Body Mass Index ; Female ; Humans ; Male ; Oxygen ; metabolism ; Oxygen Consumption ; physiology ; Sports ; physiology

BACKGROUND:Musculoskeletal complaints, especially non-traumatic neck and back pain, are routinely encountered in the emergency department (ED) and lead to ED overcrowding, a burgeoning wait time for physiotherapy and outpatient orthopedic reviews. The study aimed to evaluate the impact of early physiotherapy evaluation and treatment (EPET) vs. standard care (SC) on clinical outcomes for patients presenting to the ED with non-traumatic neck and back pain. METHODS:A retrospective observational study of 125 patients who presented to the ED with non-traumatic neck and back pain with/without peripheral symptoms from July 2010 to February 2011. Neck Disability Index (NDI), Modified Oswestry Low Back Pain Disability Questionnaire (MODI) and 11-point Numeric Pain Rating Scale were used as outcome measures and compared between groups at a mean of 34 days from their initial ED visit. RESULTS:We identified a total of 125 patients. EPET group comprised 62 patients (mean age, 45 years; men, 63％) and SC group comprised 63 patients (mean age, 45 years; men, 43％). The EPET and SC groups received physiotherapy at a median of 4 and 34 days respectively from their first ED visit. EPET patients had significantly lower levels of disability (9.0％ vs. 33.4％, Welch t-test, P<0.001) and pain (median value, 1 vs. 4 points, Mann-Whitney U-test, P<0.001) compared with SC patients. CONCLUSION:Early access to physiotherapy in ED was associated with reduced pain and disability levels. EPET protocol can potentially decrease the demand on outpatient orthopedic services, thereby freeing up available resources to treat patients who are more likely to benefit from it.

INTRODUCTIONThe purpose of the study was to examine the determinants of self-reported disability - MODQ (Modified Oswestry Low Back Pain Disability Questionnaire) in patients with low back pain (LBP); and to examine the level of FABQ (Fear-Avoidance Belief Questionnaires) scores in an ambulatory clinical population referred to physiotherapy management. We believe that identifying potentially modifiable determinants of disability in patients with LBP provides an opportunity to broaden the strategies to reduce its socioeconomic burden.

MATERIALS AND METHODSA retrospective study was designed to be conducted in the physiotherapy department of a local hospital. The data were taken from standard examination of patients [n = 162, female 15.4%, male 84.6%, age mean = 30.6 years [standard deviation (SD), 11.4; range, 17 to 68)] presenting to the department with acute or chronic LBP. The data included physical examination of back, self-reported disability by MODQ, fear-avoidance beliefs by FABQ, pain intensity and demographic information.

RESULTSThe final model generated by hierarchical regression analysis revealed that MODQ scores included self-reported symptom aggravation with all movements, pain medication usage, average straight leg raise (SLR), pain intensity, and Fear-Avoidance Belief Questionnaire-Work (FABQ-W). Overall, these variables account for approximately 40% of variance. The mediational analysis indicated that the relationship between the FABQ-W and MODQ scores may be partially mediated by pain intensity, average SLR values and pain medication usage.

CONCLUSIONIn this correlational study of physical impairments, psychosocial factors and self-reported disability, disability was driven primarily by measures of pain and fear-avoidance beliefs. Because the FABQ is a simple and useful clinical tool, we suggest that physicians and physiotherapists alike should make it a routine attempt to characterise the fear-avoidance beliefs of patients with LBP.

Adolescent ; Adult ; Aged ; Disability Evaluation ; Fear ; psychology ; Female ; Health Knowledge, Attitudes, Practice ; Health Status Indicators ; Health Surveys ; Humans ; Low Back Pain ; physiopathology ; psychology ; Male ; Middle Aged ; Pain Measurement ; Retrospective Studies ; Surveys and Questionnaires ; Work Capacity Evaluation

The use of isokinetic dynamometry has often been criticised based on the face-validity argument that isokinetic movements poorly resemble the everyday multi-segmented, dynamic activities of human movements. In the anterior cruciate ligament (ACL) reconstruction or deficiency population where muscle deficits are ubiquitous, this review paper has made a case for using isokinetic dynamometry to isolate and quantify these deficits in a safe and controlled manner. More importantly, the usefulness of isokinetic dynamometry, as applied in individuals with ACL reconstruction or deficiency, is attested by its established known-group and convergent validity. Known-group validity is demonstrated by the extent to which a given isokinetic measure is able to identify individuals who could and could not resume pre-morbid athletic or strenuous activities with minimal functional limitations following an ACL injury. Convergent validity is demonstrated by the extent to which a given isokinetic measure closely associates with self-report measures of knee function in individuals with ACL reconstruction. A basic understanding of the measurement properties of isokinetic dynamometry will guide the clinicians in providing reasoned interventions and advancing the clinical care of their clients.
Adolescent ; Adult ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; Biomechanical Phenomena ; Female ; Humans ; Knee Injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Muscle Contraction ; physiology ; Orthopedic Procedures ; Range of Motion, Articular ; physiology ; Torque