摘要:

Study DesignThis retrospective study examined the effect of civil litigation on reports of pain and disability in chronic pain patients who sustained whiplash injuries after a motor vehicle accident.ObjectivesTo examine the effect of litigation on adjustment to chronic pain.Summary of Background DataA common methodologic weakness with many studies in this area is the composition of the nonlitigant group, which often includes individuals who have completed litigation as well as those who opted not to litigate. This introduces a confound in that litigant and nonlitigant groups differ not only with respect to litigation status but with respect to any factors that predispose one to litigate.MethodsQuestionnaire data were obtained from 41 patients (current litigants) in the process of litigation and 21 patients (postlitigants) who had completed litigation. Subjects completed self-report measures assessing demographic characteristics, psychological distress, sleep disturbance, employment status, and various pain indices.ResultsThere were no significant group differences in demographic characteristics, employment status, or psychological distress. Litigants, however, reported more pain than did postlitigants. Group differences in pain reports remained statistically significant even after controlling for length of time since accident and initial severity of the injuries.ConclusionsThat litigation status did not predict employment status suggests that secondary gain does not figure prominently in influencing the functionality of these patients. The rather robust effect of litigation status on pain reports is discussed with respect to the potential mediational role of the stress of litigation.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThree-dimensional reconstructions of the spine and rib cage were done and compared just before and 1 month after initiation of treatment with a Boston brace in a group of adolescents with idiopathic scoliosis.ObjectivesTo document the immediate changes in shape of the thoracic spine and rib cage induced by the original Boston brace design.Summary of Background DataThe effect of the Boston brace has been well documented in the frontal plane but is poorly understood in the other planes of deformity.MethodsThree-dimensional reconstructions were obtained with and without the brace using a stereoradiographic technique in a group of 40 adolescents with idiopathic scoliosis. Several geometric indices of the spine and rib cage were compared using Studentttests.ResultsThe brace produced significant curve correction of the spinal deformity in the frontal plane at the expense of a significant reduction of thoracic kyphosis in the sagittal plane, as well as in the plane of minimum deformity. No significant effect on rotation of the thoracic apical vertebra, on the rib hump, or on frontal balance could be documented, but changes were noted in the sagittal orientation of the rib cage and in the sagittal balance of the spine.ConclusionsThe original Boston brace does not completely correct the three-dimensional deformities associated with thoracic idiopathic scoliosis although it reduces Cobb angles in the frontal plane.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study used a repeated measures design to assess the effects of multiple sitting postures on various spinal angles. All subjects were tested in slouched, erect, forward inclined, and comfortable postures.ObjectivesThe purposes of this study were to evaluate the changes in head, cervical, lumbar, and pelvic postures in different sitting positions and also to determine if there is a relation between lumbar posture and cervical posture during sitting.Summary of Background DataClinicians commonly assert that head and neck position is strongly influenced by lumbar and pelvic position. A biomechanical model was developed that allowed detailed, quantitative description of head, neck, lumbar, and pelvic postures. This model enabled a distinction to be made between upper and lower cervical motions.MethodsVarious spinal angles were measured in 30 healthy subjects in four sitting positions using a three-dimensional digitizing system. Reliability of the measurement procedure was determined using an intraclass correlation coefficient and the values for most angles was above 0.8.ResultsWith the exception of head orientation, analysis of variance revealed significant differences in spinal angles between different sitting positions. Head orientation appeared to be maintained by compensatory adjustments in both the upper and lower cervical spine and changes in lumbar posture were associated with compensatory changes in overall cervical position. As the lumbar spine moved toward extension, the cervical spine flexed and as the lumbar spine flexed the cervical spine extended. However, there was variation among subjects as to whether cervical spine adjustments occurred primarily in the upper or lower cervical region.ConclusionsDifferent sitting postures clearly resulted in changes in cervical spine position. Lumbar and pelvic position should be considered when control of cervical posture is desired.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study analyzed two groups of subjects during forward bending. Group 1 (n = 20) contained subjects with a history of low back pain and Group 2 (n = 21) included subjects without a history of low back pain.ObjectiveThe purposes of this study were to establish the amount and pattern of lumbar spine and hip motion during forward bending, and determine differences in motion in subjects with and without a history of low back pain.Summary of Background DataReported values for lumbar spine motion during forward bending vary from 23.9° to 60° and hip motion during forward bending ranges from 26° to 66°. There has been no direct study of both lumbar spine and hip motion during forward bending in subjects with and without a history of low back pain to establish differences in total amounts or pattern of lumbar spine and hip motion during forward bending.MethodsA three-dimensional optoelectric motion analysis system was used to measure the amount and velocity of lumbar spine and hip motion during forward bending. Each subject performed three trials of forward bending that were averaged and used for statistical analysis. Hamstring flexibility was also assessed by two clinical tests, the passive straight leg raising and active knee extension tests.ResultsMean total forward bending for all subjects was 111°: 41.6° from the lumbar spine and 69.4° from the hips. There were no group differences for total amounts of lumbar spine and hip motion or velocity during forward bending. The pattern of motion was described by calculating lumbar-to-hip flexion ratios for early (0-30°), middle (30-60°), and late (60-90°) forward bending. For all subjects, mean lumbar-to-hip ratios for early, middle, and late forward bending were 1.9, 0.9, and 0.4, respectively. Therefore, the lumbar spine had a greater contribution to early forward bending, the lumbar spine and hips contributed almost equally to middle forward bending, and the hips had a greater contribution to late forward bending. Attest revealed a difference between groups for the pattern of motion. Group 1 tended to move more at their lumbar spine during early forward bending and had a significantly lower lumbar-to-hip flexion ratio during middle forward bending (P< 0.01). Hamstring flexibility was strongly correlated to motion in subjects with a history of low back pain, but not in healthy subjects.ConclusionsThe results provide quantitative data to guide clinical assessment of forward bending motion. Results also suggest that although people with a history of low back pain have amounts of lumbar spine and hip motion during forward bending similar to those of healthy subjects, the pattern of motion is different. It may be desirable to teach patients with a history of low back pain to use more hip motion during early forward bending, and hamstring stretching may be helpful for encouraging earlier hip motion.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignThis study correlated a specific lumbar disc abnormality described as the high-intensity zone observed on high-field magnetic resonance imaging with discography.ObjectivesTo analyze the significance of high-intensity zones in lumbar discs of symptomatic patients with low back/radicular pain.Summary of Background DataAprill and Bogduk described an 86% incidence of concordantly painful discography in lumbar discs exhibiting a posterior high-intensity zone on T2-weighted magnetic resonance imaging studies performed on back pain sufferers. They assert that the high-intensity zone is a reliable marker of discogenic pain in symptomatic subjects.MethodsConsecutive cases of lumbar spine high-field magnetic resonance imaging using T2-weighted images on symptomatic patients followed by discography at all high-intensity zone levels and at non-high-intensity zone control levels were reviewed until 100 high-intensity zone discs in 63 patients were found. Seventeen lifelong asymptomatic (for low back/radicular pain) adults were also scanned as magnetic resonance imaging controls. All magnetic resonance scans and discograms were agreed on by at least two of the radiologist authors.ResultsEighty-seven of 100 of the high-intensity zone discs proved concordantly painful at discography. All 87 painful and concordant discs exhibited abnormal morphology with anular tears extending either well into or through the outer third of the anulus fibrosus. Sixtyfive of 67 non-high-intensity zone control discs were nonconcordant and of lower sensation intensity than the high-intensity zone discs. Only one high-intensity zone was found in the control subjects.ConclusionsIn patients with symptomatic low back pain, the high-intensity zone is a reliable marker of painful outer anular disruption.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Study DesignFifty-three human thoracic and lumbar vertebrae were analyzed by dual energy x-ray absorptiomety to obtain projectional (g/cm2) and volumetric (g/cm3) bone mineral density.ObjectivesTo determine the effect of volume on the measurement of bone mineral density by DEXA.Summary of Background DataDespite the widespread use of dual energy x-ray absorptiomety to measure bone mineral density expressed as grams per projectional unit area (g/cm2), the effect of volume has been ignored in many published biomechanical studies.MethodsProjectional bone mineral density (g/cm2) of fifty-three human vertebrae was obtained by dual energy x-ray absorptiomety measurement. This was compared to bone mineral density expressed as grams per unit volume.ResultsMany specimens with near equal projectional bone mineral density were demonstrated to have significantly different true densities when measured by dual energy x-ray absorptiomety in grams per unit volume. The difference in true bone mineral density for these specimens ranged from 24.1% to 139%.ConclusionThe effect of volume on bone mineral density data based on projectional areas can cause very significant pertubations of the data in biomechanical studies.

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0362-2436    

出版商:OVID    

年代:1996

数据来源: OVID