Cultural Adaptation, Reliability and Validation of the Arabic Örebro Musculoskeletal Pain Questionnaire in Patients with Low Back Pain.

Background: The Örebro Musculoskeletal Pain Questionnaire (ÖMPQ) assesses the psychosocial factors in people with complaints of musculoskeletal disorders and predicts those likely to develop persistent symptoms. Objective: To culturally-adapt and assess the validity of the ÖMPQ in an Arabic population with low back pain (LBP). Methods: This was a prospective cohort validation study of the ÖMPQ. The Arabic-ÖMPQ was created by forward translation, translation synthesis and backward translation in an Arabic population. Participants were included if they were 18 years or older, had acute or chronic LBP and were fluent in Arabic. Eighty-four patients completed the questionnaires at baseline, 2 days later and 3 months follow-up. We assessed specific agreement and test-retest reliability using the interclass correlation coefficient (ICC). We assessed predictive validity using linear regression and relative risk. We assessed content validity by investigating the ceiling and floor effects. Results: To construct validity, the Arabic-ÖMPQ had a moderate (r≥0.3, <0.5) to high (r≥0.5) correlation with pain, disability, fear-avoidance and catastrophizing questionnaires. The test-rest reliability was high ICC2,1=0.92 (95% CI: 0.83-0.96). The Arabic-ÖMPQ score at baseline can significantly predict disability at 3 months F(1,82)=33.87, p<0.01; R2=0.29. Conclusion: The translation of the Arabic-ÖMPQ into Arabic was successful. The Arabic-ÖMPQ showed very good reliability and proper validity and thus can be used to predict the risk of developing persistent disability amongst patients with LBP in an Arabic population.

Prevalence and Determinants of Knowledge of Musculoskeletal Disorders Among Healthcare Providers and Students in Saudi Arabia: A Cross-Sectional Study.

Background: Musculoskeletal disorders (MSDs) are rapidly rising in Saudi Arabia and considered the 3rd reason for hospital visits across the country. Despite their prevalence, the adequacy of knowledge in diagnosing and treating MSDs has not been assessed. The purpose of this study is to assess MSD knowledge amongst healthcare providers (orthopedists, physicians, and physical therapists) and medical and physical therapy students and interns. Methods: In this cross-sectional study, a web-based 25-question MSD test was given to licensed physical therapists, primary care physicians and orthopedists, as well as final-year physical therapy and medical students and interns in Saudi Arabia. Two multivariable linear regression analysis models were used to determine MSD test score differences amongst (1) orthopedists, primary care physicians, and physical therapists and (2) amongst medical and physical therapy students and interns. Results: A total of 680 participants were included (response rate is 22.7%). The overall MSD test score was 48.2%, and the passing rate was 14%. Model 1 showed that orthopedist's group had a significantly higher mean score on MSD test than physical therapists (t482= 8.12, p < 0.001) and primary care physician (t482= 6.00, p < 0.05). However, primary care physician scores did not significantly differ from physical therapy group (t482= 6.47, p = 0.07). Model 2 showed that medical interns had significantly higher mean score on MSD test than physical therapy students (t240=4.46, p < 0.001), physical therapy interns (t240= 4.7, p < 0.05), and medical students (t240= 2.79, p < 0.05). There was also a significant difference between medical students and physical therapy interns (t240= 2.5, p < 0.05). However, there was no significant difference between medical students and physical therapy students. Conclusion: Except for orthopedists, the MSD knowledge appears inadequate amongst healthcare providers, medical and physical therapy students and interns in Saudi Arabia. To improve knowledge in MSDs, increasing content of MSDs in undergraduate education and postgraduate training is necessary.

Correction: Alanazi, F.; Alrwaily, M. Assessing Physical Therapy Knowledge amongst the New Graduates in Saudi Arabia: Competency Examination across the Nation. Healthcare 2022, 10, 579.

In the original publication [...].

Assessing Physical Therapy Knowledge amongst the New Graduates in Saudi Arabia: Competency Examination across the Nation.

Given the increasing demand for more trained physical therapists in providing care to patients in Saudi Arabia, it has become vital to adequately assess individual physical therapy graduate academic learning and performance. Therefore, the present study aimed at evaluating the knowledge and skills of Saudi PT graduates. A competency examination adapted from a practice test that is commercially available and simulates the National Physical Therapy Examination (NPTE) was conducted. Out of 398 Saudi physical therapists that were approached with the examination link, 149 PT graduates consented to the study. Seventy questions were randomly selected by two individuals familiar with the content of PT programs in the United States and Saudi Arabia. The content outline of the selected questions followed the NPTE recommendations for body systems and non-systems. Each question was multiple choice with four answers. The examination was distributed electronically. Each participant was given 90 min to complete the examination. The passing score was set at 55%. Out of 149, only 6six (4.02%) participants passed the examination with an average passing score of 67% (range: 56-96%). In the primary domains of body systems, the score was highest in the endocrine domain (55.1%), followed by the integumentary (42.18%) and the neurology (40.9%) domains. In the non-system, participants had the highest score in the professionalism domain (89.8%). The highest mean knowledge score was obtained in the field of assessment (38.57%). PT graduates from Saudi Arabia performed poorly in the examination, demonstrating weak domain knowledge and skills.

Adherence to low back pain clinical practice guidelines by Saudi physical therapists: a cross-sectional study.

BACKGROUND: Clinical practice guidelines (CPG) have been developed to assist physical therapists (PTs) in managing individuals with low back pain (LBP). Early adherence to the recommendations of CPG for LBP may improve quality of care, lessen the number of hospital visits, and enhance treatment outcomes. OBJECTIVE: To examine: 1) Saudi PTs' adherence to CPG for LBP; and 2) their ability to recognize red and yellow flags. METHODS: This was a cross-sectional study. We approached 583 Saudi PTs who are licensed to work in Saudi Arabia, and involved in managing patients with LBP. Data were collected through an electronic survey; it consisted of 6 clinical vignettes presenting patients with LBP. Each vignette was followed by 25 treatment options. The PTs were allowed to select up to 5 treatment options needed during the first week of treatment. RESULTS: A total of 133 PTs completed the survey. PTs overall adherence ranged from 5.3% to 57.4%. The highest adherence rate was for LBP associated with red flags, which ranged between 29.1%, and 57.4%. The lowest adherence rate was for acute LBP with mobility deficit (5.3%). Logistic regression showed that adherence rates are independent from factors such as, years of experience, caseload, and highest degree attained. CONCLUSION: The study showed an overall low adherence to the CPG. Adherence was best when LBP is associated with red flags. Education and training programs may be needed to improve PTs' adherence to CPG for LBP.

Taping for conditions of the musculoskeletal system: an evidence map review.

BACKGROUND: Taping is a common treatment modality used by many rehabilitation providers. Several types of tapes and taping methods are used in the treatment of musculoskeletal dysfunction and pain. PURPOSE: To summarize and map the evidence related to taping methods used for various joints and conditions of the musculoskeletal system, and to provide clinicians and researchers with a user-friendly reference with organized evidence tables. DATA SOURCES: The PEDro, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register for Controlled Trials, PubMed, and PROSPERO databases were searched from inception through October 31, 2019. STUDY SELECTION: Eligible studies were selected by two independent reviewers and included either systematic reviews (SRs) or randomized controlled trials (RCTs) and included a musculoskeletal complaint using a clinical outcome measure. DATA EXTRACTION: Data was extracted by two investigators independently. Risk of bias and quality were assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) for SRs or the Physiotherapy Evidence Database (PEDro) scale for RCTs. The protocol was registered with PROSPERO (CRD42019122857). DATA SYNTHESIS: Twenty-five musculoskeletal conditions were summarized from forty-one SRs and 127 RCTs. There were 6 SRs and 49 RCTs for spinal conditions. Kinesio tape was the most common type of tape considered. Four evidence tables representing the synthesized SRs and RCTs were produced and organized by body region per condition. LIMITATIONS: Inclusion of only English language studies. Also, the heterogeneous nature of the included studies prevented a meta-analysis. CONCLUSIONS: There is mixed quality evidence of effectiveness for the different types of taping methods for different body regions and conditions. All of the SRs and RCTs found during our search of the taping literature have been organized into a series of appendices. A synthesis of the results have been placed in evidence tables that may serve as a useful guide to clinicians and researchers.

Perception of verticality is altered in people with severe chronic low back pain compared to healthy controls: A cross-sectional study.

BACKGROUND: People with chronic low back pain (CLBP) have abnormal lumbar proprioception, which increases their reliance on visual input to maintain body verticality. Maintaining verticality is important for spatial orientation, balance and movement coordination. It is unknown if these patients also have altered perception of verticality. OBJECTIVE: To compare whether the perception of verticality is different between people with and without CLBP. DESIGN: Cross-sectional. METHODS: Two comparisons of perception of verticality were done between a group of people with CLBP (n = 25) and healthy people (n = 25); and between a subgroup of people with severe CLBP (n = 14) and healthy people (n = 25). In a dark room, the subjective visual vertical test was performed under 3 conditions: rod, rod-and-frame, and rod-and-disc. In each condition, the rod was tilted 40° clockwise and counterclockwise, and the participants were asked to bring it back to vertical 0° position. The rod deviation from verticality was recorded in degrees. RESULTS: When considering the CLBP group, analysis of variance showed that deviation from verticality had no significant group interaction with condition (p = 0.2), or group main effect (p = 0.2). However, deviation from verticality was significantly different between the conditions (p < 0.001). When considering the severe CLBP subgroup, the interaction effect was significant (p = 0.046). Simple main effects showed that the severe CLBP subgroup had larger deviations from verticality (7.5 ±â€¯0.9 deg) compared to the healthy group (4.2 ±â€¯0.7 deg) specifically on the rod-and-frame condition (p = 0.007). CONCLUSION: People with severe CLBP appear to have larger deviations in judging verticality compared to the healthy group.

Stabilization exercises combined with neuromuscular electrical stimulation for patients with chronic low back pain: a randomized controlled trial.

BACKGROUND: One proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the effect size of stabilization exercises has been previously reported to be small. DESIGN: Randomized controlled trial. OBJECTIVE: To investigate the clinical benefit of using neuromuscular electrical stimulation as a supplement to stabilization exercises in patients with chronic low back pain. METHODS: Thirty participants with chronic low back pain were randomized into a stabilization exercise only group (n=15) or a stabilization exercise plus neuromuscular electrical stimulation group (n=15). The stabilization exercises included abdominal, side support, and quadruped exercises. The neuromuscular electrical stimulation was applied to the lumbar paraspinal muscles for 20min each session. Both groups received their respective interventions twice a week for 6 weeks. Participant eligibility for inclusion was age between 18 and 60 years, body mass index ≤34, chronic low back pain ≥3 months, Numeric Pain Rating Scale ≥3, Modified Oswestry Disability Questionnaire score ≥20 and ability to understand English. Outcome measurements were self-reported neuromuscular electrical stimulation tolerability scale, Modified Oswestry Disability Questionnaire, Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire and paraspinal muscle strength. RESULTS: The neuromuscular electrical stimulation was reported to be tolerable. There were no significant between-group differences on any of the outcome measures (p>0.05). CONCLUSIONS: The application of neuromuscular electrical stimulation on the paraspinal muscles was reported to be tolerable. Supplementing stabilization exercises with neuromuscular electrical stimulation did not offer any additional clinical benefit for the chronic low back pain patients.

Assessment of variability in traction interventions for patients with low back pain: a systematic review.

Background: Previous systematic reviews have concluded that lumbar traction is not effective for patients with low back pain (LBP), yet many clinicians continue to assert its clinical effectiveness. Objective: To systematically identify randomized controlled trials (RCTs) of traction and explore the variability of traction interventions used in each RCT. Method: A literature search started in September 2016 to retrieve systematic reviews and individual RCTs of lumbar traction. The term "lumbar traction" and other key words were used in the following databases: Cochrane Registry, MEDLINE, EMBASE, and CINAHL. The retrieved systematic reviews were used to extract individual RCTs. The most current systematic review included RCTs from inception until August 2012. We performed an additional literature search to update this systematic review with newer RCTs published between September 2012 and December 2016. All of the identified RCTs were combined and summarized into a single evidence table. Results: We identified a total of 37 traction RCTs that varied greatly in their method of traction intervention. The RCTs included several types of traction: mechanical (57%), auto-traction (16%), manual (10.8%), gravitational (8.1%) and aquatic (5.4%). There was also great variability in the types of traction force, rhythm, session duration and treatment frequency used in the RCTs. Patient characteristics were a mixture of acute, subacute and chronic LBP; with or without sciatica. Conclusion: There is wide variability in the type of traction, traction parameters and patient characteristics found among the RCTs of lumbar traction. The variability may call into question the conclusion that lumbar traction has little no or value on clinical outcomes. Also, this variability emphasizes the need for targeted delivery methods of traction that match appropriate dosages with specific subgroups of patients with LBP.

Treatment-based Classification System for Patients With Low Back Pain: The Movement Control Approach.

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumbar spine requires both local mobility and global stability. Local mobility means that the lumbar spine and its adjacent regions possess adequate nerve and joint(s) mobility and soft tissue compliance (ie, the malleability of tissue to undergo elastic deformation). Global stability means that the muscles of the lumbar spine and its adjacent regions can generate activation that is coordinated with various joint movements and incorporated into activities of daily living. Local mobility and global stability are housed within the bio-behavioral and socio-occupational factors that should be addressed during movement rehabilitation. This schema is converted into a practical physical examination to help the rehabilitation provider to construct a clinical rationale as to why the movement impairment(s) exist. The examination findings are used to guide treatment. We suggest a treatment prioritization that aims to consecutively address neural sensitivity, joint(s) and soft tissue mobility, motor control, and endurance. This prioritization enables rehabilitation providers to better plan the intervention according to each patient's needs. We emphasize that treatment for patients with low back pain is not a static process. Rather, the treatment is a fluid process that changes as the clinical status of the patient changes. This movement control approach is based on clinical experience and indirect evidence; further research is needed to support its clinical utility.

Treatment-Based Classification System for Low Back Pain: Revision and Update.

The treatment-based classification (TBC) system for the treatment of patients with low back pain (LBP) has been in use by clinicians since 1995. This perspective article describes how the TBC was updated by maintaining its strengths, addressing its limitations, and incorporating recent research developments. The current update of the TBC has 2 levels of triage: (1) the level of the first-contact health care provider and (2) the level of the rehabilitation provider. At the level of first-contact health care provider, the purpose of the triage is to determine whether the patient is an appropriate candidate for rehabilitation, either by ruling out serious pathologies and serious comorbidities or by determining whether the patient is appropriate for self-care management. At the level of the rehabilitation provider, the purpose of the triage is to determine the most appropriate rehabilitation approach given the patient's clinical presentation. Three rehabilitation approaches are described. A symptom modulation approach is described for patients with a recent-new or recurrent-LBP episode that has caused significant symptomatic features. A movement control approach is described for patients with moderate pain and disability status. A function optimization approach is described for patients with low pain and disability status. This perspective article emphasizes that psychological and comorbid status should be assessed and addressed in each patient. This updated TBC is linked to the American Physical Therapy Association's clinical practice guidelines for low back pain.

Vestibular rehabilitation of older adults with dizziness.

The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.