Association of demographics, lumbar active range of motion and disability in chronic low back: a baseline data analysis of a randomized controlled trial from Pakistan.

BACKGROUND: The disability and significant economic costs accredited to Low back pain (LBP) are likely to rise which is an essential problem in low and middle-income countries like Pakistan. The associated factors of LBP are age, sex, and race including physical activity, high spinal load, lifting, bending, and twisting occupations. The literature highlighted there is substantial differences in associated factors of LBP within available studies in developing countries. The objective is to investigate the association of demographic factors and lumbar range of motion with disability in patients with chronic low back. METHODS: A baseline data analysis was performed as an analytical cross-sectional study among 150 patients with chronic low back in a randomized controlled trial with a duration from March 2020 and January 2021. After recording demographics, Modified-Modified Schober's test was used to measure lumbar flexion and extension and Oswestry disability index for disability. After the descriptive analysis the continuous variables, age and pain were analyzed with Spearman's correlation. Variables that were significant in bivariate analysis were then fitted in a multivariable linear regression. The Kruskal-Wallis test was used to analyze variations of disability in gender, marital status, work status, education level, and duration of pain. The p-value of 0.05 was significant. RESULTS: The results showed a significant correlation between age and pain in sitting (rh=-0.189, p = 0.021 and rh = 0.788, p < 0.001) with the disability but no significant effects of age and pain in sitting (B=-0.124, p = 0.212 and B = 1.128, p = 0.082) on disability were found. The decrease in lumbar flexion and extension was found to increase disability (B=-6.018 and - 4.032 respectively with p < 0.001). Female gender (x2(1) = 15.477, p = < 0.001) and unmarried marital status (x2(1) = 4.539, p = 0.033) had more disability than male gender and married marital status, respectively. There was a significance between groups of the duration of pain regarding disability (x2 (2) = 70.905, p < 0.001). Age, education level, and work status showed no significance (p > 0.05). CONCLUSIONS: The female gender and unmarried marital status are associated with functional disability. Decreased lumbar range of motion accompanies more disability, while age, education level, and work status do not effect on disability.

Dynamic soft tissue mobilization versus proprioceptive neuromuscular facilitation in reducing hamstring muscle tightness in patients with knee osteoarthritis: a randomized control trial.

BACKGROUND: Knee osteoarthritis (KOA) considered as one of the most common degenerative diseases of synovial joint. KOA is mostly managed by physical therapy, focused on pain management, the range of motion and muscle strengthening but muscle flexibility is usually neglected. A study was conducted to evaluate the effectiveness of dynamic soft tissue mobilization (DSTM) in comparison with the proprioceptive neuromuscular facilitation (PNF) stretching in the management of hamstring tightness, reduction of pain intensity and improvement of physical functionality in KOA. METHODS: Forty eight patients with KOA were randomly allocated to group A receiving DTSM and group B receiving PNF stretching. The cryotherapy and isometric strengthening exercises were also given to both groups. Total treatment duration consisted of 4 weeks, 3 sessions per week and total 12 sessions per patient. Each treatment session comprised of 30 min. At baseline and post treatment, Active knee extension test(AKET), Visual analogue scale (VAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were used to assess hamstring flexibility, pain intensity level and physical functional capability respectively. The continuous variables were shown as mean and standard deviations. For the comparison of outcome within and between groups, paired sample and independent t-test was applied. Considerable p value was less than 0.05. RESULTS: The between group analysis of VAS, right AKE test, and left AKE test showed non-significant (p > 0.05) mean difference as 0.2 (95% CI= -0.29, 0.70), 1.79 (95% CI= -1.84, 4.59), 1.78 (95% CI= -1.6, 5.19) respectively. KOOS domains of symptom, pain, ADLs, sports and recreational, and quality of life had also non-significant (p > 0.05) mean difference as 1.12 (95% CI= -4.05, 6.3), -5.12 (95% CI= -12.71, 2.46), -2.55 (95% CI= -7.47, 2.38), -2.7 (95% CI= -9.72, 4.3), and - 0.68 (95% CI= -7.69, 6.36) respectively. Significant (p < 0.001) improvement was shown in both groups for all outcome measures after 12 sessions. CONCLUSION: DSTM and PNF stretching, both treatments are equally beneficial in KOA for hamstring flexibility, pain reduction and functional mobility in terms of AKET, VAS, and KOOS respectively. TRIAL REGISTRATION: ClincalTrials.Gov with ID: NCT04925895, 14/06/2021, retrospectively registered.

Efficiency of proteolytic enzymes in treating lumbar spine osteoarthritis (low back pain) patients and its effects on liver and kidney enzymes.

Lumbar spine osteoarthritis with 40-85% prevalence, degeneration of spine with remarkable narrowing of disc space and osteophytes formation trigger pain in lower back. Pain in lower portion of back is now considered to be the second most commonly treated health issue in primary health care setups. This pain causes disability, functional loss and job absentees. Commonly pain is managed pharmacologically by NSAIDS but resulted in severe gastric side effects. The purpose of this trial was to appraise the properties of bromelain and papain, the vegetal proteolytic enzymes, in comparison with standard drug on LBP patients. Forty men and women with lumbar spine osteoarthritis were recruited and divided into group 1, received aceclofenac 100mg tablet b.i.d as standard treatment, group 2, patients treated with aceclofenac 100 mg tablet b.i.d and enzyme supplements 250 mg b.i.d for 6 weeks. All the participants were evaluated for their body mass index, vital signs and liver/kidney enzymes before and after treatment. Moreover intensity of pain were also measured through visual analogue scale (VAS) and oswestry low back pain questionnaire (ODI) before treatment (0 week), 3rd week and 6th week of treatment. The enzyme group patients showed significantly diminished pain scores VAS from 7.10±1.29 to 5.85±1.531*** (P=0.001), ODI score from 56.2±8.70 to 51.6±8.125*** (P=0.000), significantly diminished enzymes; ALP from 210.00±55.24 to 196.90±51.02 (P=0.054*) and serum creatinine from 0.97±0.153 to 0.87±0.139 (P=0.035*) and improved quality of life. Hence, this study suggested that the enzyme supplements for 6 weeks have prolonged beneficial carry-over effects in comparison to standard treatment without producing any change in BMI (P>0.05) and vital signs (P> 0.05).