Estimation of in vivo inter-vertebral loading during motion using fluoroscopic and magnetic resonance image informed finite element models.

Finite element (FE) models driven by medical image data can be used to estimate subject-specific spinal biomechanics. This study aimed to combine magnetic resonance (MR) imaging and quantitative fluoroscopy (QF) in subject-specific FE models of upright standing, flexion and extension. Supine MR images of the lumbar spine were acquired from healthy participants using a 0.

Uneven intervertebral motion sharing is related to disc degeneration and is greater in patients with chronic, non-specific low back pain: an in vivo, cross-sectional cohort comparison of intervertebral dynamics using quantitative fluoroscopy.

Purpose: Evidence of intervertebral mechanical markers in chronic, non-specific low back pain (CNSLBP) is lacking. This research used dynamic fluoroscopic studies to compare intervertebral angular motion sharing inequality and variability (MSI and MSV) during continuous lumbar motion in CNSLBP patients and controls. Passive recumbent and active standing protocols were used and the relationships of these variables to age and disc degeneration were assessed.

Relationships between Paraspinal Muscle Activity and Lumbar Inter-Vertebral Range of Motion.

Control of the lumbar spine requires contributions from both the active and passive sub-systems. Identifying interactions between these systems may provide insight into the mechanisms of low back pain. However, as a first step it is important to investigate what is normal.

Accuracy and repeatability of quantitative fluoroscopy for the measurement of sagittal plane translation and finite centre of rotation in the lumbar spine.

Quantitative fluoroscopy (QF) was developed to measure intervertebral mechanics in vivo and has been found to have high repeatability and accuracy for the measurement of intervertebral rotations. However, sagittal plane translation and finite centre of rotation (FCR) are potential measures of stability but have not yet been fully validated for current QF. This study investigated the repeatability and accuracy of QF for measuring these variables.

Relationships between lumbar inter-vertebral motion and lordosis in healthy adult males: a cross sectional cohort study.

Background: Intervertebral motion impairment is widely thought to be related to chronic back disability, however, the movements of inter-vertebral pairs are not independent of each other and motion may also be related to morphology. Furthermore, maximum intervertebral range of motion (IV-RoMmax) is difficult to measure accurately in living subjects. The purpose of this study was to explore possible relationships between (IV-RoMmax) and lordosis, initial attainment rate and IV-RoMmax at other levels during weight-bearing flexion using quantitative fluoroscopy (QF).

Proportional lumbar spine inter-vertebral motion patterns: a comparison of patients with chronic, non-specific low back pain and healthy controls.

Introduction: Identifying biomechanical subgroups in chronic, non-specific low back pain (CNSLBP) populations from inter-vertebral displacements has proven elusive. Quantitative fluoroscopy (QF) has excellent repeatability and provides continuous standardised inter-vertebral kinematic data from fluoroscopic sequences allowing assessment of mid-range motion. The aim of this study was to determine whether proportional continuous IV rotational patterns were different in patients and controls.

Ionizing radiation exposure and the development of intervertebral disc degeneration--no case to answer.

In the following perspective article, Mellor and Breen provide a counterpoint to a previous perspective on the potential link between ionizing radiation exposure and intervertebral disc degeneration in humans [1]. The previous perspective asked, is this link a myth or reality? It suggested the potential for such a link. Mellor and Breen offer a drastically alternate view, in essence, that the question itself is flawed.

Measurement of intervertebral motion using quantitative fluoroscopy: report of an international forum and proposal for use in the assessment of degenerative disc disease in the lumbar spine.

Quantitative fluoroscopy (QF) is an emerging technology for measuring intervertebral motion patterns to investigate problem back pain and degenerative disc disease. This International Forum was a networking event of three research groups (UK, US, Hong Kong), over three days in San Francisco in August 2009. Its aim was to reach a consensus on how best to record, analyse, and communicate QF information for research and clinical purposes.

Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study.

Background: Back pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes.

Methods: We assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass.

Midlumbar lateral flexion stability measured in healthy volunteers by in vivo fluoroscopy.

Study Design: Prospective fluoroscopic and electromyographic study of coronal plane lumbar spine motion in healthy male volunteers.

Objectives: Assess the intervertebral motion profiles in healthy volunteers for symmetry, regularity, and neutral zone laxity during passive recumbent lateral bending motion.

Summary Of Background Data: Previous continuous in vivo motion studies of the lumbar spine have mainly been limited to active, weight-bearing, flexion-extension (sagittal plane) motion.

Consent: its practices and implications in United kingdom and United States chiropractic practice.

Objective: This study explores the implementation of consent procedures in a sample of chiropractors in the United Kingdom (UK) and the United States (US) and how well they satisfy the core ethical principles of autonomy, veracity, justice, nonmaleficence, and beneficence.

Methods: A precoded questionnaire was sent to 500 geographically stratified, randomly selected chiropractors in the UK and 500 similarly selected chiropractors within 10 states (50 from each) across the US. Questionnaires were dispatched 100 per month over a 5-month period.

Psychosocial factors and their predictive value in chiropractic patients with low back pain: a prospective inception cohort study.

Background: Being able to estimate the likelihood of poor recovery from episodes of back pain is important for care. Studies of psychosocial factors in inception cohorts in general practice and occupational populations have begun to make inroads to these problems. However, no studies have yet investigated this in chiropractic patients.

"You feel so hopeless": a qualitative study of GP management of acute back pain.

Background: Biopsychosocial management of non-specific back pain in general practice has been problematical, with frequent inappropriate referral for imaging and secondary care interventions and lack of self-confidence in the ability to provide evidence-based care.

Aims: To examine GP attitudes to managing back pain as a biopsychosocial problem in order to inform future educational strategies that may improve practice.

Methods: Twenty-one GPs from separate practices within the Dorset and Somerset Strategic Health Authority area (UK) participated in telephone interviews leading to the development of vignettes to refine the theoretical framework for subsequent focus group interviews about evidence-based back pain management.

An objective spinal motion imaging assessment (OSMIA): reliability, accuracy and exposure data.

Background: Minimally-invasive measurement of continuous inter-vertebral motion in clinical settings is difficult to achieve. This paper describes the reliability, validity and radiation exposure levels in a new Objective Spinal Motion Imaging Assessment system (OSMIA) based on low-dose fluoroscopy and image processing.

Methods: Fluoroscopic sequences in coronal and sagittal planes were obtained from 2 calibration models using dry lumbar vertebrae, plus the lumbar spines of 30 asymptomatic volunteers.

Mono-disciplinary or multidisciplinary back pain guidelines? How can we achieve a common message in primary care?

Description of a workshop entitled "Sharing Guidelines for Low Back Pain Between Primary Health Care Providers: Toward a Common Message in Primary Care" that was held at the Fifth International Forum on Low Back Pain in Primary Care in Canada in May 2002. Despite a considerable degree of acceptance of current evidence-based guidelines, in practice, primary health care providers still do not share a common message. The objective of the workshop was to describe the outcomes of a workshop on the sharing of guidelines in primary care.

Acute back pain management in primary care: a qualitative pilot study of the feasibility of a nurse-led service in general practice.

Objectives: (1) To determine the acceptability of the Royal College of General Practitioner Guidelines to small samples of nurses, General Practitioners and acute back pain patients, (2) to determine what additional roles for nurses in the management of acute back pain in primary care might be acceptable to these samples, (3) to evaluate the responses of General Practitioners, nurses and patients to a suggested service model based on the RCGP Guidelines, (4) to identify opportunities for and barriers to the further development of such models and to obtain the appraisal of the above by an external group of assessors.

Methodology: Using a qualitative design the pilot study included Primary Care (General Practitioners, Practice Nurses and Patients) with the main outcome measures as: appraisal questionnaires (for RCGP Guideline), qualitative content analysis of focus group narratives, and appraisal of process and outcomes by an external panel.

Results: Attitudes towards the RCGP guidelines were positive, but professionals and patients alike did not think their recommendations could be implemented with the current service provision in primary care.

Back pain and satisfaction with chiropractic treatment: what role does the physical outcome play?

Objectives: This study sought to determine what functional and affective outcomes had the most predictive value for overall satisfaction and improvement in patients seeking chiropractic treatment of low back pain.

Method: Baseline questionnaires were completed by 965 patients seeking chiropractic help for low back pain, with blinded follow-up at 6 weeks. Patients were asked about effects on pain, anxiety, normal activity, work, depression, lifestyle, satisfaction, and overall improvement.

Third Prize: Chiropractic and the national health care system: a basis for partnership in the UK.

Background: Changes in United Kingdom (UK) health care policy and legislation have the potential to radically change care for patients with musculoskeletal conditions by widening access to manipulation services under its National Health Service (NHS).

Objective: To investigate chiropractors past and current provision of musculoskeletal services for NHS patients and optimal future arrangements.

Methods: One thousand forty-two UK chiropractors on professional registers were sent a 2-part questionnaire.

General practice and chiropractic in Norway: how well do they communicate and what do GPs want to know?

Background: Some within the medical establishment believe that the education and training of chiropractors is grounded in orthodox medicine and that these professional groups share a common language allowing for close dialogue. However, levels of communication and collaboration often remain low. Furthermore, studies have shown chiropractors to be lax in providing written reports to referring clinicians, a practice important to both patient care and interprofessional relationships.

Adverse effects of spinal manipulation.

Guidelines on acute back pain recommend spinal manipulation, but some commentators express concern that the adverse effects are under-reported. Eleven chiropractors distributed questionnaires to 108 consecutive new patients aged > 18 years, enquiring about adverse effects one hour, one day and two days after spinal manipulation. The forms were to be completed anonymously.

Communication between general and manipulative practitioners: a survey.

A survey of general practitioners (GPs) in the south of England was undertaken to determine their understanding and communication needs in referring patients to practitioners of manipulation. Eighty-six out of 309 GPs replied to a postal questionnaire (28% response). The results suggest that, while routine communication is important for improving understanding, GPs appear to have a preference for disciplines of which they have personal experience.