Effectiveness of postsurgical rehabilitation following lumbar disc herniation surgery: A systematic review.

Introduction: The effectiveness of post-surgical rehabilitation following lumbar disc herniation (LDH) surgery is unclear. Research question: To investigate the effectiveness and safety of rehabilitation interventions initiated within three months post-surgery for adults treated surgically for LDH. Material and methods: This systematic review searched seven databases from inception to November 2023. Independent reviewers screened studies, assessed and extracted data, and rated the certainty of the evidence using the GRADE approach. Results: This systematic review retrieved 20,531 citations and included 25 randomized controlled trials. The high certainty evidence suggests that adding Pilates exercise to routine care and cognitive behavioral therapy may improve function immediately post-intervention (1 RCT), and that adding whole-body magnetic therapy to exercise, pharmacological and aquatic therapy may reduce low back pain intensity (1 RCT) immediately post-intervention. Compared to placebo, pregabalin did not reduce low back pain or leg pain intensity (1 RCT) (moderate to high certainty evidence). We found no differences between: 1) behavioral graded activity vs. physiotherapy (1 RCT); 2) exercise and education vs. neck massage or watchful waiting (1 RCT); 3) exercise, education, and in-hospital usual care vs. in-hospital usual care (1 RCT); 4) functional or staged exercise vs. usual post-surgical care including exercise (2 RCTs); and 5) supervised exercise with education vs. education (1 RCT). No studies assessed adverse events. Discussion and conclusion: Evidence on effective and safe post-surgical rehabilitation interventions is sparse. This review identified two interventions with potential short-term benefits (Pilates exercises, whole-body magnetic therapy) but safety is unclear, and one with an iatrogenic effect (pregabalin).

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults.

PURPOSE: To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS: We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE. RESULTS: Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95% confidence interval -1.54 to -0.26), and a reduction in pain catastrophizing in the short term (3 months) with TENS versus no intervention or interventions with TENS specific effects (1 RCT) (MD = -11.20, 95% CI -17.88 to -3.52). For other outcomes, little or no difference was found between TENS and the comparison interventions. The certainty of the evidence for all outcomes was very low. CONCLUSIONS: Based on very low certainty evidence, TENS resulted in brief and marginal reductions in pain (not deemed clinically important) and a short-term reduction in pain catastrophizing in adults with CPLBP, while little to no differences were found for other outcomes.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults.

PURPOSE: Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS: Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence. RESULTS: We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved health-related quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95%CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = - 1.21, 95%CI - 1.50; - 0.92) and 3 months (9 RCTs; MD = - 1.56, 95%CI - 2.80; - 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = - 1.39, 95%CI - 2.00; - 0.77) and 3 months (8 RCTs; SMD = - 0.57, 95%CI - 0.92; - 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = - 1.10, 95%CI - 1.71; - 0.48) and 3 months (SMD = - 1.04, 95%CI - 1.66; - 0.43). Compared with usual care, NT reduced pain (MD = - 1.35, 95%CI - 1.86; - 0.84) and functional limitations (MD = - 2.55, 95%CI - 3.70; - 1.40) at 3 months. CONCLUSION: Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults.

PURPOSE: Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. METHODS: Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence. RESULTS: We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low. CONCLUSION: Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.

Does induced fatigue alter dynamic balance in athletes? A systematic review.

OBJECTIVES: To determine the influence of induced fatigue on dynamic balance in healthy athletes. DESIGN: Systematic review. DATA SOURCES: PUBMED, MEDLINE, CINAHL, Sports Discus, and the Cochrane library from onset to May 28, 2019. ELIGIBILITY CRITERIA: Eligible studies included any study examining the effects of induced-fatigue on dynamic balance, as measured by the SEBT/YBT, in healthy athletic populations. Studies with a low risk of bias were considered scientifically admissible for a best evidence synthesis. RESULTS: Fifteen studies with low risk of bias were included - seven investigated recreational athletes while eight focused on competitive athletes. In the recreational population, five of the studies found significant decrease in dynamic balance following the fatiguing intervention. However, the remaining two concluded with insignificant changes. As for the competitive population, three studies showed significant effects of induced fatigue on dynamic balance, while five showed no effects. CONCLUSION: There are conflicting results regarding the effects of induced fatigue on dynamic balance. The majority of studies focused on competitive athletes found that fatigue did not alter their dynamic balance. Per contra, the majority of studies focused on recreational athletes concluded the opposite - fatigue did indeed affect dynamic balance.

OBJECTIFS: Déterminer si la fatigue musculaire a des effets sur l'équilibre dynamique chez les athlètes en bon état de santé. MÉTHODOLOGIE: Revue systématique. SOURCES DES DONNÉES: PUBMED, MEDLINE, CINAHL, Sports Discus et la bibliothèque Cochrane du début des publications jusqu'au 28 mai 2019. CRITÈRES D'ADMISSION: Les études admissibles comprenaient toutes celles qui avaient porté sur les effets de la fatigue musculaire sur l'équilibre dynamique, telle qu'elle mesurée par le SEBT/YBT dans des populations de sportifs sains. Les études comportant un faible risque de biais ont été considérées comme scientifiquement admissibles pour faire une synthèse des meilleures données probantes. RÉSULTATS: Quinze études présentant un faible risque de biais ont été retenues; sept portaient sur des athlètes amateurs et les huit autres, sur des athlètes de compétition. En ce qui concerne les athlètes amateurs, cinq études ont montré une diminution importante de l'équilibre dynamique après une activité causant de la fatigue. Cependant, dans les deux autres études, les changements n'étaient pas importants. En ce qui concerne les athlètes de compétition, trois études ont montré que la fatigue musculaire avait d'importants effets sur l'équilibre dynamique, tandis que cinq n'en ont montré aucun. CONCLUSION: Les résultats des études sur les effets de la fatigue musculaire sur l'équilibre dynamique sont contradictoires. La majorité des études portant sur des athlètes de compétition ont montré que la fatigue n'avait aucun effet sur l'équilibre dynamique. Par contre, la majorité portant sur les athlètes récréatifs ont conclu le contraire, c'est-à-dire que la fatigue avait un effet sur l'équilibre dynamique.

Calcaneonavicular coalition: a case study of non-operative management in an adult patient.

OBJECTIVE: This study describes the radiographic diagnosis and nonoperative chiropractic management for a case of a chronic calcaneonavicular coalition in an adult patient. BACKGROUND: Calcaneonavicular coalition is a congenital/acquired condition of the tarsal bones often diagnosed in individuals 8-12 years old. Considering its rare presentation (less than 1% of the population), there remains little literature on the conservative management of this condition. CASE PRESENTATION: Chronic calcaneonavicular coalition in a 35-year-old recreational athlete is presented. MANAGEMENT/OUTCOME: Following radiographic diagnosis, the patient was placed in a walking boot for four-weeks. After removal of the boot, the patient was managed nonoperatively. They reported a full resolution of symptoms with noted return to all pre-injury activities. SUMMARY: Presentation of calcaneonavicular coalition may be dependent on many factors, including age, medical history, and chronicity of the condition. Previous medical background may include recurrent inversion ankle sprains, aggravated with activity, and alleviated with rest. Nonoperative management of calcaneonavicular coalition may be considered as a viable intervention.

OBJECTIF: Cette étude présente le diagnostic à l'aide de radiographies et la prise en charge non chirurgicale par la chiropratique d'un cas de coalition calcanéonaviculaire chronique chez un patient adulte. CONTEXTE: La coalition calcanéo-naviculaire est une affection congénitale ou acquise des tarses souvent diagnostiquée chez des individus âgés de 8 à 12 ans. Comme il s'agit d'une affection rare (moins de 1% de la population), il existe peu de littérature sur le traitement conservateur de cette affection. PRÉSENTATION DU CAS: Présentation d'une coalition calcanéo-naviculaire chronique chez un athlète amateur de 35 ans. PRISE EN CHARGE/RÉSULTAT: Après le diagnostic établi à l'aide de radiographies, le patient a été placé dans une botte de marche orthopédique pendant quatre semaines. Après le retrait de la botte, le patient a été pris en charge de manière non chirurgicale. Tous ses symptômes sont disparus et il a pu reprendre toutes les activités qu'il avait avant sa blessure. RÉSUMÉ: La survenue d'une coalition calcanéonaviculaire peut dépendre de nombreux facteurs, dont l'âge, les antécédents médicaux et la chronicité de l'affection. Les antécédents médicaux peuvent inclure des entorses récurrentes de la cheville en inversion, aggravées par l'activité et soulagées par le repos. La prise en charge non chirurgicale de la coalition calcanéo-naviculaire peut être considérée comme une intervention viable.