MH Residency-Spine

BACKGROUND: Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. METHODS: A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy...

Representational body maps are dynamically maintained in the brain and negatively influenced by neglect, decreased movement and pain. Graded motor imagery (GMI) utilizing various tactile and cognitive processes has shown efficacy in decreasing pain, disability and movement restrictions in musculoskeletal pain. Limited information is known about the cortical changes patients undergo during lumbar surgery (LS), let alone the therapeutic effect of GMI for LS. A 56-year-old patient underwent LS for low back pain, leg pain and progressive neurological deficit...

Objective: To evaluate the evidence for the effectiveness of sham surgery in orthopedics by conducting a systematic review of literature. Methods: Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search...

PURPOSE: To determine the referral patterns, utilization and indications for postoperative physical therapy (PT) for lumbar radiculopathy. At least 50 % of patients following lumbar surgery (LS) for radiculopathy are referred for PT to address postoperative pain and disability. Very little is known regarding factors following LS that predict referral to PT, patient perceptions, satisfaction of postoperative PT and predictors of success for PT following LS for radiculopathy. METHODS: Sixty-five patients who underwent LS for radiculopathy completed outcome measures on pain and disability prior to, and 1, 3, 6 and 12 months after LS...

STUDY DESIGN: Multicenter, randomized, controlled trial on preoperative pain neuroscience education (NE) for lumbar radiculopathy. OBJECTIVE: To determine if the addition of NE to usual preoperative education would result in superior outcomes with regard to pain, function, surgical experience, and health care utilization postsurgery. SUMMARY OF BACKGROUND DATA: One in 4 patients after lumbar surgery (LS) for radiculopathy experience persistent pain and disability, which is nonresponsive to perioperative treatments...

BACKGROUND AND STUDY DESIGN: Several physical therapy classification systems exist for low back pain (LBP). Little is known about how these systems could be integrated in clinical practice. This case report describes an episode of care utilizing elements of the mechanical diagnosis and therapy (MDT), movement system impairment (MSI) and treatment-based classification (TBC) systems. CASE DESCRIPTION: Patient History - the patient was a 40-year-old male presenting to an outpatient musculoskeletal clinic with a complaint of chronic LBP...

Orthopaedic manual therapy (OMT) should be based not only on the best available evidence but also on patient values and clinician expertise. Low back pain (LBP) is a complex issue as the majority of people who suffer from LBP cannot be given a specific diagnosis based on imaging studies but kinematic analyses appear to be useful to determine dysfunctional patterns. In physical therapy, various forms of OMT are currently used to manage LBP and there is growing evidence for its use. The underlying principles of OMT are to treat neuro-musculo-skeletal disorders, the aim of which is to reduce pain, as well as improve movement and function...

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF). The purpose of these low back pain clinical practice guidelines, in particular, is to describe the peer-reviewed literature and make recommendations related to (1) treatment matched to low back pain subgroup responder categories, (2) treatments that have evidence to prevent recurrence of low back pain, and (3) treatments that have evidence to influence the progression from acute to chronic low back pain and disability...

BACKGROUND: Systematic reviews have shown that exercise therapy and spinal manipulation are both more effective for low back pain (LBP) than no treatment at all. However, the effects are at best modest. To enhance the clinical outcomes, recommendations are to improve the patient selection process, and to identify relevant subgroups to guide clinical decision-making. One of the systems that has potentials to improve clinical decision-making is a treatment-based classification system that is intended to identify those patients who are most likely to respond to direction-specific exercises, manipulation, or stabilisation exercises...

The treatment-based classification (TBC) system for the treatment of patients with low back pain (LBP) has been in use by clinicians since 1995. This perspective article describes how the TBC was updated by maintaining its strengths, addressing its limitations, and incorporating recent research developments. The current update of the TBC has 2 levels of triage: (1) the level of the first-contact health care provider and (2) the level of the rehabilitation provider. At the level of first-contact health care provider, the purpose of the triage is to determine whether the patient is an appropriate candidate for rehabilitation, either by ruling out serious pathologies and serious comorbidities or by determining whether the patient is appropriate for self-care management...

BACKGROUND: The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. METHODS: We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation...