| 1. |
- Abbott, Allan, et al.
(författare)
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Is there a need for cervical collar usage post anterior cervical decompression and fusion? : A randomized control pilot trial
- 2013
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 29:4, s. 290-300
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Tidskriftsartikel (refereegranskat)abstract
- Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for radiculopathy resulting from degenerative cervical spine conditions. Post-surgical cervical collar use is believed to reduce post-operative pain, provide the patient with a sense of security during activities of daily living and even reduce rates of non-fusion. This prospective randomized controlled pilot trial investigates trial design feasibility in relation to prospective physical, functional, and quality of life-related outcomes of patients undergoing ACDF with interbody cage, with (n = 17) and without (n = 16) post-operative cervical collar usage. Results show that the sample provides sufficient statistical power to show that the use of a rigid cervical collar during 6 post-operative weeks is associated with significantly lower levels of neck disability index after 6 weeks and significantly lower levels of prospective neck pain. To investigate causal quality of life or fusion rate outcomes, sample size needs to be increased at least fourfold and optimally sixfold when accounting for data loss in prospective follow-up. The study suggests that post-surgical cervical collar usage may help certain patients cope with initial post-operative pain and disability.
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| 2. |
- Abbott, Allan, et al.
(författare)
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The validity of using an electrocutaneous device for pain assessment in patients with cervical radiculopathy
- 2014
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Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 30:7, s. 500-506
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to evaluate the validity and preference for assessing pain magnitude with electrocutaneous testing (ECT) compared to the visual analogue scale (VAS) and Borg CR10 scale in men and women with cervical radiculopathy of varying sensory phenotypes. An additional purpose was to investigate ECT sensory and pain thresholds in men and women with cervical radiculopathy of varying sensory phenotypes. This is a cross-sectional study of 34 patients with cervical radiculopathy. Scatterplots and linear regression were used to investigate bivariate relationships between ECT, VAS and Borg CR10 methods of pain magnitude measurement as well as ECT sensory and pain thresholds. The use of the ECT pain magnitude matching paradigm for patients with cervical radiculopathy with normal sensory phenotype shows good linear association with arm pain VAS (R(2) = 0.39), neck pain VAS (R(2) = 0.38), arm pain Borg CR10 scale (R(2) = 0.50) and neck pain Borg CR10 scale (R(2) = 0.49) suggesting acceptable validity of the procedure. For patients with hypoesthesia and hyperesthesia sensory phenotypes, the ECT pain magnitude matching paradigm does not show adequate linear association with rating scale methods rendering the validity of the procedure as doubtful. ECT for sensory and pain threshold investigation, however, provides a method to objectively assess global sensory function in conjunction with sensory receptor specific bedside examination measures.
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| 3. |
- Abbott, Allan, 1978-, et al.
(författare)
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What biopsychosocial factors are associated with work ability in conservatively managed patients with cervical radiculopathy? : A cross-sectional analysis
- 2020
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Ingår i: PM&R. - : John Wiley & Sons. - 1934-1482 .- 1934-1563. ; 12:1, s. 64-72
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundNo previous studies have investigated what biopsychosocial factors are associated with self‐reported work ability in conservatively managed patients with cervical radiculopathy.ObjectiveTo develop a theoretical model of factors and potential processes associated with variation in work ability based on a thorough assessment of biopsychosocial variables in conservatively managed patients with cervical radiculopathy.DesignCross‐sectional observational study.SettingTertiary neurosurgery clinic.PatientsA total of 144 conservatively managed patients with cervical pain and radiculopathy participated in the study.MethodsFrom 64 biopsychosocial candidate variables, significant (P < .05) bivariate correlators with Work Ability Index (WAI) were entered as independent variables in a categorical regression. Elastic net regularization maintained the most parsimonious set of independent variables significantly associated with variation in WAI as the dependent variable. Process analysis of significant independent variable associations with WAI was performed.Main Outcome MeasurementWAI.ResultsFrom 42 bivariate correlates of WAI, multivariate regression displayed a total of seven variables that were significantly (F [25,98] = 5.74, P < .05) associated with 65.8% of the variation in WAI. The Neck Disability Index (NDI) and Fear‐Avoidance Beliefs Questionnaire Work subscale (FABQ‐W) were significant individual factors within the final regression model. Process analysis displayed FABQ‐W having a significant specific indirect association with the direct association between NDI and WAI, with the model associated with 77% of the variability in WAI (F [2,84] = 141.17, P < .001).ConclusionOf 64 candidate biopsychosocial factors, NDI and FABQ‐W were the most significant multivariate correlates with work ability. FABQ‐W has a significant indirect association with baseline NDI scores and perceived work ability. This warrants future research trialing work‐related fear avoidance interventions in conservatively managed patients with cervical radiculopathy.Level of EvidenceIII
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| 4. |
- Dedering, Åsa
(författare)
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Lumbar muscle fatigue : analysis of electromyography, endurance time and subjective factors in patients with lumbar disc herniation and healthy subjects
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to investigate the relation between objectively and subjectively assessed lumbar muscle fatigue and subjective factors in patients with lumbar disc herniation and in healthy subjects. Eighty healthy subjects and 43 patients undergoing surgery for lumbar disc herniation and selected consecutively for the study participated. Muscle fatigue in the lower back was assessed during a modified Sorensen test, an isometric prone holding test for the back extensors against gravity and until exhaustion, or a staircase protocol (20%, 40%, 60%, and 80% of maximum voluntary contraction). Concomitantly, EMG was detected from the lumbar extensor muscles and subjects rated their perceived fatigue - and the patients also their pain - on a Borg CR- 10 scale. Recovery was assessed after the modified Sorensen test during 5-second contractions at 1-5 minutes of recovery then examined using an exponential time dependence model. To measure activity, participation, self-efficacy and health, the patients also filled in questionnaires. The reliability of the modified Sorensen test was also assessed. The modified Sorensen test with concomitant measures of EMG provided useful reliability (ICC>0.60) for evaluation purposes. Borg scale ratings correlated highly (r>0.7) with endurance time. The EMG median frequency slopes correlated low-to-moderately (r<0.54). At Borg rating 3 (moderate fatigu'), 5 (strong fatigue), and 7 (very strong fatigue), the medians of median frequency and endurance time had changed by 28-37%, 48-69%, 63-89% at each time respectively. This relation can be used in clinical testing where maximum endurance tests are unsuitable: a fixed time performance until Borg rating 5 may be used. That healthy women's back muscles were more fatigue-resistant than healthy men's was shown in a smaller median frequency decrease. However the opposite was indicated for patients with lumbar disc herniation. Elimination of pain due to surgery reduced muscle fatigue with respect to a smaller median frequency decrease but not enough to increase endurance time. Patients could not fatigue their muscles as much as healthy subjects could, as shown by significantly shorter endurance time and smaller median frequency decrease than healthy subjects. The applicability of the exponential time dependence model was excellent to all healthy subjects except three. Of the patients, only 14 had an exponential recovery process both before and after surgery indicating that the recovery process had been impaired due to the disc herniation. Measurements of fatigue and recovery were associated with activity limitations, participation restrictions, self-efficacy and health in patients with lumbar disc herniation. These interactions were seen by correlation coefficients of 0.53-0.95 between endurance time and some of the questionnaire answers, especially for women. Patients with non-significant fatigue and an impaired recovery process scored significantly worse on the questionnaires than those with both fatigue and non-impaired recovery.
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| 5. |
- Dedering, Åsa, et al.
(författare)
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Neck-specific training with a cognitive behavioural approach compared with prescribed physical activity in patients with cervical radiculopathy : a protocol of a prospective randomised clinical trial
- 2014
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Ingår i: BMC Musculoskeletal Disorders. - : BioMed Central. - 1471-2474. ; 15:274
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with cervical radiculopathy often have neck- and arm pain, neurological changes, activity limitations and difficulties in returning to work. Most patients are not candidates for surgery but are often treated with different conservative approaches and may be sick-listed for long periods. The purpose of the current study is to compare the effectiveness of neck- specific training versus prescribed physical activity. Methods/Design: The current protocol is a two armed intervention randomised clinical trial comparing the outcomes of patients receiving neck specific training or prescribed physical activity. A total of 144 patients with cervical radiculopathy will be randomly allocated to either of the two interventions. The interventions will be delivered by experienced physiotherapists and last 14 weeks. The primary outcome variable is neck- and arm pain intensity measured with a Visual Analogue Scale accompanied with secondary outcome measures of impairments and subjective health measurements collected before intervention and at 3, 6, 12 and 24 months after base-line assessment. Discussion: We anticipate that the results of this study will provide evidence to support recommendations as to the effectiveness of conservative interventions for patients with cervical radiculopathy.
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| 6. |
- Grooten, Wilhelmus Johannes Andreas, et al.
(författare)
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Summarizing the effects of different exercise types in chronic low back pain : a systematic review of systematic reviews
- 2022
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability.METHODS: We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022-01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE.RESULTS: Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention.CONCLUSIONS: Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources.TRIAL REGISTRATION: PROSPERO: Reg no 190409 Registration date 01AUG 2020.
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| 7. |
- Halvorsen, Marie, et al.
(författare)
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Endurance and fatigue characteristics in the neck muscles during sub-maximal isometric test in patients with cervical radiculopathy
- 2014
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Ingår i: European spine journal. - : Springer Berlin/Heidelberg. - 0940-6719 .- 1432-0932. ; 23:3, s. 590-598
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Tidskriftsartikel (refereegranskat)abstract
- PurposeThe aim of the study was to compare myoelectric manifestation in neck muscle endurance and fatigue characteristics during sub-maximal isometric endurance test in patients with cervical radiculopathy and asymptomatic subjects. An additional aim was to explore associations between primary neck muscle endurance, myoelectric fatigability, and self-rated levels of fatigue, pain and subjective health measurements in patients with cervical radiculopathy.MethodsMuscle fatigue in the ventral and dorsal neck muscles was assessed in patients with cervical radiculopathy and in an asymptomatic group during an isometric neck muscle endurance test in prone and supine. 46 patients and 34 asymptomatic subjects participated. Surface electromyography signals were recorded from the sternocleidomastoid, cervical paraspinal muscles and upper and middle trapezius bilaterally during the endurance test. Subjective health measurements were assessed with questionnaires.ResultsThe results showed altered neck muscle endurance in several of the muscles investigated with greater negative median frequency slope, greater variability, side imbalance, lower endurance time and higher experience of fatigue among the cervical radiculopathy patients compared with healthy subjects. Endurance times were significantly lower in both prone and in supine positions between the patients compared to asymptomatic subjects. During the neck muscle endurance test, fatigues in the upper trapezius muscles during the prone test and in the sternocleidomastoid muscles during the supine test were of more importance than self-perceived pain, fatigue, disability and kinesiophobia in predicting neck muscle endurance (NME).ConclusionNME testing in the primary neck muscles seems to be an important factor to take into consideration in rehabilitation.
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| 8. |
- Halvorsen, Marie, et al.
(författare)
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Endurance and fatigue characteristics of static test of the neck muscles in patients with cervical radiculopathy
- 2012
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Ingår i: Proceedings of the XIXth Congress of the International Society of Electrophysiology and Kinesiology. - : The International Society of Electrophysiology and Kinesiology (ISEK). - 9780646582283 ; , s. 55-55
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- INTRODUCTION: Neck muscle function is important for support and control of the cervical spine. With the application of frequency analysis of the electromyography (EMG) signal, the fatigue rate of muscles can be monitored. In several EMG studies, the neck muscles have been shown to fatigue faster in subjects with neck pain. This can be seen when the median frequency (MF) decreases when a contraction is sustained.AIM: In this experimental study the purpose was to evaluate patients with cervical radiculopathy compared to healthy subjects regarding changes in neckZmuscle fatigue during static endurance test in prone and supine.METHODS: A total of 33 patients (19 women and 14 men) with cervical radiculopathy and 28 healthy subjects (17 women and 11 men) were included in the study. Neck muscle fatigue was studied using EMG with surface electrodes bilaterally on cervical paraspinal and sternocleidomastoid muscle groups with electrode placement according to SENIAM. Measurements of neck muscle fatigue were performed in supine and prone positions until patient perceived time till exhaustion. Subjective neck muscle fatigue was rated on a Borg CRZ10 scale while subjective neck pain was measured on 0Z10 Visual analogue scale (VAS). Patients with cervical radiculopathy even completed the Neck Disability Index (NDI).RESULTS: The mean endurance time during static extension between groups was significantly different (p<0.001) with cervical radiculopathy patients recording 190 seconds (Sd=119) and the healthy subjects 509 seconds (Sd=213). Differences in mean endurance time during static flexion between groups were nonZsignificant with cervical radiculopathy patients recording 64 seconds (Sd=40) and the healthy subjects 96 seconds (Sd=69). Cervical radiculopathy patients MF EMG slope (Z0.039) for the right cervical paraspinal muscles significantly decreased (p=0.009) more the healthy subjects (Z0.017) during the extension test. NDI significantly correlated with MF EMG slope for both left (r=Z0.631 p= 0.001) and right side (r=Z0Z496 p=0.014) cervical paraspinal muscles during extension for the patient group.CONCLUSION: Patients with cervical radiculopathy perform similar to healthy subjects with regards to static supine flexion endurance time and cervical muscle fatigue. Patients with cervical radiculopathy however have significantly lower endurance times and fatigue faster in the right side cervical paraspinal muscles during static prone extension.ACKNOWLEDGEMENT: The authors declare no conflicts of interest. The present study was supported by funds from Karolinska Institute.
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| 9. |
- Hermansen, Anna, et al.
(författare)
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Dizziness and balance outcomes after two different postoperative rehabilitation approaches following neck surgery : analyses of a multicenter randomized controlled trial
- 2023
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Ingår i: Physiotherapy Theory and Practice. - Philadelphia, PA, United States : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 39:4, s. 750-760
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Tidskriftsartikel (refereegranskat)abstract
- Background Dizziness and balance problems are common symptoms in patients with cervical radiculopathy. Objective To evaluate the effect of neck surgery postoperatively combined with either structured rehabilitation or standard approach in patients with cervical radiculopathy and dizziness and/or balance problems, and investigate factors influencing dizziness and balance at 6-month follow-up.Methods Individuals (n = 149) with cervical radiculopathy and dizziness and/or balance problems were randomized preoperatively to structured postoperative rehabilitation or standard postoperative approach. Outcomes were intensity of dizziness and subjective balance, and clinical measures of balance.Results Self-reported measures improved at three months (p < 0.001 to p = .007) and the standing balance at six months (p = .008). No between-group differences. Baseline values, neck pain, and physical activity level explained 23-39% of the variance in 6-month outcomes for self-reported measures. Baseline values and physical activity level explained 71% of the variance in walking balance, and lower baseline scores were significantly associated with standing balance impairments (OR 0.876).Conclusion Patients improved significantly in dizziness and subjective balance intensity shortly after surgery, and in standing balance at 6 months, independent of postoperative rehabilitation. Neck pain, physical activity, and neck muscle function influenced dizziness and balance, although preoperative values and neck pain were of most importance for 6-month outcomes.
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| 10. |
- Lam, Kwun, et al.
(författare)
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Larger pain extent is associated with greater pain intensity and disability but not with general health status or psychosocial features in patients with cervical radiculopathy
- 2021
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Ingår i: Medicine. - : Lippincott, Williams & Wilkins. - 0025-7974 .- 1536-5964. ; 100:8
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Tidskriftsartikel (refereegranskat)abstract
- Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy. An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy. Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01). Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.
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