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V Mooney

Publications and source records attributed to V Mooney.

At least 19 recordsLinked to original sources

Restorative exercise for clinical low back pain. A prospective two-center study with 1-year follow-up.

STUDY DESIGN: A comparison of treatment of 412 patients with chronic back pain at two separate centers using the same treatment protocols and outcome measures. Outcome was defined by specific strength testing; Short Form-36 scores at intake, discharge, and 1-year follow-up; self-appraisal of improvement at discharge and in a 1-year follow-up; and reuse of health care services after discharge. OBJECTIVES: To investigate the efficacy of standardized treatment methods using isolated lumbar strength testing and strengthening based on progressive protocols using specific equipment. Comparison of results should clarify the effect of the treatment center versus the efficacy of standardized protocols. SUMMARY OF BACKGROUND DATA: There has been little support in the scientific literature for exercise programs based on standardized protocols. The use of specialized equipment to achieve intense specific exercise also has been poorly supported. Overall health benefit has not often been related to specific improvement in strength. METHODS: More than 400 individuals with chronic back pain were evaluated at the initiation of treatment, discharge, and 1 year after discharge. Measures of efficacy were based on Short Form-36 scores, self-appraisal of improvement, and reuse of health care services after discharge. Study participants were patients with chronic back pain consecutively referred to each treatment site and underwritten by a variety of payers, including workers' compensation, Medicare, and private insurance. RESULTS: Overall response during the course of the program and at 1-year follow-up was similar between the two centers. Similar proportions of participants at each site demonstrated improvement in SF-36 scores, self-appraisal of improvement, and reuse of health care services. CONCLUSIONS: Standardized protocols using specific strength and measurement equipment can achieve similar benefits at different sites.

Adult

Comparison of hydroxyapatite granules to autogenous bone graft in fusion cages in a goat model.

BACKGROUND: With the increased use of fusion cages to achieve lumbar intervertebral fusion, the question arises as to the potential for bone ingrowth from the host bone through the entire cage. Is it even necessary to have an autogenous graft to achieve total bone incorporation? METHODS: Nine adult male goats had fusion cages implanted into three vertebral bodies. The design was Surgical Dynamics/Ray Fusion Cage, measuring 21 mm x 14 mm. In each animal, one fusion cage was filled with autogenous graft, one with hydroxyapatite, porous granules, and the other with nonporous granules. Amount of new bone formation was determined by backscatter electron microscopy at 3 months post implantation in all animals. RESULTS: The histologic section shows that there was total incorporation in all specimens at 3 months. There was slightly more new bone (43%) with the nonporous granules compared with the porous granules (35%). The amount of residual void space was about the same in all specimens, indicating that the amount of new bone formation was similar and not statistically different in cages filled with hydroxyapatite granules versus granules of autogenous bone. CONCLUSION: This study confirms that total incorporation by ingrowth of new bone can be expected in fusion cages. The amount of ingrowth is about the same for autogenous graft versus hydroxyapatite granules. Apparently, it is not necessary to use bone graft to achieve successful bone incorporation if an acceptable biocompatable lattice, such as hydroxyapatite granules, is used.

Animals

Physical measurements of the lumbar spine.

This article describes measurement of lumbar function. The simplest range of motion devices are compared with the progressive, more complex computerized devices for range and strength testing. The author presents his own opinion as to the place of these devices in both research and clinical practices. The economics of accurate physical testing is compared to the clinical realities of current payment systems.

Anthropometry

Relationships between myoelectric activity, strength, and MRI of lumbar extensor muscles in back pain patients and normal subjects.

Eight normal individuals and eight patients with chronic back pain were evaluated. They undertook a treatment program lasting 8 weeks, with two exercise sessions each week. Myoelectric activity, lumbar extensor strength, and cross-sectional magnetic resonance imaging appearance of the lumbar paraspinal extensor muscles was assessed at the beginning and end of the program. Initial baseline and final extensor strength measurements were done isometrically at seven points through full range. Surface myoelectric activity was monitored during both flexion and extension exercise. Subsequently, electromyographic (EMG) signals were analyzed for mean frequency (MPF) and amplitude (RMS). An average functional improvement of 65% and reduction of pain complaint of 41% occurred in the eight patients with chronic low back pain. Extensor strength improved an average of 48% contrasted to 6% for the normal subjects. Four patients who showed severe fatty infiltration in the extensors had a decrease in the degree of infiltration and no change in muscle mass. Changes in fatty infiltration did not correlate with strength changes. The dynamic EMG changes documented a decrease in amplitude (RMS) and a smaller decrease in frequency (MPF) for the same resistance when used at the beginning and end of the program. Structural changes in the muscles are not always needed to achieve strength gains or symptomatic improvement.

Back Pain

Relationship of lumbar strength in shipyard workers to workplace injury claims.

STUDY DESIGN: Strength testing of lumbar extensors of shipyard workers without back injury claims was accomplished to compare isolated lumbar strength with the severity of their workplace physical demands and the incidence of workplace back injury during a 2-year period. OBJECTIVES: To determine if strength is a predictor of workplace injury and if there is a relationship between the physical demands of the job and strength. SUMMARY OF BACKGROUND DATA: The role of preplacement strength testing has not been clarified as a potential means for predicting workplace injury. It has not been clarified whether work activity affects the strength of the worker. METHODS: One hundred fifty-two shipyard workers were strength tested for isometric lumbar extensor strength. They had been classified as to the severity of their job demands according to the Physical Demand Characteristics. All workers at this industry were likewise classified. Those workers who were tested were followed for 2 years to evaluate for claims of back injury. RESULTS: There was a higher incidence of low back injuries in the heavy and very heavy classification. There was, however, no difference in strength among those workers classified in medium, heavy, and very heavy work. Nine percent of those workers tested had back pains during the following 2 years. All but two had higher-than-average strength. CONCLUSIONS: There is no evidence that preplacement back strength testing would predict workplace claims of injury.

Adult

Comparison of female geriatric lumbar-extension strength: asymptotic versus chronic low back pain patients and their response to active rehabilitation.

We compared lumbar-extension strength between healthy asymptomatic geriatric females (HEAL) and symptomatic geriatric females (INJ) seeking medical attention for chronic low back pain. The INJ group used the MedX lumbar-extension machine to perform isotonic exercises two times per week and were eventually reduced to one time per week. Range of motion (ROM) and strength were significantly different between groups before beginning the program. After the program, ROM and strength improved significantly and were not different from those of the HEAL group. The average length of treatment was 97 days and 20 visits. Subjective pain ratings were significantly reduced (60%) and exercise weights significantly increased (71%). This reconfirms the notion that many back pain sufferers have weaker lumbar-extension strength and that some symptomatic geriatric women can increase strength with progressive resistance exercise, which leads to a decrease in low back pain.

Aged

A test to measure lift capacity of physically impaired adults. Part 1--Development and reliability testing.

STUDY DESIGN: Two laboratory studies and one field study evaluated the safety and test-retest reliability of a new test of lift capacity. The first two studies were conducted in a carefully controlled laboratory setting. The first study investigated the safety and intra-rater reliability of the EPIC Lift Capacity test protocol with healthy adult subjects. The second study assessed the safety and inter-rater reliability of the test with disabled subjects. The third study was conducted in the field with 65 evaluators and investigated the safety and intra-rater reliability of the test with healthy adult subjects. OBJECTIVE: To assess the safety and reliability of a new test of lift capacity. SUMMARY OF BACKGROUND DATA: A new test of lift capacity has been developed. Test development occurred within the context of ergonomic standards and guide-lines of the major professional associations and public agencies that govern test development in the United States. METHODS: In study no. 1, 26 healthy subjects participated. In study no. 2, 14 disabled subjects participated. In study no. 3, 318 healthy subjects participated. After subjects underwent basic screening and warm-up, the EPIC Lift Capacity test was administered. One to 2 weeks later, the test was administered again. Correlations between the times of testing were calculated. RESULTS: No subjects were injured. Hamstring soreness the next day that resolved without complication was reported by some healthy subjects. None of the disabled subjects reported new symptoms. CONCLUSION: The safety and reliability of the EPIC Lift Capacity test was adequately demonstrated in a laboratory setting and across multiple field sites with evaluators who have varying types and degrees of professional preparation.

Adult

A test to measure lift capacity of physically impaired adults. Part 2--Reactivity in a patient sample.

STUDY DESIGN: Test reactivity is the based on the idea that experience with a test may affect performance on subsequent tests, independent of what the test purports to measure. The reactivity of a test of lift capacity was studied in a single-blind randomized clinical trial was studied in a single-blind randomized clinical trial in which subjects were assigned to one or two groups. One group received lift testing before and after a therapeutic trial, while the other group received lift testing only at the conclusion of the therapeutic trial. OBJECTIVE: To measure the reactivity of a lift capacity test over the course of treatment. SUMMARY OF BACKGROUND DATA: The reactivity of a test is an important criterion by which an outcome measure must be judged. Change in response to treatment is assumed to be independent of changes resulting from the evaluee's experience with the test, although this is rarely addressed. METHODS: The EPIC Lift Capacity test was administered to 55 patients with low back pain in a treatment program after they were randomized into a pre-test/post-test and a post-test only group. Additional measures were taken on a pre-test/post-test basis for all subjects. RESULTS: Analyses of variance demonstrated no difference between the randomized groups after treatment. However, the pre-test/post-test group demonstrated significant improvement over the course of treatment. Other measures of outcome were similarly affected. CONCLUSION: The reactivity of the EPIC Lift Capacity test was negligible over an 8-week treatment regimen that did not include lifting tasks.

Adult

The effect of lumbar belts on isolated lumbar muscle. Strength and dynamic capacity.

STUDY DESIGN: This study analyzed the effect of lumbar support belts on functional performance. OBJECTIVE: To compare lumbar muscle strength and lifting capacity with and without a lumbar belt. SUMMARY OF BACKGROUND DATA: Industrialized settings have begun to encourage the use of lumbar support belts for their employees. It is believed that the belts may decrease the risk of injury and enhance the functional performance of the individual. METHODS: Twenty-two subjects (average age, 27.5 years) were tested on four separate days to evaluate the effect of a commercially available belt on isolated lumbar isometric strength and functional dynamic lifting capacity. All subjects had no history of low back problems. The order of testing with and without a belt was randomized for both conditions. On the first 2 days, subjects performed a seven-angle isometric lumbar extension strength test, 1 day with and 1 day without a lumbar belt. On the following 2 days, subjects were tested to evaluate functional capacity with and without a lumbar belt. The functional capacity evaluation was performed by progressively lifting weighted canisters from various levels. Heart rates were monitored to ensure that a maximum effort was achieved over the different days. RESULTS: T tests revealed that isometric lumbar strength and functional lifting capacity was not significantly affected by the belt. CONCLUSION: The use of a lumbar belt does not enhance isometric lumbar muscle strength or dynamic lifting capacity.

Adult

Trunk strength testing in patient evaluation and treatment.

A wide variety of trunk strength testing devices has been developed, the goal being to quantify back strength, patient effort, and spinal function or dysfunction. Although the idea of applying quantitative values to spine function is appealing, controversy exists regarding the reliability and validity of these testing systems. In this issue, two experienced investigators give their opinions as to the values and pitfalls of lumbar trunk strength testing, and provide insight into the most appropriate applications of these often costly systems.

Back Pain