Physical Examination of the Spine Using Telemedicine: A Systematic Review

Study Design: This is a systematic review. Objective: To systematically review (1) the reliability of the physical examination of the spine using telehealth as it pertains to spinal pathology and (2) patient satisfaction with the virtual spine physical examination. Methods: We searched EMBASE, PubMed, Medline Ovid, and SCOPUS databases from inception until April 2020. Eligible studies included those that reported on performing a virtual spine physical examination. Two reviewers independently assessed all potential studies for eligibility and extracted data. The primary outcome of interest was the reliability of the virtual spine physical exam. Secondary outcomes of interest were patient satisfaction with the virtual encounter. Results: A total of 2321 studies were initially screened. After inclusion criteria were applied, 3 studies (88 patients) were included that compared virtual with in-person spine physical examinations. These studies showed acceptable reliability for portions of the low back virtual exam. Patient satisfaction surveys were conducted in 2 of the studies and showed general satisfaction (>80% would recommend). Conclusions: These results suggest that the virtual spine examination may be comparable to the in-person physical examination for low back pain, though there is a significant void in the literature regarding the reliability of the physical examination as it pertains to specific surgical pathology of the spine. Because patients are overall satisfied with virtual spine assessments, validating a virtual physical examination of the spine is an important area that requires further research.

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Analgesic medicines for adults with low back pain: protocol for a systematic review and network meta-analysis

Systematic Reviews ◽

10.1186/s13643-020-01506-3 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Michael A. Wewege ◽

◽

Matthew K. Bagg ◽

Matthew D. Jones ◽

James H. McAuley

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Analgesic Effect ◽

Meta Analysis ◽

Low Back ◽

Randomised Trials ◽

Limited Evidence ◽

Pain Duration ◽

Secondary Outcomes

Abstract Background There is limited evidence for the comparative effectiveness of analgesic medicines for adults with low back pain. This systematic review and network meta-analysis aims to determine the analgesic effect, safety, acceptability, effect on function, and relative rank according to analgesic effect, safety, acceptability, and effect on function of a single course of [an] analgesic medicine(s) or combination of these medicines for people with low back pain. Methods We will include published and unpublished randomised trials written in any language that compare an analgesic medicine to either another medicine, placebo/sham, or no intervention in adults with low back pain, grouped according to pain duration: acute (fewer than 6 weeks), sub-acute (6 to 12 weeks), and chronic (greater than 12 weeks). The co-primary outcomes are pain intensity following treatment and safety (adverse events). The secondary outcomes are function and acceptability (all-cause dropouts). We will perform a network meta-analysis to compare and rank analgesic medicines. We will form judgements of confidence in the results using the Confidence in Network Meta-Analysis (CINeMA) methodology. Discussion This network meta-analysis will establish which medicine, or combination of medicines, is most effective for reducing pain and safest for adults with low back pain. Systematic review registration PROSPERO CRD42019145257

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Yoga as an Alternative and Complementary Treatment for Patients With Low Back Pain

Journal of Evidence-Based Complementary & Alternative Medicine ◽

10.1177/2156587212458693 ◽

2012 ◽

Vol 18 (1) ◽

pp. 23-28 ◽

Cited By ~ 4

Author(s):

Manoj Sharma ◽

Taj Haider

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

English Language ◽

Holistic Approach ◽

The United States ◽

Low Back ◽

Inclusion Criteria ◽

Complementary Treatment ◽

Study Inclusion

Low back pain is not only a leading cause of disability in the United States but also one of the most expensive to treat. Exercise proves to be inconsistent, and surgery often leads to disease reappearance. Yoga offers a holistic approach to overcome the psychological and physical aspects of low back pain. A systematic review was performed to determine the efficacy of yoga for low back pain. Study inclusion criteria were studies ( a) published in the English language, ( b) published between January 2000 and June 2012, ( c) included any form of yoga as an intervention, ( d) used any quantitative study design, and (5) measured low back pain as an outcome. Of the 13 studies included, 9 demonstrated a reduction in low back pain using yoga as part of the intervention. Limitations include lack of theory-based approaches, unclear definitions of low back pain, and multiple instruments used to measure the outcome.

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Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215511411113 ◽

2011 ◽

Vol 26 (1) ◽

pp. 10-20 ◽

Cited By ~ 42

Author(s):

Ligia M Pereira ◽

Karen Obara ◽

Josilainne M Dias ◽

Maryela O Menacho ◽

Débora A Guariglia ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Mean Difference ◽

Cochrane Central Register ◽

Low Back ◽

Inclusion Criteria ◽

Lumbar Stabilization ◽

Pilates Method

Objective: To perform a systematic review with meta-analyses that evaluates the effectiveness of the Pilates method on the pain and functionality outcome in adults with non-specific chronic low back pain. Data sources: The search was performed in the following databases: Medline, Embase, AMED, Cinahl, Lilacs, Scielo, SportDiscus, ProQuest, Web of Science, PEDro, Academic Search Premier and the Cochrane Central Register of Controlled Trials from 1950 to 2011; the following keywords were used: ‘Pilates’, ‘Pilates-based’, ‘back exercises’, ‘exercise therapy’, ‘low back pain’, ‘back pain’ and ‘backache.’ Review methods: The inclusion criteria were studies that assessed the effects of the Pilates method on patients with chronic low back pain. Results: Five studies met the inclusion criteria. The total number of patients was 71 in the Pilates group and 68 in the control group. Pilates exercise did not improve functionality (standardized mean difference (SMD = –1.34; 95% confidence interval (CI) −2.80, 0.11; P = 0.07) or pain between Pilates and control groups (SMD = –1.99; 95% CI −4.35, 0.37; P = 0.10). Pilates and lumbar stabilization exercises presented no significant difference in functionality (mean difference (MD) = –0.31; 95% CI −1.02, 0.40; P = 0.39) or pain (MD = –0.31; 95% CI −1.02, 0.40; P = 0.39). Conclusion: The Pilates method did not improve functionality and pain in patients who have low back pain when compared with control and lumbar stabilization exercise groups.

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Efficacy of Platelet-rich Plasma for Low Back Pain: A Systematic Review and Meta-analysis

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1709170 ◽

2020 ◽

Vol 81 (06) ◽

pp. 529-534 ◽

Cited By ~ 1

Author(s):

Zhaopeng Xuan ◽

Wenjun Yu ◽

Yichen Dou ◽

Tao Wang

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Patient Satisfaction ◽

Back Pain ◽

Pain Relief ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Low Back ◽

Pain Scores ◽

Control Intervention

Abstract Background Platelet-rich plasma (PRP) may be beneficial for patients with low back pain. However, the results remain controversial. We conducted a systematic review and meta-analysis to explore the efficacy of PRP for low back pain. Methods PubMed, Embase, Web of Science, EBSCO, and Cochrane Library databases were searched systematically. Randomized controlled trials (RCTs) assessing the effect of PRP on low back pain were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcome was pain scores within 8 weeks. Meta-analysis was performed using the random-effects model. Results Three RCTs involving 131 patients were included in the meta-analysis. Overall, compared with control intervention for low back pain, PRP injection was found to reduce pain scores significantly (mean difference: − 1.47; 95% confidence interval [CI], − 2.12 to − 0.81; p < 0.0001), improve the number of patients with > 50% pain relief at 3 months (risk ratio [RR]: 4.14; 95% CI, 2.22–7.74; p < 0.00001), and offer relatively good patient satisfaction (RR: 1.91; 95% CI, 1.04–3.53; p = 0.04). No increase in adverse events was reported after PRP injection (RR: 1.92; 95% CI, 0.94-3.91; p = 0.07). Conclusions Compared with control intervention for low back pain, PRP injection was found to improve pain relief and patient satisfaction significantly with no increase in adverse events.

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Effects of behavioural exercise therapy on the effectiveness of multidisciplinary rehabilitation for chronic non-specific low back pain: a randomised controlled trial

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04353-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jana Semrau ◽

Christian Hentschke ◽

Stefan Peters ◽

Klaus Pfeifer

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Exercise Therapy ◽

Primary Outcome ◽

Controlled Trial ◽

Study Groups ◽

Mean Difference ◽

Low Back ◽

Secondary Outcomes ◽

Randomised Controlled

Abstract Background The long-term effects of behavioural medical rehabilitation (BMR), as a type of multidisciplinary rehabilitation, in the treatment of chronic non-specific low back pain (CLBP) have been shown. However, the specific effects of behavioural exercise therapy (BET) compared to standard exercise therapy (SET) within BMR are not well understood. The aim of the study was to assess the effectiveness of BMR + BET compared to BMR + SET in individuals with CLBP in a two-armed, pre-registered, multicentre, parallel, randomised controlled trial (RCT). Methods A total of 351 adults with CLBP in two rehabilitation centres were online randomised based on an ‘urn randomisation’ algorithm to either BMR + SET (n = 175) or BMR + BET (n = 176). Participants in both study groups were non-blinded and received BMR, consisting of an multidisciplinary admission, a psychosocial assessment, multidisciplinary case management, psychological treatment, health education and social counselling. The intervention group (BMR + BET) received a manualised, biopsychosocial BET within BMR. The aim of BET was to develop self-management strategies in coping with CLBP. The control group (BMR + SET) received biomedical SET within BMR with the aim to improve mainly physical fitness. Therapists in both study groups were not blinded. The BMR lasted on average 27 days, and both exercise programmes had a mean duration of 26 h. The primary outcome was functional ability at 12 months. Secondary outcomes were e.g. pain, avoidance-endurance, pain management and physical activity. The analysis was by intention-to-treat, blinded to the study group, and used a linear mixed model. Results There were no between-group differences observed in function at the end of the BMR (mean difference, 0.08; 95% CI − 2.82 to 2.99; p = 0.955), at 6 months (mean difference, − 1.80; 95% CI; − 5.57 to 1.97; p = 0.349) and at 12 months (mean difference, − 1.33; 95% CI − 5.57 to 2.92; p = 0.540). Both study groups improved in the primary outcome and most secondary outcomes at 12 months with small to medium effect sizes. Conclusion BMR + BET was not more effective in improving function and other secondary outcomes in individuals with CLBP compared to BMR + SET. Trial registration Current controlled trials NCT01666639, 16/08/2012.

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Systematic review of patient history and physical examination to diagnose chronic low back pain originating from the facet joints

European Journal of Pain ◽

10.1002/ejp.963 ◽

2016 ◽

Vol 21 (3) ◽

pp. 403-414 ◽

Cited By ~ 12

Author(s):

E.T. Maas ◽

J.N.S. Juch ◽

R.W.J.G. Ostelo ◽

J.G. Groeneweg ◽

J.W. Kallewaard ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Physical Examination ◽

Chronic Low Back Pain ◽

Low Back ◽

Facet Joints ◽

Patient History

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Diagnostic utility of patient history and physical examination data to detect spondylolysis and spondylolisthesis in athletes with low back pain: A systematic review

Manual Therapy ◽

10.1016/j.math.2016.03.011 ◽

2016 ◽

Vol 24 ◽

pp. 7-17 ◽

Cited By ~ 17

Author(s):

Linn Helen J. Grødahl ◽

Louise Fawcett ◽

Madeleine Nazareth ◽

Richard Smith ◽

Simon Spencer ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Physical Examination ◽

Diagnostic Utility ◽

Low Back ◽

Patient History

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Antineuropathic and Antinociceptive Drugs Combination in Patients with Chronic Low Back Pain: A Systematic Review

Pain Research and Treatment ◽

10.1155/2012/154781 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 6

Author(s):

Carlo Luca Romanò ◽

Delia Romanò ◽

Marco Lacerenza

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Combined Therapy ◽

Single Agent ◽

Rational Approach ◽

Low Back ◽

Inclusion Criteria ◽

Pharmacological Treatments

Purpose. Chronic low back pain (LBP) is often characterized by both nociceptive and neuropathic components. While various monotherapies have been reported of only limited efficacy, combining drugs with different mechanisms of action and targets appears a rational approach. Aim of this systematic review is to assess the efficacy and safety of different combined pharmacological treatments, compared to monotherapy or placebo, for the pharmacological treatment of chronic LBP. Methods. Published papers, written or abstracted in English from 1990 through 2011, comparing combined pharmacological treatments of chronic LBP to monotherapy or placebo were reviewed. Results. Six articles met the inclusion criteria. Pregabalin combined with celecoxib or opioids was shown to be more effective than either monotherapy. Oxycodone-paracetamol versus previous treatments and tramadol-paracetamol versus placebo were also reported as effective, while morphine-nortriptyline did not show any benefit over any single agent. Conclusions. In spite of theoretical advantages of combined pharmacological treatments of chronic LBP, clinical studies are remarkably few. Available data show that combined therapy, including antinociceptive and antineuropathic agents is more effective than monotherapy, with similar side effects.

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Heart rate variability in patients with low back pain: a systematic review

Scandinavian Journal of Pain ◽

10.1515/sjpain-2021-0006 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Pamela M. Bandeira ◽

Felipe J.J. Reis ◽

Vanessa C.C. Sequeira ◽

Anna C.S. Chaves ◽

Orlando Fernandes ◽

...

Keyword(s):

Systematic Review ◽

Heart Rate ◽

Heart Rate Variability ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Healthy Controls ◽

Low Back ◽

Inclusion Criteria ◽

Limited Evidence

Abstract Objectives Heart rate variability (HRV) is an important physiological measure of the capacity for neurogenic homeostatic regulation, and an indirect measure of emotional processing. We aimed to investigate whether HRV parameters are altered in people with chronic low back pain when compared to healthy controls. Methods We searched on PubMed, Scopus, CINAHL, Web of Science, Cochrane Library, and PsycINFO from inception to January 2018. The inclusion criteria were: patients with non-specific chronic low back pain, absence of radiculopathy, age from 18 to 65 years, and comparison with healthy controls. Data extraction was performed by two independent review authors. The methodological quality of the studies was assessed using the appraisal tool for cross-sectional studies. Results After screening 2,873 potential articles, two studies met the inclusion criteria. Studies were composed of 153 patients with chronic low back pain and 62 healthy controls. An electrocardiogram was used to record HRV and linear methods (time and frequency) were used to analyze the results. The main findings indicate that patients with chronic low back pain have a significant reduction in HRV, with sympathetic predominance compared to healthy controls. Conclusions There is limited evidence suggesting that chronic low back pain patients presented a lower vagal activity evidenced by HRV, when compared to healthy controls. The results of this systematic review should be interpreted with caution due to the restricted number of included studies, small sample sizes and different protocols used to measure HRV. The limited evidence about HRV alterations in low back pain also suggests the need of future studies to investigate if HRV parameters can be a useful measure in chronic pain samples or even if it can be used as an outcome in clinical trials aiming to investigate the effectiveness of interventions based on emotion regulation.

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