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).

Rehabilitation of back pain in the pediatric population: a mixed studies systematic review.

BACKGROUND: A significant proportion of children and adolescents experience back pain. However, a comprehensive systematic review on the effectiveness of rehabilitation interventions is lacking. OBJECTIVES: To evaluate benefits and harms of rehabilitation interventions for non-specific low back pain (LBP) or thoracic spine pain in the pediatric population. METHODS: Seven bibliographic electronic databases were searched from inception to June 16, 2023. Moreover, reference lists of relevant studies and systematic reviews, three targeted websites, and the WHO International Clinical Trials Registry Platform were searched. Paired reviewers independently conducted screening, assessed risk of bias, and extracted data related to study characteristics, methodology, subjects, and results. Certainty of evidence was evaluated based on the GRADE approach. RESULTS: We screened 8461 citations and 307 full-text articles. Ten quantitative studies (i.e., 8 RCTs, 2 non-randomized clinical trials) and one qualitative study were included. With very low to moderate certainty evidence, in adolescents with LBP, spinal manipulation (1-2 sessions/week over 12 weeks, 1 RCT) plus exercise may be associated with a greater likelihood of experiencing clinically important pain reduction versus exercise alone; and group-based exercise over 8 weeks (2 RCTs and 1 non-randomized trial) may reduce pain intensity. The qualitative study found information provided via education/advice and compliance of treatment were related to effective treatment. No economic studies or studies examining thoracic spine pain were identified. CONCLUSIONS: Spinal manipulation and group-based exercise may be beneficial in reducing LBP intensity in adolescents. Education should be provided as part of a care program. The overall evidence is sparse. Methodologically rigorous studies are needed. TRIAL REGISTRATION: CRD42019135009 (PROSPERO).

Characteristics of adolescent athletes seeking early versus late care for sport-related concussion.

OBJECTIVES: 1) To determine which characteristics of adolescent athletes with SRC are associated with 'early' versus 'late' presentation for multimodal treatment; 2) to build a propensity score to investigate the effects of treatment timing during the management of SRCs. METHODS: Associations between early (0-7 days) versus late (8-28 days) presentation for treatment and pre-specified sociodemographic, pre-injury and injury characteristics were investigated in a historical cohort study of 2949 multi-sport athletes across Canada aged 12-18 years diagnosed with a SRC in community-based healthcare clinics. RESULTS: Early presentation was associated with being male, completing a pre-injury baseline assessment, and responding 'yes' or 'no' to having a diagnosed learning disability. Older athletes who reported previous SRCs were less likely to present early. The propensity score demonstrated an area under the curve of 0.71 (95% CI, 0.69 to 0.73). CONCLUSIONS: Male athletes with a completed baseline assessment were more likely to seek early treatment following a SRC, and older athletes who reported a greater number of previous SRCs were less likely to present early. External validation of the propensity score is needed before examining the impact of treatment timing on adolescent athlete recovery outcomes.

OBJECTIFS: 1) Trouver les caractéristiques des athlètes adolescents ayant subi une CCLS qui sont associées à la consultation précoce et à une consultation tardive; 2) établir un score de propension pour étudier les effets du moment du traitement pendant la prise en charge de la CCLS. MÉTHODOLOGIE: Les liens entre la consultation précoce (de 0 à 7 jours) et la consultation tardive (de 8 à 28 jours) et les caractéristiques sociodémographiques, les caractéristiques avant la blessure et les caractéristiques après des blessure prédéterminées ont été examinés au cours d'une étude de cohorte historique menée auprès de 2 949 adolescents multisports répartis dans toutes les régions du Canada, âgés de 12 à 18 ans, chez lesquels une CCLS avait été diagnostiquée dans des cliniques de santé communautaires. RÉSULTATS: La consultation précoce a été associée au sexe masculin, à une évaluation de départ avant la blessure et à la présence ou à l'absence d'un trouble de l'apprentissage. Les athlètes plus âgés ayant signalé des CCLS antérieures étaient moins susceptibles de consulter précocement. Le score de propension a démontré une aire sous la courbe de 0,71 (IC à 95 %: 0,69 à 0,73). CONCLUSIONS: Les athlètes masculins ayant subi une évaluation de départ étaient plus susceptibles de consulter précocement après une CCRS alors que les athlètes âgés ayant déclaré un plus grand nombre de CCRS antérieures étaient moins susceptibles de consulter précocement. Une validation externe du score de propension serait nécessaire avant d'examiner l'effet du moment de la consultation sur les résultats de récupération chez les athlètes adolescents.

Multi-modal management of sport and non-sport related concussion by chiropractic sports specialists: a case series.

This case series describes the multi-modal treatment plans delivered by two chiropractic sports specialists for the management of post-concussive symptoms (PCS). Three concussion cases are presented each with different mechanisms of injury (two sportrelated and one non-sport-related) and each within a different stage of recovery (acute, sub-acute, and chronic). Treatment plans included patient education, sub-symptom threshold exercise, soft-tissue therapy, spinal manipulation, and cervical spine as well as visual/vestibular rehabilitation exercises. This series highlights three important observations: (1) the efficacy of individualized, multi-modal treatment plans based on suggested clinical profiles for patients with PCS of various stages; (2) that the delineation of concussion literature based on mechanism of injury (i.e. sport- vs. non-sport-related) may be unnecessary; and (3) these cases provide encouraging evidence to support the inclusion of manual therapists with advanced knowledge of concussion treatment, such as chiropractors, as part of the interdisciplinary healthcare team when managing patients with PCS.

Cette série de cas sert à présenter les plans multimodaux utilisés par deux spécialistes de la chiropratique sportive pour traiter des symptômes postcommotionnels (SPC). Trois cas de commotion cérébrale pour chaque type de mécanisme de lésion (deux cas de blessure liée au sport et un cas de blessure non liée au sport), chacun avec un stade différent (aigu, subaigu et chronique). Les plans de traitement englobaient l'information au patient, la réduction du seuil nociceptif par des exercices, le traitement des tissus mous, des manipulations vertébrales, des manipulations cervicales et des exercices de rééducation visuelle et/ou vestibulaire. Cette série de cas met en relief trois importantes observations, à savoir : 1)l'efficacité des plans multimodaux personnalisés élaborés selon les profils cliniques suggérés de patients présentant des SPC de divers stades sont efficaces; 2) la segmentation de la littérature sur la commotion cérébrale selon le mécanisme de la blessure (commotion liée au sport et commotion non liée au sport) pourrait s'avérer superflue; et 3) ces cas fournissent des preuves encourageantes qu'il est pertinent d'inclure un thérapeute manuel possédant des connaissances poussées en matière de traitement des commotions cérébrales, comme le chiropraticien, à l'équipe interdisciplinaire de soins de santé prenant soin du patient ayant des SPC.

Effects of local vibration therapy on various performance parameters: a narrative literature review.

INTRODUCTION: The therapeutic effects of local muscle vibration (LMV) remain controversial due to a lack of specific protocols. This review was conducted to better understand the effects of various LMV application protocols. METHODS: A comprehensive literature search was performed based on title and abstract and a set of predetermined inclusion criteria. Study quality was then evaluated via the PEDro scale. RESULTS: 23 articles were returned initially, and 21 studies were evaluated. The average PEDro score was 5.97/10. Reported outcome measures included muscle activation, strength, power, and range of motion / flexibility. The frequency and amplitude of LMV ranged from 5 - 300 Hz and 0.12-12 mm respectively, and duration from 6 seconds - 30 minutes. CONCLUSION: Most studies found that LMV elicits beneficial changes in the mentioned outcome measures. However, the methodological procedures used are quite heterogeneous. Further research is needed to understand the optimal application of LMV.

INTRODUCTION: Les effets thérapeutiques des vibrations musculaires locales (VML) demeurent controversés en raison de l'absence de protocoles précis. Cette revue de synthèse visait à mieux comprendre les effets de divers protocoles d'utilisation des VML. MÉTHODOLOGIE: On a effectué une recherche exhaustive de littérature à l'aide des mots du titre et du résumé ainsi qu'un ensemble de critères d'inclusion prédéterminés. La qualité de l'étude a ensuite été évaluée à l'aide de l'échelle PEDro. RÉSULTATS: 23 articles ont été envoyés au point de départ et 21 études ont été évaluées. La cote moyenne sur l'échelle PEDro était de 5,97 sur 10. Les résultats signalés étaient l'activation musculaire, la force, la puissance, l'amplitude du mouvement et la souplesse. La fréquence et l'amplitude des VML étaient de 5 à 300 Hz et de 0,12 à 12 mm respectivement, et la durée variait de 6 secondes à 30 minutes. CONCLUSION: La plupart des études ont montré que les VML étaient bénéfiques sur les résultats mentionnés. Cependant les méthodologies utilisées étaient très hétérogènes. Il faudrait mener d'autres études pour savoir dans quels cas les VML procurent des bienfaits optimaux.