Is One Enough? The Effectiveness of a Single Session of Education and Exercise Compared to Multiple Sessions of a Multimodal Physiotherapy Intervention for Adults With Spinal Disorders in an Advanced Practice Physiotherapy Model of Care: A Randomized Controlled Trial.

OBJECTIVE: To assess the effectiveness of a single session of education and exercise compared with multiple sessions of a multimodal physiotherapy intervention for adults with spinal disorders in an advanced practice physiotherapy specialized spine model of care. DESIGN: Pragmatic randomized controlled trial. METHODS: We randomized patients with spinal disorders, who were referred for a spinal surgery consultation and triaged as nonsurgical cases by an advanced practice physiotherapist, to a single session of education and prescription of an exercise program (n = 52) or multiple sessions (6 in total) of a multimodal physiotherapy intervention (n = 54). The primary outcomes were the short form Brief Pain Inventory pain severity scale (BPI-S) and the Brief Pain Inventory pain interference scale (BPI-I), and secondary outcomes included disability, quality of life, catastrophization, and satisfaction. Linear mixed models were used to assess differences between groups across time points at 6, 12, and 26 weeks. RESULTS: There were no significant between-group differences on the BPI-S and only a significant improvement at 6 weeks on the BPI-I in the multiple-session group (mean difference: -0.96/10; 95% CI, -1.87 to -0.05). There were no other statistically significant differences between groups, except for satisfaction where participants in the multiple-session group reported statistically significantly greater satisfaction on the 9-item Visit-Specific Satisfaction Questionnaire and the MedRisk questionnaire. Both groups saw significant improvements over time on all outcomes except for the BPI-S. CONCLUSION: Adding supervised multimodal physiotherapy sessions did not result in better clinical outcomes when compared to a single session of education and exercise. Patients were more satisfied with the multiple-session approach. J Orthop Sports Phys Ther 2024;54(10):1-13. Epub 9 September 2024. doi:10.2519/jospt.2024.12618.

Virtual reality skateboarding training for balance and functional performance in degenerative lumbar spine disease.

BACKGROUND: Degenerative lumbar spine disease (DLD) is a prevalent condition in middle-aged and elderly individuals. DLD frequently results in pain, muscle weakness, and motor impairment, which affect postural stability and functional performance in daily activities. Simulated skateboarding training could enable patients with DLD to engage in exercise with less pain and focus on single-leg weight-bearing. The purpose of this study was to investigate the effects of virtual reality (VR) skateboarding training on balance and functional performance in patients with DLD. METHODS: Fourteen patients with DLD and 21 age-matched healthy individuals completed a 6-week program of VR skateboarding training. The motion capture and force platform systems were synchronized to collect data during a single-leg stance test (SLST). Musculoskeletal simulation was utilized to calculate muscle force based on the data. Four functional performance tests were conducted to evaluate the improvement after the training. A Visual Analogue Scale (VAS) was also employed for pain assessment. RESULTS: After the training, pain intensity significantly decreased in patients with DLD (p = 0.024). Before the training, patients with DLD took longer than healthy individuals on the five times sit-to-stand test (p = 0.024). After the training, no significant between-group differences were observed in any of the functional performance tests (p > 0.05). In balance, patients with DLD were similar to healthy individuals after the training, except that the mean frequency (p = 0.014) was higher. Patients with DLD initially had higher biceps femoris force demands (p = 0.028) but shifted to increased gluteus maximus demand after the training (p = 0.037). Gluteus medius strength significantly improved in patients with DLD (p = 0.039), while healthy individuals showed consistent muscle force (p > 0.05). CONCLUSION: This is the first study to apply the novel VR skateboarding training to patients with DLD. VR skateboarding training enabled patients with DLD to achieve the training effects in a posture that relieves lumbar spine pressure. The results also emphasized the significant benefits to patients with DLD, such as reduced pain, enhanced balance, and improved muscle performance.

Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility.

PURPOSE: Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions. METHODS: We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation. CONCLUSIONS: This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.

Moving toward better health: exercise practice is associated with improved outcomes after spine surgery in people with degenerative lumbar conditions.

Background: Recovery and rehabilitation following surgery can take many months. Understanding what patients can do to facilitate recovery would be beneficial for spinal surgeons. This study sought to evaluate the impact of exercise practice, before and after surgery, on long-term outcomes of spine surgery in a robust clinical sample. Methods: This prospective longitudinal cohort study included adult patients undergoing spinal surgery for degenerative spinal conditions. Patients were administered a survey that included preoperative and postoperative exercise practices and the following patient-reported outcome measures: the physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-Item Short Form Survey (Rand-36), the Oswestry Disability Index (ODI) score, the Numeric Rating Scale (NRS) score for pain and the Patient-Reported Outcome Measurement Information System (PROMIS) Pain Interference Short Form score. Random effects models investigated the relationship of exercise, follow-up time and their interaction in predicting each patient-reported outcome measure over time, with and without sociodemographic covariates. Results: There were 168 patients in the study sample with up to 12 months of follow-up data. Analysis revealed modest significant main effects of exercise on PCS, MCS, ODI and PROMIS scores and main effects of time on all outcomes. The exercise-by-time interaction was significant in predicting the trajectories of the ODI and MCS scores. When full models were adjusted for education and employment status, interaction effects were no longer significant, but exercise main effects remained significant for ODI score. Conclusion: Patients who engage in exercise before and after spine surgery have better mental health and spine-specific recovery trajectories than those who do not. All health care providers should encourage patients to exercise while they are waiting for surgery within preoperative limitations and as soon as they are able after surgery and to continue this over the long term.

Contexte: Le rétablissement et la réadaptation postopératoires s'échelonnent parfois sur plusieurs mois. Comprendre ce que les patients peuvent faire pour faciliter leur rétablissement serait utile aux spécialistes de la chirurgie de la colonne vertébrale. Cette étude a voulu évaluer l'impact de la pratique d'exercices avant et après une chirurgie de la colonne vertébrale sur son issue à long terme dans un solide échantillon clinique. Méthodes: Cette étude de cohorte longitudinale prospective a regroupé des patients adultes qui devaient subir une chirurgie de la colonne vertébrale pour des maladies dégénératives. Les patients ont été invités à répondre à un questionnaire qui portait entre autre sur la pratique d'exercices pré- et postopératoires et sur les paramètres autorapportés suivants : scores aux composantes physique (PCS) et mentale (MCS) du questionnaire SF-36 (Medical Outcomes Study 36-Item Short Form Survey [Rand-36]), à l'échelle d'incapacité d'Oswestry (ODI), à une échelle d'évaluation numérique (ÉÉN) de la douleur et au questionnaire court PROMIS (Patient-Reported Outcome Measurement Information System) sur l'interférence de la douleur. Des modèles à effets aléatoires ont permis d'analyser les liens entre l'exercice, la durée du suivi et leur interaction pour ce qui est de prédire chacun des paramètres autorapportés au fil du temps, avec et sans les covariables sociodémographiques. Résultats: L'étude a regroupé 168 patients et les données pour un suivi allant jusqu'à 12 mois. L'analyse a fait état d'effets majeurs significatifs modestes de l'exercice sur les paramètres PCS, MCS, ODI et PROMIS et d'effets majeurs du temps sur tous les paramètres. L'interaction entre exercices et durée du suivi a été significative pour prédire la trajectoire des scores ODI et MCS. Lorsque les modèles intégraux ont été ajustés pour tenir compte du niveau de scolarité et du statut professionnel, les effets de l'interaction n'étaient plus significatifs, mais les effets majeurs de l'exercice sont demeurés significatifs pour le score ODI. Conclusion: Les patients qui ont fait des exercices avant et après une chirurgie de la colonne vertébrale ont présenté des trajectoires plus favorables au plan de la santé mentale et du rétablissement de leur colonne vertébrale comparativement à ceux qui n'avaient pas fait d'exercices. Tous les professionnels de la santé devraient encourager les patients à faire des exercices pendant qu'ils attendent leur chirurgie en tenant compte de leurs limites préopératoires, à les reprendre le plus rapidement possible après la chirurgie et à les maintenir à long terme.

How Many Steps Per Day During the Early Postoperative Period are Associated With Patient-Reported Outcomes of Disability, Pain, and Opioid Use After Lumbar Spine Surgery?

OBJECTIVE: To investigate whether early postoperative walking is associated with "best outcome" and no opioid use at 1 year after lumbar spine surgery and establish a threshold for steps/day to inform clinical practice. DESIGN: Secondary analysis from randomized controlled trial. SETTING: Two academic medical centers in the United States. PARTICIPANTS: We enrolled 248 participants undergoing surgery for a degenerative lumbar spine condition (N=248). A total of 212 participants (mean age, 62.8±11.4y, 53.3% female) had valid walking data at baseline. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Disability (Oswestry Disability Index), back and leg pain (Brief Pain Inventory), and opioid use (yes vs no) were assessed at baseline and 1 year after surgery. "Best outcome" was defined as Oswestry Disability Index ≤20, back pain ≤2, and leg pain ≤2. Steps/day (walking) was assessed with an accelerometer worn for at least 3 days and 10 h/d at 6 weeks after spine surgery, which was considered as study baseline. Separate multivariable logistic regression analyses were conducted to determine the association between steps/day at 6 weeks and "best outcome" and no opioid use at 1-year. Receiver operating characteristic curves identified a steps/day threshold for achieving outcomes. RESULTS: Each additional 1000 steps/d at 6 weeks after spine surgery was associated with 41% higher odds of achieving "best outcome" (95% confidence interval [CI], 1.15-1.74) and 38% higher odds of no opioid use (95% CI, 1.09-1.76) at 1 year. Walking ≥3500 steps/d was associated with 3.75 times the odds (95% CI, 1.56-9.02) of achieving "best outcome" and 2.37 times the odds (95% CI, 1.07-5.24) of not using opioids. CONCLUSIONS: Walking early after surgery may optimize patient-reported outcomes after lumbar spine surgery. A 3500 steps/d threshold may serve as an initial recommendation during early postoperative counseling.

Feasibility and Acceptability of Telemedicine to Substitute Outpatient Rehabilitation Services in the COVID-19 Emergency in Italy: An Observational Everyday Clinical-Life Study.

OBJECTIVES: To investigate the feasibility and acceptability of telemedicine as a substitute for outpatient services in emergency situations such as the sudden surge of the COVID-19 pandemic in Italy. DESIGN: Observational cohort study with historical control. SETTING: Tertiary referral outpatient institute. PARTICIPANTS: Consecutive services provided to patients with spinal disorders (N=1207). INTERVENTIONS: Telemedicine services included teleconsultations and telephysiotherapy, and lasted as long as usual interventions. They were delivered using free teleconference apps, caregivers were actively involved, and interviews and counseling were performed as usual. Teleconsultations included standard, but adapted, measurements and evaluations by video and from photographs and videos sent in advance according to specific tutorials. During telephysiotherapy, new sets of exercises were defined and recorded as usual. MAIN OUTCOME MEASURES: We compared the number of services provided in 3 phases, including corresponding periods in 2018 and 2019. During the control (30 working d) and COVID-19 surge (13d) only usual consultations and physiotherapy were provided; during the telemed phase (15d), only teleconsultations and telephysiotherapy were provided. If a reliable medical decision was not possible during teleconsultations, usual face-to-face interventions were prescribed. Continuous quality improvement questionnaires were also evaluated. RESULTS: During telemed, 325 teleconsulations and 882 telephysiotherapy sessions were provided in 15 days. We found a rapid decrease (-39%) of outpatient services from the control to the COVID-19 phase (R2=0.85), which partially recovered in the telemed phase for telephysiotherapy (from -37% to -21%; P<.05) and stabilized for teleconsultation (from -55% to -60%) interventions. Usual face-to-face interventions were required for 0.5% of patients. Patients' satisfaction with telemedicine was very high (2.8 out of 3). CONCLUSIONS: Telemedicine is feasible and allows medical professionals to continue providing outpatient services with a high level of patient satisfaction. During the current pandemic, this experience can provide a viable alternative for many outpatient services while reducing the need for travel and face-to-face contact to a minimum.

Establishment of a Novel Porcine Model to Study the Impact of Active Stretching on a Local Carrageenan-Induced Inflammation.

OBJECTIVE: Active stretching of the body is integral to complementary mind-body therapies such as yoga, as well as physical therapy, yet the biologic mechanisms underlying its therapeutic effects remain largely unknown. A previous study showed the impact of active stretching on inflammatory processes in rats. The present study tested the feasibility of using a porcine model, with a closer resemblance to human anatomy, to study the effects of active stretching in the resolution of localized inflammation. DESIGN: A total of 12 pigs were trained to stretch before subcutaneous bilateral Carrageenan injection in the back at the L3 vertebrae, 2 cm from the midline. Animals were randomized to no-stretch or stretch, twice a day for 5 mins over 48 hrs. Animals were euthanized for tissue collection 48 hrs postinjection. RESULTS: The procedure was well tolerated by the pigs. On average, lesion area was significantly smaller by 36% in the stretch group compared with the no-stretch group (P = 0.03). CONCLUSION: This porcine model shows promise for studying the impact of active stretching on inflammation-resolution mechanisms. These results are relevant to understanding the stretching-related therapeutic mechanisms of mind-body therapies. Future studies with larger samples are warranted.

Objective activity tracking in spine surgery: a prospective feasibility study with a low-cost consumer grade wearable accelerometer.

Patient-reported outcome measures (PROMs) are commonly used to estimate disability of patients with spinal degenerative disease. Emerging technological advances present an opportunity to provide objective measurements of activity. In a prospective, observational study we utilized a low-cost consumer grade wearable accelerometer (LCA) to determine patient activity (steps per day) preoperatively (baseline) and up to one year (Y1) after cervical and lumbar spine surgery. We studied 30 patients (46.7% male; mean age 57 years; 70% Caucasian) with a baseline activity level of 5624 steps per day. The activity level decreased by 71% in the 1st postoperative week (p < 0.001) and remained 37% lower in the 2nd (p < 0.001) and 23% lower in the 4th week (p = 0.015). At no time point until Y1 did patients increase their activity level, compared to baseline. Activity was greater in patients with cervical, as compared to patients with lumbar spine disease. Age, sex, ethnic group, anesthesia risk score and fusion were variables associated with activity. There was no correlation between activity and PROMs, but a strong correlation with depression. Determining activity using LCAs provides real-time and longitudinal information about patient mobility and return of function. Recovery took place over the first eight postoperative weeks, with subtle improvement afterwards.

Massage manipulation vs. low back muscle exercise for lumbar intervertebral instability: A preliminary randomized clinical trial.

This is a preliminary randomized clinical trial on patients conducted at Wuxi Hospital Affiliated with Nanjing University of Chinese Medicine from September 2015 to December 2016. The patients with intervertebral instability were randomized 1:1 for massage (20 min/day for 6 days) or exercise (3 sessions/day for 15 days). Japanese Orthopaedic Association (JOA) score, Oswestry disability score, and quantitative fluoroscopy (QF) were performed before and after the treatment and at 1 and 3 months thereafter. Improvement rates were noted to be 86.7% and 40.0% in the massage and exercise groups, respectively. Massage group showed significant changes in the JOA and Oswestry disability scores (p < 0.001 and p = 0.002), while the exercise group did not show any significant change (p > 0.05). Changes in the JOA and Oswestry disability scores were more important in the massage group (p < 0.05). All dynamic imaging parameters were improved in the massage group (all p < 0.05) but not in the exercise group (all p>0.05). These results suggest that the massage manipulation could be an appropriate way to treat intervertebral instability.

Clinical course of pain and disability following primary lumbar discectomy: systematic review and meta-analysis.

PURPOSE: To conduct a meta-analysis to describe clinical course of pain and disability in adult patients post-lumbar discectomy (PROSPERO: CRD42015020806). METHODS: Sensitive topic-based search strategy designed for individual databases was conducted. Patients (> 16 years) following first-time lumbar discectomy for sciatica/radiculopathy with no complications, investigated in inception (point of surgery) prospective cohort studies, were included. Studies including revision surgery or not published in English were excluded. Two reviewers independently searched information sources, assessed eligibility at title/abstract and full-text stages, extracted data, assessed risk of bias (modified QUIPs) and assessed GRADE. Authors were contacted to request raw data where data/variance data were missing. Meta-analyses evaluated outcomes at all available time points using the variance-weighted mean in random-effect meta-analyses. Means and 95% CIs were plotted over time for measurements reported on outcomes of leg pain, back pain and disability. RESULTS: A total of 87 studies (n = 31,034) at risk of bias (49 moderate, 38 high) were included. Clinically relevant improvements immediately following surgery (> MCID) for leg pain (0-10, mean before surgery 7.04, 50 studies, n = 14,910 participants) and disability were identified (0-100, mean before surgery 53.33, 48 studies, n = 15,037). Back pain also improved (0-10, mean before surgery 4.72, 53 studies, n = 14,877). Improvement in all outcomes was maintained (to 7 years). Meta-regression analyses to assess the relationship between outcome data and a priori potential covariates found preoperative back pain and disability predictive for outcome. CONCLUSION: Moderate-level evidence supports clinically relevant immediate improvement in leg pain and disability following lumbar discectomy with accompanying improvements in back pain. These slides can be retrieved under Electronic Supplementary Material.

Rehabilitation following lumbar fusion surgery (REFS) a randomised controlled feasibility study.

PURPOSE: Following lumbar fusion surgery (LFS), 40% of patients are unsure/dissatisfied with their outcome. A prospective, single-centre, randomised, controlled trial was conducted to evaluate the feasibility (including clinical and economic impact) of a theoretically informed rehabilitation programme following LFS (REFS). METHODS: REFS was informed by an explicit theoretical framework and consisted of 10 consecutive weekly group rehabilitation sessions (education, low-tech cardiovascular, limb and spine strengthening exercises, and peer support). Participants were randomised to REFS or 'usual care.' Primary feasibility outcomes included recruitment and engagement. Secondary outcomes, collected preoperatively and 3, 6, and 12  months postoperatively, comprised the Oswestry disability index, European Quality of Life 5 dimensions score, pain self-efficacy questionnaire, hospital anxiety and depression scale and the aggregated functional performance time. Economic impact was evaluated with the Client Services Receipt Inventory. RESULTS: Fifty-two of 58 eligible participants were recruited, and engagement with REFS was > 95%. REFS participants achieved a clinically meaningful reduction in unadjusted mean short-term disability (- 13.27 ± 13.46), which was not observed in the 'usual care' group (- 2.42 ± 12.33). This was maintained in the longer term (- 14.72% ± 13.34 vs - 7.57 ± 13.91). Multilevel regression analyses, adjusted for body mass index, baseline depression, and smoking status reported a statistically significant short-term improvement in disability (p = 0.014) and pain self-efficacy (p = 0.007). REFS costs £275 per participant. CONCLUSIONS: Results suggest that REFS is feasible and potentially affordable for delivery in the National Health Service. It is associated with a clinically meaningful impact. A multicentre randomised controlled study to further elucidate these results is warranted. These slides can be retrieved under Electronic Supplementary Material.

Effect of physiotherapy on spinal alignment in children with postural defects.

OBJECTIVES: This paper assesses the effect of neurophysiological rehabilitation in children with postural defects on the depth of thoracic kyphosis, lateral spinal deviation and rotation of spinal motor segments. MATERIAL AND METHODS: A total of 201 patients aged 8-15 years old with a postural defect diagnosed by medical examination were enrolled. The analyzed parameters were determined using the DIERS system before the first therapeutic session and after 4 weeks of therapy. The angle of thoracic kyphosis, lateral deviation of the spine and spinal rotation were assessed. The therapy employed techniques associated with the proprioceptive neuromuscular facilitation (PNF) and Vojta's approaches. The results were analyzed separately for both sexes and for patients rehabilitated solely with Vojta's techniques vs. patients rehabilitated according to combined Vojta's and PNF techniques. The χ2 test was used for statistical analyses, at p < 0.05. RESULTS: There was improvement in the angle of thoracic kyphosis, ranging from 0.14 (among boys with kyphosis < 42°) to 5.47 (among girls with kyphosis ≥ 42°), spinal rotation, from 0.37 (among boys with kyphosis ≥ 42°) to 4.33 (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method), and lateral deviations, ranging from 1.32 mm (among boys with kyphosis < 42°) to 2.99 mm (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method). CONCLUSIONS: Neurophysiological rehabilitation of patients with postural defects produced positive effects by improving the angle of thoracic kyphosis, spinal rotation and lateral deviation of the spine. Children with reduced thoracic kyphosis achieved less improvement in the kyphosis angle, lateral spinal deviation and spinal rotation than children with kyphosis ≥ 42°. The DIERS Formetric System enables precise monitoring of therapeutic outcomes. Int J Occup Med Environ Health. 2019;32(1):25-32.

"Prehabilitation" in degenerative spine surgery: A literature review. / «Prehabilitación¼ en cirugía de columna degenerativa: revisión de la literatura.

Surgery for lumbar degenerative pathology, although effective, results in suboptimal outcome and degrees of disability in a relevant proportion of patients. Postoperative rehabilitation has failed to demonstrate efficacy in the mid and long term. So-called "prehabilitation" (physiotherapy and/or cognitive-behavioral therapy) focuses in augmenting patients' functional capacities before surgery by improving their physical condition and their perception of pain, surgical experience or its consequences. Several studies suggest that prehabilitation improves postoperative outcome, shortens hospital stay and may reduce costs compared to classic postoperative rehabilitation. However, its true effect seems to be influenced by factors like obesity, co-morbidity and, especially, by a wrong perception of the natural history of this pathology in terms of catastrophising and kinesiphobia. In this paper we describe the concept of prehabilitation, review the literature, and discuss the role of some clinical conditionings involved.

Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial.

BACKGROUND: To analyze the safety and effects of early initiation of rehabilitation including objective measurement outcomes after lumbar spine fusion based on principles of strength training. METHODS: The study recruited 27 patients, aged 45 to 70 years, who had undergone lumbar spine fusion. The method of concealed random allocation without blocking was used to form two groups. The strength training group started rehabilitation 3 weeks after surgery. Patients exercised twice weekly over 9 weeks focusing on muscle activation of lumbopelvic stabilization muscles. The control group followed a standard postoperative protocol, where no exercises were performed at that stage of rehabilitation. Functional outcomes and plain radiographs were evaluated at 3 weeks and subsequently at 3 and 18 months after the surgery. RESULTS: No hardware loosening of failure was observed in the training group. Both groups improved their walking speed after 3 months (p < 0.01), although improvement in the training group was significantly greater than in the control group (p < 0.01). Moreover, the training group significantly improved after the training period in all isometric trunk muscles measurements (p < 0.03), standing reach height (p < 0.02), and pre-activation pattern (p < 0.05). After 18 months, no training effects were observed. CONCLUSIONS: The study showed that early initiation of a postoperative rehabilitation program based on principles of strength training is safe, 3 weeks after lumbar spine fusion, and enable earlier functional recovery than standard rehabilitation protocol. TRIAL REGISTRATION: The study is registered at the US National Institutes of Health ( ClinicalTrials.gov ) NCT03349580 . The date of registration: November 21, 2017 - Retrospectively registered.

Negotiating acquired spinal conditions: Recovery with/in bodily materiality and fluids.

The paper explores the concept of recovery; the unexpected material changes that occur to, and within bodies following acquired spinal conditions. The phrase 'acquired spinal conditions' is used as a collective name for the four accounts of recovery that emerged using Participatory Action Research in the north east of England (2010-11). Using two qualitative methods, Photovoice and participatory diagramming, the empirical material examines the role of physiological changes as a way to enrich understandings of disability and the bodily experience of impairment. Three themes, bodily materiality, material objects and fluids became significant during one-to-one and small group interactions with participants. The paper is situated in wider debates in geographies of disability and impairment, focusing on the interplay between different physiological states of being and the bodily changes experienced through recovery. It argues that recovery is the process of negotiating, adapting and adjusting to changes, from the way bodily materiality shifts and fluctuates following accidents and medical interventions, settling over time as participants become aware of bodily changes, to the role of material objects and the fluids that pass back and forth changing bodily interiors. The paper closes with a call for geographies of affect to explore the individual and collective feelings associated with fluids, and the human-animal relations affecting recovery and bodily interiors.

[Combined rehabilitation in the patients presenting with dorsopathies of the lumbar spine and concomitant irritable bowel syndrome based at a therapeutic clinic].

BACKGROUND: Comorbidity constitutes a serious challenge for rehabilitative medicine. The comorbidity of the dorsopathy of the lumbar spine and irritable bowel syndrome mutually complicates the clinical course of both conditions, significantly reduces the patients' quality of life. and increases the costs of diagnostic procedures and restoration of the working capacity. The approaches to the non-pharmacological management of the patients presenting with these diseases remain to be developed. AIMS: The objective of the present study was to evaluate the effectiveness of the proposed combined non-medicinal rehabilitation modality which included a course of therapy with the application of modulated sinusoidal currents, total wrappings with the use of a Rapan saline solution, and sedative inhalations additionally introduced into the basic medicinal therapy of the patients presenting with dorsopathy of the lumbar spine combined with irritable bowel syndrome in the stationary phase. MATERIALS AND METHODS: A total of 59 patients at the age from 20 to 65 years suffering from dorsopathy of the lumbar spine and concomitant irritable bowel syndrome were examined and treated. All the patients were randomized into two groups, the main (n=21) and control (n=38) one, matched for the sex and age. The patients in the control group received the conventional medical treatment in accordance with the adopted medical and economic standards during 2 weeks. The patients of the main group received, in addition to the basal medicinal therapy, the proposed combined rehabilitative physiotherapeutic treatment that included a course of therapy with modulated sinusoidal currents, total wrapping with the use of a Rapan saline solution, and sedative inhalations of the of peony root extract. The effectiveness of these rehabilitation modalities was monitored before and after the course of therapy based on the estimation of bowel function dynamics, the severity of pain syndrome, and the patient's quality of life in terms of the health status with the use of the SF-36 questionnaire. RESULTS: The therapeutic and rehabilitative procedures resulted in a well apparent improvement of the genera condition in the patients of the main group associated with a greater degree of reduction of the incidence of specific clinical symptoms, more rapid relief of the pain syndrome, and a more pronounced improvement of the quality of life indices in comparison with the same variables in the patients comprising the control group. After the course of the treatment and rehabilitation, the incidence of spinal pain in the patients of the main group was significantly reduced by 87% (p=0.001) compared with those of the control group (32%; p=0.005). The frequency of abdominal pain decreased in the main group by 47% (p=0.021) versus the control group (by 27%; p=0.007). The quality of life indices increased 1.2 times in the main group but remained unaltered in the control group. DISCUSSION: The patients of the main group exhibited a more pronounced than in the control group positive dynamics of health conditions characterized by a well apparent reduction in the incidence of the major clinical symptoms of the disease, faster alleviation of the pain syndrome, and the marked improvement of the quality of life indices. CONCLUSIONS: The results of the study with the inclusion of therapy with modulated sinusoidal currents together with total wrapping using the Rapan saline solution and sedative inhalations into the program of the combined treatment of the patients presenting with dorsopathy of the lumbar spine and concomitant irritable bowel syndrome provide a basis for recommending this physiotherapeutic modality for personalized rehabilitation of this group of patients under conditions of a therapeutic clinic.

Rogue one: a story of tophaceous gout in the spine.

A 26-year-old man with history of extensive tophaceous gout presented to the referring facility with decreased bilateral lower extremity sensation and motor function that began acutely 1 week prior to admission and had progressed to urinary incontinence. The patient was admitted to the intensive care unit due to concern for sepsis secondary to epidural abscess. The patient was started on empiric vancomycin and cefepime. Neurosurgery did not recommend acute neurosurgical intervention given the lack of a compressive lesion. Aspiration of the paraspinal collection by interventional radiology subsequently showed crystals consistent with tophaceous gout. Given the high initial suspicion for gout and results of the paraspinal aspiration, the patient was started on prolonged steroid taper as well as allopurinol and colchicine. The patient eventually had partial neurological recovery with discharge to an inpatient rehabilitation facility for further physical therapy rehabilitation.

Beliefs in the population about cracking sounds produced during spinal manipulation.

OBJECTIVES: To examine beliefs about cracking sounds heard during high-velocity low-amplitude (HVLA) thrust spinal manipulation in individuals with and without personal experience of this technique. METHODS: We included 100 individuals. Among them, 60 had no history of spinal manipulation, including 40 who were asymptomatic with or without a past history of spinal pain and 20 who had nonspecific spinal pain. The remaining 40 patients had a history of spinal manipulation; among them, 20 were asymptomatic and 20 had spinal pain. Participants attended a one-on-one interview during which they completed a questionnaire about their history of spinal manipulation and their beliefs regarding sounds heard during spinal manipulation. RESULTS: Mean age was 43.5±15.4years. The sounds were ascribed to vertebral repositioning by 49% of participants and to friction between two vertebras by 23% of participants; only 9% of participants correctly ascribed the sound to the formation of a gas bubble in the joint. The sound was mistakenly considered to indicate successful spinal manipulation by 40% of participants. No differences in beliefs were found between the groups with and without a history of spinal manipulation. CONCLUSIONS: Certain beliefs have documented adverse effects. This study showed a high prevalence of unfounded beliefs regarding spinal manipulation. These beliefs deserve greater attention from healthcare providers, particularly those who practice spinal manipulation.