To determine the effects of self-management interventions (SMIs) including an exercise component (EC) on low back pain (LBP) and disability and to determine whether SMIs with tailored exercises (TEs) have superior outcomes compared to SMIs with general exercises (GEs). An electronic systematic search of randomized controlled trials (RCTs) was performed in 5 electronic databases. RCTs compared SMIs with an EC to control interventions. Data were extracted at 3 follow-up points (short-term, intermediate and long-term) and meta-analyses were performed. Reviewed RCTs were divided into subgroups based on whether the EC was tailored or generic. A subgroup meta-analysis was performed at the short-term follow-up to assess whether the SMIs with TEs have superior outcomes compared to SMIs with GEs.Abstract
Objectives
Methods
Evidence suggests classification system (CS) guided treatments are more effective than generalized and practice guidelines based treatments for low back pain (LBP) patients. This study evaluated clinicians' and managers' attitudes towards LBP classification and its usefulness in guiding LBP management. Data from 3 semi-structured interviews with physiotherapy service managers and advanced spinal physiotherapy practitioner and a focus group (5 physiotherapists) in two NHS Health Boards, South Wales, UK, was thematically analysed.Background
Methods
Subjects with Low Back Pain (LBP) often have altered trunk muscle activity and postural sway during perturbations. Research suggests different perturbations have differing results on abdominal muscle activity and postural sway, however, the majority of perturbations investigated are not realistic daily tasks and little evidence exists if the changes are still present following resolution of symptoms. Aim: to determine trunk muscle activity, Lumbar multifidus (M), iliocostalis lumborum (IL), external oblique (EO), transversus abdominus/internal oblique TrA/IO and postural sway during two reaching tasks between subjects with history of LBP (HLBP) and those without. 20 volunteers, 8 HLBP (22±2yrs, 174.9±6.0cm, 68.3±6.22kgs,) and 12 without HLBP (20.58±2.23 yrs, 174.5±9.8cm, 68.6±13.9kgs) gave informed consent. Surface Electromyography (sEMG) measured muscle activity of M, IL, TrA/IO, EO and VICON force plate measured postural sway (anterior posterior (AP)centre of pressure (CoP), medial lateral(ML)CoP during high (HRT) and low reaching tasks (LRT). sEMG data was normalized to maximum voluntary contractions. Force plate data was processed using Matlab R2009b. Results: Mann-Whitney U tests noted a significant increase in EO sEMG activity in HLBP group for HRT (p=0.03). Results were insignificant for HRT: M(p=0.64), IL(0.19), TrA/IO,(p=0.14), AP CoP(p=0.44), ML CoP(p=0.69), LRT: M(p=0.58), IL(0.35) TrA/IO(p=0.58), EO(p=0.28), AP CoP (p=0.39), ML CoP (p=0.24).Background
Method
Movement dysfunction resulting in a knee valgus position during weight bearing activity is associated with increased risk of Anterior Cruciate Ligament injury and Patellofemoral Pain Syndrome especially in young active females. In clinical practice determining the critical knee flexion angle (CKFA) during a single leg squat (SLS) test is used to assess this dysfunction, yet its reliability is unknown. This study aimed to determine rater agreement in determining the presence of knee valgus movement (yes/no) during a SLS test in recreational females (n = 16, age 24.3 ±7.9 yrs, height 165.7±4.8m, mass 62.5±6.4kg) and the intra and inter-rater reliability of measuring CKFA using SiliconCoach™. Three experienced physiotherapists viewed 48 randomised SLS test videos. One physiotherapist repeated the viewing for test-retest analysis. Test-retest agreement for rating SLS test was acceptable (weighted kappa (k) = 0.667). Inter-rater agreement was moderate to substantial (weighted k = 0.284–0.613). Intra-rater reliability of CKFA was acceptable for all three raters (ICC>0.6). Inter-rater absolute reliability was below 5% of the mean CKFA (SEM 4.26 degrees). As previous research reports intra-rater agreement is better than inter-rater agreement when assessing movement dysfunction during functional activity via visual rating. Intra-rater within session and between session reliability for measuring the CKFA using SiliconCoach™ was acceptable and better than inter-rater reliability. Further research is needed to assess the concurrent and construct validity of the protocols used in this study. It is recommended that qualitative research be performed to identify factors that affect physiotherapist's rating of functional activities.
