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The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
ISPR8-1746
End-growth results of a personalised conservative approach in 1938 high risk adolescents with idiopathic scoliosis: Prospective observational multicentre study S. Donzelli 1,∗ , S. Negrini 2 , F. Zaina 3 , F. Di Felice 3 Italian Scientific Spine Institute, Isico, Milano, Italy 2 University of Brescia, Chair of Physical and Rehabilitation Medicine, Brescia BS, Italy 3 Italian Scientific Spine Institute, Isico, Milan, Italy ∗ Corresponding author. E-mail address: [email protected] (S. Donzelli), [email protected] (S. Negrini)
1
Introduction/Background End of growth RCTs showed the efficacy of bracing and physiotherapic scoliosis specific exercises (PSSE). Current guidelines propose PCA according to the step-by-step theory: invasivity increases with treatment intensity, from observation to PSSE to soft, rigid and very rigid bracing. This requires to set individualised outcomes and propose the less invasive treatment according to the outcome. Material and method Inclusion criteria: AIS, 11–45◦ , Risser 0–2, age 10–16, first consultation, no previous bracing. End of observation: Risser 3, medical prescription. Groups were defined according to the main end outcome (SRS-SOSORT Consensus): low degree (LD) (< 31◦ at start) remain < 30◦ ; high degree (HD) (> 30◦ at start) remain < 50◦ . Treatment: PCA including observation, PSSE (SEAS school), soft (SpineCor), hard (Sibilla) and very rigid (Sforzesco) braces. Classical statistics and propensity scores have been applied. Results We excluded 207 (10.7%) drop-outs and 274 (14.1%) still in therapy. Treatment intensity increased with Cobb degrees, as well as rate of improvement (from 13.6% to 56.1% – P < 0.05). Rate of progression was higher in the less intensively treated very low degree curves (11–20◦ ) (P < 0.05), while did not change significantly in those above 20◦ (between 12.9 and 15.9%). Rate of patients < 30◦ were 69.3% at start and 78.3% at the end (P < 0.05); patients > 50◦ at the end were 1.6%. Conclusion Defining different outcomes according to PCA allows to perform less aggressive treatments for LD, and concentrating the efforts in HD. Failure rates can be low in both groups. Progression is not the best outcome for all patients and type of treatments. Keywords Scoliosis; Brace Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.354 ISPR8-0015
The effect of needle tip position on lumbar transforaminal epidural steroid injection using nerve stimulator C.H. Lee 1,∗ , S.U. Lee 2 1 Gyeongsang National University Hospital, Department of Rehabilitation Medicine, Jinju, Republic of Korea 2 Seoul National University Boramae Medical Center, Department of Rehabilitation Medicine, Seoul, Republic of Korea ∗ Corresponding author. E-mail address: [email protected] (C.H. Lee) Introduction/Background To determine the effect of needle tip positions on short-term effect of transforaminal epidural steroid injection (TFESI) using nerve stimulator (NS) for lumbar radiculopathy. Material and method Forty-five patients who received TFESI using NS were retrospectively reviewed. The TFESI was conducted under fluoroscopic guide. The goal of positioning was to allow a
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needle tract toward injection site such as “safe triangle”. We used the NS to optimize the position of needle tip. The needle tip was repositioned to achieve minimal current output (0.2 mV) when the patients had paresthesias within dermatomal areas. The needle tip positions were assessed by dividing the intervertebral foramen into 4 quadrants in the anterior-posterior view. The grade of nerve root compression on MRI in 45 patients was evaluated. The outcome measurement (OM) was evaluated before pre-injection and after 2 weeks. Results Ninety-one TFESIs were conducted in the 45 patients. The position of needle tip was 68, 19 and 4 cases in the quadrant 1, 2 and 3, respectively. The mean score of OM reduced significantly in the quadrant 1 and 2, but not in the quadrant 3 after 2 weeks. There were no significant differences in the mean score of OM according to the grade of nerve root compression. Conclusion As the neural structures lie medially in the foramen, it is believed that a medially placed needle such as quadrant 2 has a higher likelihood of causing neurological complication. Bogduk proposed the ideal needle tip position by defining a “safe triangle” like quadrant 1. Our study showed that there was a similar effect in the quadrant 2 just the same in the quadrant 1. We conclude that the NS to guide TFESI in addition to fluoroscopy can be a useful therapeutic tool in the patient with radicular symptoms. Keywords Needle tip position; Nerve stimulator; Transforaminal epidural steroid injection Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.355 ISPR8-0597
The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women
J. Bogaert ∗ , M. Stack , S. Partington , J. Marceca , A. Tremback-Ball Misericordia University, Physical Therapy, Dallas, USA ∗ Corresponding author. E-mail address: [email protected] (J. Bogaert) Introduction/Background Pain in the lumbar or sacroiliac region during pregnancy is common. However, it should not be considered a normal part of pregnancy. There are non-invasive approaches to treatment to effectively manage symptoms not only during pregnancy but also postpartum. A systematic review was performed to examine the effects of stabilization exercises on low back and pelvic girdle pain in pregnant women. Material and method A database search of EBSCO (CINAHL, HealthSource, MEDLINE, and PsycINFO) was conducted from September 2017 to January 2018. Our search terms included “pregnancy”, “pregnan*”, “stab* exercis*”, “back pain”, “pelvic pain”, and “pelvic floor”. The studies were reviewed for content to determine if they met the inclusion and exclusion criteria. Articles were then examined for quality on a hierarchy of evidence scale and the PEDro Scale by four researchers. Results Twenty-three articles were included in the systematic review. Most concluded that stabilization exercises had a positive effect on low back and pelvic girdle pain in pregnant women. A few articles found no significant reduction in pain. The discrepancies may be due to differences in protocol such as administering a home exercise program, frequency of exercises, weeks of gestation, and direct supervision exercises. These factors may influence the effectiveness of stabilization exercise in this population. Conclusion The effects of stabilization exercise vary based on type of pain, type of exercise, location of pain and timing of intervention. Overall, the use of stabilization exercises is beneficial in reducing low back and pelvic girdle pain in pregnant women. Further, rehabilitation during pregnancy may prevent future episodes of low back and pelvic girdle pain in subsequent pregnancies.
e158
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Keywords Pregnancy; Low back/pelvic girdle pain; Stabilization exercise Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.356 ISPR8-0626
Differences of nature of disease, socioeconomic and psychological factors in chronic low back pain patients between Thailand and Germany P. Boonyapaisancharoen 1,∗ , P. Yotnuengnit 1 , K. Piravej 1 , E. Kraft 2 , N. Arnstadt 2 , H. Schulte-Goecking 2 , N. Jamin 2 1 Faculty of Medicine, Chulalongkorn University, Rehabilitation Medicine, Bangkok, Thailand 2 Ludwig-Maximilian-University, University Clinic, Department of Orthopedics, Physical Medicine and Rehabilitation, Munich, Germany ∗ Corresponding author. E-mail address: [email protected] (P. Boonyapaisancharoen) Objectives To study the differences of nature of disease, socioeconomic status and psychological factors in chronic low back pain (LBP) patients between Thailand and Germany. Study design Cross-sectional analytic study. Setting Out patient clinic, department of rehabilitation medicine, King Chulalongkorn Memorial Hospital, Thailand and Department of Orthopedics & PM&R, Großhadern Hospital, Germany. Subjects Hundred Thai and 100 German patients with chronic LBP more than 6 months. Methods The data from both hospitals were collected before chronic LBP patients received treatment. The data consisted of 4 domains; demographic data, socioeconomic status, nature of disease i.e. Numerical Rating Scale (NRS), Pain Disability Index (PDI), etc. and psychological factors (Center for Epidemiologic Studies Depression Scale: CES-D). The data was analyzed by using statistic program. Results Mean age of both Thai and German was 47.7 ± 11.7 years old. Majority was female, married, white collar and has LBP duration for more than 3 years. Comparison between Thai and German, the average and maximal NRS were not significantly different. However, German patients had significantly higher than Thai patients in PDI (median 26 and 10, respectively, P = 0.00) and CES-D total scores (median 17 and 4, respectively, P = 0.00). Conclusion Despite the non-significant difference in LBP severity, there were the differences among Thai and German patients. German patients had more depressive symptom and pain related impairment than Thai patients. Keywords Chronic low back pain; Thailand; Germany Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.357
ISPR8-0891
Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain: A randomized controlled trial M. Azimi 1,∗ , M. Abolhasani (Assistant professor of Sports, Exercise Medicine) 2 , R. Kordi 1 1 Sports Medicine Research center, Neuroscience Institute, Tehran University of Medical Sciences, Sports and Exercise Medicine, Tehran, Iran 2 MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Sports and Exercise Medicine Department, Tehran, Iran ∗ Corresponding author. E-mail address: [email protected] (M. Azimi) Introduction/Background Pelvic girdle pain is a common complaint of pregnant women. There are limited data on comparison between the effectiveness of stabilizing exercises and lumbopelvic belt on the treatment of these patients. The objective of this study was to compare the effect of lumbopelvic belt plus information, home based pelvic girdle stabilizing exercises plus information and information alone on pain intensity, functional status and quality of life of pregnant women with pelvic girdle pain. Material and method In this randomized clinical trial pregnant women with pelvic girdle pain (n = 105) were randomly allocated to three groups; control group (n = 35) that received general information, exercise group (n = 31) that in addition to general information were asked to perform specific pelvic stabilizing exercises at home and belt group (n = 31) that received non-rigid lumbopelvic belt and the information. The primary outcome variables were pain intensity and functional status of the participants, which were measured using visual analogue scale and Oswestry Disability Index (ODI) respectively. Quality of life of participants was measured using WHOQOL-BREF questionnaire. All measurements were performed at baseline, 3 and 6 weeks after the study conduction. Results The pain intensity of patients in belt group in comparison to other groups was decreased significantly at both 3 and 6 weeks follow-ups. The mean score of ODI of patients in belt group was also improved more than exercise and control groups significantly. Conclusion On base of our results, it can be found that in shortterm lumbopelvic belt and information in treatment of pregnant women with pelvic girdle pain is superior to exercise plus information or information alone. Keywords Multiple sclerosis; Resistance training; Muscle strength Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.358 ISPR8-1049
Association between idiopathic scoliosis and bone quality
X. Zhou ∗ , Q. Du Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Rehabilitation, Shanghai, China ∗ Corresponding author. E-mail address: [email protected] (X. Zhou) Introduction/Background It is reported that adolescent idiopathic scoliosis patients have abnormal bone quality. However, the study of bone quality in idiopathic scoliosis (IS) patients is still sparse. The objective of this study was to determine whether an association exists between IS and bone quality in a school scoliosis screening program.
ISPR8-1746
End-growth results of a personalised conservative approach in 1938 high risk adolescents with idiopathic scoliosis: Prospective observational multicentre study S. Donzelli 1,∗ , S. Negrini 2 , F. Zaina 3 , F. Di Felice 3 Italian Scientific Spine Institute, Isico, Milano, Italy 2 University of Brescia, Chair of Physical and Rehabilitation Medicine, Brescia BS, Italy 3 Italian Scientific Spine Institute, Isico, Milan, Italy ∗ Corresponding author. E-mail address: [email protected] (S. Donzelli), [email protected] (S. Negrini)
1
Introduction/Background End of growth RCTs showed the efficacy of bracing and physiotherapic scoliosis specific exercises (PSSE). Current guidelines propose PCA according to the step-by-step theory: invasivity increases with treatment intensity, from observation to PSSE to soft, rigid and very rigid bracing. This requires to set individualised outcomes and propose the less invasive treatment according to the outcome. Material and method Inclusion criteria: AIS, 11–45◦ , Risser 0–2, age 10–16, first consultation, no previous bracing. End of observation: Risser 3, medical prescription. Groups were defined according to the main end outcome (SRS-SOSORT Consensus): low degree (LD) (< 31◦ at start) remain < 30◦ ; high degree (HD) (> 30◦ at start) remain < 50◦ . Treatment: PCA including observation, PSSE (SEAS school), soft (SpineCor), hard (Sibilla) and very rigid (Sforzesco) braces. Classical statistics and propensity scores have been applied. Results We excluded 207 (10.7%) drop-outs and 274 (14.1%) still in therapy. Treatment intensity increased with Cobb degrees, as well as rate of improvement (from 13.6% to 56.1% – P < 0.05). Rate of progression was higher in the less intensively treated very low degree curves (11–20◦ ) (P < 0.05), while did not change significantly in those above 20◦ (between 12.9 and 15.9%). Rate of patients < 30◦ were 69.3% at start and 78.3% at the end (P < 0.05); patients > 50◦ at the end were 1.6%. Conclusion Defining different outcomes according to PCA allows to perform less aggressive treatments for LD, and concentrating the efforts in HD. Failure rates can be low in both groups. Progression is not the best outcome for all patients and type of treatments. Keywords Scoliosis; Brace Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.354 ISPR8-0015
The effect of needle tip position on lumbar transforaminal epidural steroid injection using nerve stimulator C.H. Lee 1,∗ , S.U. Lee 2 1 Gyeongsang National University Hospital, Department of Rehabilitation Medicine, Jinju, Republic of Korea 2 Seoul National University Boramae Medical Center, Department of Rehabilitation Medicine, Seoul, Republic of Korea ∗ Corresponding author. E-mail address: [email protected] (C.H. Lee) Introduction/Background To determine the effect of needle tip positions on short-term effect of transforaminal epidural steroid injection (TFESI) using nerve stimulator (NS) for lumbar radiculopathy. Material and method Forty-five patients who received TFESI using NS were retrospectively reviewed. The TFESI was conducted under fluoroscopic guide. The goal of positioning was to allow a
e157
needle tract toward injection site such as “safe triangle”. We used the NS to optimize the position of needle tip. The needle tip was repositioned to achieve minimal current output (0.2 mV) when the patients had paresthesias within dermatomal areas. The needle tip positions were assessed by dividing the intervertebral foramen into 4 quadrants in the anterior-posterior view. The grade of nerve root compression on MRI in 45 patients was evaluated. The outcome measurement (OM) was evaluated before pre-injection and after 2 weeks. Results Ninety-one TFESIs were conducted in the 45 patients. The position of needle tip was 68, 19 and 4 cases in the quadrant 1, 2 and 3, respectively. The mean score of OM reduced significantly in the quadrant 1 and 2, but not in the quadrant 3 after 2 weeks. There were no significant differences in the mean score of OM according to the grade of nerve root compression. Conclusion As the neural structures lie medially in the foramen, it is believed that a medially placed needle such as quadrant 2 has a higher likelihood of causing neurological complication. Bogduk proposed the ideal needle tip position by defining a “safe triangle” like quadrant 1. Our study showed that there was a similar effect in the quadrant 2 just the same in the quadrant 1. We conclude that the NS to guide TFESI in addition to fluoroscopy can be a useful therapeutic tool in the patient with radicular symptoms. Keywords Needle tip position; Nerve stimulator; Transforaminal epidural steroid injection Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.355 ISPR8-0597
The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women
J. Bogaert ∗ , M. Stack , S. Partington , J. Marceca , A. Tremback-Ball Misericordia University, Physical Therapy, Dallas, USA ∗ Corresponding author. E-mail address: [email protected] (J. Bogaert) Introduction/Background Pain in the lumbar or sacroiliac region during pregnancy is common. However, it should not be considered a normal part of pregnancy. There are non-invasive approaches to treatment to effectively manage symptoms not only during pregnancy but also postpartum. A systematic review was performed to examine the effects of stabilization exercises on low back and pelvic girdle pain in pregnant women. Material and method A database search of EBSCO (CINAHL, HealthSource, MEDLINE, and PsycINFO) was conducted from September 2017 to January 2018. Our search terms included “pregnancy”, “pregnan*”, “stab* exercis*”, “back pain”, “pelvic pain”, and “pelvic floor”. The studies were reviewed for content to determine if they met the inclusion and exclusion criteria. Articles were then examined for quality on a hierarchy of evidence scale and the PEDro Scale by four researchers. Results Twenty-three articles were included in the systematic review. Most concluded that stabilization exercises had a positive effect on low back and pelvic girdle pain in pregnant women. A few articles found no significant reduction in pain. The discrepancies may be due to differences in protocol such as administering a home exercise program, frequency of exercises, weeks of gestation, and direct supervision exercises. These factors may influence the effectiveness of stabilization exercise in this population. Conclusion The effects of stabilization exercise vary based on type of pain, type of exercise, location of pain and timing of intervention. Overall, the use of stabilization exercises is beneficial in reducing low back and pelvic girdle pain in pregnant women. Further, rehabilitation during pregnancy may prevent future episodes of low back and pelvic girdle pain in subsequent pregnancies.
e158
Posters (First Part) / Annals of Physical and Rehabilitation Medicine 61S (2018) e103–e308
Keywords Pregnancy; Low back/pelvic girdle pain; Stabilization exercise Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.356 ISPR8-0626
Differences of nature of disease, socioeconomic and psychological factors in chronic low back pain patients between Thailand and Germany P. Boonyapaisancharoen 1,∗ , P. Yotnuengnit 1 , K. Piravej 1 , E. Kraft 2 , N. Arnstadt 2 , H. Schulte-Goecking 2 , N. Jamin 2 1 Faculty of Medicine, Chulalongkorn University, Rehabilitation Medicine, Bangkok, Thailand 2 Ludwig-Maximilian-University, University Clinic, Department of Orthopedics, Physical Medicine and Rehabilitation, Munich, Germany ∗ Corresponding author. E-mail address: [email protected] (P. Boonyapaisancharoen) Objectives To study the differences of nature of disease, socioeconomic status and psychological factors in chronic low back pain (LBP) patients between Thailand and Germany. Study design Cross-sectional analytic study. Setting Out patient clinic, department of rehabilitation medicine, King Chulalongkorn Memorial Hospital, Thailand and Department of Orthopedics & PM&R, Großhadern Hospital, Germany. Subjects Hundred Thai and 100 German patients with chronic LBP more than 6 months. Methods The data from both hospitals were collected before chronic LBP patients received treatment. The data consisted of 4 domains; demographic data, socioeconomic status, nature of disease i.e. Numerical Rating Scale (NRS), Pain Disability Index (PDI), etc. and psychological factors (Center for Epidemiologic Studies Depression Scale: CES-D). The data was analyzed by using statistic program. Results Mean age of both Thai and German was 47.7 ± 11.7 years old. Majority was female, married, white collar and has LBP duration for more than 3 years. Comparison between Thai and German, the average and maximal NRS were not significantly different. However, German patients had significantly higher than Thai patients in PDI (median 26 and 10, respectively, P = 0.00) and CES-D total scores (median 17 and 4, respectively, P = 0.00). Conclusion Despite the non-significant difference in LBP severity, there were the differences among Thai and German patients. German patients had more depressive symptom and pain related impairment than Thai patients. Keywords Chronic low back pain; Thailand; Germany Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.357
ISPR8-0891
Comparison between the effect of lumbopelvic belt and home based pelvic stabilizing exercise on pregnant women with pelvic girdle pain: A randomized controlled trial M. Azimi 1,∗ , M. Abolhasani (Assistant professor of Sports, Exercise Medicine) 2 , R. Kordi 1 1 Sports Medicine Research center, Neuroscience Institute, Tehran University of Medical Sciences, Sports and Exercise Medicine, Tehran, Iran 2 MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Sports and Exercise Medicine Department, Tehran, Iran ∗ Corresponding author. E-mail address: [email protected] (M. Azimi) Introduction/Background Pelvic girdle pain is a common complaint of pregnant women. There are limited data on comparison between the effectiveness of stabilizing exercises and lumbopelvic belt on the treatment of these patients. The objective of this study was to compare the effect of lumbopelvic belt plus information, home based pelvic girdle stabilizing exercises plus information and information alone on pain intensity, functional status and quality of life of pregnant women with pelvic girdle pain. Material and method In this randomized clinical trial pregnant women with pelvic girdle pain (n = 105) were randomly allocated to three groups; control group (n = 35) that received general information, exercise group (n = 31) that in addition to general information were asked to perform specific pelvic stabilizing exercises at home and belt group (n = 31) that received non-rigid lumbopelvic belt and the information. The primary outcome variables were pain intensity and functional status of the participants, which were measured using visual analogue scale and Oswestry Disability Index (ODI) respectively. Quality of life of participants was measured using WHOQOL-BREF questionnaire. All measurements were performed at baseline, 3 and 6 weeks after the study conduction. Results The pain intensity of patients in belt group in comparison to other groups was decreased significantly at both 3 and 6 weeks follow-ups. The mean score of ODI of patients in belt group was also improved more than exercise and control groups significantly. Conclusion On base of our results, it can be found that in shortterm lumbopelvic belt and information in treatment of pregnant women with pelvic girdle pain is superior to exercise plus information or information alone. Keywords Multiple sclerosis; Resistance training; Muscle strength Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.rehab.2018.05.358 ISPR8-1049
Association between idiopathic scoliosis and bone quality
X. Zhou ∗ , Q. Du Xin Hua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Rehabilitation, Shanghai, China ∗ Corresponding author. E-mail address: [email protected] (X. Zhou) Introduction/Background It is reported that adolescent idiopathic scoliosis patients have abnormal bone quality. However, the study of bone quality in idiopathic scoliosis (IS) patients is still sparse. The objective of this study was to determine whether an association exists between IS and bone quality in a school scoliosis screening program.