Efectividad de la entrevista motivacional en la atención fisioterápica de los trastornos musculoesqueléticos de la espalda / Effectiveness of the motivational interview in the physiotherapy care of musculoskeletal disorders of the back: A quasi-experimental study

Objetivo: Evaluar la efectividad de la entrevista motivacional (EM) junto al tratamiento fisioterapéutico habitual en pacientes con trastornos musculoesqueléticos (TME) de la espalda en atención primaria (AP). Métodos: Estudio cuasiexperimental en pacientes que iniciaron su tratamiento en el año 2020 en una unidad de fisioterapia tras diagnóstico médico de TME en la espalda, con seguimiento prospectivo de 2grupos con actuación terapéutica: grupo experimental (GE) y grupo de control (GC). Se empleó la EM solo en el GE. A ambos grupos se les entrevistó telefónicamente a los 3y 6meses de finalizar el tratamiento fisioterápico, preguntando por el cumplimiento de pautas domiciliarias y por la percepción subjetiva del estado de salud (escala de Barthel). Se ajustaron modelos de regresión lineales (coeficiente de regresión, IC del 95%) y logísticos (OR, IC del 95%). Resultados: La población de estudio fue de 154 personas (76,6% mujeres). La salud percibida fue significativamente mejor (p<0,001) en el GE que en el GC, tanto a los 3meses de seguimiento (7,4 versus 5,0, respectivamente) como a los 6(7,1 versus 4,6, respectivamente). Hubo una fuerte asociación entre percepción de salud y cumplimiento (coeficiente de regresión 3,0 [IC del 95%=2,5-3,4]). La asociación entre la EM y el cumplimiento terapéutico se mantuvo tras ajustes multivariados (OR a 6meses=383,6 [IC del 95% = 31,0-4.742,4]). Conclusiones: la incorporación de la EM como complemento de los tratamientos de fisioterapia es una herramienta factible y efectiva para mejorar el cumplimiento de las pautas domiciliarias y la percepción subjetiva de salud. (AU)

Objective: To evaluate the effectiveness of motivational interviewing (MI) combined with the usual physiotherapy treatment in patients with back musculoskeletal disorders (MSD) in primary care (PC). Methods: Quasi-experimental study with 2groups with therapeutic action (control group and experimental group) and prospective follow-up, in a physiotherapy unit in PC, in patients who began their treatment in 2020, with a medical diagnosis of MSD in the back. MI was used only in the face-to-face visits of the experimental group. Both groups were interviewed by telephone about 3and 6months after finishing the physiotherapy treatment. For this purpose, the Barthel scale was used for the subjective perception of the state of health, and the scale of compliance with home guidelines. Linear (regression coefficient, 95% CI) and logistic (OR, 95% CI) regression models were fitted. Results: The study population was 154 people (76.6% women). Perceived health was significantly better (P<.001) in the experimental group than in the control group, both at 3(7.4 versus 5.0, respectively) and at 6months of follow-up (7.1 versus 4.6, respectively). There was a strong association between perceived health and compliance (regression coefficient 3.0 [95% CI=2.5–3.4]). The strong association between MI and treatment adherence was maintained after multivariate adjustments (6-month OR=383.6 [95% CI 31.0–4742.4]). Conclusions: MI is a feasible and effective complement to physiotherapy treatments to improve compliance with home recommendations and subjective perception of health. (AU)

Headache and musculoskeletal pain in school children are associated with uncorrected vision problems and need for glasses: a case-control study.

Musculoskeletal pain and headache are leading causes of years lived with disability, and an escalating problem in school children. Children spend increasingly more time reading and using digital screens, and increased near tasks intensify the workload on the precise coordination of the visual and head-stabilizing systems. Even minor vision problems can provoke headache and neck- and shoulder (pericranial) pain. This study investigated the association between headaches, pericranial tenderness, vision problems, and the need for glasses in children. An eye and physical examination was performed in twenty 10-15 year old children presenting to the school health nurse with headache and pericranial pain (pain group), and twenty age-and-gender matched classmates (control group). The results showed that twice as many children in the pain group had uncorrected vision and needed glasses. Most children were hyperopic, and glasses were recommended mainly for near work. Headache and pericranial tenderness were significantly correlated to reduced binocular vision, reduced distance vision, and the need for new glasses. That uncorrected vision problems are related to upper body musculoskeletal symptoms and headache, indicate that all children with these symptoms should have a full eye examination to promote health and academic performance.

Relationship between trapezius muscle hardness and transverse cervical artery flow in association with neck and upper-back stiffness.

Neck and upper-back stiffness is a common discomfort encountered occasionally in daily life among otherwise healthy subjects. The pathogenesis of this condition could be attributable to increased tension in muscles such as the trapezius muscle (TM). The transverse cervical artery (TCA) is one of the feeding arteries for the TM, and TCA flow is reportedly related to symptoms of neck and upper-back stiffness. This study quantitatively investigated relationships between TM hardness and TCA hemodynamics as evaluated on Doppler sonography. Questionnaires regarding neck and upper-back stiffness, muscle hardness measurements obtained using a muscle hardness meter and examinations of TCA hemodynamics using Doppler sonography were performed on 55 healthy young adults (25 males, 30 females; mean age, 22 ± 2 years). Subjects displaying neck and upper-back stiffness actually exhibited high muscle hardness (median, 14.0; interquartile range (IQR), 12.9-18.0) compared to those without the symptom (median, 12.0; IQR, 9.9-14.0; p = .002). Peak systolic velocity in the TCA on Doppler sonography was lower in subjects with the symptom (median, 65.1 cm/s; IQR 59.6-72.5 cm/s) than in those without the symptom (median, 72.5 cm/s; IQR 66.5-84.2 cm/s; p = .012). Resistive index in the TCA was high (r2  = .605, p = .014) with increasing TM hardness, particularly among male subjects with the symptom. The present study suggests that high resistance and low blood flow velocity in the TCA could be closely associated with the underlying pathogenesis of neck and upper-back stiffness.

Comparisons of physical exposure between workers harvesting apples on mobile orchard platforms and ladders, part 1: Back and upper arm postures.

This study compared farmworkers' exposure to non-neutral postures using a new mobile platform apple harvesting method and the traditional method using ladders. Twenty-four workers were recruited and assigned into three groups: ladder workers (n = 8) picking apples from full trees using a ladder, mobile platform workers (n = 8) picking apples from upper part of the trees while standing on a moving platform, and ground-based mobile platform workers (n = 8) picking apples from lower part of the trees which the mobile platform workers left out. Upper arm and back inclinations were continuously monitored during harvesting using tri-axial accelerometers over full work shifts (~8 h). Upper arm posture was characterized as the percentage of time that upper arm flexion and abduction exceeded 30°, 60°, and 90°. Back posture was characterized as the percentage of time that torso angles (sagittal flexion or lateral bending) exceeded 10°, 20°, and 30°. The 10th, 50th, and 90th postural percentiles were also calculated. The platform workers had lower exposures to upper arm flexion and abduction than the ground and ladder workers. There were no differences in torso angles between the ladder and mobile platform workers; however, the ground workers were exposed to more and greater percentages of time in torso flexions.

Backpack palsy and other brachial plexus neuropathies in the military population.

Brachial plexus neuropathy is often seen in the military population, especially due to pressure (backpack palsy, BPP) or idiopathic (neuralgic amyotrophy, NA). We aimed to gain insight in the disease characteristics of soldiers with brachial plexus neuropathies in the Dutch military population and to compare disease characteristics between patients with BPP and NA. In this retrospective chart review study we aimed to include all patients with brachial plexus neuropathy, who presented in the Joint Military Hospital between 1 January, 2011 and 31 December, 2016. We calculated the incidence of NA and BPP and Chi-square tests or Student t tests were performed for differences in patient characteristics between NA and BPP. We included 127 patients, 63 with BPP, 45 with NA, 10 with traumatic brachial plexus neuropathy, and 9 with other plexopathy. The incidence of brachial plexus neuropathy was 50/100 000 person years overall, 25/100 000 person years for BPP, and 18/100 000 person years for NA. Patients in the BPP group differed from the NA with regard to pain (BPP 41% vs NA 93%, P = .000), atrophy (13% BPP vs 29% NA, P = .049), and sensory symptoms (83% BPP vs 44% NA, P = .000). In the BPP group 90% had incomplete recovery and in the NA group 78%. Our study showed a high incidence of BPP and NA in the military population and suggests recovery is not so benevolent as previously thought. Future research is necessary to improve insight and outcome of military patients with brachial plexus neuropathies.

Comparing Two Moderate-to-Vigorous Physical Activity Accelerometer Cut Points in Older Adults With Neck and Back Disabilities Undergoing Exercise and Spinal Manipulation Interventions.

Different techniques used to analyze and reduce accelerometer data may impact its interpretation. To determine which variables were impacted by changing analysis parameters, the authors performed a secondary analysis of data gained from a clinical trial conducted on older adults (aged ≥65 years; M = 71.1 and SD = 5.3; n = 100) with neck and back disabilities and compared the effects of two different cut- point sets (Matthews and Freedson sets) commonly used to analyze older adult accelerometry data. The Matthews set was found to assign significantly greater moderate-to-vigorous physical activity per day than the Freedson set in all comparisons. This suggests that, if moderate-to-vigorous physical activity per unit time is a primary outcome measure, the choice of which analysis method is used should be carefully considered. Further results from analyses of dependent variables, time in moderate-to-vigorous physical activity bouts of >10 min/day, mean bout length, and number of bouts per day are discussed.

From "bedside" to "bench" and back: A translational approach to studying dopamine dysfunction in schizophrenia.

Despite multiple lines of research, a mechanistic understanding of schizophrenia remains elusive. Neuroimaging studies have yielded observations that can be used in translational studies in animals to attempt to uncover their cellular and circuit basis and their significance for the diseased human brain. Enhanced D2 stimulation in the striatum is a well replicated and established observation in patients with schizophrenia. This "bedside" observation was reproduced "at the bench" level by creating a transgenic mouse overexpressing D2 receptors in dorsal striatum (D2R-OE mouse). The D2R-OE mouse showed multiple behavioral, molecular, electrophysiological and anatomical alterations. Some of these are consistent with findings in patients with schizophrenia, providing construct validity to the model and mechanistic insights for the observations made in humans. Other findings were novel, and provide an opportunity for a reverse translational effort back into the clinic. In this review we will summarize the process of translation and back translation from the D2R-OE mouse and describe the insights into the pathophysiology of the disease gained through this type of translational work.

Involvement of legs and other body parts in patients with restless legs syndrome and its variants.

BACKGROUND: Restless legs syndrome (RLS) is characterized by the urge to move the legs accompanied by movement-responsive, abnormal sensations, which worsen at rest and night. We investigated the distribution of sensory symptoms and clinical correlations in patients with RLS and its variants. METHODS: Eighty-nine patients diagnosed with RLS or RLS variants (age 61.4 ±â€¯18.5 years 40 M/49 F) according to established criteria, with the exclusion of those with augmentation, were included in this study. The international RLS rating scale (IRLS) was used to assess the severity of RLS/RLS variant symptoms. RESULTS: Eighty-three patients (93.3%) had RLS, and 6 patients (6.7%) had RLS variants. Among the patients with RLS and RLS variants, 33 patients (36.0%) reported restlessness involving other body parts: arms (16.9%) were the most frequent region, followed by the back (10.1%), abdomen (6.7%), and buttocks (4.5%). There were no between-group differences in clinical characteristics, except for the level of sleep disturbances being higher in patients with RLS variants (n=6) than in patients with RLS (n=83). No significant difference was observed in clinical characteristics including RLS severity and treatment between patients with RLS only (n=57) and patients with RLS with other body part involvement (n=26). No relationship was observed between the onset of symptoms in the legs and other body parts, but the IRLS scores for legs and other body parts were significantly correlated. CONCLUSION: We should recognize that RLS can involve not only legs but also other body parts to varying degrees in each patient.

Effect of foot reflexology and slow stroke back massage on the severity of fatigue in patients undergoing hemodialysis: A semi-experimental study.

Background Fatigue is one of the most disturbing and the most common symptoms reported by patients dialyzed. There are methods available on complementary and alternative medicine, through which nurses can help patients to promote their health. Reflexology is a treatment which has a long history and is considered as one of the most popular and the most widespread methods of alternative medicine. In this study, the effects of foot reflexology and slow stroke back massage on the severity of fatigue in patients treated with hemodialysis were measured. Methods This is a quasi-experimental study that performed on 52 patients chosen from Imam Khomeini dialysis center in Zabol and divided into control and intervention groups by randomize allocation method. Required information collected from a demographic and fatigue severity questionnaire. After completing questionnaires by the study subjects, foot massage and slow stroke back massage was performed during three weeks, two sessions each week (5 sessions in total). At the end of intervention data of two groups was collected. Data was analyzed using independent sample t-Test, Chi-squared test, Fisher exact test, oneway ANOVA with repeated measures and Bonferroni test by SPSS software version 21. Results The mean [±SD] fatigue in patients with foot reflexology massage and slow stroke back massage reflect on the 53.61[±10.12] and 52.20 [±10.37], and the differences were not significant, but after the intervention, fatigue in the group receiving foot reflexology massage was reduced significantly compared to slow stroke back massage group (p<0.0001). Conclusions The result of this study showed that reflexology massage is a safe and economical nursing intervention for decreasing fatigue in hemodialysis patients.

Effect of cervicolumbar coupling on spinal reflexes during cycling after incomplete spinal cord injury.

Spinal networks in the cervical and lumbar cord are actively coupled during locomotion to coordinate arm and leg activity. The goals of this project were to investigate the intersegmental cervicolumbar connectivity during cycling after incomplete spinal cord injury (iSCI) and to assess the effect of rehabilitation training on improving reflex modulation mediated by cervicolumbar pathways. Two studies were conducted. In the first, 22 neurologically intact (NI) people and 10 people with chronic iSCI were recruited. The change in H-reflex amplitude in flexor carpi radialis (FCR) during leg cycling and H-reflex amplitude in soleus (SOL) during arm cycling were investigated. In the second study, two groups of participants with chronic iSCI underwent 12 wk of cycling training: one performed combined arm and leg cycling (A&L) and the other legs only cycling (Leg). The effect of training paradigm on the amplitude of the SOL H-reflex was assessed. Significant reduction in the amplitude of both FCR and SOL H-reflexes during dynamic cycling of the opposite limbs was found in NI participants but not in participants with iSCI. Nonetheless, there was a significant reduction in the SOL H-reflex during dynamic arm cycling in iSCI participants after training. Substantial improvements in SOL H-reflex properties were found in the A&L group after training. The results demonstrate that cervicolumbar modulation during rhythmic movements is disrupted in people with chronic iSCI; however, this modulation is restored after cycling training. Furthermore, involvement of the arms simultaneously with the legs during training may better regulate the leg spinal reflexes. NEW & NOTEWORTHY This work systematically demonstrates the disruptive effect of incomplete spinal cord injury on cervicolumbar coupling during rhythmic locomotor movements. It also shows that the impaired cervicolumbar coupling could be significantly restored after cycling training. Actively engaging the arms in rehabilitation paradigms for the improvement of walking substantially regulates the excitability of the lumbar spinal networks. The resulting regulation may be better than that obtained by interventions that focus on training of the legs only.

Potential Relevance of Altered Muscle Activity and Fatigue in the Development of Performance-Related Musculoskeletal Injuries in High String Musicians.

BACKGROUND: Muscle fatigue seems to be a risk factor in the development of performance-related musculoskeletal disorders (PRMDs) in musicians, but it is unclear how muscle activity characteristics change between musicians with and without PRMDs over a prolonged playing period. PURPOSE: To investigate muscle activity patterns in muscles of the arms, shoulder, and back of high string musicians during prolonged performance. METHODS: Fifteen professional or university high string musicians were divided into PRMD and non-PRMD groups. All musicians played a chromatic scale, then an individual "heavy" piece for 1 hr, and finally the chromatic scale again. Surface electromyography (sEMG) data were recorded from 16 muscles of the arm, shoulder, and trunk on both sides of the body. Two parameters were analyzed: the percentage load in relation to the respective maximum force during the chromatic scale, and the low-frequency spectrum to determine the fatigue behavior of muscles during the 1-hr play. RESULTS: Changes in muscle activation patterns were observed at the beginning and end of the trial duration; however, these varied depending on whether musicians had PRMDs or no PRMDs. In addition, low-frequency spectrum changes were observed after 1 hr of playing in the PRMD musicians, consistent with signs of muscular fatigue. CONCLUSION: Differences in muscle activity appear between high string musicians with and without PRMDs as well as altered frequency spectrum shifts, suggesting possible differential muscle fatigue effects between the groups. The applied sEMG analysis proved a suitable tool for detailed analysis of muscle activation characteristics over prolonged playing periods for musicians with and without PRMDs.

Prevalence of Playing-related Musculoskeletal Disorders in String Players: A Systematic Review.

OBJECTIVE: This systematic review aimed to assess the methodological quality of articles about the prevalence of playing-related musculoskeletal disorders (PRMDs) in string players and to identify the rate of prevalence and associated factors of PRMD. METHODS: Cross-sectional studies describing data on separate string players published in 5 different languages between January 1, 1980, and January 31, 2014, were included. The following databases were searched: MEDLINE, sciELO, and LILACS. Other sources and reference lists of published papers also were searched. The Loney Scale was used by 2 independent reviewers to evaluate the methodological quality, and only studies that achieved high scores were included. RESULTS: Of 1910 retrieved articles, 34 cross-sectional studies were selected for methodological assessment. However, only 8 studies reached satisfactory methodological quality scores. The prevalence rate of PRMD was alarmingly high, ranging from 64.1% to 90%. Women and older musicians were more affected in comparison to other instrumentalists. There seems to be a predominance of symptoms in the left upper limb in violinists and violists, whereas cellists and bassists report injuries in the right upper limb. CONCLUSIONS: Professional and amateur string players are subject to development of PRMD. Low response rates were the most observed source of bias, and there is still a lack of publications with high methodological quality in the literature.

Association between spectral characteristics of paraspinal muscles and functional disability in patients with low back pain: a cohort study.

OBJECTIVES: Characteristics of muscle activity, represented by surface electromyography (EMG), have revealed differences between patients with low back pain (LBP) and healthy adults; how they relate to functional and clinical parameters remains unclear. The purpose of the current study was to examine the correlation between frequency characteristics of EMG (analysed using continuous wavelet transform (CWT) analysis) and patients' self-rated score of disability. DESIGN AND SETTING: This is a case-control study with 15 patients with mechanical LBP without radicular symptoms. Patients were recruited from the orthopaedic clinic at Charing Cross Hospital. Ten healthy adults were recruited from the staff working in the hospital and associated university. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) and bilateral EMG activity was obtained from erector spinae at vertebral levels L4 and T12. Subjects performed three brief maximal voluntary isometric contractions (MVICs) of the back extensors and the torque was measured using a dynamometer. CWT was applied to the EMG signals of each muscle in a 200 ms window centred around the peak torque obtained during the MVICs. The ratio (low/high frequencies) of the energy, the peak power and the frequency of the peak power were calculated for each recording site, averaged and correlated with the individual's RMDQ score. RESULTS: Patients had lower peak power (T12 and L4) and lower frequency of the peak power (at T12) than the healthy adults. Additionally, RMDQ positively correlated to the average ratio of energy at T12 (r=0.63; p=0.012), that is, greater self-rated disability corresponded to a dominant distribution of energy in the lower frequencies. CONCLUSION: The current findings reveal alterations in EMG profile and its association with self-related back pain disability, suggesting that spectral characteristics of EMG reflect muscle function.

Measurement properties of instruments assessing permanent functional impairment of the spine: a systematic review protocol.

INTRODUCTION: Permanent functional impairment (PFI) of the spine is a rating system used by compensation authorities, such as workers compensation boards, to establish an appropriate level of financial compensation for persistent loss of function. Determination of PFI of the spine is commonly based on the assessment of spinal movement combined with other measures of physical and functional impairments; however, the reliability and validity of the measurement instruments used for these evaluations have yet to be established. The aim of this study is to systematically review and synthesise the literature concerning measurement properties of the various and different instruments used for assessing PFI of the spine. METHODS: Three conceptual groups of terms (1) PFI, (2) spinal disorder and (3) measurement properties will be combined to search Medline, EMBASE, CINAHL, Web of Science, Scopus, PEDro, OTSeeker and Health and Safety Science Abstracts. We will examine peer-reviewed, full-text articles over the full available date range. Two reviewers will independently screen citations (title, abstract and full text) and perform data extraction. Included studies will be appraised as to their methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. Findings will be summarised and presented descriptively, with meta-analysis pursued as appropriate. ETHICS AND DISSEMINATION: This review will summarise the current level of evidence of measurement properties of instruments used for assessing PFI of the spine. Findings of this review may be applicable to clinicians, policy-makers, workers' compensation boards, other insurers and health and safety organisations. The findings will likely provide a foundation and direction for future research priorities for assessing spinal PFI. PROSPERO REGISTRATION NUMBER: CRD42017060390.

Tailor-made management of thoracic scoliosis with cervical hyperextension in muscular dystrophy.

PURPOSE: We report the case of a 13-year-old boy managed for fixed cervical hyperextension due to congenital muscular dystrophy with partial merosin deficiency. He presented a right decompensated thoracic scoliosis (T6-L1 Cobb angle 72°) associated with cervical and lumbar lordosis. The spinal extension was accompanied by major flexion of the hip resulting in the trunk being bent forward. This posture caused daily severe back pain responsible for significant loss of quality of life. This led to the decision to perform surgery. METHODS: Initially, the surgery was limited to the thoraco-lumbo-sacral area. An anterior release was done, followed by posterior T1-pelvis vertebral fusion using a modified Luque-Galveston technique. The correction achieved was satisfactory in the coronal plane, but the correction of the thoracic kyphosis was insufficient to compensate for the cervical hyperextension. Cervical spine was fixed at 52° of lordosis, and associated with a left 50° rotation and a right 45° inclination of the head. We performed a posterior and lateral release of the cervical muscles followed by positioning of the halo, itself connected to a made-for-measure thoracic corset. A daily adjustment of the threaded rods was done daily for 3 months to correct the cervical position. Then, we performed a spinal fusion without instrumentation, by posterior articular abrasion and grafting from the occiput to T1. Following that, the halo-corset was kept in place for 4 months. RESULTS: At the end of 8 month treatment, the clinical result was satisfactory with a balanced spine both face on, and sideways, allowing for comfortable painless positioning. At 5 year follow-up, he showed stable spinal fusion without any loss of correction. CONCLUSION: There is no gold standard treatment for cervical hyperextension, but approaches have to be tailor-made to the patient's needs and the team's experience.

Pre-existing low-back symptoms impact adversely on sitting time reduction in office workers.

OBJECTIVES: Initiatives to reduce office-workplace sitting are proliferating, but the impact of pre-existing musculoskeletal symptoms on their effectiveness has not been determined. We assessed the influence of musculoskeletal symptoms on the outcomes of a workplace sitting intervention. METHODS: Baseline and 3-month data from a cluster-randomized controlled trial of a workplace sitting intervention (Stand Up Victoria; trial registration number ACTRN12611000742976) were used. Office workers (n = 231) from 14 work teams within one organisation were randomised (by worksite) to a multicomponent program with individual-, organisational-, and environmental-level (sit-stand workstations) change strategies; or, to a control condition (no intervention). Musculoskeletal symptoms in the low-back, upper and lower extremities (present/absent) were assessed through self-report. Linear regression models tested the moderation by baseline musculoskeletal symptoms of intervention effects on workplace sitting and standing time and on sitting and standing bout durations, assessed by the activPAL3™ activity monitor. RESULTS: There were significant reductions in sitting and increased standing at work (p < 0.05). However, effects varied significantly by the presence of pre-existing low-back (but not other) symptoms, with greater benefit being seen in those without symptoms. Effects on sitting time and sitting bout duration were weaker in those with low-back symptoms compared to those without by 34.6 [95% CI (0.9; 68.3)] min/8-h workday and 5.1 [95% CI (0.2; 9.9)] min, respectively. Comparable effects were seen for standing. CONCLUSION: Low-back symptoms may impact on the extent to which office workers change their workplace sitting and standing time. A prudent next step to improve the effectiveness of workplace sitting-reduction initiatives such as Stand Up Victoria may be to assess and address the needs of those who displayed comparatively limited behaviour change, namely those with pre-existing low-back discomfort.

Effect of MELT method on thoracolumbar connective tissue: The full study.

Altered connective tissue structure has been identified in adults with chronic low back pain (LBP). A self-care treatment for managing LBP is the MELT method. The MELT method is a hands-off, self-treatment that is said to alleviate chronic pain, release tension and restore mobility, utilizing specialized soft treatments balls, soft body roller and techniques mimicking manual therapy. The objective of this study was to determine whether thickness of thoracolumbar connective tissue and biomechanical and viscoelastic properties of myofascial tissue in the low back region change in subjects with chronic LBP as a result of MELT. This study was designed using a quasi experimental pre-post- design that analyzed data from subjects who performed MELT. Using ultrasound imaging and an algorithm developed in MATLAB, thickness of thoracolumbar connective tissue was analyzed in 22 subjects. A hand-held digital palpation device, called the MyotonPRO, was used to assess biomechanical properties such as stiffness, elasticity, tone and mechanical stress relaxation time of the thoracolumbar myofascial tissue. A forward bending test assessing flexibility and pain scale was added to see if MELT affected subjects with chronic LBP. A significant decrease in connective tissue thickness and pain was observed in participants. Significant increase in flexibility was also recorded.

Effects of an intervention based on the Transtheoretical Model on back muscle endurance, physical function and pain in rice farmers with chronic low back pain.

BACKGROUND: Chronic low back pain (LBP) can be managed by exercises which should be tailored to an individual's readiness to behavioral change. OBJECTIVE: To evaluate the effects of an intervention program based on the Transtheoretical Model of behavioral change (TTM) on back muscle endurance, physical function and pain in rice farmers with chronic LBP. METHODS: In a 32-week study, 126 rice farmers were allocated to the TTM (n= 62) and non-TTM (n= 64) groups. Modified Biering-Sorensen test, Oswestry Disability Questionnaire and visual analogue scale were used for evaluating back muscle endurance, physical function and severity of pain, respectively. The evaluations were performed at baseline and at weeks 8, 20 and 32 of the study. Data were analyzed using repeated measure ANOVA. RESULTS: The back muscle endurance was significantly greater in the TTM group than in the non-TTM group at week 32 (p= 0.025). Physical function and severity of pain were significantly improved in the TTM group when compared with the non-TTM group at weeks 20 and 32 (p< 0.01). CONCLUSIONS: A TTM-based intervention could improve back muscle endurance and physical function, and reduce the pain in rice farmers with LBP. Further studies should be considered to explore the long-term effects of this intervention.