Classification criteria for cervical radiculopathy: An international e-Delphi study.

BACKGROUND: Establishing a set of uniform classification criteria (CC) for cervical radiculopathy (CR) is required to aid future recruitment of homogenous populations to clinical trials. OBJECTIVES: To establish expert informed consensus on CC for CR. DESIGN: A pre-defined four round e-Delphi study in accordance with the guidance on Conducting and Reporting Delphi Studies. METHODS: Individuals with a background in physiotherapy who had authored two or more peer-reviewed publications on CR were invited to participate. The initial round asked opinions on CC for CR. Content analysis was performed on round one output and a list of discrete items were generated forming the round two survey. In rounds two to four, participants were asked to rate the level of importance of each item on a six-point Likert scale. Data were analysed descriptively using median, interquartile range and percentage agreement. Items reaching pre-defined consensus criteria were carried forward to the next round. Items remaining after the fourth round constituted expert consensus on CC for CR. RESULTS: Twelve participants participated with one drop out. The final round identified one inclusion CC and 12 exclusion CC. The inclusion CC that remained achieved 82% agreement and was a cluster criterion consisting of radicular pain with arm pain worse than neck pain; paraesthesia or numbness and/or weakness and/or altered reflex; MRI confirmed nerve root compression compatible with clinical findings. CONCLUSIONS: The CC identified can be used to inform eligibility criteria for future CR trials although caution should be practiced as consensus on measurement tools requires further investigation.

Comparative effects of proprioceptive and isometric exercises on pain intensity and difficulty in patients with knee osteoarthritis: A randomised control study.

PURPOSE: The study compared the effects of isometric quadriceps exercise and proprioceptive exercise on pain, joint stiffness and physical difficulties of patients with knee osteoarthritis. SUBJECTS: Forty-five patients with history of knee osteoarthritis were randomly allocated into two groups; A with 23 subjects and B with 22 subjects. METHODS: All subjects received infrared radiation for 20 minutes and kneading massage with methyl salicylate ointment. Group A underwent proprioceptive exercises while Group B had isometric quadriceps exercise. Each exercise session lasted for 10 minutes according to standard protocol, twice in a week for six weeks. Pre-treatment, 3rd week and 6th week pain intensity, joint stiffness and physical difficulties were assessed using Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Statistical package for social sciences (SPSS) version 17 was used to analyse the data while descriptive and inferential statistics were used to summarise the result. RESULTS: Proprioceptive exercises reduced pain intensity significantly (F = 4.76; p = 0.00) at 6th week with effect size of 2.79, and physical difficulty (F = 3.69; p < 0.04) with effect size of 7.53 better than isometric exercises. There was a significant reduction in the pain intensity (F = 12.08; p < 0.001), and physical difficulties (F = 3.69, p = 0.04) in pre-treatment, 3rd week and 6th week in both Group A and B. CONCLUSION: Both exercises are effective but proprioceptive exercises may be more effective in the management of patients with knee osteoarthritis (KOA) than isometric exercises.

Transverse oscillatory pressure in management of cervical radiculopathy: A randomised controlled study.

BACKGROUND: Cervical radiculopathy is an important subgroup of neck disorders causing severe pain and disability. OBJECTIVES: The study assessed the effect of transverse oscillatory pressure (TOP) on pain intensity and functional disability of patients with cervical radiculopathy. METHODS: Twenty-six individuals with unilateral radiating neck pain were randomly allocated into Group A (8 males and 5 females) and Group B (6 males and 7 females). Participants in the two groups received kneading massage, cryotherapy, and active isometric exercises to the posterior paraspinal muscles, trapezuis, and sternomastoid muscles. TOP was administered to Group A, whereas Group B served as control. Treatment was applied three times per week for 4 weeks, making 12 treatment sessions for each participant. Visual analogue scale and Neck Disability Index were used to assess pain intensity and neck disability, respectively, at baseline, 2 weeks, and 4 weeks. Data were analysed using repeated-measures analysis of variance. RESULTS: There was a significant improvement in pain intensity and neck functional disability of patients between baseline, 2nd week, and 4th week of treatment sessions in Groups A and B (p < 0.05). There was a significant reduction in pain intensity in Group A (f = 7.08, p < 0.05) at the 2nd week and 4th week compared with Group B. CONCLUSION: It can be concluded that TOP reduces pain faster in patients with cervical radiculopathy.

Therapeutic efficacy of Lofnac Gel via phonophoresis in the management of chronic nonspecific low back pain: A randomised controlled trial.

BACKGROUND: The prevalence of nonspecific low back pain is very high among Nigerians and in Africa. Lofnac Gel is a nonsteroidal anti-inflammatory gel that has been used to treat musculoskeletal pain, but its efficacy on nonspecific low back pain is inconclusive. OBJECTIVE: The objective of this study was to examine the therapeutic efficacy of Lofnac Gel in the management of nonspecific low back pain. METHODS: Seventy patients diagnosed with mechanical low back pain of 3 months' duration were divided into two groups: experimental group (n = 35) and control group (n = 35). Participants in both groups were placed on supervised strengthening exercises for multifidus muscles of the low back. The experimental group was placed on ultrasound phonophoresis therapy with Lofnac Gel (with diclofenac and methyl salicylate as active ingredients), whereas the control group was placed on ultrasound with water as coupling medium. The treatment was applied twice per week for 6 weeks. Present pain intensity and disability were measured before treatment, and in the 3rd week and 6th week of treatment. Data were analysed using descriptive and inferential statistics, and post hoc analysis was carried out when necessary. RESULTS: There was a significant difference between the pre- and posttreatment pain intensity and disability index for both the experimental (F = 17.947, p < 0.001; F = 20.712, p < 0.001) and control (F = 14.791, p < 0.001; F = 10.418, p < 0.001) groups. There was also a significant difference between the experimental and control group data in terms of pain intensity (F = 28.76, p < 0.001) and disability index (F = 39.817, p < 0.001) in the 6th week. CONCLUSION: Exercise combined with Lofnac phonophoresis was more effective in the management of patients with chronic low back pain than exercise and ultrasound alone.

Effect of vertical oscillatory pressure on disability of patients with chronic mechanical low back pain using Roland Morris Disability questionnaire.

Prevalence of low back pain (LBP) among Africans is rising. Many adults in any given year experience low back pain at one time or the other, this should be of concern. It is then imperative to research into how to reduce the disability caused by LBP. The objective of this study was to assess the effect of Vertical Oscillatory Pressure (VOP) on the pain and disability of patients with mechanical low back pain. A total of 84 patients (34 males and 50 females) diagnosed with mechanical low back pain were purposely selected to participate in the study after obtaining their consent. The pain intensity of all the patients was assessed individually using Present Pain Intensity (PPI) on the first day of their appointment in addition to other examinations. Roland-Morris Disability Questionnaire (RMDQ) was also administered to all patients individually on the first day of report to the clinic. This is pre test record. VOP was then administered to each patient twice in a week for 6 weeks making 12 treatment sessions. Pain intensity and disability were assessed regularly every week of appointment for the 6-week period using PPI and RMDQ (post-test) by another physiotherapist in order to avoid bias. The difference between the first week score of RMDQ and the 6th week score was calculated and the percentage of improvement was determined. Dependent t-test was used to compare the pre and post test values and an alpha level of 0.05 was set as level of significance. An independent t-test was used to analyse the difference between male and female values. Result revealed that the maximum complaint of patients using RMDQ showed a significant disability for males but not for females, and the rate of improvement of male was higher than that of females. There were significant differences (P<.00 1) between the pre-test and post test measurements of PPI and RMDQ, respectively. The rate of improvement in males was significantly higher than that of females. The study concluded that VOP can be useful in ameliorating pain and disability of patients with low back pain.