This randomised clinical trial investigated the effect of intermittent theta burst stimulation (iTBS) over the dorsolateral prefrontal cortex (DLPFC) on pain alleviation in patients with chronic low back pain (CLBP) and its underlying mechanisms.

Forty CLBP patients were randomly assigned to receive either active or sham iTBS combined with core stability exercise. Pain assessments were completed before and after the intervention. Eleven patients from each group underwent resting-state functional magnetic resonance imaging scans pre- and post-intervention to analyse DLPFC activation and connectivity with other brain regions.

The active iTBS group had a greater pain reduction than the sham group (p = 0.05, 95% CI: -0.009 to 1.109). In the active and sham groups, 80% (16/20) and 40% (8/20) reached the minimal clinically important difference, respectively, with a number needed to treat of 2.5. For the Fear-Avoidance Beliefs Questionnaire, there was a significant difference between the two groups (p = 0.011, r = 0.40). The active iTBS group showed a significantly enhanced functional connectivity between the left DLPFC and the right cerebellum, as well as both occipital gyri (voxel-level, p < 0.001; cluster-level familywise error rate, p < 0.01). Spearman's correlation analysis showed a significant negative correlation between Numerical Rating Scale and the FC of the left DLPFC and the right cerebellum (rho = -0.55, p = 0.008), the right (rho = -0.439, p = 0.01), and left occipital gyri (rho = -0.45, p = 0.034).

iTBS may alleviate pain in CLBP patients by enhancing DLPFC connectivity with the cerebellum and occipital gyrus.

This study showed a facilitatory effect of iTBS on alleviating CLBP, which might be modulated by brain functional connectivity. Trial Registration Chinese Clinical Trial Registry: ChiCTR2200064899.

Lumbar facet joint syndrome (LFJS) is one of most common forms of chronic low back pain. Despite several decades of real-world use and a plethora of published studies, debate still exists regarding the effectiveness of Radiofrequency Ablation (RFA) as a therapy in LFJS-diagnosed patients.

Here, we sought to evaluate real-world clinical outcomes in RFA-treated patients with chronic lumbar facetogenic pain participating in one of the largest studies of its kind published to date.

The RAPID study (Clinicaltrials.gov identifier: NCT04673032) is an international, multicenter, prospective study of patients using a commercially-available radiofrequency ablation system for the treatment of chronic pain, provided per standard of care. Patients were assessed at pre-specified study follow-up visits (1-, 3-. 6-, 12-, and 24-months post-index procedure). Key clinical endpoint measures collected and evaluated include NRS (pain score), Oswestry Disability Index (functional disability, ODI), EQ-5D-5L (quality-of-life), and Patient Global Impression of Change (PGIC).

To date, 193 patients have been enrolled in this lumbar facetogenic pain patient cohort. Evaluation of pain relief amongst patients assessed out to 24-months demonstrated a mean NRS score of 3.4 (baseline NRS: 6.6, p < 0.0001). Consistent functional improvement out to 24-months was observed per an 8.6-point mean ODI score reduction (baseline ODI: 38.0, p < 0.0001). Following RFA treatment at 1-month and out to 24-months, 77.0% and 79.0% of patients were observed to be treatment responders (i.e., ≥50% pain relief), respectively. Enhanced levels in measures of quality-of-life (EQ-5D-5L) and self-reported health-related change (PGIC) were also consistently noted.

Clinically meaningful and durable improvements in pain relief, functional disability, quality-of-life and treatment satisfaction were observed across all RAPID study follow-up visits. The results of the RAPID study provide for the potential clinical outcomes amongst selected patients with lumbar facetogenic pain within the real-world clinical setting.

Osteopathic physicians take a whole-person approach to medical care that may be seen in their relationships with patients and may involve utilizing osteopathic manipulative treatment (OMT) as an alternative to opioid therapy in patients with chronic pain.

This study aimed to compare the outcomes of patients with chronic low back pain (CLBP) treated by osteopathic and allopathic physicians in the United States utilizing a pragmatic design reflecting medical care in real-world settings, including an assessment of potential mediators of osteopathic medical care.

A retrospective cohort study was conducted utilizing patients with CLBP selected from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION) from September 2016 through September 2024. Patients were followed at quarterly encounters for up to 36 months after PRECISION enrollment to determine if they were receiving their CLBP medical care from either osteopathic or allopathic physicians. Outcomes pertaining to pain, function, pain impact, health-related quality of life (HRQOL), and the frequency of chronic widespread pain (CWP) and CLBP recovery were also measured at these encounters utilizing generalized estimating equations. Results were adjusted for sociodemographic and clinical characteristics in multivariable analyses. Regression-based analyses were utilized to determine if OMT, opioid prescribing, or physician empathy mediate the outcomes of osteopathic medical care.

There were 1,491 patients in the study, including 278 (18.6 %) and 1,213 (81.4 %) treated by osteopathic and allopathic physicians, respectively. A total of 8,854 encounters were completed over 36 months, including 2,107 (23.8 %) and 6,747 (76.2 %) in the osteopathic and allopathic medical care groups, respectively. The adjusted means (95 % confidence intervals [CIs]) for patients treated by osteopathic vs. allopathic physicians were 6.3 (6.0-6.6) vs. 6.5 (6.3-6.7) for low back pain intensity (p=0.05); 14.8 (13.8-15.8) vs. 15.6 (14.8-16.4) for back-related disability (p=0.008); 31.9 (30.6-33.2) vs. 32.7 (31.7-33.7) for pain impact (p=0.07); and 57.8 (56.7-58.8) vs. 58.4 (57.6-59.3) for HRQOL deficits (p=0.04). The frequency of CWP occurrence (risk ratio [RR], 1.00; 95 % CI, 0.87-1.15; p=0.98) and CLBP recovery (RR, 0.65; 95 % CI, 0.38-1.11; p=0.12) did not differ between the osteopathic and allopathic medical care groups after adjusting for potential confounders. The significant results pertaining to pain, function, and HRQOL were consistently and most strongly mediated by physician empathy and, to a lesser extent, by OMT.

This study found that patients with CLBP treated by osteopathic physicians reported better outcomes for pain, function, and HRQOL than patients treated by allopathic physicians over 36 months of follow-up. These effects of osteopathic medical care were most consistently and strongly mediated by physician empathy and, to a lesser extent, by OMT. Osteopathic medical care was not associated with decreased CWP occurrence or increased CLBP recovery.

Sensorimotor training (SoMT) is a gradual balance training technique employed to treat various chronic musculoskeletal pain. Core strength training (CST) is one of the most commonly used interventions for managing low back pain (LBP). This randomied controlled trial protocol aims to determine whether the combination of SoMT and CST can significantly reduce LBP, and improve scoliosis-related outcomes and overall functional status in adult idiopathic scoliosis (AdIS) patients.

A total of 300 AdIS patients will be recruited from the outpatient clinic and randomly assigned to one of three groups: CST group, SoMT group or the combined therapy group, using stratified block randomization based on the severity of scoliosis curve. All groups will receive the intervention three times a week for 12 weeks. Sessions will be conducted in the hospital, and no home programme will be provided. Adherence and attendance will be monitored and recorded. The CST group will receive CST therapy, while the SoMT group will receive SoMT therapy, which consists of three progressive phases: static, dynamic and functional. Participants will progress to the next phase on achieving pelvic stability in the current phase. The combined therapy group will receive both CST and SoMT. Assessors and statisticians will remain blinded to participant allocation throughout the study. Assessments will be performed at baseline and at the endpoint, 12 weeks after the initiation of the intervention. The primary outcome will be the self-reported pain level, measured using the visual analogue scale. Secondary outcomes will include pain-related disability (by the Oswestry Disability Index and the Roland-Morris Disability Questionnaire), spinal morphology indicators (including Cobb angle, the angle of trunk rotation and the Sagittal Index), postural control ability (by the Tetrax IBSTM), proprioceptive sensitivity (by the repositioning error test) and health-related quality of life (by the 36-Item Short Form Health Survey). Statistical analysis will adhere to the intention-to-treat principle and will be complemented by per-protocol analysis. To compare the effects of SoMT versus CST and combined therapy versus SoMT on both primary and secondary outcomes, a linear mixed-effects model or generalised linear mixed model will be applied.

The current study received ethical approval from the Xinhua Hospital Ethics Committee Affiliated to Shanghai Jiao Tong University School of Medicine (XHEC-C-2024-080-3). Written informed consent will be obtained from all participants. Any interim analysis and full results will be published in an international peer-reviewed journal.

This protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2400085370).

Low back pain is a leading cause of disability worldwide, with most cases classified as non-specific(NSLBP). While manual therapy appears effective for treating NSLBP, further research is needed to identify candidate baseline factors associated with improvement to help tailor personalized treatment strategies. This prospective observational exploratory study, therefore, aims to identify candidate prognostic factors collected at baseline that are associated with short-term improvement in people with NSLBP.

This study was conducted in chiropractic clinics across France between March 1, 2022, and February 28, 2023. Adults with a new episode of NSLBP were included. Baseline data, including individual, clinical, and therapist-related candidate factors, were collected before and during the initial consultation. Participants were considered improved if they: (i) reported "all better" or "better" on perceived global change, (ii) achieved a 20-point improvement on both Visual Analog Scales (VAS for intensity and unpleasantness) or scored 0 on reassessment, and (iii) showed a 30% improvement on the Oswestry Disability Index (ODI) at 7 days and 4 weeks post-consultation. Missing data were handled using multiple imputation with chained equations (MICE). Logistic regression analyses (univariate and multivariable with spline terms when superior fit was demonstrated) identified candidate prognostic factors associated with clinical improvement.

Out of 1,394 patients contacted, 241 met the inclusion criteria, and 207 completed at least one follow-up assessment. After imputation and multivariable analysis, duration of episode (spline 1: 0.94[0.89-1.00]), Number of painful sites (0.75[0.62-0.92]), negative treatment expectations (0.48 [0.25-0.94]), disability score (spline 1: 0.94[0.89-1.00], spline 2: 0.77[0.62-0.96]), and pain intensity (1.05 [1.02-1.07]) were associated with improvement at 7 days. At 4 weeks, disability score (spline 1: 1.24[1.07-1.45], spline 2: 0.77[0.63-0.95]), pain intensity (1.02 [1.00-1.04]), episode duration (spline 1: 0.95[0.91-1.00]), new patient (0.50 [0.28-0.91]), and clinican's prognosis (3.89 [1.49-10.10]) were associated with improvement.

Less-studied factors, such as negative treatment expectations, clinician's prognosis, number of therapists, and perceived stiffness, highlighted significant associations with improvement in this exploratory phase. These findings suggest that incorporating these factors may be used when updating existing models.

The reliability of patient-reported outcome measures is typically evaluated in patients with chronic or stable symptoms, pre-treatment. After treatment, symptoms may be less extreme and less variable within a group, which may influence indices of reliability. Further, few studies have examined the reliability of retrospective, single item global assessment scores after treatment, despite the latter often being used as the external criterion when determining an instrument's minimal clinically important change (MCIC) score. This study examined the stability of Core Outcome Measures Index (COMI) and Global Treatment Outcome (GTO) scores after spine surgery.

Data were extracted for patients with lumbar spinal stenosis who had completed the COMI and GTO twice at follow-up, for both an in-house outcomes database (ROUTINE) and as part of a separate prospective study (LSOS). To be included, the questionnaires had to have been completed within 3 months of each other for 1-year follow-up (FU), within 4 months for 2-year FU and within 5 months for 5-year FU. Repeated measures ANOVA, intraclass correlation coefficients (ICC; 2-way mixed, absolute agreement), and weighted Kappa values were calculated.

64 patients (72.9 ± 6.9 y; 48% female) had a COMI and GTO available from both ROUTINE and LSOS, completed on average 9.8 ± 6.2 weeks apart. There were no significant differences between test and retest scores for any of the COMI domains or for the COMI summary score (all p > 0.05), and ICCs/weighted Kappas were moderate to good (0.73-0.87). In the ROUTINE and LSOS datasets, 83% and 81% patients, respectively, reported a "good global outcome" on the GTO (i.e. treatment helped/helped a lot); the corresponding Kappa for agreement between the ratings on an individual basis was 0.74 ("good agreement").

Despite the more stringent nature of the evaluation given by this "real-life" analysis of the stability of outcome scores, the FU COMI scores showed moderate to good reliability comparable to that reported in previous studies with reliability assessed 1-2 weeks apart. The GTO was also confirmed as a reliable variable yielding stable values at mid to longer term follow-up.

Background and Objective: This study aimed to compare functional and clinical outcomes between patients with chronic non-specific lower back pain (NSLBP) with restricted hip extension mobility who performed spinal stabilization exercises with hip mobilization either with or without additional hip exercises. Methods: A total of 42 patients with chronic NSLBP with restricted hip extension mobility were enrolled (21 with and 21 without additional hip exercises). Functional and clinical outcomes were assessed based on hip joint mobility, back extensor endurance, postural stability, and patient-reported outcomes, including visual analog scale (VAS) and Oswestry disability index (ODI) scores. Results: A significant group-time interaction was identified for postural stability (Rt: p < 0.001, Lt: p = 0.002) and the ODI (p = 0.004). After the intervention, the group with additional hip exercises demonstrated significantly greater improvements in postural stability (Rt: p < 0.001; Lt: p = 0.01) and ODI scores (p < 0.001) compared with the group without additional hip exercises. However, no significant main group effect or group-time interaction was observed for the hip joint mobility, back extensor endurance, or VAS scores (all p > 0.05). Furthermore, the ODI score (r2 = 0.123, p = 0.023) was an independent predictor of hip joint mobility but not the VAS score (p > 0.05). Conclusions: Hip exercises may improve postural stability and function in patients with chronic NSLBP with restricted hip extension mobility. Notably, clinicians and therapists must recognize the importance of hip exercises during rehabilitation of patients with chronic NSLBP with restricted hip extension mobility.

Disorders of the patella are among the most prevalent knee injuries. While exercise therapy is widely accepted as an effective treatment strategy, the positive effects of conventional exercise therapy under the guidance of a physiotherapist may be offset by inherent limitations, such as difficulties in scheduling appointments or statutory policies restricting the number of training sessions. Home-based exercise interventions using digital health applications (DHAs) may help address some of these limitations.

This study aimed to assess the efficacy of a 12-week exercise intervention using a web-based DHA for improving knee function and reducing pain in patients with disorders of the patella (International Classification of Diseases code M22).

The outcomes of the DHA intervention group (IG) were compared to a control group (CG) that received conventional physiotherapy covered by statutory health insurance in Germany (SHI-PT). A total of 259 patients with diagnosed disorders of the patella were included in the trial and randomly allocated to IG DHA (n=136, 52.5%) and CG SHI-PT (n=123, 47.5%). Two primary end points were examined: "knee function" (Knee Injury and Osteoarthritis Outcome Score-Activities of Daily Living [KOOSADL] subscale, range 0-100 points) and "knee pain" (visual analog scale [VAS], range 0-100 points). Participants were asked to complete 2 surveys: one before the first therapy session (PRE) and one after completing the treatment period of 12 weeks (POST).

Training with the DHA resulted in a 4.5-fold greater improvement in "knee function" (PRE-POST differences in KOOSADL score; IG DHA: 15.7 points, 95% CI 13.7-17.6 vs CG SHI-PT: 3.5 points, 95% CI 1.5-5.5) and a 3.5-fold greater reduction in "knee pain" (PRE-POST differences in VAS pain score; IG DHA: -22.5 points, 95% CI -25.2 to -19.9 vs CG SHI-PT: -6.5 points, 95% CI -8.7 to -4.4) compared to SHI-PT. The improvements in IG DHA exceeded the limits of clinical relevance. The differences between the treatment groups (KOOSADL score -10.1 points, 95% CI -infinity to -8.0; VAS pain score 14.3 points 95% CI 11.7-infinity) were statistically significant (P<.001) for both end points in favor of IG DHA. No effect was found for age or sex. The reported use of pain medication decreased substantially in IG DHA, and showed almost no change in CG SHI-PT.

Our findings indicated that the investigated DHA is superior to SHI-PT for treating disorders of the patella. Therefore, DHA has been approved by the German Federal Institute for Drugs and Medical Devices for treating disorders of the patella in persons of all sexes aged ≥12 years.

German Clinical Trials Register (DRKS) DRKS00023454; https://drks.de/search/en/trial/DRKS00023454.

Degeneration of the intervertebral disc is a significant source of chronic axial low back pain. Direct supplementation of degenerated nucleus pulposis (NP) tissue with intradiscally delivered allogeneic NP represents an opportunity to bridge the treatment gap between failed conservative care and spine surgery for patients with lumbar discogenic pain.

Prospective, single-arm clinical study conducted at 6 sites in the US. The primary objective was to determine the magnitude of improvement in back pain severity and back function in patients with chronic lumbar discogenic pain at 12 months after a single intradiscal supplementation procedure using a commercially available NP allograft at up to two vertebral levels identified on magnetic resonance imaging. Back pain severity was evaluated using an 11-point numeric rating scale (NRS) and back function using the Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) and substantial clinical benefit (SCB) were set at ≥ 30% and ≥ 50% over baseline, respectively. The patient acceptable symptom state (PASS) threshold for pain severity was ≤ 3.

Twenty-eight participants with a mean age of 44 ± 13 yrs. were enrolled and 22 provided 12-month outcomes. The average overall improvement in back pain severity was 43% through 12 months (p < 0.001). Approximately 64% (14 of 22) achieved the MCID in back pain at 12 months, with 55% (12 of 22) realizing SCB. Almost 60% (13 of 22) reported a 12-month back pain severity score of ≤ 3. The corresponding average decrease in ODI values was 50% (p < 0.001) with approximately 59% (13 of 22) of study participants achieving the MCID. At baseline approximately 82% (23 of 28) of participants reported severe or crippled back impairment compared to 18% (4 of 22) at 12 months (p < 0.001).

The results of this study provide additional evidence that supplementation of the degenerated intervertebral disc with intradiscally delivered allogeneic NP is associated with clinically significant pain palliation and functional improvement.

This trial was prospectively registered at ClinicalTrials.gov on December 30, 2021 (NCT05201287).

The efficacy of tumor necrosis factor inhibitors for treating chronic low-back pain with Modic changes is uncertain. This study investigated the superiority of infliximab over placebo in patients with Modic type 1 changes.

In this multicenter, randomized, triple-blind, placebo-controlled trial, patients aged 18 to 65 years with moderate to severe chronic low-back pain and Modic type 1 changes were enrolled from five Norwegian public hospitals between January 2019 and October 2022. Participants were randomly assigned to four intravenous infusions of 5 mg/kg infliximab or placebo. The primary outcome was difference in change in the Oswestry Disability Index (ODI) score from baseline to five months. Secondary outcomes included changes in low-back pain intensity, disability, and health-related quality of life. A linear mixed model was used for efficacy analyses.

A total of 128 patients (mean age 43 years, 65.6% women) participated (64 in each group). All patients who received at least one dose of the allocated infusion were included in the primary analyses. The average ODI score (±SD) change was -7.0 (±9.7) in the group who received infliximab and -6.4 (±10.4) in the group who received placebo. The difference in the ODI score change between the two groups was 1.3 ODI points (95% confidence interval -2.1 to 4.6, P = 0.45). Analyses showed no effect of infliximab compared to placebo on secondary outcomes. Adverse event rates were similar between groups.

Infliximab did not demonstrate superiority over placebo in reducing pain-related disability in patients with moderate to severe chronic low-back pain with Modic type 1 changes at five months.

We developed the SupportPrim PT clinical decision support system (CDSS) using the artificial intelligence method case-based reasoning to support personalised musculoskeletal pain management. The aim of this study was to evaluate the effectiveness of the CDSS for patients in physiotherapy practice. A cluster randomised controlled trial was conducted in primary care in Norway. We randomised 44 physiotherapists to (1) use the CDSS alongside usual care or (2) usual care alone. The CDSS provided personalised treatment recommendations based on a case base of 105 patients with positive outcomes. During the trial, the case-based reasoning system did not have an active learning capability; therefore, the case base size remained the same throughout the study. We included 724 patients presenting with neck, shoulder, back, hip, knee, or complex pain (CDSS; n = 358, usual care; n = 366). Primary outcomes were assessed with multilevel logistic regression using self-reported Global Perceived Effect (GPE) and Patient-Specific Functional Scale (PSFS). At 12 weeks, 165/298 (55.4%) patients in the intervention group and 176/321 (54.8%) in the control group reported improvement in GPE (odds ratio, 1.18; confidence interval, 0.50-2.78). For PSFS, 173/290 (59.7%) patients in the intervention group and 218/310 (70.3%) in the control group reported clinically important improvement in function (odds ratio, 0.41; confidence interval, 0.20-0.85). No significant between-group differences were found for GPE. For PSFS, there was a significant difference favouring the control group, but this was less than the prespecified difference of 15%. We identified several study limitations and recommend further investigation into artificial intelligence applications for managing musculoskeletal pain.

BackgroundChronic low back pain can severely affect quality of life. While several treatments are available, the combination of therapies often results in better outcomes.ObjectiveThis study delves into the comparative effectiveness of combining monopolar dielectric diathermy radiofrequency (MDR) with supervised therapeutic exercise against the latter treatment alone.MethodsA randomized single-blind controlled trial was conducted. The intervention group (( n = 30 ) 30) received MDR with supervised therapeutic exercises for eight weekly sessions for four weeks. The control group (n = 30) received only the same exercise protocol. The following self-report measures were assessed before the first treatment session, at four, and 12 weeks: disability, pain, kinesiophobia, quality of life, sleep quality, emotional distress, isometric trunk strength, and trunk flexion range.ResultsRepeated ANOVA measures revealed significant time*group interactions for the McQuade test (p = 0.003), the physical role (p = 0.011), vitality (p = 0.023), social function (p = 0.006), and mental health subscales (p = 0.042). Between-group analyses showed significant differences for all outcomes at each follow-up: RMDQ (post-treatment, p = 0.040), ODI (post-treatment and 12-week, p = 0.040), VAS (p < 0.001), TSK (p < 0.001), and McQuade Test (p < 0.020).ConclusionThe combination of diathermy radiofrequency with supervised therapeutic exercise significantly surpasses the efficacy of supervised therapeutic exercise alone, showcasing improvements in pain, disability, kinesiophobia, lumbar mobility in flexion, and overal quality of life in patients with chronic low back pain.

To evaluate the responsiveness and the minimal important change (MIC) of Neck Disability Index (NDI) and pain during activity by the numeric rating scale (NRSa) in the Norwegian neck and back registry (NNRR).

Participants with neck pain responding to baseline, 6 and 12-months follow-up in the NNRR were included. Responsiveness was calculated using the area under the receiver operating characteristic (ROC). The minimal important change (MIC) was calculated with an anchor-based method and distribution-based methods. For the anchor-based method we used the Patient Global Impression of Change (PGIC) as the anchor. The PGIC was on a 7-point Likert scale, and trichotomized into three ordinal categories.

A total of 551 patients with neck pain were included. Among these patients, 60% were women with an average age of 48, and 63% had experienced neck pain for more than one year. For improved patients NDI and NRSa had adequate responsiveness at both follow-ups. MIC calculations using an anchor-based method were more accurate than those using a distribution-based method, which fell below the measurement error for the instruments. Using anchor-based calculation of MIC, the MIC for NDI was 17 at the 6-months follow-up and 9 at 12-months follow-up. Correspondingly, NRSa had a MIC of 2.5 at both follow-ups.

NDI and NRSa were responsive at both 6-months and 12-months follow-up and can be used in registries following patients with neck pain over time.

To assess the 10-item Spine Functional Index (SFI-10) clinimetric properties in a general musculoskeletal disorder (MSD) spine population. Ascertain the psychometric characteristics' consistency with the developmental study findings for structural and criterion validity, internal consistency, and floor/ceiling effect; establish the longitudinal characteristics for test-retest reliability, responsiveness, construct validity, and error scores; and clarify practical characteristics of readability, missing responses, and time/errors for completion/scoring related to administrative burden.

A longitudinal study of deidentified spine MSD patients (n = 1317, 53.4% female, age = 18-91yrs, av = 49.5 ± 16.4yrs; neck = 36.5%, mid-back = 8.4%, low back = 56.0%, multi-site = 0.3%) who completed the SFI-10, the Patient Specific Functional Scale (PSFS), and Numerical Rating Scales for Global-function (G-NRS) and Pain (P-NRS). Structural validity used factor analysis, exploratory (EFA) and confirmatory (CFA), plus Rasch analysis. Criterion validity used Spearman's correlation coefficient (r) between the SFI-10 and criteria (PSFS, G-NRS and P-PRS) scores, and construct validity (n = 91, known-groups independent t-test). Internal consistency used Cronbach's alpha (α) and floor/ceiling effects were determined. Subgroups determined reliability (n = 104, intraclass correlation coefficient, ICC2.1); error (n = 171) through the standard error of measurement (SEM) and minimum detectable change (MDC90). Responsiveness (n = 171) was calculated using effect-size (ES), standard response mean (SRM), and area under the curve (AUC); and interpretability through the minimal clinically important difference (MCID). Practicality (n = 16) clarified missing responses, readability, and time/errors for completion/scoring.

The SFI-10's structural validity was unequivocally one-dimensional from EFA and verified by CFA with acceptable fit-indices (chi-square/df = 2.88, CFI = 0.981, TLI = 0.975, RMSEA = 0.061), and supported by Rasch analysis (PSR = 0.79, Infit = 0.678-1.216, Outfit = 0.604-1.279, Item-difficulties = -1,215-2.488). Criterion validity varied from high (G-NRS, r = 0.60) and moderate (PSFS, r = 0.43) to low-inverse (P-NRS, r = -0.24). Internal consistency was strong (α = 0.84) and no floor/ceiling effects were present. Reliability was excellent (ICC2.1 = 0.97), responsiveness substantial (ES = 1.54; SRM = 1.64; AUC = 0.89), and measurement error robust (SEM = 3.84; MDC90 = 8.98%, MDIC = 10.4%), with construct validity confirmed (p < 0.001). Practicality showed no missing responses, completion/scoring errors < 1%, excellent readability (Grade = 5.1, Ease = 74.1%), short completion (39.2 ± 10.3 s) and scoring times (8.5 ± 1.8 s).

The SFI-10 demonstrates sound measurement properties in a general physiotherapy outpatient MSD spine population for both psychometric and practical characteristics. Further investigation in culturally diverse settings that include both inpatients and community settings with whole-spine and regional-spine criteria is required.

Low back pain (LBP) is the leading cause of disability worldwide, with most cases classified as non-specific low back pain (NSLBP). Various treatments exist, among which are physical exercises that promote flexibility, mobility and core stabilization, improving muscle function and body posture. The Canali Postural Method (CPM) is a kinesiological method that offers a personalized approach to postural reprogramming. This study compares the effects of the CPM and generic exercises in individuals with NSLBP.

Subjects with NSLBP were engaged in a four-week intervention either based on a CPM reprogramming phase (CPM group) or generic exercises for the control group (CG). The CPM group underwent an assessment phase to identify the possible musculoskeletal causes of compensatory postural arrangements. The functional disability and pain level were assessed before, immediately after and 3 months post-intervention in both groups. Data were analyzed using repeated measures ANOVA.

Thirty-five subjects per group participated, with the CPM group averaging 38.6 ± 10.1 years and the CG 40.2 ± 12.1 years. The CPM group experienced significantly greater pain relief both immediately post-intervention and at the 3-month follow-up (p < 0.001). While the disability perception decreased in both groups, the CPM group showed superior improvement at the 3-month follow-up (p < 0.001).

The CPM represents promise for enhancing motor control and quality of life, suggesting potential benefits for other musculoskeletal issues. Future research should explore its broader applications and underlying physiological mechanisms.

This prospective, single-arm, multicentre study evaluated the effectiveness of 10 kHz spinal cord stimulation (SCS) in relieving pain and improving function and quality of life in patients with chronic intractable leg pain in routine clinical practice.

Patients with leg pain refractory to conservative therapy and scoring ≥ 5 cm on a 10-cm visual analog scale (VAS) were enrolled at 12 centres. Those who achieved ≥ 50% leg pain relief during a temporary trial underwent permanent implantation and were followed for 12 months. Outcomes collected included the proportion of patients who achieved ≥ 50% reduction in leg pain VAS score, health-related quality-of-life (EQ-5D-5 L, functional disability [ODI]), opioid use, sleep quality (PSQ-3), global impression of change (GIC), and patient satisfaction.

Of 121 patients trialed, 118 completed the trial and 95 proceeded to implant. At 3 months, 61/95 (64.2%) of all implanted patients were responders to therapy (≥ 50% VAS reduction), which remained stable at 64.2% through 12 months. EQ-5D-5 L, ODI, and PSQ-3 showed clinically important and sustained improvement over 12 months (repeated measures ANOVA, p < 0.001). Patients also reduced opioid dosage on average (p = 0.022). The safety profile was consistent with previous reports using 10 kHz SCS.

This study supports 10 kHz SCS as an effective and safe therapeutic option to reduce pain and disability while improving health-related quality of life in patients with chronic intractable leg pain. 10 kHz SCS appears to be effective in significantly improving the severe disability and poor quality of life experienced by patients with chronic intractable leg pain.

ISRCTN Registry - ISRCTN11180496.

To determine benefits and adverse effects (AE) of oral muscle-relaxants (MR) (non-benzodiazepines) for acute (< 6 weeks) and chronic (> 12 weeks) primary LBP, administered alone or combined with analgesics/NSAIDs.

CENTRAL, MEDLINE, EMBASE, CINAHL were searched for pertinent randomized controlled trials. Primary outcomes comprised lack of pain relief, global efficacy and AE at 5-7 days follow-up assessed dichotomously (risk ratio, RR).

Fifty studies (7531 participants) were included, with data from 4775 pooled in meta-analyses. For acute LBP, non-benzodiazepine MR were associated with increased likelihood of pain relief (moderate certainty; RR: 0.53, p < 0.0001), global efficacy (RR: 0.49, p = 0.0001), muscle spasm (RR: 0.62, p < 0.00001), and physical outcomes (RR: 0.60, p < 0.00001) compared to placebo. AE were more frequent with non-benzodiazepine MR compared to placebo (low-to-moderate certainty; RR: 1.56; p = 0.003), and at central nervous system (CNS; RR: 2.40; p < 0.00001), but not at gastrointestinal (GI) level (RR: 0.77; p = 0.62). Combined non-benzodiazepines + analgesics/non-steroidal anti-inflammatory drugs (NSAIDs) provide a larger and clinically meaningful benefit compared to placebo + analgesics/NSAIDs for global efficacy at 5-7 days (low-certainty; RR: 0.62; p = 0.01). Combined therapy did not result in significant between-group differences for total AE (moderate-certainty; RR: 1.15; p = 0.50) and GI AE (RR: 0.63; p = 0.08), despite responsible for more CNS AE (low-certainty; RR: 1.91; p = 0.002). When comparing non-benzodiazepine MR versus placebo for chronic LBP, only data on total AE could be pooled, without between-group difference (RR: 0.93; p = 0.69).

Non-benzodiazepine MR for acute LBP were associated with increased likelihood of pain relief and global efficacy compared to placebo. Combined therapy with analgesics/NSAIDs proved superior for global efficacy. Studies are needed to evaluate if non-benzodiazepine MR are of larger benefit than analgesics/NSAIDs, and if stand-alone administration provides more benefit than combined treatment. The observed AE warrant caution.

To evaluate the effectiveness of an evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) on disability in patients undergoing lumbar fusion surgery (LFS), compared to usual care.

A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to usual care (N = 36) or the REACT rehabilitation pathway (N = 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support towards an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively.

Participants in the REACT group demonstrated significantly greater improvements in disability (p = 0.003), back pain intensity (p = 0.007), and return-to-work rates (88% vs 56%, p = 0.34) compared to the control group. The REACT group also showed greater improvements in fear of movement (p = 0.038), pain catastrophizing (p < 0.001), combined negative emotional states (p = 0.007), sit-to-stand performance (p = 0.021), and reduced analgesic use (p = 0.001). No significant differences were observed in leg pain intensity (p = 0.042), length of hospital stay (p = 0.095) or adverse events (p = 1.00).

The REACT rehabilitation pathway significantly reduced disability in the first postoperative year after LFS compared to usual care. The most promising result is the significantly higher return-to-work rate in the REACT group.

Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the "value" (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.

We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion. Time-driven activity-based costing was used to calculate total intraoperative costs. Neck Disability Index (NDI) scores were recorded at baseline and 3 months postsurgery. Patients were categorized into groups based on their preoperative NDI score. Our primary outcome was a novel Operative Value Index (OVI), defined as the percent change in NDI per $1000 spent intraoperatively. Generalized linear mixed model regression was used to determine if severe-to-complete ("high") baseline neck disability was significantly associated with OVI and total cost.

Compared to patients with "high" preoperative neck disability, the OVI was significantly lower for patients with no neck disability (β-coefficient: -14.0; P < 0.001) and mild neck disability (β-coefficient: -4.06; P < 0.001). There were no significant associations between the NDI groups and total intraoperative cost.

Surgery provided the most value for patients with "high" baseline neck disability, with more favorable outcomes per dollar spent compared to those with low baseline neck disability. Patients with low baseline neck disability may therefore be suboptimal candidates for bundled payments, emphasizing the importance of careful patient selection to optimize resource use and outcomes in value-based care models.

Chronic back pain is a long-lasting disorder that is significantly associated with a reduction in the quality of life. Previously, the efficacy of intradiscal and epidural injections of plasma rich in growth factors (PRGF) was demonstrated at 6 months. The objective of this study was to retrospectively examine the medical records of these patients in order to determine whether the observed improvement at the 6-month follow-up was sustained over time.

PRGF efficacy was evaluated using validated questionnaires: Core Outcome Measure Index (COMI) Pain score, COMI Disability score, COMI total score, and Oswestry Disability Index (ODI). Furthermore, an evaluation was conducted to determine whether the patients had undergone additional treatments.

the results demonstrated that 85.2% of the 27 patients who were enrolled exhibited sustained improvement across all scales over a median follow-up period of 24 months. The results of all questionnaires administered at 24 months exhibited statistically significant differences when compared to the baseline data (p < 0.01). Furthermore, there were no statistically significant differences between the results reported at 6 months and those at 24 months (p > 0.05).

the results of this retrospective study demonstrate that treatment of chronic back pain with PRGF was effective in maintaining pain reduction and improving function for at least 24 months after the end of treatment.

Exercise consistently demonstrates a small effect size for patients with persistent low back pain (PLBP). Determining patient characteristics that influence intervention responsiveness may improve treatment allocation and effect sizes. An exercise intervention for patients with PLBP and maladaptive changes in lateral abdominal muscle (LAM) contraction was recently trialed.

To identify factors predicting responsiveness to an exercise intervention for patients with PLBP and why.

This was a secondary mixed methods analysis of results from a feasibility randomized controlled trial with 50 participants. The 12-week program included individualized motor control and graded activity exercise. Regressions were performed to understand potential associations between characteristics (demographic, condition-specific signs and symptoms, compliance with exercise, and beliefs about exercise) and outcomes (pain, function, disability, and LAM contraction). Interview transcripts were analyzed for characteristics unique to participants that responded most and least to the intervention. Data was integrated for complementarity.

At baseline, females, participants with lower BMIs, decreased chronicity, fewer areas of pain, who had less previous interactions with healthcare professionals, and who were more positive about the potential for exercise to improve their pain had greater responsiveness (Adjusted R2 ranged from 0.17 to 0.66). During and after the program, increased physical activity levels was a positive predictor.

Responsiveness to the intervention may have been mediated by several baseline factors which may have affected participants' engagement with the intervention and continuation with exercise post intervention. Such characteristics may assist clinicians identifying whether this may be an appropriate intervention for patients with PLBP.

Antidepressants are commonly used to treat low back pain and spine-related leg pain. However, their benefits and harms are uncertain. This is an update of a 2008 Cochrane review of antidepressants for non-specific low back pain.

To assess the benefits and harms of antidepressants for non-specific low back pain and spine-related leg pain.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and EU Clinical Trials Register from inception to 14 November 2024.

We included randomised controlled trials that compared antidepressants with placebo, usual care, or no treatment/waiting list. Participants were 18 years of age or older with non-specific low back pain or spine-related leg pain of any duration. We excluded participants with low back pain due to spinal fracture, inflammatory disease, aortic dissection, malignancy, or infection. Primary outcomes were pain intensity and disability, measured at short-term follow-up (> 4 to 14 weeks post-randomisation), and total adverse events. Secondary outcomes were serious adverse events, withdrawals due to adverse events, depressive symptoms, and health-related quality of life.

Two review authors independently screened records to determine study inclusion, extracted data, and evaluated risk of bias using RoB 1 tool. Where possible, we conducted meta-analyses. We used GRADE to assess the certainty of evidence.

We included 26 randomised controlled trials. Eighteen studies included 2535 participants with non-specific low back pain, seven studies included 329 participants with spine-related leg pain, and one study included 68 participants with either condition. Most participants had pain lasting more than three months, with a mean duration between 18 months and 20 years. Mean ages ranged from 27 to 59 years. Studies evaluated serotonin and norepinephrine reuptake inhibitors (SNRIs; eight studies), selective serotonin reuptake inhibitors (SSRIs; two studies), tricyclic antidepressants (TCAs; 14 studies), tetracyclic antidepressants (TeCAs; two studies), or 'other antidepressants' (two studies). All studies were placebo-controlled. Outcomes were measured at short-term follow-up in 73% of studies. All included studies had at least one domain judged at high risk of bias, with 69% at high risk of attrition bias. Non-specific low back pain (benefits) Moderate-certainty evidence demonstrated that SNRIs probably have a small effect on pain intensity (mean difference (MD) (0 to 100 scale) -5.25, 95% confidence interval (CI) -7.17 to -3.34; I2 = 0; 4 studies, 1415 participants) and a trivial effect on disability (MD (0 to 24 scale) -0.91, 95% CI -1.30 to -0.51; I2 = 0; 4 studies, 1348 participants) at short-term follow-up. Low-certainty evidence showed that SSRIs may have little to no effect on pain intensity (MD 1.20, 95% CI -4.90 to 7.30; I2 = 0; 3 studies, 199 participants) and disability (MD -2.20 (0 to 100 scale), 95% CI -8.11 to 3.71; 1 study, 92 participants) at short-term follow-up. Moderate-certainty evidence demonstrated that TCAs probably have little to no effect on pain intensity (MD -2.00, 95% CI -7.25 to 3.24; I² = 31%; 4 studies, 417 participants), but probably have a small effect on disability (MD (0 to 24 scale) -1.76, 95% CI -2.70 to -0.82; I2 = 0; 3 studies, 330 participants) at short-term follow-up. The effects of TeCAs (MD -4.50, 95% CI -17.59 to 8.59; 1 study, 52 participants) and other antidepressants (MD -5.40, 95% CI -23.08 to 12.28; 1 study, 39 participants) on pain intensity at short-term follow-up are unclear (very low-certainty evidence). No studies assessed the effects of TeCAs or other antidepressants on disability. Spine-related leg pain (benefits) The effects of SNRIs on pain intensity (MD -46.10, 95% CI -89.29 to -2.91; 1 study, 11 participants) and disability (MD (0 to 100 scale) -4.40, 95% CI -20.25 to 11.45; 1 study, 11 participants) at short-term follow-up are very uncertain (very low-certainty evidence). Low-certainty evidence showed TCAs may have a large effect on pain intensity at short-term follow-up (MD -23.00, 95% CI -32.12 to -13.88; 1 study, 60 participants), and a moderate effect on disability (MD (0 to 100 scale) -13.00, 95% CI -19.42 to -6.58; 1 study, 60 participants). There were no studies that assessed the effects of SSRIs, TeCAs, or other antidepressants in people with spine-related leg pain. Non-specific low back pain and spine-related leg pain (harms) Moderate-certainty evidence demonstrated that SNRIs probably increase the risk of adverse events (risk ratio (RR) 1.17, 95% CI 1.07 to 1.27; I2 = 0%; 5 studies, 1510 participants), but it is unclear whether they increase the risk of serious adverse events (Peto odds ratio (OR) 1.75, 95% CI 0.79 to 3.89; 5 studies, 1510 participants; very low-certainty evidence). It is unclear whether TCAs increase the risk of adverse events (RR 1.76, 95% CI 0.79 to 3.90; 7 studies, 474 participants; low-certainty evidence) or serious adverse events (Peto OR 6.64, 95% CI 0.41 to 106.72; I² = 0%; 1 study, 142 participants; very low-certainty evidence). It is unclear whether SSRIs (RR 1.83, 95% CI 0.14 to 24.19; I² = 95%; 2 studies, 107 participants; very low-certainty evidence) or TeCAs increase the risk of adverse events (RR 0.93, 95% CI 0.79 to 1.09; 1 study, 52 participants; very low-certainty evidence). No studies assessed the risk of serious adverse events for these classes. No studies measured total adverse events for other antidepressants. It is unclear whether other antidepressants increase the risk of serious adverse events (Peto OR 0.90, 95% CI 0.16 to 4.96; 1 study, 42 participants; very low-certainty evidence).

We found that in people with non-specific low back pain, SNRIs probably have small effects on pain intensity, trivial effects on disability, and are probably associated with adverse effects. TCAs probably do not reduce low back pain intensity, but may have a small effect on disability. The effects of antidepressants on spine-related leg pain are uncertain, though SNRIs and TCAs might be prioritised over other classes for future investigations. Evidence for the safety of SSRIs, TCAs, TeCAs, and other antidepressants in non-specific low back pain and spine-related leg pain remains unclear.

The impact of surgical interventions on lumbar disc herniation (LDH) is often assessed using objective functional impairment (OFI) tests like the five-repetition sit-to-stand (5R-STS) test. This study calculates the minimum clinically important difference (MCID) for 5R-STS improvement in patients with LDH one year after surgery.

Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Numeric Rating Scale for back and leg pain, EQ-5D-3L health-related quality of life questionnaire and EQ5D-VAS were recorded preoperatively, at 6-weeks and 1-year post-operatively. The MCID was calculated using anchor-based methods (within-patient change; between-patient change; and receiver-operating characteristic approaches) and distribution-based methods (0.5 standard deviation (SD); effect size; standard error of measurement; standardized response mean; and 95% minimum detectable change (MDC)). The final MCID value was based on the "gold standard": an averaging of the anchor-based methods using ODI and RMDQ as the closest available anchors.

We prospectively recruited 134 patients. One-year follow-up was completed by 103 (76.8%) of patients. The MCID values derived using different methods varied from 0.7 to 5.1 s (s). The final, averaged, anchor-based MCID for improvement was 3.6 s. Within distribution-based methods, 95% MDC and 0.5SD approach, yielded an MCID of 3.0 and 3.8 s, respectively, aligning closely with the overall anchor-derived MCID for 5R-STS.

In a patient with LDH, an improvement in 5R-STS performance of at least 3.6 s can be regarded as a clinically relevant improvement.

Chronic low back pain is a major cause of pain and disability with limited effective therapies. Metformin is a safe, inexpensive, well-tolerated drug that has pleotropic effects, including effects on pain pathways that may influence low back pain. The aim of this randomised, double-blind, placebo-controlled trial is to determine whether metformin reduces low back pain over 4 months in individuals with chronic low back pain.

One hundred and twenty-three participants with chronic low back pain will be recruited from the community in Melbourne, Australia, and randomly allocated in a 1:1 ratio to receive either metformin 2g or identical placebo daily for 4 months. The primary outcome will be change in pain intensity assessed using a 100 ​mm visual analogue scale at 4 months and the secondary outcomes will be change in low back disability, physical activity and narcotic use. Adverse events will be recorded. The primary analysis will be by intention to treat.

Given the societal burden of LBP and the limited effective treatment options available, this study that evaluates the efficacy of metformin in LBP, if proves to be effective, will offer an important therapeutic approach for this disabling condition.

Ethics approval has been obtained from the Alfred Hospital Ethics Committee (392/21) and Monash University Human Research Ethics Committee (30607). Written informed consent will be obtained from all the participants. The findings will be disseminated through peer-review publications and conference presentations.

Australian New Zealand Clinical Trials Registry, ACTRN12621001453875 (registered 25th October 2021).

To describe the outcomes of an interdisciplinary multimodal pain treatment (IMPT) for chronic musculoskeletal pain (CMP) patients up until 12 months post-treatment.

Data were gathered during routine clinical practice during a 3-year period (2019-2021) at six Dutch rehabilitation centres. Assessments included patient-reported outcome measures for multiple domains including disability, pain and fatigue. Longitudinal data were analysed using repeated-measures models and by quantifying responder rates.

Included were 2309 patients with a mean age of 43.7 (SD 12.9) years, of which 73% female. All outcomes showed significant improvements at each timepoint. At discharge, large effect sizes were found for disability, average and worst pain, fatigue and health-related quality of life. Improvements were largely sustained at 12-months. Relatively large proportions of patients had clinically relevant improvements after treatment (pain-related disability: 60%; average pain: 52%; worst pain: 37.4%; work capacity: 50%; concentration: 50%; fatigue: 46%). Patients who received a treatment extension showed further improvements for all outcome measures, except average pain.

At group level, all outcomes significantly improved with mainly large effect sizes. The results were mostly sustained. The proportion of patients showing clinically relevant improvements tends to be larger than previously reported for mixed CMP patients.

To evaluate the effectiveness of physical exercise and its implications on pain, functional mobility (FM) and quality of life (QoL) in individuals with isolated hip osteoarthritis (HO).

Intervention systematic review.

Pubmed, Embase, CINAHL, CENTRAL (Cochrane) and PEDro were searched for studies evaluating the effect of exercise on pain, FM and QoL in people with HO from the first publication until August 2022.

Two reviewers independently assessed studies for inclusion and quality of evidence. We included randomized controlled trials on HO where the intervention was physical exercise compared with the control group (exercise different from the intervention or no intervention).

Available data were analyzed using meta-analysis when comparison was possible. Otherwise, the data were synthesized qualitatively. The quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Seven trials were identified. Low-quality evidence indicated that there was no significant difference between the mixed exercise versus no intervention groups in the meta-analysis for pain and QoL in short term. Low-quality evidence indicated that low-intensity resistance exercise showed a statistically significant difference when compared to high-intensity resistance exercise in terms of pain, and very low-quality evidence indicated that there was no significant difference regarding functional mobility, both in short term.

New clinical trials with methodological rigor should be carried out to investigate the effectiveness of physical exercise in individuals with HO and which is the most effective modality in pain, FM and QoL for future clinical decision-making.

Chronic non-specific low back pain (CNLBP) is a common health problem worldwide. Patients with CNLBP often suffer from persistent pain, with a few being disabled by their pain, affecting their daily functioning and social participation. This study aims to systematically evaluate the effects of pain and dysfunction in Qigong patients with chronic non-specific back pain through systematic evaluation and gathered analysis of random control test data.

We searched nine databases from their inception dates until April 2024. Relevant randomized controlled trials (RCTs) were included. Patients were assessed for pain using the Visual Analog Scale and Numeric Pain Rating Scale and for disability using the Oswestry Disability Index and Roland-Morris disability questionnaire. The risk of bias was assessed using the Cochrane Collaboration tool. CMA V3.0 was used to analyze data.

Sixteen RCTs involving 1175 participants were included. These studies have different designs, and the participants are mainly around 60 years old. The results showed that the qigong practice improved pain significantly more than the control measures ([Mean Difference MD] = - 1.34, 95% confidence intervals [CI] - 1.76 to - 0.92, p < 0.001 Minimal Clinically Important Differences MCID = 1.5), and the efficacy of short-term interventions (MD = - 1.88, 95% CI - 2.87 to - 0.9, p < 0.001) was superior to that of long-term interventions (MD = - 1.07, 95% CI - 1.49 to - 0.65, p < 0.001). For improvement in the degree of dysfunction, qigong practice showed a higher effect size (MD = - 5.88, 95% CI - 7.98 to - 3.78, p < 0.001 MCID = 5) than that observed in the control group.

Qigong practice is effective in improving disability in patients with CNLBP, but has no significant effect on improving pain. However, due to the high heterogeneity, the results need to be interpreted with caution.

Transforaminal epidural steroid injections (TEI) have been suggested to alleviate symptoms in patients with lumbar disc herniation (LDH) through its anti-inflammatory effect. However, treatment effect varies among patients and reliable predictors are lacking. Modic changes (MC) are also associated with inflammatory processes and, therefore, we hypothesize that MC may be correlated with outcome after TEI.

To investigate the correlation between the presence of MC at the level of LDH and the effect of TEI.

Patients with unilateral lumbar radiculopathy secondary to LDH undergoing TEI were included. MC was graded by two independent assessors. Outcome measures included leg pain, back pain, disability and patient-received recovery at baseline, 30 min, 2 weeks and 6 weeks after treatment. Multivariate analysis was performed for all outcomes and for dichotomized scores using a cutoff of ≥30% improvement. A p-value of ≤0.05 was considered statistically significant.

A total of 88 patients were included of whom 52.3% demonstrated MC. The vast majority was classified as type II (94%). The presence of MC was not correlated with any outcome measure when correcting for age, gender, duration of symptoms and the use of analgesics, nor for dichotomized scores.

The findings indicate that type II MC is not associated with outcome within six weeks after TEI. Therefore, type II MC cannot be used as a predictor for TEI outcome. Future studies should include longer follow-up and investigate the correlation between the type of MC and the effect of TEI.

To address the comparative effectiveness of common interventional procedures for chronic non-cancer (axial or radicular) spine pain.

Systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs).

Medline, Embase, CINAHL, CENTRAL, and Web of Science from inception to 24 January 2023.

RCTs that enrolled patients with chronic non-cancer spine pain, randomised to receive a commonly used interventional procedure versus sham procedure, usual care, or another interventional procedure.

Pairs of reviewers independently identified eligible studies, extracted data, and assessed risk of bias. We conducted frequentist network meta-analyses to summarise the evidence and used the GRADE approach to rate the certainty of evidence.

Of 132 eligible studies, 81 trials with 7977 patients that explored 13 interventional procedures or combinations of procedures were included in meta-analyses. All subsequent effects refer to comparisons with sham procedures. For chronic axial spine pain, the following probably provide little to no difference in pain relief (moderate certainty evidence): epidural injection of local anaesthetic (weighted mean difference (WMD) 0.28 cm on a 10 cm visual analogue scale (95% CI -1.18 to 1.75)), epidural injection of local anaesthetic and steroids (WMD 0.20 (-1.11 to 1.51)), and joint-targeted steroid injection (WMD 0.83 (-0.26 to 1.93)). Intramuscular injection of local anaesthetic (WMD -0.53 (-1.97 to 0.92)), epidural steroid injection (WMD 0.39 (-0.94 to 1.71)), joint-targeted injection of local anaesthetic (WMD 0.63 (-0.57 to 1.83)), and joint-targeted injection of local anaesthetic with steroids (WMD 0.22 (-0.42 to 0.87)) may provide little to no difference in pain relief (low certainty evidence); intramuscular injection of local anaesthetic with steroids may increase pain (WMD 1.82 (-0.29 to 3.93)) (low certainty evidence). Evidence for joint radiofrequency ablation proved of very low certainty.For chronic radicular spine pain, epidural injection of local anaesthetic and steroids (WMD -0.49 (-1.54 to 0.55)) and radiofrequency of dorsal root ganglion (WMD 0.15 (-0.98 to 1.28)) probably provide little to no difference in pain relief (moderate certainty evidence). Epidural injection of local anaesthetic (WMD -0.26 (-1.37 to 0.84)) and epidural injection of steroids (WMD -0.56 (-1.30 to 0.17)) may result in little to no difference in pain relief (low certainty evidence).

Our NMA of randomised trials provides low to moderate certainty evidence that, compared with sham procedures, commonly performed interventional procedures for axial or radicular chronic non-cancer spine pain may provide little to no pain relief.

PROSPERO (CRD42020170667).

 While the rates of lumbar spinal stenosis (LSS) surgery have increased continuously internationally, the role of fusion surgery in the treatment of LSS has been under debate. We aimed to assess the outcome of LSS surgery at 1 year postoperatively and to compare decompression surgery with or without fusion based on the Finnish national spine register FinSpine data.

 FinSpine data of surgically treated LSS from 2015 to 2022 was included. The primary outcome was Oswestry Disability Index (ODI), and secondary ones were Visual Analogue Scale for leg and back pain. Predetermined minimal clinically important difference (MCID) for all outcome measures was used to assess the clinical significance of differences in outcomes. Propensity score matching was utilized to ensure that the treatment groups were comparable.

 There were 8,647 LSS patients in the data, of whom 6,751 (77%) were the subject of decompression surgery. Over 90% of patients without spondylolisthesis received decompression alone. At 1-year follow-up, ODI was on average 20.6 (95% confidence interval [CI] 19.3-21.9]) for the fusion group and 23.3 (CI 22.5-24.0) for the decompression group. Differences in ODI, VAS leg pain, or VAS back pain were below the MCID. The share of patients reaching ODI percentage change score ≥ 30% was 74% (CI 71-78) in the fusion group and 66% (CI 63-68) in the decompression group.

 Most of the LSS patients experienced significant improvement after LSS surgery. We found no clinical differences between decompression surgery with and without fusion.

The objective of this study was to conduct a comprehensive comparison of the effects of hip and knee strengthening training in patients with patellofemoral pain (PFP). A meta-analysis was conducted to investigate the effects of these two types of strengthening training on patients' lower limb biomechanics, knee pain and function. The aim was to evaluate the effectiveness of the two training modalities and provide evidence-based recommendations for the rehabilitation of patients with PFP. A total of 12 studies were identified through a search of the Web of Science, EBSCO, and PubMed databases. The selected studies comprised nine randomized controlled trials (RCTs), one comparative controlled trial (CCTs) and two cohort studies (CSs), with a total of 1,066 patients. The quality of the included studies was evaluated via the PEDro scale, and a meta-analysis was conducted via Stata18 software. The results show that both types of strengthening training positively impact pain reduction and improved knee function in PFP patients. Moderate evidence from meta-analyses indicated that hip strengthening training (SMD = -1.740, 95%; CI -2.212 to -1.267, P < 0.001) was more effective than knee strengthening training (SMD = -1.302, 95%; CI -1.75 to -0.86, P < 0.001) in reducing pain (VAS). Similarly, Strong evidence suggests that hip strengthening training (SMD = 1.205, 95%; CI 0.968 to 1.443, P < 0.001) was significantly more effective than knee strengthening training (SMD = 1.023, 95%; CI 0.722 to 1.325, P < 0.001) in improving knee function (AKPS). Additionally, moderate evidence suggests that hip strengthening training significantly increased hip abductor strength (SMD = 0.848, 95%; CI 0.508-1.187, P < 0.001) and external rotator strength (SMD = 0.780, 95%; CI 0.416-1.145, P < 0.001), while strong evidence suggests that knee strengthening training did not significantly enhance knee extensor strength (SMD = 0.212, 95%; CI -0.014 to 0.439, P = 0.066). Therefore, clinicians should use hip strengthening as one of the primary training interventions when treating patients with PFP.

Cryotherapy, long used for its pain-relieving and anti-inflammatory effects, is widely applied in sports medicine, physiotherapy, and postoperative care. Advances in cryotherapy methods, including the use of topical vapocoolant sprays, offer enhanced pain management and support recovery from musculoskeletal injuries by alleviating pain and reducing swelling in a targeted manner.

The primary aim was to assess both immediate and sustained pain relief in subjects with mild to moderate musculoskeletal complaints.

Observational cohort study.

Fifty-nine participants with mild to moderate musculoskeletal pain participated in a three-week observational study evaluating a cryotherapy spray. Pain and range of motion (ROM) were assessed using the Visual Analogue Scale (VAS) and goniometer measurements at multiple time points, including T-1 (before treatment), T0 (beginning of treatment), T2-min, T5-min, T10-min, T15-min, T30-min, T60-min, T7-days, T14-days, while participants were actively receiving treatment exclusively with the cryotherapy spray, and T21-days (1 week after treatment cessation). Acceptability Test and additional subjective questionnaires evaluated participants analysis of cooling sensation and product tolerance. Data were analyzed using Cumulative Logit Mixed Models (CLMM) and the non-parametric Friedman test for repeated measures.

The cryotherapy spray significantly reduced pain (VAS) from baseline (p < 0.001, Hedges' g = -1.90) and improved joint mobility (ROM) with derived scores increasing from 3 (3-4) to 4 (4-4) by Day 21 (p < 0.001). Rapid pain relief was reported by 35% of participants within 10 seconds, with 80% experiencing relief within three minutes. Comfort ratings were consistently high, with 95% of participants expressing satisfaction at Day 0, rising to 99% by Day 14. Global efficacy satisfaction measured by a subjective Likert scale also increased from 75% at baseline to 95% by Day 14. No adverse events were reported.

This study supports the effectiveness of the cryotherapy spray in reducing pain and improving joint mobility, with both immediate and sustained benefits. High patient satisfaction and a favorable safety profile suggest its potential for clinical use. Further controlled studies could confirm its efficacy in broader populations.

Level 3.

The US National Institutes of Health (NIH) has produced a minimal data set to promote more accurate and consistent reporting of clinical trials, facilitating easier comparison of research on low back pain patients worldwide. The NIH-minimal dataset has not been previously translated into Turkish, and its features are currently unknown. This study aimed to adapt the NIH-Minimal Data Set into Turkish and investigate its validity and reliability in Turkish-speaking patients with chronic low back pain (CLBP).

In the study, 245 patients with CLBP were included. Test-retest and internal consistency analyzes were performed to evaluate the reliability of the NIH-minimal dataset. The intraclass correlation coefficient (ICC2,1) value was used to assess test-retest analysis. Cronbach's alpha value was calculated for internal consistency. Total impact scores of the NIH-minimal dataset were compared with total scores of the Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) to assess construct validity. The minimal detectable change (MDC95) was calculated based on the standard error of measurement (SEM95).

The NIH-Minimal Data Set was found to have high test-retest reliability (ICC2,1 = 0.928) and high internal consistency (Cronbach α = 0.905). The NIH-minimal dataset correlated well with RMDQ and ODI (r = 0.750 and 0.810, respectively). There were no floor or ceiling effects. Also, SEM95 and MDC95 for the total score were 4.57 and 12.55, respectively.

Considering all these data, it was concluded that the Turkish version of the NIH-minimal dataset is a valid and reliable outcome measure for evaluating patients with CLBP.

OBJECTIVE: To assess whether spinal manipulative therapy (SMT) application procedures (ie, target, thrust, and region) impacted changes in pain and disability for adults with spine pain. DESIGN: Systematic review with network meta-analysis. LITERATURE SEARCH: We searched PubMed and Epistemonikos for systematic reviews indexed up to February 2022 and conducted a systematic search of 5 databases (MEDLINE, EMBASE, CENTRAL [Cochrane Central Register of Controlled Trials], PEDro [Physiotherapy Evidence Database], and Index to Chiropractic Literature) from January 1, 2018, to September 12, 2023. We included randomized controlled trials (RCTs) from recent systematic reviews and newly identified RCTs published during the review process and employed artificial intelligence to identify potentially relevant articles not retrieved through our electronic database searches. STUDY SELECTION CRITERIA: We included RCTs of the effects of high-velocity, low-amplitude SMT, compared to other SMT approaches, interventions, or controls, in adults with spine pain. DATA SYNTHESIS: The outcomes were spinal pain intensity and disability measured at short-term (end of treatment) and long-term (closest to 12 months) follow-ups. Risk of bias (RoB) was assessed using version 2 of the Cochrane RoB tool. Results were presented as network plots, evidence rankings, and league tables. RESULTS: We included 161 RCTs (11 849 participants). Most SMT procedures were equal to clinical guideline interventions and were slightly more effective than other treatments. When comparing inter-SMT procedures, effects were small and not clinically relevant. A general and nonspecific rather than a specific and targeted SMT approach had the highest probability of achieving the largest effects. Results were based on very low- to low-certainty evidence, mainly downgraded owing to large within-study heterogeneity, high RoB, and an absence of direct comparisons. CONCLUSION: There was low-certainty evidence that clinicians could apply SMT according to their preferences and the patients' preferences and comfort. Differences between SMT approaches appear small and likely not clinically relevant. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 7 January 2025. https://doi.org/10.2519/jospt.2025.12707.

To examine the characteristics, satisfaction levels and clinical outcomes of rural and remote Australians with chronic pain completing an internet-delivered psychological pain management program (PMP).

Longitudinal routine care cohort study.

An Australian national digital psychology service.

Patients in inner regional locations (n = 401), outer regional and remote locations (n = 198), and major cities (n = 968), who used the service over a 6-year period.

Demographic and clinical data, patient-reported satisfaction and improvements, and meaningful clinical improvements (≥ 30% improvement).

Clinical improvements were observed from pre-treatment to post-treatment in pain-related disability (32% [95% CI: 29, 34]), depression symptoms (44% [95% CI: 39, 49]), anxiety symptoms (43% [95% CI: 39, 47]), and average pain intensity (23% [95% CI: 21, 26]), which were maintained to 3-month follow-up. High levels of satisfaction and treatment completion were also observed. Minor demographic and clinical differences were observed. However, there were similar rates of clinical improvement, treatment satisfaction and treatment completion in all groups.

The current findings further highlight the value of internet-delivered psychological PMPs for Australians with chronic pain living in regional and remote parts of the country. Further work is needed to raise awareness about the availability of these effective programmes and to integrate their use with traditional pain management services.

Musculoskeletal pain (MSKP) disorders entail a significant burden for individuals and healthcare systems. The PainSMART-strategy has been developed aiming to reduce divergences between patients and healthcare practitioners in their understanding of MSKP by providing a shared basis for communication and to facilitate patients' self-management of MSKP. The objective of the PainSMART-project is to evaluate the effects of the PainSMART-strategy as an adjunct to usual physiotherapy management compared to usual physiotherapy management alone.

The PainSMART-project is a research program with a collective suite of studies utilising mixed methods, centred around a randomised controlled trial (ClinicalTrials.gov NCT06187428). Subjects: Adults (18 years or older) seeking primary care for MSKP who are triaged and booked for an initial physiotherapy consultation at five primary care physiotherapy departments within the Swedish public healthcare regions of Östergötland and Jönköping. A total of 490 subjects will be randomised to receive one of two possible interventions.

Both groups will receive usual physiotherapy management for benign MSKP. The intervention group will also receive the PainSMART-strategy consisting of an educational film, reflection and reinforcement of the film's key messages prior to the initial physiotherapy consultation and a patient-practitioner discussion based on the film.

The primary outcome is 1) between group mean change over time from baseline to 24 hours post initial physiotherapy consultation and baseline to 3 months regarding self-reported average pain intensity and pain self-efficacy. Secondary outcomes include similar measurements for MSKP illness perception, reassurance of benign nature, pain coping, physical activity, analgesic medication use, sick leave, healthcare use and direct healthcare costs. Physiotherapist and patient reported experience measures and qualitative evaluation of the effects of the PainSMART-strategy on communication at the initial physiotherapy consultation will also be explored.

This study will investigate potential added effects of PainSMART-strategy upon usual primary care physiotherapy for MSKP.

Background and Objectives: The International Society for Modulation defines persistent spinal pain syndrome type 2 (PSPS-type 2), formerly known as failed back surgery syndrome, as a condition where patients continue to experience pain or develop new pain following spinal surgery intended to alleviate back or lower-limb discomfort. PSPS-type 2 is characterized by pain and significant disability, affecting quality of life. Spinal cord stimulation has proven effective in treating this syndrome, although the role of psychological factors, such as pain catastrophizing and central sensitization, remain unclear. This study seeks to examine the potential connection between psychosocial responses and both functionality and pain perception in patients with persistent spinal pain syndrome type 2 who have undergone spinal cord stimulation treatment. Materials and Methods: A single-site, cross-sectional study was conducted on individuals diagnosed with persistent spinal pain syndrome type 2 who were receiving spinal cord stimulation. Study participants were required to meet specific eligibility criteria and were assessed for disability, pain perception, fear of movement, pain catastrophizing, and central sensitization. The spinal cord stimulation procedure involved the placement of electrodes at vertebral levels T8-T11 for precise pain control, with a particular focus on targeting the dorsal root ganglion to alleviate chronic pain. Results: Thirty-seven patients with persistent spinal pain syndrome type 2 have undergone spinal cord stimulation treatment for 4.68 ± 5.25 years. Clinical assessments indicated a pain perception score of 5.6 ± 1.96, Central Sensitization Inventory score of 42.08 ± 18.39, disability score of 37.62 ± 16.13, fear of movement score of 33.11 ± 8.76, and pain catastrophizing score of 28.43 ± 13.14. Finally, pain catastrophizing was significantly associated with pain perception (β = 0.075 and p = 0.008) and disability (β = 0.90 and p < 0.01). Conclusions: Catastrophizing plays a crucial role in pain perception and disability among patients with persistent spinal pain syndrome type 2 receiving spinal cord stimulation. Integrating psychological interventions may improve clinical outcomes for these patients.