Arnold, Y L Wong
Dr 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.
Phone: 852-2766-6741
Address: Department of Rehabilitation Sciences, Hong Kong Polytechnic University
Phone: 852-2766-6741
Address: Department of Rehabilitation Sciences, Hong Kong Polytechnic University
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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.
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.
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.
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.
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
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.
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
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Book chapter
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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.
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.
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.
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.
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
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.