BACKGROUND AND OBJECTIVE

The Oswestry Disability Index (ODI)–English is a valid and reliable instrument for disability measurement in low back pain (LBP) patients. There is no existing ODI–Ilokano that evaluates LBP patients. This study aimed to cross-culturally adapt the ODI–English into Ilokano.

The ODI–English was cross-culturally adapted into Ilokano through a process that included forward translation, synthesis of the translations, back translation, expert committee review, and testing of the pre-final version.

Forward translation focused on capturing the essence of terms related to pain intensity, personal care, and daily activities, achieving consensus on phrases that accurately mirrored the original English meanings. Subsequent synthesis refined these translations, emphasizing idiomatic and conceptual equivalence over literal interpretations, particularly in nuanced areas like sleep disturbance and social life activities. Backward translation processes aligned Ilokano and English terms, especially for pain intensity and personal care, ensuring consistency across languages. The expert committee review addressed spelling, word choice, and sentence structure, making strategic adjustments for cultural relevance. Pilot testing with participants from Ilocos Norte and Ilocos Sur, Philippines highlighted comprehension challenges with specific terms, leading to adaptations like replacing 'milya' and 'yarda' with metric units and retaining culturally sensitive terms with supplementary English explanations.

This study refined the ODI–English into a culturally adapted Ilokano version, focusing on semantic, idiomatic, and cultural equivalence. Incorporating pilot testing feedback, such as modifying measurement units and addressing sensitive terms, highlighted the thorough adaptation process. The collaborative translation efforts and diverse patient input ensured a culturally resonant ODI version for Ilokano speakers. This adaptation enhances physical therapy practices by improving patient assessments and advocates for adapting patient-reported outcomes to diverse cultures, advancing patient-centered care.

BACKGROUND

Low back pain is a major global cause of disability, typically treated through traditional onsite rehabilitation. However, the advancement of telerehabilitation during the COVID-19 pandemic presents an opportunity to examine its effectiveness as a treatment option for low back pain. This study aims to seek and explore the experiences and perspectives of healthcare professionals about onsite or online management of LBP.

The study will employ a phenomenological qualitative study design that will use quota sampling to recruit a total of 16 participants, equally distributed among rehabilitation doctors, physical therapists, barangay healthworkers, and patients with low back pain, coming from hospitals and centers affiliated with the University of Santo Tomas in Metro Manila. Key informant interviews that follow a semi-structured interview format will be conducted either on-site or online, depending on the preference of the invited informant. The NVivo data analysis software will be utilized to produce codes and outline themes from the gathered data.

The research is expected to highlight the nuanced interplay between individual viewpoints and contextual factors that influence decision-making in rehabilitation settings, besides identifying these themes. Findings will be instrumental in informing best practices for managing low back pain, thereby helping physical therapists determine the most effective treatment approach—whether through telerehabilitation or traditional on-site care. The study can provide actionable recommendations through grounding the implications of the analysis to the anticipated findings that might affect the rehabilitation practices and patient outcomes in the Philippines.

BACKGROUND AND OBJECTIVE

Low back pain is one of the most common work-related musculoskeletal disorders. Healthcare workers are prone to low back pain because of the nature of their profession. Low back pain may be related to lumbar multifidi atrophy or instability and poor core stability. Core stability can be assessed using the unilateral hip bridge endurance test. This cross-sectional study aims to determine the correlation between unilateral hip bridge endurance (UHBE) and sonologic characteristics of the bilateral L4-L5 lumbar multifidus muscles of physically active allied healthcare professionals.

Forty (40) physically active healthcare professionals (mean age = 31.3 ± 6.39 years, mean height = 161.17 ± 8.45 cm, mean weight = 61.88 ± 13.58 kg, mean BMI = 23.61 ± 3.68 kg/m2) were recruited via purposive sampling. The participants answered online versions of the Global Physical Activity Questionnaire (GPAQ) and Oswestry Disability Index. They subsequently underwent the UHBE test and ultrasound assessment of the L4-L5 multifidi. Multiplied anteroposterior (AP) and lateral linear (L) measurements were used to estimate L4-L5 multifidi size. The Pearson test was used to test for correlation between the primary outcomes of the study.

There was no statistically significant correlation between Lumbar Multifidi CSA and UHBE Scores (r = -0.172, p > 0.05), and between Lumbar Multifidi CSA% Difference and UHBE Scores (r = -0.140, p > 0.05). However, results showed a very weak negative correlation between the Lumbar Multifidi CSA% Difference and UHBE Scores.

There is no definite evidence showing a correlation between core stability tests such as the unilateral hip bridge test scores and sonologic characteristics of the lumbar multifidi. However, lumbar multifidi symmetry may have a role with core stability. The correlation between core stability tests and lumbar multifidus morphology should be further investigated.

Based on the physiological and pathological characteristics of meridian sinew theory, the staging treatment of non-specific low back pain (NLBP) is explored to provide the reference of clinical practice. The twelve meridian sinews of the human body communicate with the bones and joints of the whole body, which governs the movement, body protection and defense, and meridian regulation. Physiologically, the meridian sinew maintains the functions of the lumbar region. In pathology, the meridian sinew may encounter stasis and pain, contraction and spasm or "transverse collateral" formation. According to the pathological staging of meridian sinew disorders, the progress of NLBP is divided into 3 phases and the corresponding treatments are provided. Mild stimulation and rapid analgesia is suggested to promote tissue repair at the early phase; muscle spasm is relieved to adjust muscular status at the middle phase; and the "cord-like" muscle foci is removed at the later phase of the disease.
Humans ; Low Back Pain ; Meridians ; Pain Management ; Analgesia ; Lumbosacral Region

OBJECTIVE: To assess the clinical effects of percutaneous endoscopic surgery through two different approaches for stable degenerative lumbar spondylolisthesis. METHODS: Sixty-four patients with stable degenerative lumbar spondylolisthesis who underwent percutaneous endoscopic procedures between January 2016 and December 2019 were divided into transforaminal approach group and interlaminar approach group according to surgical approaches, 32 patients in each group. There were 16 males and 16 females in transforaminal approach group, aged from 52 to 84 years old with an average of (66.03±9.60) years, L₂ slippage in 4 cases, L₃ slippage in 5, and L₄ slippage in 23. There were 17 males and 15 females in interlaminar approach group, aged from 46 to 81 years old with an average of (61.38±9.88) years, L₃ slippage in 3 cases, L₄ slippage in 15, and L₅ slippage in 14. Operative time, intraoperative fluoroscopy times, and postoperative bedtime were compared between two groups. Anteroposterior displacement values, interbody opening angles, and the percentage of slippage were measured on preoperative and postoperative 12-month dynamic radiographs. Visual analogue scale (VAS) of low back pain and lower extremity pain, and the Japanese Orthopaedic Association (JOA) score before and after surgery were observed, and clinical effects were evaluated according to the modified MACNAB criteria. RESULTS: All operations were successfully completed, and patients in both groups were followed up for more than 1 year, and without complications during follow-up period. ①There was no significant difference in operation time between two groups(P>0.05). Intraoperative fluoroscopy times were longer in transforaminal approach group than that in intervertebral approach group(P<0.05). Postoperative bedtime was shorter in transforaminal approach group than that in intervertebral approach group (P<0.05).② No lumbar instability was found on dynamic radiography at 12 months postoperatively in both groups. There were no significant differences in anteroposterior displacement values, interbody opening angles, and the percentage of slippage between two groups postoperative 12 months and preoperative 1 day(P>0.05). ③There was no significant difference between two groups in VAS of low back pain at 3 days and 1, 12 months after the operation compared with the preoperative(P>0.05), but the VAS of the lower extremity pain was significantly improved compared with the preoperative(P<0.05). Both of groups showed significant improvement in JOA score at 12 months compared with preoperatively(P<0.05). There was no significant difference in VAS of low back pain, lower extremity pain and JOA scores between two groups during the same period after surgery(P>0.05). According to modified Macnab criteria, excellent, good, fair and poor outcomes were 21, 7, 3 and 1 in transforaminal approach group respectively, and which in intervertebral approach group were 20, 7, 5 and 0, there was no significant difference in clinical effect between the groups(P>0.05). CONCLUSION Intervertebral approach may reduce intraoperative fluoroscopy times and transforaminal approach can shorten postoperative bedtime, both approaches achieve satisfactory results in the treatment of stable degenerative lumbar spondylolisthesis with no progression of short-term slippage.
Male ; Female ; Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Spondylolisthesis/surgery* ; Low Back Pain/surgery* ; Treatment Outcome ; Lumbar Vertebrae/surgery* ; Spinal Fusion/methods* ; Retrospective Studies

BACKGROUND: Low-back pain (LBP) in nurses is a major health concern that affects their quality of life and ability to work, with consequences for their economic status. OBJECTIVE: This study evaluates the effect of low-level laser acupuncture combined with auricular acupressure (LAA) on pain intensity, pain interference and quality of life in nurses with LBP. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This randomized controlled trial recruited a convenience sample of hospital-based nurses from one teaching hospital in Taiwan, China. Participants were randomly assigned to the LAA group (n = 38) receiving low-level laser acupuncture and auricular acupressure for 4 weeks, and the control group (n = 38) receiving only sham laser acupuncture treatment without laser energy output. MAIN OUTCOME MEASURES: Data were collected for the primary pain outcome using the Short Form of the Brief Pain Inventory, while the secondary outcome, quality of life, was evaluated using the Roland-Morris Disability Questionnaire. Both primary and secondary outcomes were scored before the intervention, and after 2-week and 4-week intervention. The rate of LBP recurrence was evaluated at the 4th week and 8th week after the end of intervention. RESULTS: After controlling for prior pain, the result of linear mixed model analysis showed trends in significant between-group differences in the level of current pain occurring in week 4 (P < 0.001), worst pain in week 2 (P < 0.001) and week 4 (P < 0.001), least pain in week 2 (P = 0.032) and week 4 (P < 0.001), pain interference in week 2 (P = 0.009) and week 4 (P < 0.001), and in the life dysfunction in week 2 (P < 0.001) and week 4 (P < 0.001). Recurrence rates of LBP at the 4th and 8th weeks after the end of intervention were 0% and 36.89% in the LAA group, and 69.44% and 36.11% in the control group. CONCLUSION: This study shows that 4-week LAA intervention reduced pain intensity and pain interference, and improved quality of life for hospital-based nurses with LBP. These effects were maintained continuously for at least 4 weeks after the intervention. The nonpharmacological intervention, LAA, may be another efficacious, feasible, noninvasive, analgesic intervention for LBP. TRIAL REGISTRATION This study is registered at Clinicaltrials.gov (registration number NCT04423445).
Humans ; Acupressure ; Quality of Life ; Treatment Outcome ; Low Back Pain/therapy* ; Acupuncture Therapy ; Nurses

This study aims to provide evidence for clinical practice by systematically reviewing the efficacy and safety of Gusongbao preparation in the treatment of primary osteoporosis(POP). The relevant papers were retrieved from four Chinese academic journal databases and four English academic journal databases(from inception to May 31, 2022). The randomized controlled trial(RCT) of Gusongbao preparation in the treatment of POP was included after screening according to the inclusion and exclusion criteria. The quality of articles was evaluated using risk assessment tools, and the extracted data were subjected to Meta-analysis in RevMan 5.3. A total of 657 articles were retrieved, in which 15 articles were included in this study, which involved 16 RCTs. A total of 3 292 patients(1 071 in the observation group and 2 221 in the control group) were included in this study. In the treatment of POP, Gusongbao preparation+conventional treatment was superior to conventional treatment alone in terms of increasing lumbar spine(L2-L4) bone mineral density(MD=0.03, 95%CI[0.02, 0.04], P<0.000 01) and femoral neck bone mineral density, reducing low back pain(MD=-1.69, 95%CI[-2.46,-0.92], P<0.000 1) and improving clinical efficacy(RR=1.36, 95%CI[1.21, 1.53], P<0.000 01). Gusongbao preparation was comparable to similar Chinese patent medicines in terms of improving clinical efficacy(RR=0.95, 95%CI[0.86, 1.04], P=0.23). Gusongbao preparation was inferior to similar Chinese patent medicines in reducing traditional Chinese medicine syndrome scores(MD=1.08, 95%CI[0.44, 1.71], P=0.000 9) and improving Chinese medicine syndrome efficacy(RR=0.89, 95%CI[0.83, 0.95], P=0.000 4). The incidence of adverse reactions of Gusongbao preparation alone or combined with conventio-nal treatment was comparable to that of similar Chinese patent medicines(RR=0.98, 95%CI[0.57, 1.69], P=0.94) or conventio-nal treatment(RR=0.73, 95%CI[0.38, 1.42], P=0.35), and the adverse reactions were mainly gastrointestinal discomforts. According to the available data, Gusongbao preparation combined with conventional treatment is more effective than conventional treatment alone in increasing lumbar spine(L2-L4) bone mineral density and femoral neck bone mineral density, reducing low back pain, and improving clinical efficacy. The adverse reactions of Gusongbao preparation were mainly gastrointestinal discomforts, which were mild.
Humans ; Bone Density ; Low Back Pain ; Medicine, Chinese Traditional ; Osteoporosis/drug therapy*

OBJECTIVE: To analyze the early effectiveness of unilateral biportal endoscopy (UBE) laminectomy in the treatment of two-level lumbar spinal stenosis (LSS). METHODS: The clinical data of 98 patients with two-level LSS treated with UBE between September 2020 and December 2021 were retrospectively analyzed. There were 53 males and 45 females with an average age of 59.9 years (range, 32-79 years). Among them, there were 56 cases of mixed spinal stenosis, 23 cases of central spinal canal stenosis, and 19 cases of nerve root canal stenosis. The duration of symptoms was 1.5- 10 years, with an average of 5.4 years. The operative segments were L _{2, 3} and L _{3, 4} in 2 cases, L _{3, 4} and L _{4, 5} in 29 cases, L _{4, 5} and L _5, S ₁ in 67 cases. All patients had different degrees of low back pain, among of which 76 cases were with unilateral lower extremity symptoms and 22 cases were with bilateral lower extremity symptoms. There were 29 cases of bilateral decompression in both segments, 63 cases of unilateral decompression in both segments, and 6 cases of unilateral decompression and bilateral decompression of each segment. The operation time, intraoperative blood loss, total incision length, hospitalization stay, ambulation time, and related complications were recorded. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months after operation, and at last follow-up. The Oswestry disability index (ODI) was used to evaluate the functional recovery of lumbar spine before operation and at 3 months and last follow-up after operation. Modified MacNab criteria was used to evaluate clinical outcomes at last follow-up. Imaging examinations were performed before and after operation to measure the preservation rate of articular process, modified Pfirrmann scale, disc height (DH), lumbar lordosis angle (LLA), and cross-sectional area of the canal (CAC), and the CAC improvement rate was calculated. RESULTS: All patients underwent surgery successfully. The operation time was (106.7±25.1) minutes, the intraoperative blood loss was (67.7±14.2) mL, and the total incision length was (3.2±0.4) cm. The hospitalization stay was 8 (7, 9) days, and the ambulation time was 3 (3, 4) days. All the wounds healed by first intention. Dural tear occurred in 1 case during operation, and mild headache occurred in 1 case after operation. All patients were followed up 13-28 months with an average of 19.3 months, and there was no recurrence or reoperation during the follow-up. At last follow-up, the preservation rate of articular process was 84.7%±7.3%. The modified Pfirrmann scale and DH were significantly different from those before operation ( P<0.05), while the LLA was not significantly different from that before operation ( P=0.050). The CAC significantly improved ( P<0.05), and the CAC improvement rate was 108.1%±17.8%. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and the differences between each time points were significant ( P<0.05). According to the modified MacNab criteria, 63 cases were excellent, 25 cases were good, and 10 cases were fair, with an excellent and good rate of 89.8%. CONCLUSION UBE laminectomy is a safe and effective technique with little trauma and fast recovery for two-level LSS and the early effectiveness is satisfactory.
Male ; Female ; Humans ; Middle Aged ; Laminectomy ; Spinal Stenosis/surgery* ; Constriction, Pathologic/surgery* ; Low Back Pain ; Retrospective Studies ; Blood Loss, Surgical ; Endoscopy ; Lumbar Vertebrae/surgery* ; Spinal Fusion/methods* ; Decompression, Surgical ; Surgical Wound/surgery* ; Treatment Outcome

This study systematically searched and sorted out randomized controlled trial(RCT) of acupuncture-moxibustion treatment for non-specific low back pain by scoping review, so as to demonstrate the current state of the research evidence and provide a reference point for future clinical research and healthcare decision-making. Eight commonly used Chinese and English databases were searched, and the search time was from the establishment of the databases to July 7, 2023, so as to analyze the characteristics of the current status of the current research through visualization methods. A total of 50 studies were included, including 23 studies in Chinese and 27 studies in English. The overall number of studies showed an increasing trend. The percentage of studies published in Chinese non-core journals was 42.0%. The disease subtypes of interest were mainly chronic non-specific low back pain, accounting for 68.0% of the studies. The sample sizes of the studies were mainly concentrated in the range of 50-100 cases. A total of 15 types of interventions were categorized, with acupuncture interventions being the most studied. Duration of treatment did not exceed one month in 80.0% of the studies. Only 8.0% of the studies used minimal clinical important difference(MCID) as a basis for judgment. The follow-up period was set within 3 months in 28.0% of the studies, and 82.0% of the studies concluded that acupuncture-moxibustion was effective in the treatment of non-specific lower back pain. Adverse events were reported in 20.0% of the studies. The risk of bias in the included studies was dominated by low risk of bias and uncertain risk of bias, with fewer studies focusing on high risks of bias. In most of the studies, acupuncture-moxibustion was significantly more effective than the control group. The research on acupuncture-moxibustion treatment for non-specific low back pain is developing rapidly, but there are still insufficient studies on psychological state, safety, and other indicators, and there are still some studies with uncertain risks of bias, which is not conducive to the generalization and application of the findings. Therefore, future studies should improve and refine these shortcomings.
Humans ; Acupuncture Therapy/methods* ; Low Back Pain/etiology* ; Moxibustion/methods* ; Randomized Controlled Trials as Topic

OBJECTIVE: To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L_{4, 5} degenerative lumbar spondylolisthesis (DLS). METHODS: The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. RESULTS: Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). CONCLUSION OSE-assisted posterolateral approach lumbar interbody fusion for L_{4, 5} DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.
Humans ; Spondylolisthesis/surgery* ; Low Back Pain/surgery* ; Retrospective Studies ; Lumbosacral Region ; Blood Loss, Surgical ; Endoscopes