The impact of COVID-19 on neck pain intensity and onset: A systematic review.

BACKGROUND: The COVID-19 pandemic has had significant impacts on most aspects of life, including physical and psychological wellbeing. Neck pain is a very common musculoskeletal complaint worldwide, and one that has been impacted by COVID-19. Such impacts have been studied by a few researchers, but not without inconstancies. Moreover, understanding those impacts in relation to rehabilitation is not fully comprehended. OBJECTIVE: The aim of this study was to systematically examine the impacts of COVID-19 on neck pain intensity and onset pre and post the pandemic. METHODS: This study was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A systematic literature search was conducted on PubMed-MEDLINE, EMBASE, and Cochrane Library. Keywords used were "COVID-19" and "Neck Pain". Risk of bias was assessed using the Joanna Briggs Institute Checklist for prevalence studies. RESULTS: A total of five studies were included with an overall sample size of 2618 participants. Three studies were at moderate risk and two were at high risk of bias. Results from three studies reported an increase in neck pain intensity and onset, while the other two did not report an increase. CONCLUSION: The impact of COVID-19 on neck pain is unclear. The inconsistency in results sheds the light on the importance of having future research (including longitudinal studies) to help guide us towards understanding the real impacts of COVID-19 on neck pain.

Knowledge related to low back pain and its associated factors in patients with low back pain: A cross-sectional study.

BACKGROUND: Patients' knowledge about low back pain (LBP) negatively influences LBP prognosis. Studying the extent of patients' knowledge about LBP may help clinicians design effective LBP treatment strategies. OBJECTIVE: To explore the level of LBP knowledge and its associated factors in patients with LBP. METHODS: A cross-sectional study with a representative sample. Participants with acute or chronic LBP completed a self-administered questionnaire including sociodemographic and clinical characteristics. We used the Low Back Pain Knowledge Questionnaire (LBP_KQ) to assess knowledge, the Fear-Avoidance Beliefs Questionnaire for LBP (FABQ_LBP) to assess fear of movement, the Oswestry Disability Index (ODI) to assess functional disability, Depression Anxiety Stress Scales (DASS 21) to assess mental health status, and the Numeric Pain Rating Scale (NPRS) to assess pain intensity. RESULTS: A total of 271 individuals with LBP completed the study. The mean age of participants was 39.86 (± 11.27), the LBP chronicity median was 18 (IQR = 44) months, and 56.5% of the participants were females. The mean LBP_KQ score was 9.29 (± 3.89)/24. An educational level higher than high school (diploma education (ß= 1.202 [95%CI: 5.633 to 11.498], p< 0.001), bachelor or higher education (ß= 2.270 [95%CI: 1.107 to 3.433], p< 0.001)), and using pain killers (ß= 1.180 [95%CI: 0.140 to 2.221], p= 0.026) were significantly associated with higher LBP_KQ score. While being employed (ß=-1.422 [95%CI: -2.462 to -0.382], p= 0.008) and having higher DASS Anxiety score (ß=-0.144 [95%CI: -0.240 to -0.048], p= 0.003) were significantly associated with lower LBP_KQ score. CONCLUSIONS: Individuals with chronic LBP in Jordan demonstrated relatively low levels of LBP knowledge related to their condition. Rehabilitation personnel, healthcare stakeholders, and policymakers should carefully monitor the level of LBP knowledge and its associated factors.

Autonomic nervous system markers of music-elicited analgesia in people with fibromyalgia: A double-blind randomized pilot study.

Purpose: To investigate the feasibility of using music listening by adults with fibromyalgia (FM) as a potential tool for reducing pain sensitivity. Patients and methods: We report results from a double-blind two-arm parallel randomized pilot study (NCT04059042) in nine participants with FM. Pain tolerance and threshold were measured objectively using quantitative sensory tests; autonomic nervous system (ANS) reactivity was measured with an electrocardiogram. Participants were randomized to listen to instrumental Western Classical music or a nature sound control to test whether music listening elicits greater analgesic effects over simple auditory distraction. Participants also completed separate control testing with no sound that was counterbalanced between participants. Results: Participants were randomized 1:1 to music or nature sounds (four Music and five Nature). Although the groups were not different on FM scores, the Music group had marginally worse temporal pain summation (p = 0.06), and the Nature group had higher anxiety scores (p < 0.05). Outcome measures showed a significant difference between groups in the magnitude of change in temporal summation between sessions (p < 0.05), revealing that the Nature group had greater pain reduction during audio compared to silence mode, while the Music group had no difference between the sessions. No significant effects were observed for either mechanical pain tolerance or ANS testing. Within the Music group, there was a trend of vagal response increase from baseline to music listening, but it did not reach statistical significance; this pattern was not observed in the Nature group. Conclusion: Auditory listening significantly altered pain responses. There may be a greater vagal response to music vs. nature sounds; however, results could be due to group differences in pain and anxiety. This line of study will help in determining whether music could be prophylactic for people with FM when acute pain is expected.

Work-related musculoskeletal disorders among Jordanian physiotherapists: Prevalence and risk factors.

BACKGROUND: Musculoskeletal complaints associated with work are common health problems among physiotherapists due to overload exposure and unsuitable postures. OBJECTIVE: To assess work-related musculoskeletal disorders (WMSDs) among Jordanian physiotherapists and investigate the factors that might increase the risk of having WMSDs among physiotherapists by using the ICF model as a guiding framework. METHODS: A cross-sectional study was conducted on 139 physiotherapists. Participants' ages ranged from 23 to 61 years with 53.2% who identified as female. To assess WMSDs the Quick Exposure Check was used. Furthermore, depression, sleep, social support and job satisfaction were all assessed using Beck Depression Inventory, Pittsburgh Sleep Quality Index, Multidimensional Scale of Perceived Social Support, and Minnesota Satisfaction Questionnaire, respectively. Furthermore, age, gender, body mass index (BMI), educational level, smoking status and marital status were also collected from all participants. RESULTS: The results showed that the most common musculoskeletal complaints were as follows: 100% of the participants reported overload occurrence in the cervical spine, 97.9% in the lumbar spine, 96.5% in the shoulder joint, and 24.1% in the wrist joint. There was a significant negative correlation between total exposure and gender. Also, total exposure was significantly and positively correlated with BMI and the Minnesota Satisfaction Questionnaire (MSQ). CONCLUSION: This study suggests a need to increased knowledge of self-protection strategies among physiotherapists to reduce the occurrence of musculoskeletal disorders. Understanding the factors that might increase WMSDs is useful for future research, quality improvement, and educational programs to reduce the rates of WMSDs among physiotherapists.

Arabic translation, cross-cultural adaptation, and psychometric properties of the low back pain knowledge questionnaire.

BACKGROUND: Low Back Pain Knowledge Questionnaire (LBP_KQ) was originally developed and validated for English speakers but not yet available for Arabic speakers. PURPOSE: To translate, cross-culturally adapt, and test the psychometric properties of the Arabic version of the LBP_KQ. METHODS: Translation and cross-cultural adaptation were performed according to recommended guidelines. Construct validity was assessed through principal component analysis, and contrasted groups including physical therapists, nurses, and patients with low back pain. Concurrent validity was assessed by the correlation of LBP_KQ with the fear avoidance-belief questionnaire and depression, anxiety, and stress scale. Reliability was assessed using internal consistency (Cronbach's α) and test-retest reliability using intra-class correlation coefficient (ICC) and Bland-Altman analyses. Sensitivity to change was measured by comparing an educational intervention group (IG) and a control group (CG). RESULTS: The questionnaire has four components. Physical therapists had significantly (p < .001) higher LBP_KQ scores than nurses and patients indicating good construct validity. There was a significant correlation between LBP_KQ and fear avoidance-belief questionnaire total score (r = 0.200, p = .04), depression score (r = -0.219, p = .024), anxiety score (r = -0.251, p < .01), stress score (r = -0.199, p < .041). Cronbach's α was 0.662, and ICC (2,1) was 0.760 which reflects good reliability. There was a significant difference in LBP_KQ scores between IG and CG (p < .001) indicating sensitivity to change. CONCLUSION: The Arabic version of LBP_KQ is valid, reliable, and sensitive to change.

Post-stroke fatigue level is significantly associated with mental health component of health-related quality of life: a cross-sectional study.

PURPOSE: Individuals post-stroke might have high levels of post-stroke fatigue (PSF) which might affect their quality of life. This study aimed to investigate the prevalence of post-stroke fatigue in Jordan and to comprehensively identify its possible associated factors. METHODS: A cross-sectional design was implemented through one-hour face-to-face assessment sessions. The modified fatigue impact scale, 12-item Short-Form Health Survey, Montreal Cognitive Assessment, Motor Assessment Log, Upper Extremity Fugl Meyer assessment, Nine Hole Peg Test, 10 Meter Walk Testing, active and passive goniometry, Hand-held dynamometry, and modified Ashworth scale were used as outcome measures. Prevalence of post-stroke fatigue and levels of quality of life were reported using descriptive analyses. Multiple variable linear regression analysis was used to identify PSF associated factors of post-stroke fatigue. P < 0.05 was considered significant for all statistical tests. RESULTS: 153 individuals with stroke participated in the study. A total of 117 participants (69.9%, 95% CI = 62.0-77.1%) were fatigued. Fatigue was significantly predicted by mental component of quality of life (ß -0.42 [95% CI -0.53--0.31]; p < 0.001), cognition (ß -0.69 [95% CI -1.08--0.29], p = 0.001), weekly sport hours (ß -0.94 [95% CI -1.73--0.14], p = 0.022), and shoulder abduction spasticity (ß -1.81 [95% CI -3.38--0.24], p = 0.024. The model explained 51% of the variation in the fatigue (F = 29.006, p < 0.001). CONCLUSION: Jordanian individuals with stroke have a high prevalence of fatigue. Mental related quality of life was significantly associated with PSF levels. Other factors significantly associated with PSF included cognition status, sport participation, and spasticity. Healthcare practitioners working in neurorehabilitation should take PSF and its significant correlates into consideration when treating individuals with stroke.

Arabic version of the Back Pain Attitudes Questionnaire: Translation, cross-cultural adaptation, and psychometric properties.

BACKGROUND: The Back Pain Attitudes Questionnaire (Back-PAQ) is a tool developed for the assessment of attitudes about back pain. However, this tool is not available in the Arabic language. The availability of the Arabic version of the questionnaire will enable clinicians and researchers in Arabic-speaking countries to assess patients' attitudes towards back pain. OBJECTIVE: We aimed to translate and cross-culturally adapt the English version of the Back-PAQ into Arabic and study its psychometric properties. METHODS: The translation and cross-cultural adaptation processes were performed according to published guidelines. The translated Arabic version was tested for face and content validity on 40 participants. The psychometric properties of the final Arabic version were tested on 110 participants. Participants completed the Arabic version of the Back-PAQ and Fear-Avoidance Beliefs Questionnaire (FABQ). A subgroup of 50 participants completed the questionnaire twice in a week interval to determine the Back-PAQ test-retest reliability. RESULTS: The majority of participants found the questionnaire understandable and the questions relevant and appropriate for their back problem. There was a fair correlation between the Back-PAQ-Arabic and the FABQ physical activity scale (rho = 0.283, p= 0.001), and little to no correlation with total FABQ (rho = 0.186, p= 0.026) and education level (rho =-0.162, p= 0.045). The Arabic Back-PAQ-Arabic showed moderate internal consistency with Cronbach's α of 0.601, and excellent test-retest reliability (ICC2,1= 0.963). The Back-PAQ standard error of measurement was 3.57 and minimum detectable changes was 9.90. CONCLUSION: The Arabic version of the Back-PAQ has adequate validity and reliability properties.

Brain Response to Non-Painful Mechanical Stimulus to Lumbar Spine.

Pressure application to the lumbar spine is an important assessment and treatment method of low back pain. However, few studies have characterized brain activation patterns in response to mechanical pressure. The objective of this study was to map brain activation associated with various levels of mechanical pressure to the lumbar spine in healthy subjects. Fifteen healthy subjects underwent functional magnetic resonance imaging (fMRI) scanning while mechanical pressure was applied to their lumbar spine with a custom-made magnetic resonance imaging (MRI)-compatible pressure device. Each subject received three levels of pressure (low/medium/high) based on subjective ratings determined prior to the scan using a block design (pressure/rest). Pressure rating was assessed with an 11-point scale (0 = no touch; 10 = max pain-free pressure). Brain activation differences between pressure levels and rest were analyzed. Subjective pressure ratings were significantly different across pressure levels (p < 0.05). The overall brain activation pattern was not different across pressure levels (all p > 0.05). However, the overall effect of pressure versus rest showed significant decreases in brain activation in response to the mechanical stimulus in regions associated with somatosensory processing including the precentral gyri, left hippocampus, left precuneus, left medial frontal gyrus, and left posterior cingulate. There was increase in brain activation in the right inferior parietal lobule and left cerebellum. This study offers insight into the neural mechanisms that may relate to manual mobilization intervention used for managing low back pain.

Structural Brain Imaging in People With Low Back Pain.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: The aim of this study was to determine whether low back pain (subacute and chronic) is related to differences in brain volume. SUMMARY OF BACKGROUND DATA: Inconsistent findings have been reported about the effect of chronic low back pain on brain volume, and the effect of subacute low back pain on brain volume has not been sufficiently investigated. METHODS: A total of 130 participants were included (23 subacute and 68 chronic low back pain; 39 healthy controls). The main outcome measure was whole and regional brain volume. Clinical outcome measures included pain duration, pain intensity, fear avoidance belief questionnaire, Oswestry Disability Index, and Beck's Depression Inventory. RESULTS: Decrease in brain volume in several regions was observed in chronic low back pain when compared with health subjects; however, after correcting for multiple comparisons, no significant differences were detected between any of the three groups in whole-brain volume. Regionally, we detected less gray matter volume in two voxels in the middle frontal gyrus in chronic low back pain participants compared with healthy controls. None of the clinical outcome measures were correlated with brain volume measurements. CONCLUSION: Low back pain (subacute or chronic) is not related to significant differences in brain volume after correction for multiple comparisons. The effect size was too small to detect possible subtle changes unless much larger sample sizes are examined, or it is possible that low back pain does not affect brain volume. LEVEL OF EVIDENCE: 5.