- Department of Rehabilitation Sciences, Hong Kong Polytechnic University
- 852-2766-6741
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The University of Hong Kong, Biology, AlumnusThe University of Hong Kong, Orthopaedics and Traumatology, Alumnus, and 2 more add
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Engineering, Sport Biomechanics, Robotics, Spinal Stiffness, Rehabilitative ultrasound imaging of muscle, Spinal Manipulative Therapy, and 21 moreBiomechanics, Low back pain, Physical Therapy, Sport, Physical Education, Exercise Science, Statistics, Epidemiology, Sports Medicine, Bayesian, Sports Injuries, Orthopedic physical therapy, Wheelchairs, Prevention Sports Injuries, Fencing Performance, Disabled People and Sport, Back Research, Lumbar Muscles, Paraspinal Muscles, Back Muscle, and Ethics edit
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Dr Wong is the Program Leader of the BSc (Hons) in Physiotherapy Program at The Hong Kong Polytechnic University. His... moreDr Wong is the Program Leader of the BSc (Hons) in Physiotherapy Program at The Hong Kong Polytechnic University. His research interests focus on spinal disorders, low back pain, osteoarthritis, and ergonomics. He uses state-of-the-art wearable technologies and artificial intelligence in his research. He has published over 100 peer-reviewed publications in prestigious academic journals (e.g., Sleep Medicine Reviews, Ageing Research Reviews, The Journal of Bone & Joint Surgery, and Osteoarthritis and Cartilage). His outstanding academic performance was attested by 44 academic and 6 community services awards. His research funding was valued at approximately USD 2 million. He has been awarded four best papers at both international and local medical conferences. He has established strong research connections in Hong Kong, Australia, China, Japan, France, Brazil, Italy, Nigeria, Denmark, Netherlands, Brazil, Sweden, Switzerland, the UK and the USA. Currently, Dr Wong is accepting postdoctoral fellows and graduate students. edit
Approximately 60-80% of people experience low back pain at least once in their lifetime. Given the poor correlation between radiological findings and low back pain, physicians and physiotherapists usually palpate patients with low back... more
Approximately 60-80% of people experience low back pain at least once in their lifetime. Given the poor correlation between radiological findings and low back pain, physicians and physiotherapists usually palpate patients with low back pain to assess the severity of back pain and to make differential diagnosis. However, this clinical assessment has been criticized for its subjectivity and low reliability. This book includes comprehensive reviews on different spinal stiffness assessments and paraspinal surface electromyography, as well as two empirical studies using state-of-the-art technology to investigate the relation between spinal stiffness and back muscle activity. The results of these studies revealed that there was a directional specific relation between the two in healthy individuals. The results help develop a new method that may improve the accuracy of back assessment in clinical practice. This book proivdes up-to-date information on spinal research for both researchers and clinicians.
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Related content Similar articles: Open Access COVID-19 and Spine Surgery: A Review and Evolving Recommendations Open Access Intradural Neurocysticercosis of Lumbar Spine: A Case Report Open Access Defining the Role of... more
Related content
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Low back pain is the most common musculoskeletal complaint affecting every population worldwide.1 It is the leading cause of diminished activity and loss of work in addition to one of the most frequent reasons for physician visits.2-3 In 2016, direct treatment for back and neck pain was reported to cost over $134 billion US dollars annually in the United States, the highest of 154 conditions reviewed.4 An earlier review noted that the direct treatment expenditures are only a small percentage of the total economic impact when indirect costs of disability are calculated. Furthermore, outcomes of low back pain treatment are often tenuous and tremendous efforts have been initiated to improve phenotyping of such pain patients in hopes to lend to more precision to spine care management and outcomes.5 Spinal disorders are of particular concern in underserved and low- and middle-income countries, especially in the elderly and working populations.6 Back pain is more common and associated with worse outcomes and lower life expectancy in underserved populations.7 Thus, back pain represents a considerable physical and socioeconomic burden and should be considered a global public health issue. The relationship or association between the coronavirus-19 (COVID-19) infection and spine pain, however, has yet to be investigated.
Similar articles:
Open Access
COVID-19 and Spine Surgery: A Review and Evolving Recommendations
Open Access
Intradural Neurocysticercosis of Lumbar Spine: A Case Report
Open Access
Defining the Role of Cognitive Behavioral Therapy in Treating Chronic Low Back Pain: An Overview
SAGE recommends:
SAGE Knowledge
Entry
Health Consequences of Child Maltreatment
SAGE Knowledge
Book chapter
Pain
CQR
Report
Long COVID
Low back pain is the most common musculoskeletal complaint affecting every population worldwide.1 It is the leading cause of diminished activity and loss of work in addition to one of the most frequent reasons for physician visits.2-3 In 2016, direct treatment for back and neck pain was reported to cost over $134 billion US dollars annually in the United States, the highest of 154 conditions reviewed.4 An earlier review noted that the direct treatment expenditures are only a small percentage of the total economic impact when indirect costs of disability are calculated. Furthermore, outcomes of low back pain treatment are often tenuous and tremendous efforts have been initiated to improve phenotyping of such pain patients in hopes to lend to more precision to spine care management and outcomes.5 Spinal disorders are of particular concern in underserved and low- and middle-income countries, especially in the elderly and working populations.6 Back pain is more common and associated with worse outcomes and lower life expectancy in underserved populations.7 Thus, back pain represents a considerable physical and socioeconomic burden and should be considered a global public health issue. The relationship or association between the coronavirus-19 (COVID-19) infection and spine pain, however, has yet to be investigated.
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Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively... more
Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively review the scope of mHealth technology in managing hip/knee OA. This scoping review and scientometric analyses aimed to summarize the current state of research on the use of mHealth technology (mobile applications/web-based interventions) for self-management/education of adults with hip/knee OA, identify key research activities, and provide future directions on the development/usage of mHealth technology. Methods: The Arksey and O'Malley methodological framework was employed, augmented with scientometric analyses. Six databases were searched from inception to 31 May 2021. Findings were reported according to the PRISMA extension for scoping review. Co-word, co-author, and co-citation scientometric analyses were conducted to examine the social and intellectual connections of the research field (e.g., research hotspots and researcher collaborations). Results: Twenty mHealth programs for promoting self-management of hip/knee OA were identified. The programs mainly included exercises or directives on performance of exercises. Compared to no interventions, mHealth technology was usable and might be more effective in improving pain, physical function, and quality of life in individuals with OA. The scientometric analyses identified multiple co-occurring keywords that reflected conceptual properties of this research domain. Although some intellectual connections among authors, research articles, and journals were noted, there were insufficient international collaborations in this field. Discussion: While individual small-scale studies highlighted promising short-term effects of mHealth technology in self-managing hip/knee OA, many mHealth technologies were developed without clinicians' and/or patients' contributions. Future mHealth programs should be developed based on a strong theoretical background and professional inputs. The long-term benefits and cost-effectiveness of mHealth technologies, user experience, as well as cross-cultural adaptation of these technologies should be evaluated.
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Background The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of... more
Background
The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of COVID-19 on chiropractors internationally, and examines the public health response of chiropractors to the COVID-19 pandemic practising under a musculoskeletal spine-care versus subluxation-based care paradigm.
Methods
A survey was distributed to chiropractors in Australia, Canada, Denmark, Hong Kong, United Kingdom and United States (Oct. 2nd–Dec. 22nd, 2020) via professional bodies/publications, and social media. Questions were categorised into three domains: socio-demographic, public health response and business/financial impact. Multivariable logistic regression explored survey items associated with chiropractors practising under different self-reported paradigms.
Results
A total of 2061 chiropractors representing four global regions completed the survey. Our recruitment method did not allow the calculation of an accurate response rate. The vast majority initiated COVID-19 infection control changes within their practice setting, including increased disinfecting of treatment equipment (95%), frequent contact areas (94%) and increased hand hygiene (94%). While findings varied by region, most chiropractors (85%) indicated that they had implemented regulator advice on the use of personal protective equipment (PPE). Suspension of face-to-face patient care during the peak of the pandemic was reported by 49% of the participants with 26% implementing telehealth since the pandemic began. Chiropractors practising under a musculoskeletal spine-care paradigm were more likely to implement some/all regulator advice on patient PPE use (odds ratio [OR] = 3.25; 95% confidence interval [CI]: 1.57, 6.74) and practitioner PPE use (OR = 2.59; 95% CI 1.32, 5.08); trust COVID-19 public health information provided by government/World Health Organisation/chiropractic bodies (OR = 2.47; 95% CI 1.49, 4.10), and initiate patient telehealth in response to COVID-19 (OR = 1.46; 95% CI 1.02, 2.08) compared to those practising under a subluxation-based paradigm.
Conclusions
Chiropractors who responded to our survey made substantial infectious control changes in response to COVID-19. However, there was regional variation in the implementation of the advised practitioner and patient use of PPE and limited overall use of telehealth consultations by chiropractors during COVID-19. Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.
The unprecedented impact of COVID-19 on healthcare professionals has implications for healthcare delivery, including the public health guidance provided to patients. This study aims to assess the response and impact of COVID-19 on chiropractors internationally, and examines the public health response of chiropractors to the COVID-19 pandemic practising under a musculoskeletal spine-care versus subluxation-based care paradigm.
Methods
A survey was distributed to chiropractors in Australia, Canada, Denmark, Hong Kong, United Kingdom and United States (Oct. 2nd–Dec. 22nd, 2020) via professional bodies/publications, and social media. Questions were categorised into three domains: socio-demographic, public health response and business/financial impact. Multivariable logistic regression explored survey items associated with chiropractors practising under different self-reported paradigms.
Results
A total of 2061 chiropractors representing four global regions completed the survey. Our recruitment method did not allow the calculation of an accurate response rate. The vast majority initiated COVID-19 infection control changes within their practice setting, including increased disinfecting of treatment equipment (95%), frequent contact areas (94%) and increased hand hygiene (94%). While findings varied by region, most chiropractors (85%) indicated that they had implemented regulator advice on the use of personal protective equipment (PPE). Suspension of face-to-face patient care during the peak of the pandemic was reported by 49% of the participants with 26% implementing telehealth since the pandemic began. Chiropractors practising under a musculoskeletal spine-care paradigm were more likely to implement some/all regulator advice on patient PPE use (odds ratio [OR] = 3.25; 95% confidence interval [CI]: 1.57, 6.74) and practitioner PPE use (OR = 2.59; 95% CI 1.32, 5.08); trust COVID-19 public health information provided by government/World Health Organisation/chiropractic bodies (OR = 2.47; 95% CI 1.49, 4.10), and initiate patient telehealth in response to COVID-19 (OR = 1.46; 95% CI 1.02, 2.08) compared to those practising under a subluxation-based paradigm.
Conclusions
Chiropractors who responded to our survey made substantial infectious control changes in response to COVID-19. However, there was regional variation in the implementation of the advised practitioner and patient use of PPE and limited overall use of telehealth consultations by chiropractors during COVID-19. Musculoskeletal spine-care chiropractors were more adaptive to certain COVID-19 public health changes within their practice setting than subluxation-based chiropractors.
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Many experimental sleep deprivation (SD) studies were conducted to clarify the causal relationship between sleep and pain. This systematic review and meta-analysis aimed to update the evidence regarding the effects of different... more
Many experimental sleep deprivation (SD) studies were conducted to clarify the causal relationship between sleep and pain. This systematic review and meta-analysis aimed to update the evidence regarding the effects of different experimental SD paradigms on various pain outcomes. Five databases were searched from their inception to June 2022. Separate random-effects models were used to estimate the pooled effect sizes (ES) of different experimental SD paradigms on various pain outcomes. Thirty-one studies involving 699 healthy individuals and 47 individuals with chronic pain were included. For healthy individuals, limited evidence substantiated that total SD significantly reduced pain threshold and tolerance (ES 0.74e0.95), while moderate evidence supported that partial SD significantly increased spontaneous pain intensity (ES 0.30). Very limited to moderate evidence showed that sleep fragmentation significantly increased peripheral and central sensitization in healthy individuals (ES 0.42e0.79). Further, there was very limited evidence that total or partial SD significantly aggravated spontaneous pain intensity in people with chronic pain. Our results accentuated that different SD paradigms differentially increased subjective pain intensity and worsened peripheral/central pain sensitization in healthy individuals, whereas the corresponding findings in people with chronic pain remain uncertain. Further rigorous studies are warranted to quantify their relationships in clinical populations.
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Objectives To improve our understanding of patients’ perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences. Design Qualitative research... more
Objectives
To improve our understanding of patients’ perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences.
Design
Qualitative research with semi-structured interviews.
Setting
General community.
Participants
Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview.
Interventions
Not applicable.
Main Outcome Measures
Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery.
Results
Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time.
Conclusions
Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.
To improve our understanding of patients’ perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences.
Design
Qualitative research with semi-structured interviews.
Setting
General community.
Participants
Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview.
Interventions
Not applicable.
Main Outcome Measures
Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery.
Results
Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time.
Conclusions
Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.
Research Interests:
Background: Adjacent segment disease (ASD) following anterior cervical discectomy and fusion with plating (ACDF-P) may yield a poor prognosis or reoperation. This review aimed to summarize risk factors for radiographic ASD (RASD) and... more
Background:
Adjacent segment disease (ASD) following anterior cervical discectomy and fusion with plating (ACDF-P) may yield a poor prognosis or reoperation. This review aimed to summarize risk factors for radiographic ASD (RASD) and clinical ASD (CASD) after ACDF-P.
Methods:
Six electronic databases were searched from inception to October 30, 2021. Four reviewers independently screened titles, abstracts, and full-text articles to identify relevant studies. Methodological quality of the included studies was evaluated. Meta-analyses for risk factors were conducted, if possible.
Results:
Sixteen cohort and 3 case-control studies (3,563 participants) were included. These studies showed low (n = 2), moderate (n = 9), and high (n = 8) risk of bias. One risk factor for RASD was pooled for 2 meta-analyses based on the follow-up period. Four different risk factors for CASD at ≥4 years were pooled for meta-analyses. Limited evidence showed that multi-level fusion, greater asymmetry in total or functional cross-sectional area of the cervical paraspinal muscle, and preoperative degeneration in a greater number of segments were associated with a higher RASD incidence <4 years after ACDF-P. In contrast, no significant risk factors were identified for CASD <4 years after ACDF-P. At ≥4 years after ACDF-P, limited evidence supported that both cephalad and caudal plate-to-disc distances of <5 mm were associated with a higher RASD incidence, and very limited evidence supported that developmental canal stenosis, preoperative RASD, unfused C5-C6 or C6-C7 adjacent segments, use of autogenous bone graft, and spondylosis-related ACDF-P were associated with a higher CASD incidence.
Conclusions:
Although several risk factors for RASD and CASD development after ACDF-P were identified, the supporting evidence was very limited to limited. Future prospective studies should extend the existing knowledge by more robustly identifying risk factors for RASD and CASD after ACDF-P to inform clinical practice.
Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Adjacent segment disease (ASD) following anterior cervical discectomy and fusion with plating (ACDF-P) may yield a poor prognosis or reoperation. This review aimed to summarize risk factors for radiographic ASD (RASD) and clinical ASD (CASD) after ACDF-P.
Methods:
Six electronic databases were searched from inception to October 30, 2021. Four reviewers independently screened titles, abstracts, and full-text articles to identify relevant studies. Methodological quality of the included studies was evaluated. Meta-analyses for risk factors were conducted, if possible.
Results:
Sixteen cohort and 3 case-control studies (3,563 participants) were included. These studies showed low (n = 2), moderate (n = 9), and high (n = 8) risk of bias. One risk factor for RASD was pooled for 2 meta-analyses based on the follow-up period. Four different risk factors for CASD at ≥4 years were pooled for meta-analyses. Limited evidence showed that multi-level fusion, greater asymmetry in total or functional cross-sectional area of the cervical paraspinal muscle, and preoperative degeneration in a greater number of segments were associated with a higher RASD incidence <4 years after ACDF-P. In contrast, no significant risk factors were identified for CASD <4 years after ACDF-P. At ≥4 years after ACDF-P, limited evidence supported that both cephalad and caudal plate-to-disc distances of <5 mm were associated with a higher RASD incidence, and very limited evidence supported that developmental canal stenosis, preoperative RASD, unfused C5-C6 or C6-C7 adjacent segments, use of autogenous bone graft, and spondylosis-related ACDF-P were associated with a higher CASD incidence.
Conclusions:
Although several risk factors for RASD and CASD development after ACDF-P were identified, the supporting evidence was very limited to limited. Future prospective studies should extend the existing knowledge by more robustly identifying risk factors for RASD and CASD after ACDF-P to inform clinical practice.
Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Research Interests:
Background: Although the Patient-Reported Outcomes Measurement Information System Paediatric-25 Profile version 2.0 (PROMIS-25) has shown good reliability and validity in assessing HRQOL in Chinese children with cancer, its responsiveness... more
Background: Although the Patient-Reported Outcomes Measurement Information System Paediatric-25 Profile version 2.0 (PROMIS-25) has shown good reliability and validity in assessing HRQOL in Chinese children with cancer, its responsiveness (ie, the ability of the instrument to identify temporal changes in the construct to be measured) in detecting clinically meaningful changes in these children remains unclear. Objective: To evaluate the responsiveness and minimally important difference (MID) of the traditional Chinese PROMIS-25 for Chinese children with cancer. Design: Prospective study. Methods: The responsiveness of traditional Chinese PROMIS-25 domains before and after cancer treatment was evaluated by testing 24 a priori hypotheses of the correlations between changes in the domain scores and the corresponding changes in domain/total scores of the traditional Chinese Patient Health Questionnaire-9, traditional Chinese Paediatric Quality of Life Inventory 4.0, and 11-point numeric pain rating scale. The MID for each domain was determined by anchored-based method (MID-A), receiver operating characteristic curve analysis method, and distributionbased method (MID-D). Results: A total of 103 children with cancer (13.1 ± 1.8 years) were recruited. The traditional Chinese PROMIS-25 demonstrated moderate to high responsiveness. As all MID-As were higher than the MID-Ds, MID-As were recommended to determine domain changes. The MID-As were Physical Function = 12.3; Anxiety = 17.2; Depression = 15.4; Fatigue = 13.6; Peer Relationships = 6.5; and Pain Interference = 13.0. Limitations: This study excluded children with cognitive or visual impairments, as well as those requiring end-of-life care. Conclusions: The traditional Chinese PROMIS-25 is a responsive instrument to detect health-related quality of life changes among Chinese children with cancer. Our results provided important references for using PROMIS-25 in clinical practice and research.
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Purpose Although it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal... more
Purpose Although it is evident that some patients with adolescent idiopathic scoliosis (AIS) have proprioceptive deficit in peripheral joints, knowledge on the proprioceptive function of the deformed spine is limited. Nonetheless, spinal proprioception in AIS may be affected three-dimensionally, prior studies only focussed on evaluating peripheral proprioception in single plane. Therefore, this study aimed to develop a novel spinal proprioception assessment using three-dimensional motion analysis in patients with AIS. Methods Participants were included if they had a primary diagnosis of AIS who did not receive or failed conservative treatments. Three trunk repositioning tests involving flexion-extension, lateral-flexion, and axial-rotation were conducted. A three-dimensional kinematics of the trunk was used as the outcome measures. The proprioceptive acuity was quantified by the repositioning error. The intra-examiner and test-retest reliability were analysed by the intraclass correlation coefficient (ICC). Results Fifty-nine patients with AIS were recruited. Regarding the trunk flexion-extension test, the single measure ICC showed moderate reliability (0.46) and the average measures ICC demonstrated good reliability (0.72). As for the trunk lateral-flexion test, the reliability of single measure and average measures ICC was moderate (0.44) and good (0.70) reliability, respectively. For the trunk axial-rotation test, the single measure ICC indicated fair reliability (0.32), while the average measures ICC showed moderate reliability (0.59). Conclusion This is the first study to evaluate the reliability of novel three-dimensional spinal proprioception assessments in patients with AIS. The trunk flexion-extension repositioning test may be preferable clinical test given its highest reliability.
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Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively... more
Chronic low back pain (CLBP) is common among older adults. This systematic review aimed to summarize: (1) the prevalence and incidence of CLBP in older adults, and (2) demographic, psychological, and clinical factors positively/negatively associated with prevalence/incidence of CLBP among older adults. Four databases were searched to identify relevant publications. Ten studies (31,080 older adults) were included after being screened by 5 independent reviewers using predetermined criteria. The methodological quality of these studies was evaluated by standardized tools. The quality of evidence for all factors were appraised by modified GRADE for cohort studies. Twenty-eight and 1 factors were associated with a higher prevalence and a lower 5-year cumulative incidence of CLBP, respectively. No prognostic factor was identified. There was very limited to limited evidence that females, obesity, anxiety, depression, mental disorders, self-expectation of recovery, self-perceived health status, lifestyle (smoking, daily fluoride consumption), previous falls or lower body injury, retirement/disability due to ill health, family history of body pain, comorbidity (knee osteoarthritis, or chronic obstructive pulmonary disease with/without hypertension), weak abdominal muscles, leg pain, leg pain intensity, widespread pain, pain interference on functioning, use of pain medication, occupational exposure (driving for >20 years, or jobs involving bending/twisting for >10 years), disc space narrowing and severe facet osteoarthritis were significantly related to a higher prevalence of CLBP in older adults. However, very limited evidence suggested that intermediate level of leisure-time physical activity was associated with a lower prevalence of CLBP in older adults. Given the aging population and limited information regarding risk factors for CLBP in older adults, future high-quality prospective studies should identify relevant risk factors to help develop proper preventive and treatment strategies. Perspective: Despite the high prevalence of non-specific chronic low back pain among older adults, there is only very limited to limited evidence regarding factors associated with a higher
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A growing body of evidence has shown that people with chronic low back pain (CLBP) demonstrate significantly greater declines in multiple cognitive domains than people who do not have CLBP. Given the high prevalence of CLBP in the... more
A growing body of evidence has shown that people with chronic low back pain (CLBP) demonstrate significantly greater declines in multiple cognitive domains than people who do not have CLBP. Given the high prevalence of CLBP in the ever-growing aging population that may be more vulnerable to cognitive decline, it is important to understand the mechanisms underlying the accelerated cognitive decline observed in this population, so that proper preventive or treatment approaches can be developed and implemented. The current scoping review summarizes what is known regarding the potential mechanisms underlying suboptimal cognitive performance and cognitive decline in people with CLBP and discusses future research directions. Five potential mechanisms were identified based on the findings from 34 included studies: (1) altered activity in the cortex and neural networks; (2) grey matter atrophy; (3) microglial activation and neuroinflammation; (4) comorbidities associated with CLBP; and (5) gut microbiota dysbiosis. Future studies should deepen the understanding of mechanisms underlying this association so that proper prevention and treatment strategies can be developed.
Research Interests:
Background: Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic... more
Background: Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic balance of patients although it is difficult to objectively quantify these balance parameters in a clinical setting. Therefore, this pilot study aimed to evaluate the feasibility of using wearable devices in a clinical setting to examine whether people with MP-TKA have better postoperative outcomes than PS-TKA, and their balance control is more akin to age-matched asymptomatic controls. Methods: The current cross-sectional pilot study recruited 57 participants with 2 different prosthesis designs (20 PS-TKA, 18 MP-TKA) and 19 asymptomatic controls. At 1-year post-TKA, pain, knee stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Static balance, mobility, and gait stability of the participants were evaluated based on data collected from wearable motion sensors during the near tandem stance, timed-up-and-go, and 6-min walk tests. Results: Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness and demonstrated reduced functional mobility, increased stride-time-variability, and impaired balance. After Bonferroni adjustment, no significant differences in pain, balance, and mobility performance were observed between PS-TKA and MP-TKA participants 1 year after surgery. However, there was a trend for increased anteroposterior sway of the lumbar and head regions in the MP-TKA participants when undertaking the near tandem stance test. The wearable motion sensors were easy to use without any adverse effects. Conclusions: It is feasible to use wearable motion sensors in a clinical setting to compare balance and mobility performance of patients with different TKA prothesis designs. Since this was a pilot study and no definite conclusions could be drawn, future clinical trials should determine the impacts of different TKA prosthesis designs on post-operative outcomes over a longer follow-up period.
Research Interests:
Levodopa therapy is the standard pharmacological treatment for Parkinson's disease (PD). However, after an initial period of significant benefit, the effects of levodopa begin to wear off. This results in a reduction in the effect... more
Levodopa therapy is the standard pharmacological treatment for Parkinson's disease (PD). However, after an initial period of significant benefit, the effects of levodopa begin to wear off. This results in a reduction in the effect duration and the development of motor complications. We describe the case of a 69-year-old woman presented with a 3-year history of lower back pain and progressive left leg weakness. One year prior to referral for neurological assessment, the patient first noted progressive leg weakness and insufficient strength to rise from a chair. The diagnosis of PD was made after excluding potential neurological disorders. The patient was initially started on oral levodopa, which improved her motor symptoms considerably during the first year. However, dose adjustment and combined pharmacological strategies failed to sufficiently control motor symptoms during the subsequent year. The patient experienced declines in gait ability, clumsiness in the left limbs, and difficulty in performing housework. The patient then sought chiropractic attention. Gait rehabilitation was the major goal in the treatment program for this patient, with the impression of motor complications of PD. The intervention consisted of spinal manipulation, intermittent motorized traction of the lumbar segments, and gait training programs. Following 3 months of the intervention, the patient demonstrated increased muscle strength and improved gait characteristics, as depicted by a gait cyclogram and vertical ground reaction force graphing. The current report illustrates that a multicomponent chiropractic approach may be used as an additional measure to mitigate gait decline in PD patients.
Research Interests:
Purpose Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients... more
Purpose Some teenagers with adolescent idiopathic scoliosis (AIS) display compromised lung function. However, the evidence regarding the relations between pulmonary impairments and various spinal deformity parameters in these patients remains unclear, which affects clinical management. This systematic review and meta-analysis aimed to summarize the associations between various lung function parameters and radiographic features in teenagers with AIS. Methods A search of PubMed, Embase, PEDro, SPORTDiscus, CINAHL, Cochrane Library, and PsycINFO (from inception to March 14, 2022) without language restriction. Original studies reporting the associations between lung function and spinal deformity in patients with AIS were selected. Independent reviewers extracted data and evaluated the methodological quality of the included studies according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pearson correlation and 95% confidence intervals were calculated using random-effects meta-analysis. Results Twenty-seven studies involving 3162 participants were included. Limited-quality evidence supported that several spinal parameters were significantly related to lung function parameters (e.g., absolute value and percent of the predicted forced vital capacity (FVC; %FVC), forced expiratory volume in one second (FEV 1 ; %FEV 1), and total lung capacity (TLC; %TLC)) in AIS patients. Specifically, meta-analyses showed that main thoracic Cobb angles in the coronal plane were significantly and negatively related to FVC (r = − 0.245), %FVC (r = − 0.302), FEV 1 (r = − 0.232), %FEV 1 (r = − 0.348), FEV 1 /FVC ratio (r = − 0.166), TLC (r = − 0.302), %TLC (r = − 0.183), and percent predicted vital capacity (r = − 0.272) (p < 0.001). Similarly, thoracic apical vertebral rotation was negatively associated with %FVC (r = − 0.215) and %TLC (r = − 0.126) (p < 0.05). Conversely, thoracic kyphosis angles were positively related to %FVC (r = 0.180) and %FEV 1 (r = 0.193) (p < 0.05). Conclusion Larger thoracic Cobb angles, greater apical vertebral rotation angle, or hypokyphosis were significantly associated with greater pulmonary impairments in patients with AIS, although the evidence was limited. From a clinical perspective, the results highlight the importance of minimizing the three-dimensional spinal deformity in preserving lung function in these patients. More research is warranted to confirm these results.
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Traditional discipline-specific training has limitations in facilitating inter-professional communication and collaboration. To address this issue, two local universities in Hong Kong launched an interprofessional team-based learning... more
Traditional discipline-specific training has limitations in facilitating inter-professional communication and collaboration. To address this issue, two local universities in Hong Kong launched an interprofessional team-based learning program to allow the undergraduate healthcare students to form teams and experience collaborative problemsolving. This study aimed to evaluate the experiences of nursing and physiotherapy undergraduates following interprofessional learning activities. Twenty-seven 3rd-year
nursing and physiotherapy undergraduates were recruited through purposive sampling. Semi-structured interviews were conducted, and written feedback was solicited until data saturation was achieved. An inductive thematic analysis was used for the data, and each theme was mutually exclusive. The findings revealed the positive experiences of
the students with this interprofessional learning activity. Three main themes emerged: (1) the process of interprofessional learning; (2) profession-related outcomes of interprofessional learning; and (3) patient-related outcomes of interprofessional learning. The study indicated that interprofessional team-based learning activities enhanced learning experiences of the students through interactive learning with other healthcare students. Experiences of relationships that are trustful and complementary allow students to develop confidence in knowledge transfer and in interprofessional collaboration, as well as in providing a holistic patient-centered care. These findings substantiate the importance and value of interprofessional learning in healthcare education
nursing and physiotherapy undergraduates were recruited through purposive sampling. Semi-structured interviews were conducted, and written feedback was solicited until data saturation was achieved. An inductive thematic analysis was used for the data, and each theme was mutually exclusive. The findings revealed the positive experiences of
the students with this interprofessional learning activity. Three main themes emerged: (1) the process of interprofessional learning; (2) profession-related outcomes of interprofessional learning; and (3) patient-related outcomes of interprofessional learning. The study indicated that interprofessional team-based learning activities enhanced learning experiences of the students through interactive learning with other healthcare students. Experiences of relationships that are trustful and complementary allow students to develop confidence in knowledge transfer and in interprofessional collaboration, as well as in providing a holistic patient-centered care. These findings substantiate the importance and value of interprofessional learning in healthcare education
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Introduction: The prevalence of chronic low back pain (LBP) increases with age and older adults are more vulnerable to develop chronic LBP. A recent Swiss study has shown that 78% of community-dwelling older adults aged ≥65 years... more
Introduction: The prevalence of chronic low back pain (LBP) increases with age and older adults are more vulnerable to develop chronic LBP. A recent Swiss study has shown that 78% of community-dwelling older adults aged ≥65 years experienced chronic LBP. Similarly, a study in Hong Kong found that approximately 30% of people aged above 60 years experienced chronic LBP. The aim of this collaborative research project was to illuminate older adults’ experiences of living with chronic LBP and its implication on older adults’ daily life in Western and Eastern cultures.
Methods: Twenty-five older people experiencing chronic LBP living in
Switzerland or Hong Kong were recruited through health professionals or
community centres. Using semi-structured interviews, participants shared
their experiences regarding chronic LBP and its implications on their daily
life. The interviews were recorded and transcribed “ad verbatim” in the
original language. An inductive thematic analysis was used, using a qualitative data analysis software program (NVivo) and a shared code book in English. The Swiss and Hong Kong research teams engaged in collaborative analysis until a consensus was established, taking into consideration of cultural specificities. Ethical approval was obtained from the local ethic committees in both regions.
Results: Themes were related to negative perceptions/experiences: (1)
interferences of daily function; (2) pessimistic attitudes toward their
conditions/prognosis; and (3) self-perceived burden related to families.
Conversely, four themes revealed attributes to social roles: (1) maintaining
their roles in families; (2) experiencing supports from family and friends; (3) being content despite LBP; and (4) enjoying social activities. Cultural
differences between Switzerland and Hong Kong were related to social
circles and offers from the healthcare system, influencing individual
experiences and perceptions.
Discussion: Although chronic LBP may negatively impact older adults,
individual approaches as well as social and health system supports influence older adults’ attitude toward their pain and self-management strategies Developing effective and culturally sensitive interventions for an elderly population with chronic LBP can be challenging but essential for the development of innovative healthcare services tailored to the population’s needs. The methodological approach used for this research project establishes the framework for developing and evaluating complex interventions.
Methods: Twenty-five older people experiencing chronic LBP living in
Switzerland or Hong Kong were recruited through health professionals or
community centres. Using semi-structured interviews, participants shared
their experiences regarding chronic LBP and its implications on their daily
life. The interviews were recorded and transcribed “ad verbatim” in the
original language. An inductive thematic analysis was used, using a qualitative data analysis software program (NVivo) and a shared code book in English. The Swiss and Hong Kong research teams engaged in collaborative analysis until a consensus was established, taking into consideration of cultural specificities. Ethical approval was obtained from the local ethic committees in both regions.
Results: Themes were related to negative perceptions/experiences: (1)
interferences of daily function; (2) pessimistic attitudes toward their
conditions/prognosis; and (3) self-perceived burden related to families.
Conversely, four themes revealed attributes to social roles: (1) maintaining
their roles in families; (2) experiencing supports from family and friends; (3) being content despite LBP; and (4) enjoying social activities. Cultural
differences between Switzerland and Hong Kong were related to social
circles and offers from the healthcare system, influencing individual
experiences and perceptions.
Discussion: Although chronic LBP may negatively impact older adults,
individual approaches as well as social and health system supports influence older adults’ attitude toward their pain and self-management strategies Developing effective and culturally sensitive interventions for an elderly population with chronic LBP can be challenging but essential for the development of innovative healthcare services tailored to the population’s needs. The methodological approach used for this research project establishes the framework for developing and evaluating complex interventions.
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To conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in physical activity (PA) involvements and exercise habits in people with and without chronic diseases during the COVID-19 outbreak.... more
To conduct a systematic review and meta-analysis to summarize evidence regarding differential changes in physical activity (PA) involvements and exercise habits in people with and without chronic diseases during the COVID-19 outbreak. Data Sources: MEDLINE, Embase, SPORTDiscus, Cumulative Index to Nursing and Allied Health, PsycINFO, Cochrane Library, and Physiotherapy Evidence Database were searched from November 2019 to May 2021. Study Selection: Two reviewers independently screened cross-sectional and longitudinal studies that investigated changes in PA-related outcomes in people with and without chronic diseases during the pandemic. Data Extraction: PA-related outcomes and sedentary time were extracted from the included studies. Relevant risk of bias were assessed. Metaanalyses were conducted for each PA-related outcome, if applicable. Quality of evidence of each PA-related outcome was evaluated by Grading of Recommendations Assessment, Development, and Evaluation. Data Synthesis: Of 1226 identified citations, 36 articles (28 with and 8 without chronic diseases) with 800,256 participants were included. Moderate evidence from wearable sensors supported a significant reduction in pooled estimates of step count (standardized mean differences [SMD]=À2.79, P<.01). Very limited to limited evidence substantiated significant decreases in self-reported PA-related outcomes and significant increases in sedentary behaviors among people with and without chronic diseases. Specifically, pooled estimates of metabolic equivalent-minute per week (SMD=À0.16, P=.02) and PA duration (SMD=À0.07, P<.01) were significantly decreased, while sedentary time (SMD=0.09, P=.04) showed significant increases in the general population (small to large effects). Very limited evidence suggested no significant PA changes among people in a country without lockdown. Conclusions: During the pandemic, objective and self-reported assessments showed significant reductions in PA in people with and without chronic diseases globally. This mainly occurred in countries with lockdowns. Although many countries have adopted the "live with the coronavirus" policy, authorities should implement population-based strategies to revert the potential lockdown-related long-term deleterious effects on people's health.
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Background: Lumbar spinal stenosis (LSS) is a common degenerative spinal condition in older adults associated with disability, diminished quality of life, and substantial healthcare costs. Individual symptoms and needs vary. With sparse... more
Background: Lumbar spinal stenosis (LSS) is a common degenerative spinal condition in older adults associated with disability, diminished quality of life, and substantial healthcare costs. Individual symptoms and needs vary. With sparse and sometimes inconsistent evidence to guide clinical decision-making, variable clinical care may lead to unsatisfactory patient outcomes and inefficient use of healthcare resources. Methods: A three-phase modified Delphi study comprising four consensus rounds was conducted on behalf of the International Taskforce for the Diagnosis and Management of LSS to develop a treatment algorithm based on multiprofessional international expert consensus. Participants with expertise in the assessment and management of people with LSS were invited using an international distribution process used for two previous Delphi studies led by the Taskforce. Separate treatment pathways for patients with different symptom types and severity were developed and incorporated into a proposed treatment algorithm through consensus rounds 1 to 3. Agreement with the proposed algorithm was evaluated in the final consensus round. Results: The final algorithm combines stratified and stepped approaches. When indicated, immediate investigation and surgery is advocated. Otherwise, a stepped approach is suggested when self-directed care is unsatisfactory. This starts with tailored rehabilitation, then more complex multidisciplinary care, investigations and surgery options if needed. Treatment options in each step depend on clinical phenotype and symptom severity. Treatment response guides pathway entrance and exit points. Of 397 study participants, 86% rated their agreement ≥ 4 for the proposed algorithm on a 0-6 scale, of which 22% completely agreed. Only 7% disagreed. Over 70% of participants felt that the algorithm would be useful for clinicians in public healthcare (both primary care and specialist settings) and in private healthcare settings, and that a simplified version would help patients in shared decision-making. Conclusions: International and multi-professional agreement was achieved for a proposed LSS treatment algorithm developed through expert consensus. The algorithm advocates different pathway options depending on clinical indications. It is not intended as a treatment protocol and will require evaluation against current care for clinical and cost-effectiveness. It may, however, serve as a clinical guide until evidence is sufficient to inform a fully stratified care model.
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This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
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The sacroiliac joint (SIJ) is designed primarily for stability with minute motions. SIJ dysfunction refers to improper movement of the SIJs. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and... more
The sacroiliac joint (SIJ) is designed primarily for stability with minute motions. SIJ dysfunction refers to improper movement of the SIJs. Diagnosis and evaluation of SIJ dysfunction are difficult, with use of physical maneuvers and image-guided anesthetic injection. This case report describes a 47-year-old female who experienced right buttock pain and painful limp for approximately 2 months. Standing radiographs revealed inflammatory sclerosis surrounding the right SIJ. Physical examination found tenderness over the right SIJ and positive results in provocation (the distraction, compression, and thigh thrust) tests, compatible with right SIJ dysfunction. Her pain was resolved and gait performance was retrieved following 6-month program of combined thoracolumbar manipulation and rehabilitation exercises. Unexpectedly, change in pelvic incidence (PI) angles was noticed on follow-up radiograph. PI remains more or less fixed throughout adult life since the mobility of the SIJs is considered negligible. The current presentation is designed to explore the significance of PI change. The PI disparity unfolds the possibility of recognizing SIJ dysfunction based on consecutive radiographs.
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Pinto et al. Factors Influencing Back Pain Results: People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller... more
Pinto et al. Factors Influencing Back Pain Results: People with CLBP demonstrated significantly higher LBP-intensity, RMDQ, HADS, FAB, PCS, and ISI scores than asymptomatic controls (p < 0.05). The former also had significantly smaller percent thickness changes of LMM at L4/L5 during contraction. LBP-intensity was positively related to scores of PCS-total, PCShelplessness, FAB-total, FAB-work, and ISI in people with CLBP (p < 0.05). RMDQ scores were positively associated with the scores of HADS-total, HADS-depression, PCS-total, FAB-total, FAB-physical activity, PCS-helplessness, and ISI in people with CLBP (p < 0.05). FAB-work and ISI scores together explained 24% of LBPintensity. FAB-total scores alone explained 34% of variance of LBP-related disability in people with CLBP. Conclusion: More fear-avoidance belief or insomnia is related to greater LBP-intensity and/or LBP-related disability in people with CLBP. Although people with CLBP were thought to have aberrant LMM morphometry/function, no LMM characteristics were related to LBP-intensity or LBP-related disability after considering other confounders.
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Objectives: Sleep disturbance is prevalent among patients with chronic low back pain (CLBP). This systematic review aimed to summarize the evidence regarding the: (1) temporal relations between changes in sleep quality/quantity and the... more
Objectives: Sleep disturbance is prevalent among patients with chronic low back pain (CLBP). This systematic review aimed to summarize the evidence regarding the: (1) temporal relations between changes in sleep quality/quantity and the corresponding changes in pain and/or disability; and (2) role of baseline sleep quality/quantity in predicting future pain and/or disability in patients with CLBP. Methods: Four databases were searched from their inception to February 2021. Two reviewers independently screened the abstract and full text, extracted data, assessed the methodological quality of the included studies, and evaluated the quality of evidence of the findings using the Grading of Recommendations Assessment Development and Evaluation (GRADE). Results: Of 1995 identified references, 6 articles involving 1641 participants with CLBP were included. Moderate-quality evidence substantiated that improvements in self-reported sleep quality and total sleep time were significantly correlated with the corresponding LBP reduction. Low-quality evidence showed that self-reported improvements in sleep quality were related to the corresponding improvements in CLBP-related disability. There was conflicting evidence regarding the relation between baseline sleep quality/ quantity and future pain/disability in patients with CLBP. Discussion: This is the first systematic review to accentuate that improved self-reported sleep quality/quantity may be associated with improved pain/disability, although it remains unclear whether baseline sleep quality/quantity is a prognostic factor for CLBP. These findings highlight the importance of understanding the mechanisms underlying the relation between sleep and CLBP, which may inform the necessity of assessing or treating sleep disturbance in people with CLBP.
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Purpose To translate and cross-cultural validate the PROMIS Pediatric-25 Profile 2.0 (PROMIS-25) into traditional Chinese, and to investigate its psychometric properties in children with cancer in Hong Kong. Methods The Functional... more
Purpose To translate and cross-cultural validate the PROMIS Pediatric-25 Profile 2.0 (PROMIS-25) into traditional Chinese, and to investigate its psychometric properties in children with cancer in Hong Kong. Methods The Functional Assessment of Chronic Illness Therapy translation methodology was adopted in this study. Three panel members evaluated the semantic equivalence and content validity. The psychometric properties were tested with 103 children with cancer (10-18 years). Internal consistency and structural validity were examined by Cronbach's alpha and Rasch analysis. Convergent and divergent validity were assessed by correlating it with traditional Chinese pediatric quality of life inventory™ 4.0 domains (traditional Chinese PedsQL™ 4.0), traditional Chinese Health Questionnaire-9 (C-PHQ-9), and the numeric pain rating scale (NPRS). Results The semantic equivalence score and content validity index were both 100%. All domains indicated good internal consistency (α = 0.83-0.88) and unidimensionality (variance explained > 55.5% and 1st contrast eigenvalues < 2.0). All items showed good item fit (0.6-1.4). For convergent validity, the traditional Chinese PROMIS-25 domains demonstrated moderate-to-large correlations with traditional Chinese PedsQL™ 4.0 domains (r ≥ ± 0.69), C-PHQ-9 Item-4 and total score (r = 0.75-0.80), except NPRS (r = 0.44). For divergent validity, traditional Chinese PROMIS-25 had low correlations with traditional Chinese PedsQL™ 4.0 domains (r < ± 0.21), C-PHQ-9 item-4 (r = 0.3), and NPRS (r = − 0.12). The traditional Chinese PROMIS-25 fatigue domain was weakly correlated with NPRS (r = 0.39). Conclusion The traditional Chinese PROMIS-25 is semantically and conceptually like the original PROMIS-25 with satisfactory internal consistency, structural validity, and construct validity.
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Study Design: Systematic review and meta-analysis Objectives: The present review aimed to summarize the evidence regarding differences in proprioception between children with and without adolescent idiopathic scoliosis (AIS). Methods:... more
Study Design: Systematic review and meta-analysis Objectives: The present review aimed to summarize the evidence regarding differences in proprioception between children with and without adolescent idiopathic scoliosis (AIS). Methods: Seven electronic databases were searched from their inception to April 10, 2021. Articles were included if they involved: (1) AIS patients aged between 10 and 18 years, (2) measurements of proprioceptive abilities, and (3) comparisons with non-AIS controls. Animal studies, case reports, commentaries, conference proceedings, research protocols, and reviews were excluded. Two reviewers independently conducted literature screening, data extraction, risks of bias assessments, and quality of evidence evaluations. Relevant information was pooled for meta-analyses. Results: From 432 identified citations, 11 case-control studies comprising 1121 participants were included. The meta-analyses showed that AIS participants displayed proprioceptive deficits as compared to non-AIS controls. Moderate evidence supported that AIS participants showed significantly larger repositioning errors than healthy controls (pooled mean difference = 1.27 degrees, P < .01). Low evidence substantiated that AIS participants had significantly greater motion detection threshold (pooled mean difference = 1.60 degrees, P < .01) and abnormal somatosensory evoked potentials (pooled mean difference = .36 milliseconds, P = .01) than non-AIS counterparts. Conclusions: Consistent findings revealed that proprioceptive deficits occurred in AIS patients. Further investigations on the causal relationship between AIS and proprioception, and the identification of the subgroup of AIS patients with proprioceptive deficit are needed.
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While recent studies have shown that wearable sensing technology has the potential to facilitate the evaluation of physical fatigue, the reliability and validity of such measurements during construction tasks have not been reported. Thus,... more
While recent studies have shown that wearable sensing technology has the potential to facilitate the evaluation of physical fatigue, the reliability and validity of such measurements during construction tasks have not been reported. Thus, the primary objective of the current study is to establish absolute and relative reliability of textilebased wearable sensors to monitor physical fatigue during bar bending and fixing construction tasks. The secondary objective is to establish correlations between physiological parameters and subjective fatigue scores or blood lactate levels in order to demonstrate the convergent validity. Physiological parameters such as heart rate, breathing rate, and skin temperature were evaluated using textile-based wearable sensors. The test-retest reliability (intra-class correlation coefficient-ICC) values of the measured resting and working heart rate (ICC = 0.73 and 0.85), breathing rate (ICC = 0.78 and 0.82), and skin temperature (ICC = 0.68 and 0.77) were moderate to good and good, respectively. There were moderate to excellent correlations (r-values ranging from 0.414 to 0.940) between physiological parameters and subjective fatigue scores, although there were no correlations between any physiological parameters and blood lactate levels. Both laboratory and field data substantiated that the wearable sensing system has the potential to be a reliable noninvasive device to monitor physical fatigue (especially among workers at risk of sustaining fatigue-related injury due to advanced age, poor health, or job nature. However, because the current study validated the system exclusively in bar benders, additional research is necessary to confirm the findings in other construction workers.
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To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations. Data Sources: Articles were searched in 9 databases from... more
To synthesize evidence regarding the psychometric properties of the Brief-Balance Evaluation Systems Test (BESTest) in assessing postural controls across various populations. Data Sources: Articles were searched in 9 databases from inception to March 2020. Study Selection: Two reviewers independently screened titles, abstracts, and full-text articles to include studies that reported at least 1 psychometric property of the Brief-BESTest. There were no language restrictions. Data Extraction: The 2 independent reviewers extracted data (including psychometric properties of Brief-BESTest) from the included studies. The methodological quality of the included studies was appraised by the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist, and the quality of statistical outcomes was assessed by the Terwee et al method. A best-evidence synthesis for each measurement property of the Brief-BESTest in each population was conducted. Data Synthesis: Twenty-four studies encompassing 13 populations were included. There was moderate to strong positive evidence to support the internal consistency (Cronbach a>0.82), criterion validity (r≥0.73, r≥0.71), and construct validity (r≥0.66, r≥0.50, area under curve>0.72) of the Brief-BESTest in different populations. Moderate to strong positive evidence supported the responsiveness of the Brief-BESTest in detecting changes in postural controls of patients 4 weeks after total knee arthroplasty or patients with subacute stroke after 4-week rehabilitation. However, there was strong negative evidence for the structural validity of this scale in patients with various neurologic conditions. The evidence for the reliability of individual items and measurement errors remains unknown. Conclusions: The Brief-BESTest is a valid (criterion-and construct-related) tool to assess postural control in multiple populations. However, further studies on the reliability of individual items and minimal clinically important difference of the Brief-BESTest are warranted before recommending it as an alternative to the BESTest and Mini-BESTest in clinical research/practice.
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Objective: To summarize evidence regarding the prevalence and incidence of low back pain and associated risk factors in nursing and medical students. Type: Systematic review and meta-analysis. Literature Survey: The protocol was... more
Objective: To summarize evidence regarding the prevalence and incidence of low back pain and associated risk factors in nursing and medical students. Type: Systematic review and meta-analysis. Literature Survey: The protocol was registered with PROSPERO (CRD42015029729). Its reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seven databases were searched until August 2020 to identify relevant studies. Methodology: Two independent reviewers screened, extracted, and evaluated the risk of bias of the selected studies. Meta-analyses were used to estimate 12-month prevalence/incidence rates of low back pain and associated risk factors in these students. Levels of evidence for risk factors were determined by the updated Guidelines for Systematic Reviews in the Cochrane Collaboration Back Review Group. Synthesis: Sixteen studies involving 7072 students were included. The pooled 12-month prevalence rates of low back pain for nursing and medical students were 44% (95% confidence interval [95% CI]: 27%-61%) and 53% (95% CI: 44%-62%), respectively. The 12-month incidence of low back pain in nursing students ranged from 29% to 67%. No incidence rate was reported in medical students. Strong/moderate-quality evidence supported that final year of study (pooled odds ratio [OR] from five studies, 1.96, 95% CI: 1.13-3.40), anxiety (OR ranging from 3.12 to 4.61), or high mental pressure or psychological distress (OR ranging from 1.37 to 4.52) was associated with a higher 12-month low back pain prevalence in both student groups. Moderate-quality evidence suggested that prior history of low back pain (pooled OR from two studies: 3.46, 95% CI: 1.88-6.36) was associated with a higher 12-month low back pain incidence in nursing students. Similarly, moderate-quality evidence suggested that female medical students (pooled OR from two studies: 1.77, 95% CI: 1.09-2.86) demonstrated a higher 12-month low back pain prevalence than male counterparts. Conclusions: Although it is impossible to alter nonmodifiable risk factors for low back pain, universities may develop and implement proper strategies to mitigate modifiable risk factors in these students.
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The current study aimed to evaluate the impact of coronavirus (COVID-19) pandemic on sleep hygiene, anxiety levels, perceived stress, and research output among postgraduate research students in Hong Kong. Methods: An online survey was... more
The current study aimed to evaluate the impact of coronavirus (COVID-19) pandemic on sleep hygiene, anxiety levels, perceived stress, and research output among postgraduate research students in Hong Kong. Methods: An online survey was developed and distributed to Hong Kong postgraduate research students. The sleep hygiene, anxiety levels, and perceived stress during the outbreak of COVID-19 were assessed. Questions about COVID-19's impact on research outputs were asked. Results: A total of 108 (response rate, 72%) full-time postgraduate students (PhD, 64%; M Phil, 8%; and Masters, 28%) participated. Approximately 83% of students reported poor sleep hygiene. Similarly, nearly 76% of students reported mild to severe levels of self-perceived anxiety levels. Most of the respondents (89%) expressed a moderate level of perceived stress. Sleep hygiene scores were moderately associated with anxiety levels (r = 0.384, p < 0.01) and perceived stress scores (r = 0.423, p < 0.01). Perceived stress was strongly correlated with anxiety levels (r = 0.601, p < 0.01). A hierarchical regression analysis revealed a significant association between respondents' ethnicity (B = −0.923, p = 0.003), past medical history (such as hypertension, diabetes, and musculoskeletal disorders) (B = 1.112, p = 0.005), or poor sleep hygiene (B = 0.259, p = 0.000) and high levels of perceived stress. Additionally, prior medical history (such as hypertension, diabetes, and musculoskeletal disorders) (B = 1.957, p = 0.001) and poor sleep hygiene (B = 0.312, p = 0.000) were found to be strongly related to anxiety levels among postgraduate research students. Conclusion: This is the first study that highlights poor sleep hygiene, moderate-to-severe levels of anxiety, and perceived stress during the COVID-19 pandemic in postgraduate research students in Hong Kong. These findings will help educators to prepare strategies to alleviate the stress and psychological problems in postgraduate students.
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Purpose-Since construction workers often need to carry various types of loads in their daily routine, they are at risk of sustaining musculoskeletal injuries. Additionally, carrying a load during walking may disturb their walking balance... more
Purpose-Since construction workers often need to carry various types of loads in their daily routine, they are at risk of sustaining musculoskeletal injuries. Additionally, carrying a load during walking may disturb their walking balance and lead to fall injuries among construction workers. Different load carrying techniques may also cause different extents of physical exertion. Therefore, the purpose of this paper is to examine the effects of different load-carrying techniques on gait parameters, dynamic balance, and physiological parameters in asymptomatic individuals on both stable and unstable surfaces. Design/methodology/approach-Fifteen asymptomatic male participants (mean age: 31.5 ± 2.6 years) walked along an 8-m walkway on flat and foam surfaces with and without a load thrice using three different techniques (e.g. load carriage on the head, on the dominant shoulder, and in both hands). Temporal gait parameters (e.g. gait speed, cadence, and double support time), gait symmetry (e.g. step time, stance time, and swing time symmetry), and dynamic balance parameters [e.g. anteroposterior and mediolateral center of pressure (CoP) displacement, and CoP velocity] were evaluated. Additionally, the heart rate (HR) and electrodermal activity (EDA) was assessed to estimate physiological parameters. Findings-The gait speed was significantly higher when the load was carried in both hands compared to other techniques (Hand load, 1.02 ms vs Head load, 0.82 ms vs Shoulder load, 0.78 ms). Stride frequency was significantly decreased during load carrying on the head than the load in both hands (46.5 vs 51.7 strides/m). Step, stance, and swing time symmetry were significantly poorer during load carrying on the shoulder than the Effects of load carrying techniques
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Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which... more
Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which may restore normal LMM morphology and reduce LBP. However, its effects on LMM morphology have not been summarized. This review aimed to summarize evidence regarding the (1) effectiveness of MCE in altering LMM morphometry and decreasing LBP; and (2) relations between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, EMBASE and SPORTDiscus were searched from inception to 30 September 2020 to identify relevant randomized controlled trials. Two reviewers independently screened articles, extracted data, and evaluated risk of bias and quality of evidence. Four hundred and fifty-one participants across 9 trials were included in the review. Very low-quality evidence supported that 36 sessions of MCE were better than general physiotherapy in causing minimal detectable increases in LMM cross-sectional areas of patients with chronic LBP. Very lowto low-quality evidence suggested that MCE was similar to other interventions in increasing resting LMM thickness in patients with chronic LBP. Low-quality evidence substantiated that MCE was significantly better than McKenzie exercise or analgesics in increasing contracted LMM thickness in patients with chronic LBP. Low-quality evidence corroborated that MCE was not significantly better than other exercises in treating people with acute/chronic LBP. Low-quality evidence suggested no relation between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Collectively, while MCE may increase LMM dimensions in patients with chronic LBP, such changes may be unrelated to clinical outcomes. This raises the question regarding the role of LMM in LBP development/progression.
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Background: Although multiple studies have investigated risk factors for symptomatic adjacent segment disease (ASD) after lumbar fusion, their findings were diverse and inconsistent. This review aimed to summarize risk factors for ASD in... more
Background: Although multiple studies have investigated risk factors for symptomatic adjacent segment disease (ASD) after lumbar fusion, their findings were diverse and inconsistent. This review aimed to summarize risk factors for ASD in order to guide the management of ASD and future research. Methods: Six electronic databases were systematically searched from inception to December 2019. Two reviewers independently screened titles, abstracts, and full-text articles to identify studies investigating risk factors for ASD after lumbar fusion in humans. The methodological quality of the included studies and the strength of evidence regarding risk factors were evaluated. Results: Sixteen studies involving 3,553 patients were included. Meta-analyses revealed that high body mass index, facet joint violation, anterior shift of the preoperative and postoperative lumbosacral sagittal plumb line, decreased preoperative and postoperative lumbar lordosis, preoperative adjacent disc degeneration, decreased preoperative adjacent disc height, increased postoperative lumbopelvic mismatch, postoperative pelvic incidence, and postoperative pelvic tilt were significantly related to ASD. Conclusions: This meta-analysis addressed the limitations of prior reviews and summarized evidence with regard to risk factors for ASD following lumbar fusion. Future prospective studies should investigate whether modification of these risk factors can reduce the ASD development.
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Craniocervical instability (CCI) is a pathological condition in which ligamentous connections from the skull to the spine are incompetent (1). Rheumatoid arthritis (RA) is an immune-mediated inflammation that primarily affects the lining... more
Craniocervical instability (CCI) is a pathological condition in which ligamentous connections from the skull to the spine are incompetent (1). Rheumatoid arthritis (RA) is an immune-mediated inflammation that primarily affects the lining of the synovial joints and tendons (2). The craniocervical junction consists exclusively of synovial articulations between the occipital condyles, atlas (C1) and axis (C2). The characteristics of the craniocervical articulation make it especially vulnerable to the involvement of RA (3). Recent estimates suggest that up to 86% of RA patients have radiographic evidence of cervical spine involvement (4) even within 2 years after the initial diagnosis of RA (5). Insidious synovitis may cause erosion or incompetence of the involved ligaments, bones, or joints, and resultant CCI (3). The consequence of CCI takes the form of atlantoaxial subluxation, cranial settling
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Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case... more
Chronic orchialgia can be the result of pathological processes of the scrotal contents or stem from non-intrascrotal structures. Successful pain management depends on identifying the source of localized or referred pain. This is a case report of a 39-year-old male sports coach who presented with low back pain, right orchialgia, and sciatica refractory to conservative management. Magnetic resonance (MR) imaging revealed disc protrusion at L3/L4 and L4/L5 levels. Positive outcomes in relieving back and testicular pain were obtained after a total of 30 chiropractic sessions over a 9-week period. The evidence of the subjective improvement was corroborated by regression of the herniated discs documented on the repeat MR imaging. While chronic orchialgia is not an uncommon problem for men of all ages, it has seldom been described in association with lumbar discogenic disease. The current study provided preliminary support for a link between orchialgia and lumbar disc herniation. Chiropractic manipulation had provided a mechanistic alleviation of noxious lumbar stimuli, leading to symptomatic and functional improvements.
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Parkinson’s disease (PD) is a progressive neurological disorder with cardinal motor features of tremor, bradykinesia, muscle rigidity, impaired gait and posture. Muscular pain or arthralgia is a common non-motor symptom in PD. The... more
Parkinson’s disease (PD) is a progressive neurological disorder with cardinal motor features of tremor, bradykinesia, muscle rigidity, impaired gait and posture. Muscular pain or arthralgia is a common non-motor symptom in PD. The PD-related pain is probably attributed to a combination of altered posture, abnormal muscle tone, and truncal dystonia. A 59-year-old male taxi-driver with PD treated with levodopa for 18 months complained of progressive low back pain and gait difficulties that prevented him from normal activities in the past 2 months. Magnetic resonance imaging showed degenerative disc disease with multiple levels of bulging discs in the lumbar spine. After 35 chiropractic sessions, there was a significant improvement in various aspects of well-being, including pain resolution measured by a numeric rating scale, physical and mental improvement measured by the Parkinson’s Disease Questionnaire, gait stability depicted by gait cyclogram, and better postural alignment and stability assessed by radiographic parameters. The current study may serve as an example of spinal manipulation showing the potential to address gait and posture problems associated with pain in a patient with PD. Aging changes in the muscles, bones and joints may accompany PD. Although PD itself is an incurable neurodegenerative disease, functional capacity of the musculoskeletal system can be enhanced by different types of manual therapy, by means of improving muscle strength, joint mobility, and postural balance. The actual duration in sustaining improved outcomes following a course of manipulative intervention remains to be determined.
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Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by a false sensation of unsteadiness and dizziness due to neck pathology. An 11-year-old girl presented with neck pain and dizziness for four months. According to the... more
Cervicogenic dizziness (CGD) is a syndrome of neck pain accompanied by a false sensation of unsteadiness and dizziness due to neck pathology. An 11-year-old girl presented with neck pain and dizziness for four months. According to the patient's statement, her complaints were likely related to the prolonged smartphone use for texting. Sagittal radiograph showed cervical kyphosis, anterior wedging of several vertebrae, and mild anterolisthesis of C2 on C3 and C3 on C4. These findings might be present in as physiological variants in children. However, continuous static stress in the minor variants could aggravate biomechanical problems, such as cervicogenic dizziness. After ruling out other neurological or vestibular problems, a multicomponent approach consisted of thermal ultrasound therapy, cervical manipulation, and intermittent motorized cervicothoracic traction to release cervical complaints. Three months later, the patient reported a resolution of neck pain and dizziness. At 12-month follow-up, all radiographic metrics showed improvement, including restoration of cervical alignment and lordotic curvature. The immature growing cervical spine has unique anatomic, physiologic and biomechanical features. A static neck flexion can lead to typical injury patterns seen in this age group. This article aims to raise awareness of the potential harms of excessive smartphone use by children.
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The current systematic review aimed to summarize prevalence rates of work-related musculoskeletal disorders (WRMSDs) and quantify the associations between physical or psychosocial risk factors and WRMSDs in construction workers.... more
The current systematic review aimed to summarize prevalence rates of work-related musculoskeletal disorders (WRMSDs) and quantify the associations between physical or psychosocial risk factors and WRMSDs in construction workers. Literature searches were conducted in Web of Science, PubMed, Medline, CINAHL, and EMBASE from January 1, 2000 to September 30, 2020. The methodological quality of the included studies was assessed by a validated risk of bias assessment tool used in population-based prevalence studies. Nineteen crosssectional studies and one cohort study involving 194,863 participants were included. Eleven, five, and four included studies were classified as having high, moderate, and low quality, respectively. The 12-month prevalence rates of WRMSDs in construction workers were high (ranging from 25% to 96%). There was strong evidence to support the relationships between awkward postures (e.g., twisting, bending, or cramping positions) [odd ratio (OR) = 2.4], manual material handling (MMH) (OR = 2.2), prolonged works (OR = 4.0), high job demands (OR =1.6) or mental stress (OR =1.8) and WRMSDs in construction workers. Additionally, there was moderate evidence for the associations between overhead works (OR = 3.1), use of vibration (OR = 3.2), or low job satisfaction (OR = 1.5) and WRMSDs in construction workers. Furthermore, there was very limited evidence for the associations between repetitive works, low job control, or high job insecurity and WRMSDs in construction workers. Although many physical and psychosocial risk factors were associated with WRMSDs in construction workers, the causal relationships between these factors and the prevalence of WRMSDs remain unclear. Future prospective studies should determine whether these factors can predict future WRMSDs and whether the modification of these factors can reduce the incidence and/or prevalence of WRMSDs in construction workers. Review registration PROSPERO 2019: CRD42019135027.
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Lumbar instability has long been thought of as the failure of lumbar vertebrae to maintain their normal patterns of displacement. However, it is unknown what these patterns consist of. Research using quantitative fluoroscopy (QF) has... more
Lumbar instability has long been thought of as the failure of lumbar vertebrae to maintain their normal patterns of displacement. However, it is unknown what these patterns consist of. Research using quantitative fluoroscopy (QF) has shown that continuous lumbar intervertebral patterns of rotational displacement can be reliably measured during standing flexion and return motion using standardised protocols and can be used to assess patients with suspected lumbar spine motion disorders. However, normative values are needed to make individualised comparisons. One hundred and thirty-one healthy asymptomatic participants were recruited and performed guided flexion and return motion by following the rotating arm of an upright motion frame. Fluoroscopic image acquisition at 15fps was performed and individual intervertebral levels from L2-3 to L5-S1 were tracked and analysed during separate outward flexion and return phases. Results were presented as proportional intervertebral motion representing these phases using continuous means and 95%CIs, followed by verification of the differences between levels using Statistical Parametric Mapping (SPM). A secondary analysis of 8 control participants matched to 8 patients with chronic, non-specific low back pain (CNSLBP) was performed for comparison. One hundred and twenty-seven asymptomatic participants’ data were
analysed. Their ages ranged from 18 to 70 years (mean 38.6) with mean body mass index 23.8 kg/m2 48.8% were female. Both the flexion and return phases for each level evidenced continuous change in mean proportional motion share, with narrow confidence intervals, highly significant differences and discrete motion paths between levels as confirmed by SPM. Patients in the secondary analysis evidenced significantly less L5-S1 motion than controls (p < 0.05). A reference database of spinal displacement patterns during lumbar (L2-S1) intersegmental flexion and return motion using a standardised motion protocol using fluoroscopy is presented. Spinal displacement patterns in asymptomatic individuals were found to be distinctive and consistent for each intervertebral level, and to continuously change during bending and return. This database may be used to allow continuous intervertebral kinematics to drive dynamic models of joint and muscular forces as well as reference values against which to make patient-specific comparisons in suspected cases of lumbar spine motion disorders.
analysed. Their ages ranged from 18 to 70 years (mean 38.6) with mean body mass index 23.8 kg/m2 48.8% were female. Both the flexion and return phases for each level evidenced continuous change in mean proportional motion share, with narrow confidence intervals, highly significant differences and discrete motion paths between levels as confirmed by SPM. Patients in the secondary analysis evidenced significantly less L5-S1 motion than controls (p < 0.05). A reference database of spinal displacement patterns during lumbar (L2-S1) intersegmental flexion and return motion using a standardised motion protocol using fluoroscopy is presented. Spinal displacement patterns in asymptomatic individuals were found to be distinctive and consistent for each intervertebral level, and to continuously change during bending and return. This database may be used to allow continuous intervertebral kinematics to drive dynamic models of joint and muscular forces as well as reference values against which to make patient-specific comparisons in suspected cases of lumbar spine motion disorders.
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Purpose: This paper outlines the first steps toward developing the ICF-based assessment schedule for manual medicine with a focus on low back pain (LBP). It reports on the results of a consensus process to develop the default and optional... more
Purpose: This paper outlines the first steps toward developing the ICF-based assessment schedule for manual medicine with a focus on low back pain (LBP). It reports on the results of a consensus process to develop the default and optional versions of the set of ICF categories (ManMed Set) the assessment schedule should cover, and gives insight in expert input toward building a toolbox of instruments for assessing the ManMed Set categories. Methods: A scoping review and qualitative study were conducted, each resulting in a list of ICF categories. These categories, along with the categories of the ICF Generic-30 Set, Comprehensive ICF Core Set for LBP, and from an existing Delphi study, served as the starting point for an established consensus process to decide on the ManMed Set. Results: After alternating plenary and working group sessions, an iterative ranking process and cutoff calculation, the multi-professional and international group of 20 experts in manual medicine included 23 categories in the default ManMed version (16 + the ICF Generic-7 Set categories) and 25 in the optional version. Conclusions: Their development is a major step toward developing an assessment schedule that can be employed in standardizing the assessment and reporting of functioning in manual medicine, initially of LBP patients. � IMPLICATIONS FOR REHABILITATION � The ICF assessment schedule for manual medicine has potential use in supporting rehabilitation practice, such as for planning interventions, defining rehabilitation goals, and measuring and documenting functioning outcomes. � It can be used to promote interdisciplinary coordination of care and facilitate communication between members of a multidisciplinary rehabilitation team within manual medicine and beyond. � The ICF assessment schedule for manual medicine can facilitate rehabilitation and manual medicine research by providing evidence for optimizing rehabilitation practice.
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Background: The rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to... more
Background: The rate of falls in patients after total knee arthroplasty (TKA) is high and related to lower limb muscle weakness and poor balance control. However, since routine post-TKA rehabilitation is uncommon, it is paramount to explore alternative strategies to enhance balance and physical functioning in post-TKA patients. As Tai Chi is a proven strategy for improving balance in older people, the proposed study aims to determine the feasibility and acceptability of a 12-week community-based post-TKA multimodal Tai Chi program and to collect preliminary data with respect to the efficacy of such a program in improving balance and physical functioning in post-TKA patients as compared to usual postoperative care. Methods: A single-blinded 2-arm pilot randomized controlled trial will recruit 52 community-dwelling post-TKA patients (aged > 60 years) in Hong Kong. In addition, 26 untreated asymptomatic controls will be recruited for comparison purposes. The TKA patients will be randomized into either a 12-week multimodal Tai Chi rehabilitation group or a postoperative usual care group (26 each). Participants will perform the outcome assessments at baseline, 6, 12, 24, and 52 weeks after TKA, while asymptomatic controls will have the same assessments at baseline, 12, and 52 weeks after baseline. The rate of recruitment, retention, and attrition, as well as adherence to the intervention, will be measured and used to determine the feasibility of the study and whether a full-scale effectiveness trial is warranted. Further, qualitative interviews will be conducted to explore the acceptability and possible barriers to the implementation of the intervention. Primary and secondary outcomes including both patient-reported surveys and performance-based tests will be compared within and between groups.
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Background: Neck pain is a pervasive ailment causing work absenteeism, disabilities, and sleep disturbance among working adults. While the onset of neck pain in many individuals may date back to college-age, little is known regarding the... more
Background: Neck pain is a pervasive ailment causing work absenteeism, disabilities, and sleep disturbance among working adults. While the onset of neck pain in many individuals may date back to college-age, little is known regarding the prevalence of neck pain and associated risk factors among undergraduates. The current study aimed to compare the prevalence of neck pain among students in different undergraduate programs and to investigate their risk factors. Methods: Undergraduates from two universities were invited to participate in a self-administered online survey. The survey collected data regarding demographics, previous and the current neck pain symptoms, and potential risk factors (e.g., gender, age, body mass index, study programs, electronic devices usage, study hours, sports participation, and anxiety and depression levels, etc.). Multiple logistic regressions were conducted to identify risk factors for neck pain. Results: A total of 5,195 invitation emails were sent. Of 1,002 respondents, 22.3% reported having current neck pain. Physiotherapy (26.5%) and nursing students (26.1%) had significantly higher prevalence of neck pain as compared to business students (13.2%). Anxiety (odds ratio (OR):1.11, 95%CI:1.07-1.16), concurrent low back pain (OR:3.28, 95%CI:2.15-5.00) and senior years of studies (OR:1.19,95%CI:1.01-1.41) were significantly associated with the presence of neck pain. Taller students (OR:1.02,95%CI:0.99-1.05) and prolonged smartphone usage (OR:1.05,95%CI:0.99-1.12) appeared to be associated with the presence of neck pain. Conclusion: This study not only revealed the high prevalence of neck pain among undergraduates but also identified several modifiable and non-modifiable risk factors for neck pain in this population. Specific prevention strategies should be developed and implemented to reduce the risk of neck pain in vulnerable students.
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Background: The assessment of spinal stiffness by manual palpation in clinical settings has demonstrated both poor accuracy and reliability. More recently, mechanical methods for assessment of spinal stiffness have demonstrated superior... more
Background: The assessment of spinal stiffness by manual palpation in clinical settings has demonstrated both poor accuracy and reliability. More recently, mechanical methods for assessment of spinal stiffness have demonstrated superior accuracy and reliability. However, mechanical methods of spinal stiffness assessment can be expensive, time consuming and/or unsuited to clinical practice. While a new device has been designed to address these issues (VerteTrack), its benchtop performance remains unknown. Aim: To measure the bench-top performance of VerteTrack. Methods: A series of laboratory-based experiments were conducted in February 2018 to investigate the accuracy (precision and bias) of load and displacement measurements obtained by VerteTrack and then were compared against an appropriate reference standard. Measurements of both multiple-level continuous assessment (multiple spinal levels measured), and single-level assessment (single spinal level measured) were performed on a viscoelastic foam medium (AIREX® balance beam, Switzerland) and the resulting stiffness calculated. Results: VerteTrack demonstrated high precision at all loads and displacements. There was minimal systematic measurement bias identified for applied versus reference load (mean bias = − 0.123 N; 95%CI − 0.182 to 0.428 N, p < .001), and no systematic measurement bias for measured versus reference displacement (mean difference = 0.02 mm; 95%CI − 0.09 to 0.14 mm, p < .001). The magnitude of stiffness obtained during multiple-level continuous assessment was on average 0.25 N/mm (2.79%) less than that for single-level assessment (95%CI − 0.67 to 0.17 N/mm, p < .001). Conclusions: VerteTrack demonstrated high accuracy (high precision, low bias) under bench-top conditions. The difference in stiffness found between multiple versus single spinal levels should be considered in the research context, but is unlikely to be clinically relevant. The results of this study demonstrate that VerteTrack may be suitable for both single and multi-level spinal stiffness measurements in-vivo.
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Early onset adjacent segment degeneration (ASD) can be found within six months after anterior cervical discectomy and fusion (ACDF). Deficits in deep paraspinal neck muscles may be related to early onset ASD. This study aimed to determine... more
Early onset adjacent segment degeneration (ASD) can be found within six months after anterior cervical discectomy and fusion (ACDF). Deficits in deep paraspinal neck muscles may be related to early onset ASD. This study aimed to determine whether the morphometry of preoperative deep neck muscles (multifidus and semispinalis cervicis) predicted early onset ASD in patients with ACDF. Thirty-two cases of early onset ASD after a two-level ACDF and 30 matched non-ASD cases were identified from a large-scale cohort. The preoperative total cross-sectional area (CSA) of bilateral deep neck muscles and the lean muscle CSAs from C3 to C7 levels were measured manually on T2-weighted magnetic resonance imaging. Paraspinal muscle CSA asymmetry at each level was calculated. A support vector machine (SVM) algorithm was used to identify demographic, radiographic, and/or muscle parameters that predicted proximal/distal ASD development. No significant between-group differences in demographic or preoperative radiographic data were noted (mean age: 52.4 ± 10.9 years). ACDFs comprised C3 to C5 (n = 9), C4 to C6 (n = 20), and C5 to C7 (n = 32) cases. Eighteen, eight, and six patients had proximal, distal, or both ASD, respectively. The SVM model achieved high accuracy (96.7%) and an area under the curve (AUC = 0.97) for predicting early onset ASD. Asymmetry of fat at C5 (coefficient: 0.06), and standardized measures of C7 lean (coefficient: 0.05) and total CSA measures (coefficient: 0.05) were the strongest predictors of early onset ASD. This is the first study to show that preoperative deep neck muscle CSA, composition, and asymmetry at C5 to C7 independently predicted postoperative early onset ASD in patients with ACDF. Paraspinal muscle assessments are recommended to identify high-risk patients for personalized intervention.
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Background: Authentic assessment and effective feedback are among various strategies that promote learning in the assessment process. These strategies are commonly used during clinical placements. However, they are rarely implemented in... more
Background: Authentic assessment and effective feedback are among various strategies that promote learning in the assessment process. These strategies are commonly used during clinical placements. However, they are rarely implemented in the didactic portion of physiotherapy education despite the benefits this type of assessment may bring to achieving students' learning and outcome. Methods: This mixed method study investigated how an authentic continuous assessment coupled with rubrics facilitated physiotherapy students' learning process in a real-life complex skill of exercise prescription and instruction. The study also explored the relationship between different activities in the Learning Management System (LMS) and learning outcomes. Qualitative data was collected using a focus group and an analysis of discussion forum posts. Quantitative data included various information from a questionnaire, the LMS and assessment score. Results: Thematic analyses from the focus group and discussion forum posts suggest that students used a cyclical selfregulated learning process as a result of authentic task design and rubrics for feedback facilitation. Interestingly, the discussion forum access was found to be moderately and significantly correlated with assessment score by Spearman's rank correlation (ρ = 0.59, p < 0.01), while the students did not find the discussion forum useful. Conclusions: Overall results suggest the promotion of self-regulated learning in this authentic continuous assessment. The roles and goals of each authentic task within the assessment should be made explicit in order to raise cognitive awareness of benefits.
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Dropped head syndrome (DHS) is manifested as the inability to maintain the head in an upright posture. It has been associated with a wide spectrum of myopathies and neurological conditions. Isolated neck extensor myopathy (INEM) is one of... more
Dropped head syndrome (DHS) is manifested as the inability to maintain the head in an upright posture. It has been associated with
a wide spectrum of myopathies and neurological conditions. Isolated neck extensor myopathy (INEM) is one of many potential causes of DHS.
This is a case report of a 72-year-old man who presented with degenerative cervical spondylosis and DHS for 2years. He had previously failed
to achieve a positive outcome to medication, cervical collar and exercise rehabilitation. However, he was able to regain his voluntary head control
after a 4-month chiropractic program. It is believed that INEM is caused by isolated myopathic changes from chronic injury and overloading of
the cervical muscles. Cervical spondylosis has been attributed as the cause of DHS secondary to denervation of the cervical extensors. While
INEM associa
a wide spectrum of myopathies and neurological conditions. Isolated neck extensor myopathy (INEM) is one of many potential causes of DHS.
This is a case report of a 72-year-old man who presented with degenerative cervical spondylosis and DHS for 2years. He had previously failed
to achieve a positive outcome to medication, cervical collar and exercise rehabilitation. However, he was able to regain his voluntary head control
after a 4-month chiropractic program. It is believed that INEM is caused by isolated myopathic changes from chronic injury and overloading of
the cervical muscles. Cervical spondylosis has been attributed as the cause of DHS secondary to denervation of the cervical extensors. While
INEM associa
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age-related deterioration in central and peripheral processing of lumbar proprioceptive signals. Future studies should use advanced imaging and/or electroencephalogram to determine mechanisms underlying changes in proprioceptive... more
age-related deterioration in central and peripheral processing of lumbar proprioceptive signals. Future studies should use advanced imaging and/or electroencephalogram to determine mechanisms underlying changes in proprioceptive reweighting in middle-aged adults.
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Purpose Reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis (LSS). Methods Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS... more
Purpose Reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis (LSS). Methods Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items. An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test. Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine. Round 2: Meeting of 15 members of Taskforce defined final list of 10 items. Round 3: Survey was distributed internationally, followed by Taskforce consensus. Results Totally, 432 clinicians from 28 different countries participated. Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty (p < 0.05). The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. The diagnostic test selected most frequently as the first test was neurological examination. Conclusions This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 'rule out' tests: foot pulses/ABI, hip examination and test for cervical myelopathy. If applied, this core set of diagnostic tests can standardize outcomes and improve clinical care of LSS globally.
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The objective of this review is to identify and map current literature describing the center of rotation locations and migration paths during lumbar spine movements. Introduction: Altered lumber spine kinematics has been associated with... more
The objective of this review is to identify and map current literature describing the center of rotation locations and migration paths during lumbar spine movements. Introduction: Altered lumber spine kinematics has been associated with pain and injury. Intervertebral segments' center of rotations, the point around which spinal segments rotate, are important for determining the features of lumbar spine kinematics and the potential for increased injury risk during movements. Although many studies have investigated the center of rotations of humans' lumbar spine, no review has summarized and organized the state of the science related to center of rotation locations and migration paths of the lumbar spine during lumbar spine movements. Inclusion criteria: This review will consider studies that include human lumbar spines of any age and condition (e.g. heathy, pathological) during lumbar spine movements. Quantitative study designs, including clinical, observational, laboratory biomechanical experimental studies, mathematical and computer modeling studies will be considered. Only studies published in English will be included, and there will be no limit on dates of publication.
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Cardiorespiratory (e.g., heart rate and breathing rate) and thermoregulatory (e.g., local skin temperature and electrodermal activity) responses are controlled by the sympathetic nervous system. To cope with increased physical workload,... more
Cardiorespiratory (e.g., heart rate and breathing rate) and thermoregulatory (e.g., local skin temperature and electrodermal activity) responses are controlled by the sympathetic nervous system. To cope with increased physical workload, the sympathetic system upregulates its activity to generate greater sympathetic responses (i.e., increased heart rate and respiratory rate). Therefore, physiological measures may have the potential to evaluate changes in physical condition (including fatigue) during functional tasks. This study aimed to quantify physical fatigue using wearable cardiorespiratory and thermoregulatory sensors during a simulated construction task. Twenty-five healthy individuals (mean age, 31.8 ± 1.8 years) were recruited. Participants were instructed to perform 30 min of a simulated manual material handling task in a laboratory. The experimental setup comprised a station A, a 10-metre walking platform, and a station B. Each participant was asked to pick up a 15 kg ergonomically-designed wooden box from station A and then carried it along the platform and dropped it at station B. The task was repeated from B to A and then A to B until the participants perceived a fatigue level > 15 out of 20 on the Borg-20 scale. Heart rate, breathing rate, local skin temperature, and electrodermal activity at the wrist were measured by wearable sensors and the perceived physical fatigue was assessed using the Borg-20 scale at baseline, 15 min, and 30 min from the baseline. There were significant increases in the heart rate (mean changes: 50 ± 13.3 beats/min), breathing rate (mean changes: 9.8 ± 4.1 breaths), local skin temperature (mean changes: 3.4 ± 1.9 • C), electrodermal activity at the right wrist (mean changes: 7.1 ± 3.8 µS/cm), and subjective physical fatigue (mean changes: 8.8 ± 0.6 levels) at the end of the simulated construction task (p < 0.05). Heart rate and breathing rate at 15 and 30 min were significantly correlated with the corresponding subjective Borg scores (p < 0.01). Local skin temperature at 30 min was significantly correlated with the corresponding Borg scores (p < 0.05). However, electrodermal activity at the right wrist was not associated with Borg scores at any time points. The results implied cardiorespiratory parameters and local skin temperature were good surrogates for measuring physical fatigue. Conversely, electrodermal activity at the right wrist was unrelated to physical fatigue. Future field studies should investigate the sensitivity of various cardiorespiratory and thermoregulatory parameters for real time physical fatigue monitoring in construction sites.
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Background: While a number of studies have investigated knee symptoms among elite athletes, few have directly compared the association between engagement in different sports and knee symptoms among young adults in the general population.... more
Background: While a number of studies have investigated knee symptoms among elite athletes, few have directly compared the association between engagement in different sports and knee symptoms among young adults in the general population. The current study aimed to investigate the relation between sports participation hours, type/ number of sports engaged, self-rated competitiveness and knee symptoms among undergraduates. Methods: Undergraduates were invited to participate in a self-administered online survey through invitation emails. Respondents were instructed to provide demographic information (e.g., age, gender, sports participation hours, types of engaged sports, self-rated competitiveness in sports and anxiety level etc.) and to report knee symptoms (current, the last 7 days, the last 12 months, and lifetime). Multiple logistic regressions were conducted to investigate the association between sports participation and current knee symptoms. Results: Of 17,552 invitees, 3744 responded to the survey. Valid data from 3053 respondents was used for analysis. Forty-four percent of the respondents engaged in sports regularly (≥once per week). Running, cross-training and swimming were the most frequently participated sports among the respondents. The current prevalence rate of knee symptoms was 6.4%. Hours spent participating in combat sports, soccer, yoga, and basketball participation hours were significantly associated with current knee symptoms. Respondents who rated themselves as "competitive" demonstrated a higher risk of having current knee symptoms than "recreational" players. Number of engaged sports was not associated with current knee symptoms among undergraduates. Conclusions: Certain sports types were associated with current knee symptoms. Compared to self-rated "recreational" players, self-rated "competitive" players were more likely to have current knee symptoms. Students should take preventive measures to minimize their risk of developing knee symptoms, especially when participating in combat sports, soccer, yoga, and basketball, or engaging in sports at a highly competitive level.
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Objective: The purpose of this study was to conduct a systematic review of studies to determine whether sitting time measured objectively (by laboratory controlled time trial, direct observation, or wearable sensor) is associated with the... more
Objective: The purpose of this study was to conduct a systematic review of studies to determine whether sitting time measured objectively (by laboratory controlled time trial, direct observation, or wearable sensor) is associated with the immediate increase in low back pain (LBP) (determined by pain scale rating) in people >18 years of age. Methods: Four databases (PubMed, EMBASE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to September 1, 2018. Randomized controlled trials and cohort and crosssectional studies, where objectively measured sitting time was temporally matched with a measure of LBP in adults, were included. Studies without a control session conducted on a separate day were excluded. Screening, full-text review, data extraction, and risk of bias assessment (Quality In Prognosis Studies) of included papers were performed independently by 2 reviewers, with a third available to resolve disagreements. Results: In total, 609 articles were identified, 361 titles/abstracts were screened,75 full-text articles were assessed for eligibility, and 10 met the inclusion criteria. All but 1 reported sitting time to be associated with an immediate increase in LBP. Six of these reported clinically relevant pain levels (n ¼ 330). Half of the included studies were rated as having a low risk of bias and the remaining were rated as having a moderate risk of bias. Conclusion: Prolonged sitting increases immediate reporting of LBP in adults; however, no conclusion between sitting and clinical episodes of LBP can be made. Based upon these findings, we recommend that future prospective studies should match objectively measured sitting with temporally related pain measurements to determine whether prolonged sitting can trigger a clinical episode of LBP.
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Purpose-Sensing-and warning-based technologies are widely used in the construction industry for occupational health and safety (OHS) monitoring and management. A comprehensive understanding of the different types and specific research... more
Purpose-Sensing-and warning-based technologies are widely used in the construction industry for occupational health and safety (OHS) monitoring and management. A comprehensive understanding of the different types and specific research topics related to the application of sensing-and warning-based technologies is essential to improve OHS in the construction industry. The purpose of this paper is to examine the current trends, different types and research topics related to the applications of sensing-and warning-based technology for improving OHS through the analysis of articles published between 1996 and 2017 (years inclusive). Design/methodology/approach-A standardized three-step screening and data extraction method was used. A total of 87 articles met the inclusion criteria. Findings-The annual publication trends and relative contributions of individual journals were discussed. Additionally, this review discusses the current trends of different types of sensing-and warning-based technology applications for improving OHS in the industry, six relevant research topics, four major research gaps and future research directions. Originality/value-Overall, this review may serve as a spur for researchers and practitioners to extend sensing-and warning-based technology applications to improve OHS in the construction industry.