiculitis caused by a herniated disc, both scheduled for surgery are presented, demonstrating a specific, well defined treatment method and the response to treatment.  The recent history of medical management is discussed as is the effect on the cost of care.  A challenge to the medical community is issued to help right the wrong.

Sleep Disordered Breathing and Disrupted Sleep: General Insights, Screening, and Interventions

Jena Ogston¹, Sindy Hassig²

¹College of St. Scholastica.

²Alpine Physical Therapy in Manchester, Vermont.

The CDC has recently identified sleep as a pillar of health, wellness, and disease prevention, noting its relationship to numerous biophysical markers, cardiovascular disease, and mental well-being. The economic and societal impact of sleep-related issues underscores the importance of effective screening and intervention strategies where the lack of sleep is related to impaired mental and physical health, cognitive function, and productivity. By promoting healthier sleep habits with a goal of 7-8 hours per night for adults, and providing targeted support, healthcare providers can assist patients in significantly improving overall health and well-being for individuals and communities alike. Early detection of sleep disruption is essential with appropriate screening, interventions, and referral. This paper aims to provide an evidence-based general overview of the adult population for screening and interventions for disrupted sleep with a focus on sleep-disordered breathing/ obstructive sleep apnea through the lens of the healthcare provider.

Post Stroke Rehabilitation Awareness Among Stroke Patients - A Questionnaire Study

Vijay Janagama^1*, Gaurav Thukral², Sonam Mehta³, Sunanda Kandiraju⁴, Priyanka Bhat⁵

¹Head – Concept & Clinical Excellence at HCAH.

² Co-founder & Chief Operating Officer at HCAH.

³Deputy Manager Physiotherapy at HCAH.

⁴National Therapy Head at HCAH.

⁵AGM – Clinical Marketing, HCAH.

Background: The burden of stroke is increasing in India. Stroke is now the fourth leading cause of death and the fifth leading cause of disability. Following the acute phase of stroke management, rehabilitation becomes a cornerstone of recovery. However, despite the advancements in stroke rehabilitation, there exists a notable gap in patient awareness, with many individuals and their caregivers lacking sufficient knowledge about post-stroke rehabilitation options and the significance of their involvement in the recovery journey. Therefore, this survey was done to investigate the post stoke rehabilitation awareness among stroke patients and their family.

Aims: The objective of this survey is to assess stroke rehabilitation awareness among family members and individuals undergoing inpatient or outpatient post-stroke rehabilitation, focusing on knowledge of stroke risk factors, warning signs, prevention measures, and available rehabilitation services.

Method: From September’2023 to October’2023, 97 Participants were chosen, who underwent stroke rehabilitation either in-patient or out-patient rehabilitation for stroke recovery. Participants were made to fill out a structured questionnaire through an online link which consisted of 13 multiple-choice questions.

Results: Out of 97 respondent 40% of respondents were fully aware of the key symptoms of a stroke. 80% of respondents were aware of physical therapy importance post stroke; 58% awareness on speech therapy. Only 27% and 26% were aware about occupational therapy & robotic therapy as a post stroke rehabilitation option respectively. Around 73% of the respondents felt that post stroke rehabilitation at the Center is more effective than post stroke rehabilitation care at home.

Conclusion: These findings underscore the need for improved education and outreach efforts to enhance rehabilitation access for stroke survivors.

The data utilized in this research article are accessible upon reasonable request to the corresponding author, contingent upon adherence to applicable data protection regulations and ethical guidelines.

Kinesiology Tape Application for Postoperative Ocular Edema: A Pilot Study

Nicole D. Wood^*, Abbey Glenn

Department of Acute Therapy Services, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona.

Occupational therapists (OTs) often adapt and implement specific treatment techniques and modalities to improve patient outcomes by improving patient positioning and reducing edema and pain. One such modality is the use of kinesiology tape (K-tape), an elastic therapeutic tape that alleviates pain, provides joint support, and manages edema. A pilot study was conducted with 20 patients to determine whether using K-tape after two specific neurosurgery procedures that cause occluded eyes would assist in reducing postoperative edema and ecchymosis in the operative-side eye and face, thereby reducing pain and increasing overall patient satisfaction. In 10 patients, K-tape was used in addition to the postoperative standard of care (cryotherapy and head-of-bed elevation to greater than 30°). The 10 control patients received only the standard of care. Patient surveys and OT documentation found that using K-tape for postoperative patients with ocular edema was more beneficial than the standard of care alone in assisting with edema and hematoma reduction and faster eye-opening. Patients completed verbal surveys up to three times during their stay, depending on length of stay. Patients tolerated this easy, cost-effective modality. Patients reported reduced pain, pressure, and swelling, which suggests that K-tape be considered by OTs as an additional modality in acute care.

RUNNING TITLE: Kinesiology tape for ocular edema

Neuronal Activity Topography Reveals Neuronal Change in Comatose Patients Treated by tDCS.

Chiaki Takahashi^1,2*, Takashi Shibata³, Mieko Tanaka⁴, Yuri Watanabe⁴, Yohei Kobayashi⁴, Isao Matsushita¹

¹Department of Rehabilitation Medicine, Kanazawa Medical University.

²Department of Rehabilitation Medicine, Toyama Prefectural Rehabilitation Hospital & Support Center for Children with Disabilities.

³Department of Neurosurgery, Toyama Nishi General Hospital.

⁴Brain Functions Laboratory, Inc.

BACKGROUND: In our hospital, transcranial direct current stimulation (tDCS) is applied in combination with occupational therapy (OT) for patients with persistent consciousness disorders. There have been reports from some research groups on Left dorsolateral prefrontal area (F3) anodal stimulation as wells as Frontal pole (Fpz) anodal stimulation under different conditions. We chose either anodal stimulation site depending on the patient's condition.

CASES: Nine patients underwent tDCS with Fpz or F3 anodal stimulation for 10 days, followed by a 2-day break, after which the stimulation sites were switched, and the patients were stimulated for another 10 days. Their Electroencephalography changes were evaluated by using visual images of neuronal activity topography (NAT). The asymmetry index (AI) was also calculated to compare lateral differences in neuronal changes in the frontal lobe. Seven out of nine cases started with Fpz anode, and two with F3 anode. In the former setting, six cases improved, two aggravated and one remained unchanged. In the latter, one case unchanged and one remained aggravated. After applying tDCS, NAT and AI of the improved cases showed a tendency to approximate the normal control group. Discussion: Among these cases, all but one showed improvement in CRS-R scores, especially in Fpz stimulation. Additionally, changes in the scores indicated that most cases showed improvements in responses to visual and auditory stimulation. Furthermore, the NAT system allows for the rapid and minimally invasive assessment of changes in neuronal activity. Consequently, it is suggested that this system may be valuable for evaluating the therapeutic effects of tDCS and identifying effective stimulation sites.

Unequal Effect of Educational Attainment on Reducing Poverty and Welfare; Diminished Returns of American Indian/Alaska Native Populations

Shervin Assari^1,2,3,4*, Hossein Zare^5,6

¹Department of Internal Medicine, Charles R Drew University of Medicine and Science, USA.

²Department of Family Medicine, Charles R Drew University of Medicine and Science, USA.

³Department of Urban Public Health, Charles R Drew University of Medicine and Science, USA.

⁴Marginalization-Related Diminished Returns (MDRs) Research Center, Charles R Drew University of Medicine and Science, USA.

⁵Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, USA.

⁶University of Maryland Global Campus, Health Services Management, USA.

Background: American Indian and Alaska Native (AIAN) communities face pronounced economic and health disparities compared to White Americans, a situation rooted in long-standing historical injustices and segregation. The theory of Minorities’ Diminished Returns (MDR) provides insight beyond the traditional focus on socioeconomic status (SES) disparities, such as educational attainment. It suggests that the beneficial outcomes of educational achievements on health and economic status are less substantial for marginalized and racially non-White groups compared to White Americans.

Aims: This study investigates the applicability of the MDR theory to AIAN populations by examining whether the positive effects of education on poverty reduction and the decreased risk of disability benefit dependency are weaker for AIAN adults relative to their White counterparts.

Methods: Utilizing data from the 2022 National Health Interview Survey (NHIS), this cross-sectional study analyzed a cohort of 20,743 adults, comprising 20,474 White and 269 AIAN individuals. We assessed the relationships between educational attainment, poverty level, and the likelihood of receiving disability benefits. A structural equation model was employed, with receipt of disability benefits as a latent factor influenced by racial background (AIAN) as a potential moderator, education as the main predictor, and poverty level and self-rated health as mediators. Gender, age, employment status, marital status, and Hispanic ethnicity served as additional covariates.

Results: Findings indicate that higher educational levels are generally associated with a lower likelihood of receiving disability benefits, mediated by improved health and economic status. Nonetheless, the interaction between race (AIAN) and education significantly influenced economic outcomes, subsequently affecting the risk of receiving disability benefits. This suggests that Whites benefit more economically from education than AIAN individuals do.

Conclusion: The study underscores the MDR theory's relevance to the disparities in educational outcomes related to poverty risk and receiving disability benefits among AIAN populations. The challenges AIAN individuals face in leveraging their educational achievements for economic gain relative to Whites may be attributed to pervasive racism and discrimination within various sectors, including employment and education. Addressing these disparities necessitates policy interventions that ensure educational returns are equitable across racial groups, with a focus on equal access to resources and opportunities.

Racial Disparities in Occupational Distribution Among Black and White Adults with Similar Educational Levels: Analysis of Middle-Aged and Older Individuals in the Health and Retirement Study

Shervin Assari^1,2,3,4*, Hossein Zare^5,6, Amanda Sonnega⁷

¹Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.

₂Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.

³Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.

⁴Marginalization-Related-Diminished Returns (MDRs) Center, Los Angeles, CA, USA.

⁵Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.

⁶School of Business, University of Maryland Global Campus (UMGC), Adelphi, MD, 20774, USA.

⁷Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.

Background: Occupational classes play a significant role in influencing both individual and population health, serving as a vital conduit through which higher education can lead to better health outcomes. However, the pathway from education to corresponding occupational classes does not apply uniformly across different racial and ethnic groups, hindered by factors such as social stratification, labor market discrimination, and job segregation.

Aims: This study seeks to investigate the relationship between educational attainment and occupational classes among Black, Latino, and White middle-aged and older adults, with a focus on their transition into retirement.

Methods: Using cross-sectional data from the Health and Retirement Study (HRS), this research examines the impact of race/ethnicity, educational attainment, occupational classes, and timing of retirement among middle-aged and older adults. The analysis includes a sample of 7,096 individuals identified as White, Black, or Latino. Through logistic regression, we assess the additive and multiplicative effects of race/ethnicity and education on six defined occupational classes: 1. Managerial and specialty operations, 2. Professional Specialty, 3. Sales, 4. Clerical/administrative support, 5. Services, and 6. Manual labor.

Results: Participants were Black (n = 1,143) or White (n =5,953). This included Latino (N =459) or non-Latino (n = 6,634). Our analysis reveals a skewed distribution of Black and Latino adults in manual and service occupations, in stark contrast to White adults who were more commonly found in clerical/administrative and managerial positions. Educational attainment did not equate to similar occupational outcomes across racial groups. Key findings include: Firstly, Black individuals with a college degree or higher were less likely to occupy clerical and administrative positions compared to their White counterparts. Secondly, holding a General Educational Development (GED) credential or some college education was generally linked to reduced likelihood of being in managerial roles; however, this inverse relationship was less evident among Black middle-aged and older adults than White ones. Thirdly, having a GED reduced the chances of working in sales roles, while having a college degree increased such chances. An interaction between race and some college education revealed that the impact of some college education on sales roles was more significant for Black adults than for White ones. We did not observe any interaction between ethnicity (Latino) and educational attainment on occupational classes. Given the stability of occupational classes, these findings could also apply to the last occupation held prior to retirement.

Conclusion: This study highlights significant racial disparities in occupational classes among individuals with comparable levels of education, underscoring the profound implications for health and wellbeing disparities. Future research should explore strategies to alleviate labor market discrimination and job segregation as ways to close these occupational gaps. Additionally, the influence of social stratification, job segregation, and historical legacies, such as the repercussions of the Jim Crow era, on these disparities merits further investigation. Addressing these issues is crucial for enhancing the health and wellbeing of all populations.

Highly Educated Black Americans Report Higher than Expected Perceived Job Demands

Tiffany Hogan ¹, Amy Mancia¹, Kanah Ndiaye¹, Brenda Rodriguez¹, Babak Najand ², Hossein Zare ^3,4, Shervin Assari ^{1 5,6*}

¹Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States

²Marginalization-related Diminished Returns Center, Los Angeles, California, United States

³Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.

⁴School of Business, University of Maryland Global Campus (UMGC), Adelphi, 20783, USA.

⁵Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States

⁶Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States

Background: Educational attainment has well established and widely recognized the effects on employment conditions and job demands. However, the way in which educational attainment correlates with perceived job demands may be inconsistent across racial groups as suggested by Minorities’ Diminished Returns (MDRs). The aim was to test the moderating effect of race on the association between educational attainment and perceived job demands, particularly for Black and White individuals.

Methods: This study was a cross-sectional analysis of MIDUS Refresher 1, including 1,232 Black and White adults over the age of 25 in the United States. Education attainment was the independent variable and perceived job demands was the dependent variable covariates. Linear regression was used for multivariate models.

Results- We observed positive association between education and perceived job demands, however, statistical interaction between race and education suggested stronger positive associations for Black than White individuals.

Conclusion: Being a highly educated Black professional in the United States equals high demand such increase stress is a risk factor of being a middle class black American. Innovated and bold market policies are required to solve this unfair dilemma.

Potential Therapeutic Effects of Passive Limb Movement in Patients with Spinal Cord Injuries

Song-Young Park^1,2*, Andres Benitez-Albiter^1*, Cody P. Anderson¹, Sungyeon Kim³, Young-hwan An³, Sang-Seo Park^4*, Jung-Hyun Kim⁵

¹School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska

²Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska

³Department of Training Support Center, Korea Paralympic Committee, Republic of Korea

⁴Department of Physiology, KyungHee University, Republic of Korea

⁵Department of Sports Medicine, Kyung-Hee University, Yongin, Korea

Spinal cord injuries (SCI) lead to significant changes in autonomic function, hemodynamics, and body composition. These structural and functional alterations are closely associated with the development of cardiovascular pathologies and other metabolic diseases. Recent clinical studies suggest that passive limb movement (PLM) has beneficial effects on cardiovascular function and skeletal muscle health, which has drawn a growing interest for the use of PLM as a therapeutic option for patients with SCI. However, there is a lack of mechanistic studies that examine the underlying mechanisms of how PLM may ameliorate cardiovascular and skeletal muscle function in patients with SCIs. In this review, we will discuss potential mechanisms of SCI-induced perturbations in autonomic function, hemodynamics, and body composition. Furthermore, we will highlight the therapeutic effects of PLM on autonomic function, vascular structure and function, and skeletal muscle in patients with SCIs. Additionally, we will also introduce the effects of other passive therapeutic interventions such as vibration and massage therapy with potential benefits and concerns for cardiovascular and skeletal muscle adaptations in SCI. Therefore, optimizing the application of PLM in patients with SCIs may be useful to salvage SCI-induced attenuations in vascular function and body composition.

Psychoanalytic and Sociobiological Factors in Attitudes toward Persons with Disabilities: Discussion Focused on Rehabilitation Counseling Profession

Kenneth Thomas^1*, Jeong Han Kim²

¹University of Wisconsin - Madison

²University of Texas – Rio Grande Valley

This study's goal was to examine, expand upon, and update a chapter that was first printed in a relatively small number of copies of the book titled Essays and Research on Disability¹.  Thomas was the sole author of the original chapter, which discussed how attitudes about disability develop from a psychoanalytic and sociobiological perspective.  Kin, reciprocal, and induced altruism were the first three altruism principles in sociobiology that were covered in this study. Then, Karen Horney's neo-Freudian viewpoint (i.e., less emphasis on sex and focused more on the social environment and culture regarding personality development) and traditional Freudian theories (such as castration anxiety, loss of love, and loss of the object) were tied to sociobiology, and this relationship was further addressed in terms of the evolution of attitude toward handicap. Then, recommendations were offered across a broad range of rehabilitation counseling services and educational practices that might be improved by using these insights, both clinically and politically.  Finally, the present study extends this discussion by addressing similar concerns in the areas of counseling service priorities, multicultural rehabilitation counseling, and identity politics.

Base for Physiotherapeutic Treatment Recommendations for Long COVID-19 Patients After Questioning Experienced Physiotherapists Using a Delphi Method

Chloé Schorderet^1,2,3*, Roger Hilfiker⁴, Lara Allet^1,2,5

¹School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Sion, Switzerland

²The Sense Innovation & Research Center, Lausanne and Sion, Switzerland

³Department of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands

⁴School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland, Valais, Leukerbad, Switzerland

⁵Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland

Background: Long COVID-19 is frequently observed in people who have contracted SARS-COV-2. It is characterized by a set of symptoms that can persist for months after infection and represents a challenge for all health care professionals. Among them, physiotherapists play an essential role thanks to their extensive knowledge in the rehabilitation field. To provide quality treatment, they need recommendations on which to rely. The aim of this study is to gather opinions from therapists working in Europe on the management of long COVID-19 patients in physiotherapy.

Method: A Delphi method was conducted in three rounds. In the first round, participants were asked about the deficits observed in long COVID-19 patients and about tests, monitoring and treatment to be implemented during the treatment of these patients. During the second and third rounds, they were informed about the results already obtained and had to confirm their answers with 6-point Likert scales.

Results: The most frequently observed impairments were pain, reduction in general physical fitness and respiratory problems. For assessment and treatment, the responses are specific to each impairment category. The 6-minute test seems to be particularly relevant for the assessment of several deficits and active approaches seem to have an essential place in the treatment.

Conclusion: Our study highlighted the diversity of impairments observed by physiotherapists in long COVID-19 patients and allowed to create a consensus on the assessments and treatments to be preferred for each type of impairment. In general, active treatment should be preferred for most of the impairments for which long COVID-19 patients consult a physiotherapist.

Association Between Multifidus Intramyocellular Lipids and Pain-Related Disorders, Lumbar Spine Dysfunction, Gait Disturbance in Patients with Chronic Low Back Pain: A Cross-Sectional Study Using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire

Izaya OGON^1*, Hiroyuki TAKASHIMA², Tomonori MORITA¹, Mitsunori YOSHIMOTO¹, Yasushi FUJITA³, Tsuneo TAKEBAYASHI⁴ and Atsushi TERAMOTO¹

¹Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan

²Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

³Department of Orthopaedic Surgery, Nishioka Daiichi Hospital, Sapporo, Japan

⁴Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan

Background and aims: Fat degeneration in the multifidus muscle (Mm) was more common than in other trunk muscles. We hypothesised that the lipid contents of the Mm and patient-reported quality of life (QOL) are related. However, there are no papers examining the association between fatty degeneration of the Mm and patient-reported QOL using magnetic resonance spectroscopy (MRS). This cross-sectional study aimed to investigate the association between patient-reported QOL, evaluated with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and the intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) contents of the Mm and psoas major (PM) by MRS in patients with chronic low back pain (CLBP).

Materials and Methods:

Forty-eight patients (mean age, 64.2 ± 13.2 years; age range, 41–79 years) with nonspecific CLBP underwent MRS for the quantification of IMCL and EMCL of the right Mm and PM in a volume of interest at L4/L5. All subjects underwent MRS and completed the JOABPEQ in the same day. We performed multiple linear regression analysis of the IMCL and EMCL contents of the Mm and PM with the five domains of the JOABPEQ adjusted for age, sex, and body mass index.

Results: The IMCL content of the Mm was correlated with pain-related disorders (standardised partial regression coefficient (β)=−0.59, p<0.01), lumbar spine dysfunction (β=−0.64, p<0.01), and social life dysfunction (β=−0.31, p<0.01) which showed moderate negative correlation, but not with psychological disorders. The EMCL content of the Mm was not correlated with the five domains of the JOABPEQ. The IMCL and EMCL contents of the PM was not correlated with the five domains of the JOABPEQ.

Conclusions: IMCL content of the Mm was significantly correlated with the pain-related disorders, lumbar spine dysfunction, gait disturbance, and social life dysfunction domain scores of the JOABPEQ. Future studies using magnetic resonance spectroscopy of the Mm in patients with CLBP may help optimize exercise strategies using IMCL as an index to enhance patient-reported quality of life.

A Single Session of Spinal Decompression with Oscillation and Videofluoroscopy

Richard E. Busch III D. C^1*, Prahlad G Menon², Sergey Leo Sorin, M.D., DABFM³

¹Indiana University, Parker University, Dallas, TX

²Bioengineering, University of Pittsburgh, Pittsburgh, PA

³International Institute of Holistic Medicine, 2840 E. Chestnut Expy, Springfield, MO

Background: Computerized spinal decompression using the intervertebral differential dynamics (IDD) therapy protocol has achieved 86–92% positive results in reducing back pain. There are many causes of back pain, and one of the most common is a degenerative disc. The etiology of a degenerative disc is not completely understood, but it can be related to acute injuries, repetitive stress, nutrition, genetic factors, and oxidative stress¹. Standard of care may include physical therapy or manipulation to introduce movement to the spinal vertebrae. IDD Therapy^® uses a calculated, sinusoidal, logarithmic primary waveform to separate the spinal vertebrae. More recent studies have shown that the addition of a secondary waveform gives a significant increase in efficacy. We observed these effects on the spine during an IDD Therapy^® session.

Methods: Images of the intervertebral space were taken by videofluoroscopy during the IDD Therapy^® session.

Results: The expected separation of L5-S1 was achieved. We also noted the separation profile of the vertebrae was uniquely uniform despite the graduated pressures, particularly when the secondary oscillation waveform was introduced. L5-S1 separation was 1 mm in size, and the anterior–posterior correlation was significant (p<0.05).

Conclusion: Active oscillatory signaling introduced during the high-tension period of treatment may lead to more compliant muscle re-education and thus enhanced uniform separation of the vertebrae. We believe that IDD Therapy^® using Accu-Spina^® may achieve 92% positive results because the secondary oscillatory signal induces mechanotransduction of mechanical stimuli into electrochemical activity at the cellular level. Further research will lead to greater confidence and further exploration of mechanotransduction in intradiscal cellular tissues.

Object Relations Theory: A Primer for Rehabilitation Psychologists

Kenneth R. Thomas. DEd^1*, Kaiqi Zhou,² David A. Rosenthal, PhD³

¹Professor Emeritus, Rehabilitation Psychology, University of Wisconsin-Madison

²Ph.D Candidate, Rehabilitation Psychology, University of Wisconsin-Madison

³Professor, Rehabilitation Psychology, University of Wisconsin-Madison

Object Relations (OR) has been identified as one of the four major schools of psychoanalysis¹. This article provides a comprehensive review of OR practice and theory in the context of rehabilitation psychology. Extensive data are presented on five of the most prominent pioneer object relations theorists, including Melanie Klein, W. R. D. Fairbairn, Michal Balint, Harry Guntrip, and D. W. Winnicott. All of these individuals have contributed significantly to object relations theory. Melanie Klein and W. R. D Fairbairn have been credited with founding the object relations perspective, Michael Balint has been touted as the leading object relations theorist, Harry Guntrip was analyzed by both Fairbairn and Winnicott, and D.W. Winnicott is probably the most creative and respected psychoanalytic theorist since Sigmund Freud. All five of these theorists brought a fresh, new perspective on psychoanalytic theory and practice, and their contributions may be used to better understand the personality development of persons with a disability and to inform the practice of rehabilitation psychology.