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Prevalence and risk factors of MTTS in PETE students

Exploratory study for clinical signs of MODIC changes in patients with low-back pain in the Netherlands armed forces

Background: Magnetic resonance imaging (MRI) is being used extensively in the search for pathoanatomical factors contributing to low back pain (LBP) such as Modic changes (MC). However, it remains unclear whether clinical findings can identify patients with MC. The purpose of this explorative study was to assess the predictive value of six clinical tests and three questionnaires commonly used with patients with low-back pain (LBP) on the presence of Modic changes (MC).Methods: A retrospective cohort study was performed using data from Dutch military personnel in the period between April 2013 and July 2016. Questionnaires included the Roland Morris Disability Questionnaire, Numeric Pain Rating Scale, and Pain Self-Efficacy Questionnaire. The clinical examination included (i) range of motion, (ii) presence of pain during flexion and extension, (iii) Prone Instability Test, and (iv) straight leg raise. Backward stepwise regression was used to estimate predictive value for the presence of MC and the type of MC. The exploration of clinical tests was performed by univariable logistic regression models.Results: Two hundred eighty-six patients were allocated for the study, and 112 cases with medical records and MRI scans were available; 60 cases with MC and 52 without MC. Age was significantly higher in the MC group. The univariate regression analysis showed a significantly increased odds ratio for pain during flexion movement (2.57 [95% confidence interval (CI): 1.08-6.08]) in the group with MC. Multivariable logistic regression of all clinical symptoms and signs showed no significant association for any of the variables. The diagnostic value of the clinical tests expressed by sensitivity, specificity, positive predictive, and negative predictive values showed, for all the combinations, a low area under the curve (AUC) score, ranging from 0.41 to 0.53. Single-test sensitivity was the highest for pain in flexion: 60% (95% CI: 48.3-70.4).Conclusion: No model to predict the presence of MC, based on clinical tests, could be demonstrated. It is therefore not likely that LBP patients with MC are very different from other LBP patients and that they form a specific subgroup. However, the study only explored a limited number of clinical findings and it is possible that larger samples allowing for more variables would conclude differently.

Effect of postural threat on motor control in people with and without low back pain

Introduction Negative pain-related cognitions are associated with persistence of low-back pain (LBP), but the mechanism underlying this association is not well understood. We propose that negative pain-related cognitions determine how threatening a motor task will be perceived, which in turn will affect how lumbar movements are performed, possibly with negative long-term effects on pain. Objective To assess the effect of postural threat on lumbar movement patterns in people with and without LBP, and to investigate whether this effect is associated with task-specific pain-related cognitions. Methods 30 back-healthy participants and 30 participants with LBP performed consecutive two trials of a seated repetitive reaching movement (45 times). During the first trial participants were threatened with mechanical perturbations, during the second trial participants were informed that the trial would be unperturbed. Movement patterns were characterized by temporal variability (CyclSD), local dynamic stability (LDE) and spatial variability (meanSD) of the relative lumbar Euler angles. Pain-related cognition was assessed with the task-specific ‘Expected Back Strain’-scale (EBS). A three-way mixed Manova was used to assess the effect of Threat, Group (LBP vs control) and EBS (above vs below median) on lumbar movement patterns. Results We found a main effect of threat on lumbar movement patterns. In the threat-condition, participants showed increased variability (MeanSDflexion-extension, p<0.000, η2 = 0.26; CyclSD, p = 0.003, η2 = 0.14) and decreased stability (LDE, p = 0.004, η2 = 0.14), indicating large effects of postural threat. Conclusion Postural threat increased variability and decreased stability of lumbar movements, regardless of group or EBS. These results suggest that perceived postural threat may underlie changes in motor behavior in patients with LBP. Since LBP is likely to impose such a threat, this could be a driver of changes in motor behavior in patients with LBP, as also supported by the higher spatial variability in the group with LBP and higher EBS in the reference condition.

Three-dimensionality of contact forces during clinical manual examination and treatment : a new measuring system

Description of a new hand/palm-held computerized 3D force measuring system. The system is built for interface (direct) measurement of 3D manual contact force with real-time data presentation. Static calibration was performed of the 3D force sensor with variable preloads to study their effect as well of the prototype system adapted for clinical manual examination and treatment. The new system enables, for the first time, recording and presenting of 3D manual contact forces at the patient-practitioner interface. 3D direct manual contact force measures have the potential to give a more complete and differentiated characterization of patient and practitioner forces than 1D forces. Clinical validity of the prototype system will have to be investigated, and for studying specific clinical manual handling techniques, obvious limitations require further development.

Sensitivity to change of the field-based Wheelchair Mobility Performance Test in wheelchair basketball

In this study we measured the performance times on the Wheelchair Mobility Performance (WMP) test during different test conditions to see if the performance times changed when wheelchair settings were changed. The overall performance time on the WMP test increased when the tire pressure was reduced and also when extra mass was attached to the wheelchair. It can be concluded that the WMP test is sensitive to changes in wheelchair settings. It is recommended to use this field-based test in further research to investigate the effect of wheelchair settings on mobility performance time. Objective: The Wheelchair Mobility Performance (WMP) test is a reliable and valid measure to assess mobility performance in wheelchair basketball. The aim of this study was to examine the sensitivity to change of the WMP test by manipulating wheelchair configurations. Methods: Sixteen wheelchair basketball players performed the WMP test 3 times in their own wheelchair: (i) without adjustments (“control condition”); (ii) with 10 kg additional mass (“weighted condition”); and (iii) with 50% reduced tyre pressure (“tyre condition”). The outcome measure was time (s). If paired t-tests were significant (p < 0.05) and differences between conditions were larger than the standard error of measurement, the effect sizes (ES) were used to evaluate the sensitivity to change. ES values ≥0.2 were regarded as sensitive to change. Results: The overall performance times for the manipulations were significantly higher than the control condition, with mean differences of 4.40 s (weight – control, ES = 0.44) and 2.81 s (tyre – control, ES = 0.27). The overall performance time on the WMP test was judged as sensitive to change. For 8 of the 15 separate tasks on the WMP test, the tasks were judged as sensitive to change for at least one of the manipulations. Conclusion: The WMP test can detect change in mobility performance when wheelchair configurations are manipulated. https://www.medicaljournals.se/jrm/content/html/10.2340/16501977-2341

Completeness of the description of manipulation and mobilisation techniques in randomized controlled trials in neck pain; A review using the TiDieR checklist

Study design: A secondary analysis of a systematic review. Background: Manipulations or mobilizations are commonly used interventions in patients with mechanical neck pain. The treatment effects have often been studied in randomized controlled trials (RCT) which are generally considered the gold standard in evaluating the treatment effects, mainly due to its high internal validity. External validity is defined as the extent to which the effects can be generalised to clinical practice. An important prerequisite for this is that interventions used in clinical trials can be replicated in clinical practice. It can be questioned if interventions utilized in randomized controlled trials can be translated into clinical practice. Objectives: The overall aim of this study is to examine whether the quality of the description of manipulation and mobilization interventions is sufficient for to replication of these interventions in clinical practice. Methods: A comprehensive literature search was performed. Two independent researchers used the Template for Intervention Description and Replication (TIDieR) which is a 12-item checklist for describing the completeness of the interventions. Results: Sixty-seven articles were included that used manipulation and/or mobilization interventions for patients with mechanical neck pain. None of the articles describe the intervention e.g. all the items on the TIDieR list. Considering item 8 (a-f) of the TIDieR checklist only one article described the used techniques completely. Conclusion: Manipulation or a mobilization interventions are poorly reported in RCTs, which jeopardize the external validity of RCTs, making it difficult for clinicians and researchers to replicate these interventions.