Previous research describes an inconsistent relation between temporal changes in transversus abdo... more Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment and temporal changes in clinical outcomes. Candidate publications were identified from six electronic databases. Fifteen articles were included after scrutinization by two reviewers using the predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging or M-mode ultrasound) were unrelated to temporal changes in LBP/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements while the relation between multifidus changes and clinical improvements remains uncertain.
Although previous studies suggest braces/corsets can reduce acute pain, no prior study has assess... more Although previous studies suggest braces/corsets can reduce acute pain, no prior study has assessed back function after bracing with both self-reported and objective measures. Use of both self-reported and objective measures of spine function together may be important given evidence they assess unique aspects of function. The aim was to assess both self-reported and objective measures of spinal function before, and after, use of a nonrigid, inelastic lumbar brace. This was a non-randomized clinical trial. The sample included acute low back pain (LBP) participants and asymptomatic controls. Oswestry Disability Index (ODI), spinal stiffness, and muscle endurance were the outcome measures. Three groups were studied: -LBP/-Brace (n=19), -LBP/+Brace (n=18), and +LBP/+Brace (n=17). Both groups of braced participants were instructed to wear the brace continually for 2 weeks with the exception of bedroom and bathroom activities. Before and after the 2-week period, three measures of spinal function were performed: spinal stiffness via motorized indentation of the L3 spinous process, a modified Sorensen test (timed lumbar extension against gravity), and the ODI. Repeated measures analyses of variance were conducted for all three outcomes. Among the groups, ODI scores decreased significantly for the +LBP/+Brace group (p<.001) compared with the other two groups. The +LBP/+Brace mean ODI score decreased 3.71 points (95% confidence interval [CI] 2.01-5.40) compared with the -LBP/-Brace group and decreased 3.48 points (95% CI 1.77-5.20) compared with the -LBP/+Brace group. Change scores for the Sorensen test were significantly increased in the +LBP/+Brace group (p=.037) compared with the -LBP/-Brace group (22.47s 95% CI 8.14-36.80). Spinal stiffness did not change significantly between groups. This study demonstrates that lumbar function assessed by self-reported and objective measures does not worsen when nonrigid, inelastic bracing is used for short periods of time for those with, or without, back pain. These data add to the existing literature that suggests short-term use of nonrigid, inelastic bracing for acute LBP does not decrease spinal function when measured separately with subjective or objective tools.
Approximately 60-80% of people experience low back pain at least once in their lifetime. Given th... 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 an...
Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in pe... more Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in persons with low back pain (LBP) by improving the activity of transversus abdominis and lumbar multifidus muscles. This systematic review aims to summarize evidence regarding which post-treatment characteristics of these muscles may predict clinical improvement. Main conclusion: Overall, changes in transversus abdominis activity do not predict corresponding improvements in LBP or LBP-related disability. The relation between changes in characteristics of lumbar multifidus and post-treatment clinical improvements remains elusive.
Study Design:
Non-randomized controlled study
Objective:
To determine if low back pain (LBP) pati... more Study Design: Non-randomized controlled study Objective: To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls. Summary of Background Data: Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-responders demonstrate significant changes in spinal stiffness, muscle contraction and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls. Methods LBP participants and asymptomatic controls attended three sessions over 7 days. On sessions 1 and 2, LBP participants received SMT (+LBP/+SMT, n = 32) while asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients (ADC) from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from a LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/non-responders based on self-reported disability on day 7. A repeated measures ANCOVA was used to compare ADCs among responders, nonresponders and +LBP/SMT, as well as spinal stiffness or multifidus thickness ratio among responders, non-responders and –LBP/-SMT subjects. Results: After the first SMT, SMT-responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained over 7 days; these findings were not observed in other groups. Similarly, only SMT-responders displayed significant post-SMT improvement in ADC. Conclusions Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT-responders not present in all LBP patients. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response and the biomechanical and imaging characteristics defining responders at baseline.
Residents in private old age homes (POAHs) usually adopt a sedentary lifestyle, making them prone... more Residents in private old age homes (POAHs) usually adopt a sedentary lifestyle, making them prone to physical deconditioning. This study examined the effects of a short-term mobility exercise programme on the balance and mobility of elderly residents residing in POAHs in Hong ...
Instrumented spinal stiffness measurements have shown high test-retest reliability. However, fact... more Instrumented spinal stiffness measurements have shown high test-retest reliability. However, factors that may affect reliability have yet to be investigated. The objective of this study was to compare the: 1) within- and between-day reliability of a mechanical indentation device (MID) in measuring spinal stiffness, 2) measurement precision of averaging multiple measurements, and 3) reliability of stiffness measurements between individuals with and without low back pain (LBP). The spinal stiffness of 26 volunteers with and without LBP was measured 3 times by MID in each of two visits 1-4 days apart. Two stiffness measures were calculated from the resulting force-displacement data: global stiffness and terminal stiffness. Intraclass correlation coefficients (ICCs) were used to estimate reliability. Measurement precision was measured by minimal detectable changes, bias and 95% limits of agreement. Using the mean of three spinal stiffness measurements, the measurement precision was improved by 33.7% over a single measurement. Averaging three measurements, the within- and between-day reliability point estimates of both global and terminal stiffness were 0.99 and 0.98, respectively. The reliability estimates of spinal stiffness measurement using MID were not significantly altered by the participants' LBP status across all circumstances (95% confidence intervals overlapped). With our experimental protocol, averaging three spinal stiffness measurements using MID produces reliable stiffness measurements regardless of individuals' LBP status.
Previous research describes an inconsistent relation between temporal changes in transversus abdo... more Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment and temporal changes in clinical outcomes. Candidate publications were identified from six electronic databases. Fifteen articles were included after scrutinization by two reviewers using the predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging or M-mode ultrasound) were unrelated to temporal changes in LBP/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements while the relation between multifidus changes and clinical improvements remains uncertain.
Although previous studies suggest braces/corsets can reduce acute pain, no prior study has assess... more Although previous studies suggest braces/corsets can reduce acute pain, no prior study has assessed back function after bracing with both self-reported and objective measures. Use of both self-reported and objective measures of spine function together may be important given evidence they assess unique aspects of function. The aim was to assess both self-reported and objective measures of spinal function before, and after, use of a nonrigid, inelastic lumbar brace. This was a non-randomized clinical trial. The sample included acute low back pain (LBP) participants and asymptomatic controls. Oswestry Disability Index (ODI), spinal stiffness, and muscle endurance were the outcome measures. Three groups were studied: -LBP/-Brace (n=19), -LBP/+Brace (n=18), and +LBP/+Brace (n=17). Both groups of braced participants were instructed to wear the brace continually for 2 weeks with the exception of bedroom and bathroom activities. Before and after the 2-week period, three measures of spinal function were performed: spinal stiffness via motorized indentation of the L3 spinous process, a modified Sorensen test (timed lumbar extension against gravity), and the ODI. Repeated measures analyses of variance were conducted for all three outcomes. Among the groups, ODI scores decreased significantly for the +LBP/+Brace group (p<.001) compared with the other two groups. The +LBP/+Brace mean ODI score decreased 3.71 points (95% confidence interval [CI] 2.01-5.40) compared with the -LBP/-Brace group and decreased 3.48 points (95% CI 1.77-5.20) compared with the -LBP/+Brace group. Change scores for the Sorensen test were significantly increased in the +LBP/+Brace group (p=.037) compared with the -LBP/-Brace group (22.47s 95% CI 8.14-36.80). Spinal stiffness did not change significantly between groups. This study demonstrates that lumbar function assessed by self-reported and objective measures does not worsen when nonrigid, inelastic bracing is used for short periods of time for those with, or without, back pain. These data add to the existing literature that suggests short-term use of nonrigid, inelastic bracing for acute LBP does not decrease spinal function when measured separately with subjective or objective tools.
Approximately 60-80% of people experience low back pain at least once in their lifetime. Given th... 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 an...
Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in pe... more Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in persons with low back pain (LBP) by improving the activity of transversus abdominis and lumbar multifidus muscles. This systematic review aims to summarize evidence regarding which post-treatment characteristics of these muscles may predict clinical improvement. Main conclusion: Overall, changes in transversus abdominis activity do not predict corresponding improvements in LBP or LBP-related disability. The relation between changes in characteristics of lumbar multifidus and post-treatment clinical improvements remains elusive.
Study Design:
Non-randomized controlled study
Objective:
To determine if low back pain (LBP) pati... more Study Design: Non-randomized controlled study Objective: To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls. Summary of Background Data: Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-responders demonstrate significant changes in spinal stiffness, muscle contraction and disc diffusion. Unfortunately, the significance of these observations remains uncertain given methodological differences between studies including a lack of controls. Methods LBP participants and asymptomatic controls attended three sessions over 7 days. On sessions 1 and 2, LBP participants received SMT (+LBP/+SMT, n = 32) while asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients (ADC) from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from a LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/non-responders based on self-reported disability on day 7. A repeated measures ANCOVA was used to compare ADCs among responders, nonresponders and +LBP/SMT, as well as spinal stiffness or multifidus thickness ratio among responders, non-responders and –LBP/-SMT subjects. Results: After the first SMT, SMT-responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained over 7 days; these findings were not observed in other groups. Similarly, only SMT-responders displayed significant post-SMT improvement in ADC. Conclusions Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT-responders not present in all LBP patients. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response and the biomechanical and imaging characteristics defining responders at baseline.
Residents in private old age homes (POAHs) usually adopt a sedentary lifestyle, making them prone... more Residents in private old age homes (POAHs) usually adopt a sedentary lifestyle, making them prone to physical deconditioning. This study examined the effects of a short-term mobility exercise programme on the balance and mobility of elderly residents residing in POAHs in Hong ...
Instrumented spinal stiffness measurements have shown high test-retest reliability. However, fact... more Instrumented spinal stiffness measurements have shown high test-retest reliability. However, factors that may affect reliability have yet to be investigated. The objective of this study was to compare the: 1) within- and between-day reliability of a mechanical indentation device (MID) in measuring spinal stiffness, 2) measurement precision of averaging multiple measurements, and 3) reliability of stiffness measurements between individuals with and without low back pain (LBP). The spinal stiffness of 26 volunteers with and without LBP was measured 3 times by MID in each of two visits 1-4 days apart. Two stiffness measures were calculated from the resulting force-displacement data: global stiffness and terminal stiffness. Intraclass correlation coefficients (ICCs) were used to estimate reliability. Measurement precision was measured by minimal detectable changes, bias and 95% limits of agreement. Using the mean of three spinal stiffness measurements, the measurement precision was improved by 33.7% over a single measurement. Averaging three measurements, the within- and between-day reliability point estimates of both global and terminal stiffness were 0.99 and 0.98, respectively. The reliability estimates of spinal stiffness measurement using MID were not significantly altered by the participants' LBP status across all circumstances (95% confidence intervals overlapped). With our experimental protocol, averaging three spinal stiffness measurements using MID produces reliable stiffness measurements regardless of individuals' LBP status.
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Papers by Arnold Wong
Non-randomized controlled study
Objective:
To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls.
Summary of Background Data:
Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-responders demonstrate significant changes in spinal stiffness, muscle contraction and disc diffusion. Unfortunately, the significance of these observations remains uncertain given
methodological differences between studies including a lack of controls.
Methods
LBP participants and asymptomatic controls attended three sessions over 7 days. On sessions 1 and 2, LBP participants received SMT (+LBP/+SMT, n = 32) while asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness
and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients (ADC) from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from a LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/non-responders based on self-reported disability on day 7. A repeated measures ANCOVA was used to compare ADCs among responders, nonresponders and +LBP/SMT, as well as spinal stiffness or multifidus thickness ratio among responders, non-responders and –LBP/-SMT subjects.
Results:
After the first SMT, SMT-responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained over 7 days; these findings were not observed in other groups. Similarly, only SMT-responders displayed significant post-SMT improvement in ADC.
Conclusions
Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT-responders not present in all LBP patients. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response and the biomechanical and imaging characteristics defining responders at baseline.
Non-randomized controlled study
Objective:
To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls.
Summary of Background Data:
Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-responders demonstrate significant changes in spinal stiffness, muscle contraction and disc diffusion. Unfortunately, the significance of these observations remains uncertain given
methodological differences between studies including a lack of controls.
Methods
LBP participants and asymptomatic controls attended three sessions over 7 days. On sessions 1 and 2, LBP participants received SMT (+LBP/+SMT, n = 32) while asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness
and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients (ADC) from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from a LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/non-responders based on self-reported disability on day 7. A repeated measures ANCOVA was used to compare ADCs among responders, nonresponders and +LBP/SMT, as well as spinal stiffness or multifidus thickness ratio among responders, non-responders and –LBP/-SMT subjects.
Results:
After the first SMT, SMT-responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained over 7 days; these findings were not observed in other groups. Similarly, only SMT-responders displayed significant post-SMT improvement in ADC.
Conclusions
Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT-responders not present in all LBP patients. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response and the biomechanical and imaging characteristics defining responders at baseline.