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PubMed1994

A survey of the work practices of physiotherapists in the community.

The aim of this study was to find out what kind of physiotherapy service is available in the community. Two groups were studied (i) private practitioners and (ii) community physiotherapists employed by health boards. The results indicate that the private practitioners provide a service in the community to a mainly young, or middle-aged and mobile population. The conditions treated were mostly of an acute nature, viz. sports injuries, low back pain and whiplash injuries. The community physiotherapy service provided by the health boards served mainly the very young, i.e. 0-15 years and the elderly. The conditions seen were mostly long-term, viz. strokes and cerebral palsy. The community physiotherapist saw 50% of cases in the patient's own home, while the private practitioners saw 93% of cases in the practice premises.

Adolescent↗
PubMed2002

Fetal gunshot wound characteristics.

Firearm injury in pregnant women is reported in the literature; however, no articles to date address the forensic analysis of the wounds sustained by the fetus. This is a report of a 40 weeks gestational age fetus who died following multiple perforating gunshot wounds, while his mother survived. The fetal wounds were atypical, consisting of irregular perforations with radiating linear lacerations and adjacent abrasions. The unusual wound pattern may have been due to the presence of interposed targets, the shoring of the fetus against itself and the uterine corpus, and the intrinsic character of fetal skin.

Abdominal Injuries↗
PubMed1993

Spinal injury in sport: epidemiologic considerations.

Review of previous epidemiologic studies, involving both contact and noncontact sports at all levels of competition ranging from the high school level to the professional level, reveals that the overwhelming majority of sports injuries related to the spine are soft-tissue injuries and self-limiting. The spectrum of injury is related to the mechanism, the force involved, and the point of application of the force. The immediate consequence of a soft-tissue injury is decreased immobilization with result in deconditioning. Most athletes have a strong desire to compete both at the amateur and professional levels. The inability to compete can have both psychologic and emotional consequences. The professional athlete is potentially burdened with financial consequences as well. The mainstay of prevention and treatment is maintaining good strength and flexibility through conditioning. Injuries can occur at the level of the disc, resulting in disc herniation, disc degeneration, and ultimately developmental stenosis. The biochemistry and biomechanics of the disc are age related, and thus, the adolescent and older athlete may have different concerns with regards to the diagnosis, treatment, and prognosis after injury to the spine. Remember, not only injuries cause back pain in the athlete. Athletes, too, can have tumors, infection, rheumatologic disorders, and other nontraumatic etiologies of back pain. Rarely athletic injuries to the spine do result in significant neurologic compromise. These injuries have been brought to national attention with the tragic recent injuries of well-known professional football and hockey athletes.(ABSTRACT TRUNCATED AT 250 WORDS)

Athletic Injuries↗
PubMedDate not supplied

The treatment of fear of movement/(re)injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo.

BACKGROUND AND OBJECTIVE: Several cognitive-behavioral factors contribute to the persistence of pain disability in patients with chronic back pain. Fear-avoidance beliefs and fear of movement/(re)injury in particular have been shown to be strong predictors of physical performance and pain disability. Patients reporting substantial pain-related fear might benefit from exposure in vivo to a set of individually tailored, fear-eliciting, and hierarchically ordered physical movements rather than more general graded activity. PATIENTS AND INTERVENTIONS: Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study. After a no-treatment baseline measurement period, the patients were randomly assigned to one of two interventions. In the first intervention, patients received exposure in vivo first, followed by graded activity. In the second intervention, the sequence of treatment modules was reversed. Before each treatment module, treatment credibility was assessed. Daily measures of pain-related fear, pain catastrophizing, and pain intensity were completed using visual analog scales. In addition, standardized measures of pain disability, pain-related fear, and pain vigilance were taken before and after each treatment module and at the 1-year follow-up. To obtain more objective data on actual activity levels, an ambulatory activity monitor was carried by the patients during 1 week before and after each treatment module. RESULTS: Time series analysis of the daily measures showed that improvements in pain-related fear and pain catastrophizing occurred only during the exposure in vivo and not during the graded activity, irrespective of the treatment order. Analysis of the pretreatment to post-treatment differences also revealed that decreases in pain-related fear also concurred with decreases in pain disability and pain vigilance and an increase in physical activity levels. All improvements remained at the 1-year follow-up.

Activities of Daily Living↗
PubMed1997

Differences in the incidence of injury between rugby league forwards and backs.

Evidence with regard to the incidence of injury to forwards and backs in the game of rugby league is extremely limited. A four year prospective study of all the injuries from one professional Rugby League club was conducted. All injuries that were received during match play were recorded, and those for forwards and backs compared. Forwards had a higher overall rates of injury than backs (139.4 [124.2-154.6] vs. 92.7 [80.9-104.6] per 1000 player hours, P < 0.00006). Forwards had a higher rate of injuries to all body sites with the exception of the ankle and the 'others' category of injury. They had significantly higher rates for the arm (11.6 [6.9-16.3] vs. 3.9 [1.4-6.4] per 1000 player hours, P = 0.005) and, the head and neck (53.9 [43.9-63.8] vs. 25.0 [18.7-31.4] injuries per 1000 player hours, P < 0.00006). Forwards had significantly more injuries than backs for contusions (17.1 vs. 7.3 per 1000 player hours, z = 2.85, P = 0.0044), lacerations (26.7 vs. 13.8 per 1000 player hours, z = 2.92, P = 0.0035) and haematomas (20.6 vs. 11.6 per 1000 player hours, z = 2.29, P = 0.02). Forwards were also more likely to be injured when in possession of the ball (70.5 [59.2-81.7] vs. 38.0 [30.2-45.7]), and also when tackling (33.2 [25.3-41.1] vs. 16.8 [11.6-22.1]). The higher rates of injury experienced by forwards were most likely as a result of their greater physical involvement in the game, both in attack and in defence.

Adult↗
PubMed2005

A hypothesis of chronic back pain: ligament subfailure injuries lead to muscle control dysfunction.

Clinical reports and research studies have documented the behavior of chronic low back and neck pain patients. A few hypotheses have attempted to explain these varied clinical and research findings. A new hypothesis, based upon the concept that subfailure injuries of ligaments (spinal ligaments, disc annulus and facet capsules) may cause chronic back pain due to muscle control dysfunction, is presented. The hypothesis has the following sequential steps. Single trauma or cumulative microtrauma causes subfailure injuries of the ligaments and embedded mechanoreceptors. The injured mechanoreceptors generate corrupted transducer signals, which lead to corrupted muscle response pattern produced by the neuromuscular control unit. Muscle coordination and individual muscle force characteristics, i.e. onset, magnitude, and shut-off, are disrupted. This results in abnormal stresses and strains in the ligaments, mechanoreceptors and muscles, and excessive loading of the facet joints. Due to inherently poor healing of spinal ligaments, accelerated degeneration of disc and facet joints may occur. The abnormal conditions may persist, and, over time, may lead to chronic back pain via inflammation of neural tissues. The hypothesis explains many of the clinical observations and research findings about the back pain patients. The hypothesis may help in a better understanding of chronic low back and neck pain patients, and in improved clinical management.

Animals↗
PubMedDate not supplied

Recurrent disabling work-related spinal disorders after prior injury claims in a chronic low back pain population.

BACKGROUND CONTEXT: Multiple compensation injury claims are an understudied phenomenon in the chronic back pain and occupational injury literature. Assumptions about poor treatment outcomes for patients presenting with prior injury can lead to denial of treatment, even though these assumptions have not been empirically addressed. Functional restoration has been demonstrated to be an effective rehabilitation treatment for disabling, work-related chronic back pain, although its' relative utility with recurrent injury (RI) patients has not been previously evaluated. PURPOSE: To assess demographic, psychosocial and work history/adjustment differences between the two groups, and to investigate whether patients with recurrent work-related spinal injury claims benefit from functional restoration treatment at a level equivalent to patients with nonrecurrent injuries. STUDY DESIGN/SETTING: A prospective cohort design assessing characteristics and outcomes of patients with recurrent work-related spinal disorders, compared with a group of patients without prior work-related spine injury claims, all treated with the same interdisciplinary rehabilitation protocol. PATIENT SAMPLE: A cohort of consecutively treated functional restoration rehabilitation patients (n=395) divided into two groups based on a history of prior work-related injury. The RI (n=172) group had at least one prior work-related injury claim (with or without lost time), whereas the nonrecurrent injury (NRI; n=223) group did not. OUTCOME MEASURES: The RI and NRI groups were assessed for prospectively collected demographic, psychosocial and work history/adjustment data. A structured clinical interview addressing socioeconomic outcomes and assessing work return, health utilization, recurrent injury and case closure was administered 1 year after discharge from the treatment program. METHODS: Consecutive patients from a regional referral center for tertiary rehabilitation treatment of chronic work-related musculoskeletal injuries were evaluated with a comprehensive biopsychosocial assessment protocol at pretreatment and posttreatment. Moreover, at 1 year after completing the program, a structural telephone interview was conducted that assessed health and socioeconomic outcomes. RESULTS: For the 1-year socioeconomic outcomes (such as posttreatment injury), the RI patients responded to rehabilitation at a level equivalent to the NRI patients. Demographic analyses revealed that RI patients, relative to NRI patients, were older, more represented by the dominant culture, had more education, had a shorter length of disability, had less severe types of injuries, had a greater rate of non-work-related health conditions, received higher disability payments, and had slightly greater job demand. The RI group also had a greater rate of pre-injury Axis I psychiatric disorders, particularly substance abuse/dependence disorders, than the NRI group. In addition, the RI group had greater job stability than the NRI group. CONCLUSIONS: The results of this study indicate that, although patients with recurrent injuries evidence differences in demographic, psychosocial and work history/adjustment differences when compared with patients with nonrecurrent injuries, their 1-year outcomes after tertiary, medically directed rehabilitation are identical. Both groups demonstrate very low rates of further work-related injuries through the first posttreatment year. Patients with recurrent injuries appear to develop skills in dealing with the workers' compensation system with a familiarity not seen in NRI patients. Of course, these results will need to be replicated in other settings to determine whether they can be generalized to the entire workers' compensation population.

Adult↗
PubMed1984

Causes, prediction and prevention of back pain at work.

Pain in the back and lower limbs due to lumbar disorders has a multifactorial etiology, and there is no clear relationship between the morbid pathological change observed and the symptoms experienced. Of the precipitating factors, unaccustomed heavy work, postural fatigue, and injury are common. "Back injury," however, embodies a variety of phenomena, few of which can readily be distinguished either in national statistical data or in previous epidemiologic studies. Thus the causal relationship between back pain and work is far from clear, a difficulty compounded by the prevalence of back symptoms in all groups of the population. There are few epidemiologically established methods for identifying people who are susceptible to a first attack of back pain, though, once back pain has been reported, recurrence may be predicted. Selection of the preventive approach depends on reliable information about the prevalence of back pain/discomfort, the back injury rate, sickness absence, etc; about accidents, work stoppages, job turnover, or any other pointers to the design of the workplace or work practices; and about the resulting losses of productivity and the costs of the remedy. Though the decisions are up to management, the quality of the information required is mainly an occupational health responsibility.

Absenteeism↗
PubMed1995

Role of prostaglandins and histamine in hyperemic response to superficial and deep gastric mucosal injury and H+ back-diffusion in cats.

This study was undertaken to examine the role of prostaglandins and histamine in the hyperemic response to gastric mucosal damage followed by H+ back-diffusion. Cat stomachs were exposed to 2 mol/liter NaCl for 10 min followed by luminal perfusion at pH 1. Hypertonic saline caused extensive (microscopic) damage to the surface epithelium, increased gastric mucosal blood flow, and increased release of histamine, PGE2, and 6-keto PGF1 alpha (prostacyclin) into portal venous blood. The effect of indomethacin and histamine blockers (H1 + H2) on the hyperemic response to acid back-diffusion was related to the depth of the mucosal injury and the region of the stomach. In the corpus, indomethacin enhanced mucosal injury. In areas with superficial damage, the hyperemia was inhibited by indomethacin and antihistamines and eliminated by the combination of both. In corpus areas with indomethacin-induced deep lesions, the blood flow was very high, and this hyperemia was partly inhibited by antihistamines. In the antrum the hyperemic response was reduced by antihistamines. Indomethacin increased the release of histamine into portal venous blood (baseline recordings) and reduced basal gastric mucosal blood flow.

6-Ketoprostaglandin F1 alpha↗
PubMed1995

Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance.

Two studies are presented that investigated 'fear of movement/(re)injury' in chronic musculoskeletal pain and its relation to behavioral performance. The 1st study examines the relation among fear of movement/(re)injury (as measured with the Dutch version of the Tampa Scale for Kinesiophobia (TSK-DV)) (Kori et al. 1990), biographical variables (age, pain duration, gender, use of supportive equipment, compensation status), pain-related variables (pain intensity, pain cognitions, pain coping) and affective distress (fear and depression) in a group of 103 chronic low back pain (CLBP) patients. In the 2nd study, motoric, psychophysiologic and self-report measures of fear are taken from 33 CLBP patients who are exposed to a single and relatively simple movement. Generally, findings demonstrated that the fear of movement/(re)injury is related to gender and compensation status, and more closely to measures of catastrophizing and depression, but in a much lesser degree to pain coping and pain intensity. Furthermore, subjects who report a high degree of fear of movement/(re)injury show more fear and escape/avoidance when exposed to a simple movement. The discussion focuses on the clinical relevance of the construct of fear of movement/(re)injury and research questions that remain to be answered.

Adaptation, Psychological↗