Éric Parent | University of Alberta (original) (raw)

Papers by Éric Parent

Research paper thumbnail of Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in nonspecific low back pain? A systematic review

Although individual reports suggest that baseline morphometry or activity of transversus abdomini... more Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short-or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures.

Research paper thumbnail of Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to non-specific low back pain? A systematic review.

Journal of Pain, Oct 31, 2013

Previous research describes an inconsistent relation between temporal changes in transversus abdo... more Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment and temporal changes in clinical outcomes. Candidate publications were identified from six electronic databases. Fifteen articles were included after scrutinization by two reviewers using the predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging or M-mode ultrasound) were unrelated to temporal changes in LBP/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements while the relation between multifidus changes and clinical improvements remains uncertain.

Research paper thumbnail of Associations between quality-of-life and internal or external spinal deformity measurements in adolescent with idiopathic scoliosis (AIS)

Studies in health technology and informatics, 2006

In theory, quality-of-life measures should correlate with impairments such as spinal deformity. T... more In theory, quality-of-life measures should correlate with impairments such as spinal deformity. The goal was to determine the ability of the SRS-22 and surface topography measures to predict internal deformity. Data from 227 females with AIS were collected. Correlations and regression were used to predict Cobb angle or category. In subjects treated conservatively, the Cobb angle correlated with pain, self-image, satisfaction and total score. Only self-image correlated with surface topography. In subjects having had surgery, Cobb angle correlated with self-image, mental health, satisfaction and total scores. The cosmetic score was the only external deformity measure to correlate with the SRS-22. Function, self-image and trunk-twist predicted subjects within 3 categories (Cobb <30 degrees , 30-50 degrees , >50 degrees) with 57% accuracy compared to 53% when using self-image only. Accuracy in predicting subjects with curves smaller or larger than 50 degrees was 79% (using self-im...

Research paper thumbnail of Score Distribution of the Scoliosis Research SOCIETY-22 Questionnaire in Patients with Idiopathic Scoliosis

Spine, 2008

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home &gt; March 1, ...

Research paper thumbnail of Can changes in deep trunk muscles predict post-treatment clinical outcomes in nonspecific low back pain? A systematic review

Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in pe... more Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in persons with low back pain (LBP) by improving the activity of transversus abdominis and lumbar multifidus muscles. This systematic review aims to summarize evidence regarding which post-treatment characteristics of these muscles may predict clinical improvement. Main conclusion: Overall, changes in transversus abdominis activity do not predict corresponding improvements in LBP or LBP-related disability. The relation between changes in characteristics of lumbar multifidus and post-treatment clinical improvements remains elusive.

Research paper thumbnail of Does experimental low back pain change posteroanterior lumbar spinal stiffness and trunk muscle activity? A randomized crossover study

Background: While some patients with low back pain demonstrate increased spinal stiffness that de... more Background: While some patients with low back pain demonstrate increased spinal stiffness that decreases as pain subsides, this observation is inconsistent. Currently, the relation between spinal stiffness and low back pain remains unclear. This study aimed to investigate the effects of experimental low back pain on temporal changes in posteroanterior spinal stiffness and concurrent trunk muscle activity. Method: In separate sessions five days apart, nine asymptomatic participants received equal volume injections of hypertonic or isotonic saline in random order into the L3-L5 interspinous ligaments. Pain intensity, spinal stiffness (global and terminal stiffness) at the L3 level, and the surface electromyographic activity of six trunk muscles were measured before, immediately after, and 25-minute after injections. These outcome measures under different saline conditions were compared by generalized estimating equations. Findings: Compared to isotonic saline injections, hypertonic saline injections evoked significantly higher pain intensity (mean difference: 5.7/10), higher global (mean difference: 0.73N/mm) and terminal stiffness (mean difference: 0.58N/mm), and increased activity of four trunk muscles during indentation (p < 0.05). Both spinal stiffness and trunk muscle activity returned to baseline levels as pain subsided. Interpretation: While previous clinical research reported inconsistent findings regarding the association between spinal stiffness and low back pain, our study revealed that experimental pain caused temporary increases in spinal stiffness and concurrent trunk muscle co-contraction during indentation, which helps explain the temporal relation between spinal stiffness and low back pain observed in some clinical studies. Our results substantiate the role of spinal stiffness assessments in monitoring back pain progression.

Research paper thumbnail of The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”

Scoliosis, 2015

In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curv... more In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS. Fifty patients with AIS, aged 10-18 years, with curves 10-45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported. After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)(4) increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %). Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires&amp;amp;amp;amp;amp;amp;amp;amp;#39; domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed. Schroth Exercise Trial for Scoliosis NCT01610908.

Research paper thumbnail of Prediction of curve progression for AIS patients treated with a TLSO Brace

Scoliosis, 2009

The objective of this study was to develop a curve progression model for patients with AIS receiv... more The objective of this study was to develop a curve progression model for patients with AIS receiving brace treatment by considering compliance measures and in-brace correction factors.

Research paper thumbnail of Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from non-responders, untreated or asymptomatic controls?

Study Design: Non-randomized controlled study Objective: To determine if low back pain (LBP) pati... more Study Design:
Non-randomized controlled study
Objective:
To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls.
Summary of Background Data:
Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-responders demonstrate significant changes in spinal stiffness, muscle contraction and disc diffusion. Unfortunately, the significance of these observations remains uncertain given
methodological differences between studies including a lack of controls.
Methods
LBP participants and asymptomatic controls attended three sessions over 7 days. On sessions 1 and 2, LBP participants received SMT (+LBP/+SMT, n = 32) while asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness
and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients (ADC) from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from a LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/non-responders based on self-reported disability on day 7. A repeated measures ANCOVA was used to compare ADCs among responders, nonresponders and +LBP/SMT, as well as spinal stiffness or multifidus thickness ratio among responders, non-responders and –LBP/-SMT subjects.
Results:
After the first SMT, SMT-responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained over 7 days; these findings were not observed in other groups. Similarly, only SMT-responders displayed significant post-SMT improvement in ADC.
Conclusions
Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT-responders not present in all LBP patients. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response and the biomechanical and imaging characteristics defining responders at baseline.

Research paper thumbnail of A Systematic Review of the Reliability of Rehabilitative Ultrasound Imaging for the Quantitative Assessment of the Abdominal and Lumbar Trunk Muscles

Spine, 2009

Systematic review. To systematically review the literature on the rater reliability of Rehabilita... more Systematic review. To systematically review the literature on the rater reliability of Rehabilitative Ultrasound Imaging (RUSI) measurements to assess the morphology of the abdominal and lumbar trunk musculature. RUSI is an increasingly popular method of evaluating the morphology and function of muscles with real-time ultrasound. Conclusions regarding the reliability of measurements obtained by RUSI, need to be established before recommending its wider use. A systematic approach to searching and identifying original research articles reporting quantitative RUSI measurements was undertaken. Reliability data were extracted and methodologic quality was evaluated by 2 independent reviewers. Of the 24 studies included, 6 were deemed to be of high methodologic quality. Among high quality studies, some reported the measurement error associated with performing repeated measurements of the same image (intraimage analysis), whereas others reported the reliability of obtaining and measuring unique RUSI images (interimage analysis). Intraimage measurements demonstrated good intrarater and interrater reliability (ICC: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.93). Interimage measurements demonstrated good reliability between raters (ICC: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.90). Interimage, intrarater correlation coefficients were more variable with ICC values ranging from 0.62 to 0.97. The methodologic quality of research investigating the reliability of RUSI to measure the abdominal and lumbar trunk muscles needs to be improved. The majority of results of high quality studies indicate that RUSI has good levels of rater reliability. Improved reliability was observed among studies examining muscle thickness, and when using mean measurement values obtained by more experienced examiners.

Research paper thumbnail of Discriminative and Predictive Validity of the Scoliosis Research Society-22 Questionnaire in Management and Curve-Severity Subgroups of Adolescents With Idiopathic Scoliosis

Spine, 2009

Prospective cross-sectional measurement study. To determine the ability of the Scoliosis Research... more Prospective cross-sectional measurement study. To determine the ability of the Scoliosis Research Society (SRS)-22 questionnaire to discriminate among management and scoliosis severity subgroups and to correlate with internal and external measures of curve severity. In earlier studies of the SRS-22 discriminative ability, age was not a controlled factor. The ability of the SRS-22 to predict curve severity has not been thoroughly examined. The SRS-22 was completed by 227 females with adolescent idiopathic scoliosis. Using Analysis of covariance analyses controlling for age, the SRS-22 scores were compared among management subgroups (observation, brace, presurgery, and postsurgery) and curve-severity subgroups (in nonoperated subjects: Cobb angles of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 degrees, 30 degrees -50 degrees, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 degrees). A stepwise discriminant analysis was used to identify the SRS-22 domains most discriminative for curve-severity categories. Correlation between SRS-22 scores and radiographic or surface topography measurements was used to determine the predictive ability of the questionnaire. Pain was better for subjects treated with braces than for those planning surgery. Self-image was better for subjects under observation or postsurgery than for those planning surgery. Satisfaction was better for the brace and postsurgery subgroups than for the observation or presurgery subgroups. Statistically significant mean differences between subgroups were all larger than 0.5, which is within the range of minimal clinically important differences recommended for each of the 5-point SRS-22 domain scoring scales. Pain and mental health were worse for those with Cobb angles of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 degrees than with Cobb angles of 30 degrees to 50 degrees. Self-image and total scores were worse for those with Cobb angles of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 degrees than both other subgroups. Using discriminant analysis, self-image was the only SRS-22 domain score selected to classify subjects within curve severity subgroups. The percentage of patients accurately classified was 54% when trying to classify within 3 curve severity subgroups. The percentage of patients accurately classified was 73% when classifying simply as those with curves larger or smaller than 50 degrees . Pain, self-image, and satisfaction scores could discriminate among management subgroups, but function, mental health and total scores could not. The total score and all domain scores except satisfaction discriminated among curve-severity subgroups. Using discriminant analysis, self-image was the only domain retained in a model predicting curve-severity categories.

Research paper thumbnail of SCORE DISTRIBUTION OF THE SCOLIOSIS RESEARCH SOCIETY-22 QUESTIONNAIRE IN PATIENTS WITH IDIOPATHIC SCOLIOSIS

Spine, 2008

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home &gt; March 1, ...

Research paper thumbnail of Beyond Minimally Important Change

Spine, 2009

Study Design. Prospective, longitudinal cohort study Objective. To examine the validity of a thre... more Study Design. Prospective, longitudinal cohort study Objective. To examine the validity of a threshold that has been used to define a successful outcome for patients with low back pain (LBP), undergoing nonsurgical rehabilitation based on a 50% improvement on the Modified Oswestry disability index (ODI).

Research paper thumbnail of Brace treatment for adolescent idiopathic scoliosis – Protocols of the Canadian Spinal Deformity Study Group Surgeons

Research paper thumbnail of Spinal landmark depth in relation to body mass index

Manual Therapy, 2011

Identifying spinal landmarks by palpation is a prerequisite to many manual therapy procedures. Un... more Identifying spinal landmarks by palpation is a prerequisite to many manual therapy procedures. Understanding if landmark depth changes with a subject's body mass index (BMI) may help clinicians attribute importance to their palpation findings.

Research paper thumbnail of Reliability of 2 Ultrasonic Imaging Analysis Methods in Quantifying Lumbar Multifidus Thickness

Journal of Orthopaedic & Sports Physical Therapy, 2013

research report ] T T CONCLUSION: Both RUSI methods yielded high reliability estimates for multif... more research report ] T T CONCLUSION: Both RUSI methods yielded high reliability estimates for multifidus muscle measurements. Using an average of 2 measures obtained optimal measurement precision. Overall, video RUSI is a reliable surrogate for static RUSI for multifidus muscle measurements and has the additional advantage of requiring shorter data collection time.

Research paper thumbnail of Clinical Prediction for Success of Interventions for Managing Low Back Pain

Clinics in Sports Medicine, 2008

Research paper thumbnail of Letter to the editor concerning: "active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial" by Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S (...

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2014

Research paper thumbnail of Feasibility and three months preliminary results of an RCT on the effect of Schroth exercises in adolescent idiopathic scoliosis (AIS)

Research paper thumbnail of Within- and between-day reliability of spinal stiffness measurements obtained using a computer controlled mechanical indenter in individuals with and without low back pain

Manual Therapy, 2013

Instrumented spinal stiffness measurements have shown high test-retest reliability. However, fact... more Instrumented spinal stiffness measurements have shown high test-retest reliability. However, factors that may affect reliability have yet to be investigated. The objective of this study was to compare the: 1) within- and between-day reliability of a mechanical indentation device (MID) in measuring spinal stiffness, 2) measurement precision of averaging multiple measurements, and 3) reliability of stiffness measurements between individuals with and without low back pain (LBP). The spinal stiffness of 26 volunteers with and without LBP was measured 3 times by MID in each of two visits 1-4 days apart. Two stiffness measures were calculated from the resulting force-displacement data: global stiffness and terminal stiffness. Intraclass correlation coefficients (ICCs) were used to estimate reliability. Measurement precision was measured by minimal detectable changes, bias and 95% limits of agreement. Using the mean of three spinal stiffness measurements, the measurement precision was improved by 33.7% over a single measurement. Averaging three measurements, the within- and between-day reliability point estimates of both global and terminal stiffness were 0.99 and 0.98, respectively. The reliability estimates of spinal stiffness measurement using MID were not significantly altered by the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; LBP status across all circumstances (95% confidence intervals overlapped). With our experimental protocol, averaging three spinal stiffness measurements using MID produces reliable stiffness measurements regardless of individuals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; LBP status.

Research paper thumbnail of Do various baseline characteristics of transversus abdominis and lumbar multifidus predict clinical outcomes in nonspecific low back pain? A systematic review

Although individual reports suggest that baseline morphometry or activity of transversus abdomini... more Although individual reports suggest that baseline morphometry or activity of transversus abdominis or lumbar multifidus predict clinical outcome of low back pain (LBP), a related systematic review is unavailable. Therefore, this review summarized evidence regarding the predictive value of these muscular characteristics. Candidate publications were identified from 6 electronic medical databases. After review, 5 cohort studies were included. Although this review intended to encompass studies using different muscle assessment methods, all included studies coincidentally used ultrasound imaging. No research investigated the relation between static morphometry and clinical outcomes. Evidence synthesis showed limited evidence supporting poor baseline transversus abdominis contraction thickness ratio as a treatment effect modifier favoring motor control exercise. Limited evidence supported that high baseline transversus abdominis lateral slide was associated with higher pain intensity after various exercise interventions at 1-year follow-up. However, there was limited evidence for the absence of relation between the contraction thickness ratio of transversus abdominis or anticipatory onset of lateral abdominal muscles at baseline and the short-or long-term LBP intensity after exercise interventions. There was conflicting evidence for a relation between baseline percent thickness change of lumbar multifidus during contraction and the clinical outcomes of patients after various conservative treatments. Given study heterogeneity, the small number of included studies and the inability of conventional greyscale B-mode ultrasound imaging to measure muscle activity, our findings should be interpreted with caution. Further large-scale prospective studies that use appropriate technology (ie, electromyography to assess muscle activity) should be conducted to investigate the predictive value of morphometry or activity of these muscles with respect to LBP-related outcomes measures.

Research paper thumbnail of Do changes in transversus abdominis and lumbar multifidus during conservative treatment explain changes in clinical outcomes related to non-specific low back pain? A systematic review.

Journal of Pain, Oct 31, 2013

Previous research describes an inconsistent relation between temporal changes in transversus abdo... more Previous research describes an inconsistent relation between temporal changes in transversus abdominis or lumbar multifidus and temporal changes in clinical outcomes. Unfortunately, a relevant systematic review is unavailable. As a result, this systematic review was designed to summarize evidence regarding the association between temporal changes in muscle morphometry and activity in response to treatment and temporal changes in clinical outcomes. Candidate publications were identified from six electronic databases. Fifteen articles were included after scrutinization by two reviewers using the predetermined selection criteria. The methodological quality of these articles was appraised using a standard tool. These methods revealed strong evidence that temporal alterations in transversus abdominis thickness change during contraction (as measured by B-mode or M-mode ultrasound) or feedforward activation of transversus abdominis (assessed via electromyography, tissue Doppler imaging or M-mode ultrasound) were unrelated to temporal changes in LBP/LBP-related disability. There was limited evidence that temporal changes in transversus abdominis lateral sliding or lumbar multifidus endurance were unrelated to temporal changes in LBP intensity. Conflicting evidence was found for the relation between temporal changes in lumbar multifidus morphometry and temporal changes in LBP/LBP-related disability. This review highlights that temporal changes in transversus abdominis features tend to be unrelated to the corresponding LBP/LBP-related disability improvements while the relation between multifidus changes and clinical improvements remains uncertain.

Research paper thumbnail of Associations between quality-of-life and internal or external spinal deformity measurements in adolescent with idiopathic scoliosis (AIS)

Studies in health technology and informatics, 2006

In theory, quality-of-life measures should correlate with impairments such as spinal deformity. T... more In theory, quality-of-life measures should correlate with impairments such as spinal deformity. The goal was to determine the ability of the SRS-22 and surface topography measures to predict internal deformity. Data from 227 females with AIS were collected. Correlations and regression were used to predict Cobb angle or category. In subjects treated conservatively, the Cobb angle correlated with pain, self-image, satisfaction and total score. Only self-image correlated with surface topography. In subjects having had surgery, Cobb angle correlated with self-image, mental health, satisfaction and total scores. The cosmetic score was the only external deformity measure to correlate with the SRS-22. Function, self-image and trunk-twist predicted subjects within 3 categories (Cobb <30 degrees , 30-50 degrees , >50 degrees) with 57% accuracy compared to 53% when using self-image only. Accuracy in predicting subjects with curves smaller or larger than 50 degrees was 79% (using self-im...

Research paper thumbnail of Score Distribution of the Scoliosis Research SOCIETY-22 Questionnaire in Patients with Idiopathic Scoliosis

Spine, 2008

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home &gt; March 1, ...

Research paper thumbnail of Can changes in deep trunk muscles predict post-treatment clinical outcomes in nonspecific low back pain? A systematic review

Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in pe... more Background / Purpose: Some conservative treatments are thought to improve clinical outcomes in persons with low back pain (LBP) by improving the activity of transversus abdominis and lumbar multifidus muscles. This systematic review aims to summarize evidence regarding which post-treatment characteristics of these muscles may predict clinical improvement. Main conclusion: Overall, changes in transversus abdominis activity do not predict corresponding improvements in LBP or LBP-related disability. The relation between changes in characteristics of lumbar multifidus and post-treatment clinical improvements remains elusive.

Research paper thumbnail of Does experimental low back pain change posteroanterior lumbar spinal stiffness and trunk muscle activity? A randomized crossover study

Background: While some patients with low back pain demonstrate increased spinal stiffness that de... more Background: While some patients with low back pain demonstrate increased spinal stiffness that decreases as pain subsides, this observation is inconsistent. Currently, the relation between spinal stiffness and low back pain remains unclear. This study aimed to investigate the effects of experimental low back pain on temporal changes in posteroanterior spinal stiffness and concurrent trunk muscle activity. Method: In separate sessions five days apart, nine asymptomatic participants received equal volume injections of hypertonic or isotonic saline in random order into the L3-L5 interspinous ligaments. Pain intensity, spinal stiffness (global and terminal stiffness) at the L3 level, and the surface electromyographic activity of six trunk muscles were measured before, immediately after, and 25-minute after injections. These outcome measures under different saline conditions were compared by generalized estimating equations. Findings: Compared to isotonic saline injections, hypertonic saline injections evoked significantly higher pain intensity (mean difference: 5.7/10), higher global (mean difference: 0.73N/mm) and terminal stiffness (mean difference: 0.58N/mm), and increased activity of four trunk muscles during indentation (p < 0.05). Both spinal stiffness and trunk muscle activity returned to baseline levels as pain subsided. Interpretation: While previous clinical research reported inconsistent findings regarding the association between spinal stiffness and low back pain, our study revealed that experimental pain caused temporary increases in spinal stiffness and concurrent trunk muscle co-contraction during indentation, which helps explain the temporal relation between spinal stiffness and low back pain observed in some clinical studies. Our results substantiate the role of spinal stiffness assessments in monitoring back pain progression.

Research paper thumbnail of The effect of Schroth exercises added to the standard of care on the quality of life and muscle endurance in adolescents with idiopathic scoliosis—an assessor and statistician blinded randomized controlled trial: “SOSORT 2015 Award Winner”

Scoliosis, 2015

In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curv... more In North America, care recommendations for adolescents with small idiopathic scoliosis (AIS) curves include observation or bracing. Schroth scoliosis-specific exercises have demonstrated promising results on various outcomes in uncontrolled studies. This randomized controlled trial (RCT) aimed to determine the effect of Schroth exercises combined with the standard of care on quality-of-life (QOL) outcomes and back muscle endurance (BME) compared to standard of care alone in patients with AIS. Fifty patients with AIS, aged 10-18 years, with curves 10-45 °, recruited from a scoliosis clinic were randomized to receive standard of care or supervised Schroth exercises plus standard of care for 6 months. Schroth exercises were taught over five sessions in the first two weeks. A daily home program was adjusted during weekly supervised sessions. The assessor and the statistician were blinded. Outcomes included the Biering-Sorensen (BME) test, Scoliosis Research Society (SRS-22r) and Spinal Appearance Questionnaires (SAQ) scores. Intention-to-treat (ITT) and per protocol (PP) linear mixed effects models were analyzed. Because ITT and PP analyses produced similar results, only ITT is reported. After 3 months, BME in the Schroth group improved by 32.3 s, and in the control by 4.8 s. This 27.5 s difference in change between groups was statically significant (95 % CI 1.1 to 53.8 s, p = 0.04). From 3 to 6 months, the self-image improved in the Schroth group by 0.13 and deteriorated in the control by 0.17 (0.3, 95 % CI 0.01 to 0.59, p = 0.049). A difference between groups for the change in the SRS-22r pain score transformed to its power of four was observed from 3 to 6 months (85.3, 95 % CI 8.1 to 162.5, p = 0.03), where (SRS-22 pain score)(4) increased by 65.3 in the Schroth and decreased by 20.0 in the control group. Covariates: age, self-efficacy, brace-wear, Schroth classification, and height had significant main effects on some outcomes. Baseline ceiling effects were high: SRS-22r (pain = 18.4 %, function = 28.6 %), and SAQ (prominence = 26.5 %, waist = 29.2 %, chest = 46.9 %, trunk shift = 12.2 % and shoulders = 18.4 %). Supervised Schroth exercises provided added benefit to the standard of care by improving SRS-22r pain, self-image scores and BME. Given the high prevalence of ceiling effects on SRS-22r and SAQ questionnaires&amp;amp;amp;amp;amp;amp;amp;amp;#39; domains, we hypothesize that in the AIS population receiving conservative treatments, different QOL questionnaires with adequate responsiveness are needed. Schroth Exercise Trial for Scoliosis NCT01610908.

Research paper thumbnail of Prediction of curve progression for AIS patients treated with a TLSO Brace

Scoliosis, 2009

The objective of this study was to develop a curve progression model for patients with AIS receiv... more The objective of this study was to develop a curve progression model for patients with AIS receiving brace treatment by considering compliance measures and in-brace correction factors.

Research paper thumbnail of Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from non-responders, untreated or asymptomatic controls?

Study Design: Non-randomized controlled study Objective: To determine if low back pain (LBP) pati... more Study Design:
Non-randomized controlled study
Objective:
To determine if low back pain (LBP) patients who respond to spinal manipulative therapy (SMT) differ biomechanically from non-responders and untreated asymptomatic controls.
Summary of Background Data:
Some, but not all LBP patients report improvement in function after SMT. When compared to non-responders, studies suggest that SMT-responders demonstrate significant changes in spinal stiffness, muscle contraction and disc diffusion. Unfortunately, the significance of these observations remains uncertain given
methodological differences between studies including a lack of controls.
Methods
LBP participants and asymptomatic controls attended three sessions over 7 days. On sessions 1 and 2, LBP participants received SMT (+LBP/+SMT, n = 32) while asymptomatic controls did not (-LBP/-SMT, n = 57). In these sessions, spinal stiffness
and multifidus thickness ratios were obtained before and after SMT and on day 7. Apparent diffusion coefficients (ADC) from lumbar discs were obtained from +LBP/+SMT participants before and after SMT on session 1 and from a LBP control group that did not receive SMT (+LBP/-SMT, n = 16). +LBP/+SMT participants were dichotomized as responders/non-responders based on self-reported disability on day 7. A repeated measures ANCOVA was used to compare ADCs among responders, nonresponders and +LBP/SMT, as well as spinal stiffness or multifidus thickness ratio among responders, non-responders and –LBP/-SMT subjects.
Results:
After the first SMT, SMT-responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained over 7 days; these findings were not observed in other groups. Similarly, only SMT-responders displayed significant post-SMT improvement in ADC.
Conclusions
Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT-responders not present in all LBP patients. This work provides a foundation to investigate the heterogeneous nature of LBP, mechanisms underlying differential therapeutic response and the biomechanical and imaging characteristics defining responders at baseline.

Research paper thumbnail of A Systematic Review of the Reliability of Rehabilitative Ultrasound Imaging for the Quantitative Assessment of the Abdominal and Lumbar Trunk Muscles

Spine, 2009

Systematic review. To systematically review the literature on the rater reliability of Rehabilita... more Systematic review. To systematically review the literature on the rater reliability of Rehabilitative Ultrasound Imaging (RUSI) measurements to assess the morphology of the abdominal and lumbar trunk musculature. RUSI is an increasingly popular method of evaluating the morphology and function of muscles with real-time ultrasound. Conclusions regarding the reliability of measurements obtained by RUSI, need to be established before recommending its wider use. A systematic approach to searching and identifying original research articles reporting quantitative RUSI measurements was undertaken. Reliability data were extracted and methodologic quality was evaluated by 2 independent reviewers. Of the 24 studies included, 6 were deemed to be of high methodologic quality. Among high quality studies, some reported the measurement error associated with performing repeated measurements of the same image (intraimage analysis), whereas others reported the reliability of obtaining and measuring unique RUSI images (interimage analysis). Intraimage measurements demonstrated good intrarater and interrater reliability (ICC: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.93). Interimage measurements demonstrated good reliability between raters (ICC: &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.90). Interimage, intrarater correlation coefficients were more variable with ICC values ranging from 0.62 to 0.97. The methodologic quality of research investigating the reliability of RUSI to measure the abdominal and lumbar trunk muscles needs to be improved. The majority of results of high quality studies indicate that RUSI has good levels of rater reliability. Improved reliability was observed among studies examining muscle thickness, and when using mean measurement values obtained by more experienced examiners.

Research paper thumbnail of Discriminative and Predictive Validity of the Scoliosis Research Society-22 Questionnaire in Management and Curve-Severity Subgroups of Adolescents With Idiopathic Scoliosis

Spine, 2009

Prospective cross-sectional measurement study. To determine the ability of the Scoliosis Research... more Prospective cross-sectional measurement study. To determine the ability of the Scoliosis Research Society (SRS)-22 questionnaire to discriminate among management and scoliosis severity subgroups and to correlate with internal and external measures of curve severity. In earlier studies of the SRS-22 discriminative ability, age was not a controlled factor. The ability of the SRS-22 to predict curve severity has not been thoroughly examined. The SRS-22 was completed by 227 females with adolescent idiopathic scoliosis. Using Analysis of covariance analyses controlling for age, the SRS-22 scores were compared among management subgroups (observation, brace, presurgery, and postsurgery) and curve-severity subgroups (in nonoperated subjects: Cobb angles of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;30 degrees, 30 degrees -50 degrees, and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 degrees). A stepwise discriminant analysis was used to identify the SRS-22 domains most discriminative for curve-severity categories. Correlation between SRS-22 scores and radiographic or surface topography measurements was used to determine the predictive ability of the questionnaire. Pain was better for subjects treated with braces than for those planning surgery. Self-image was better for subjects under observation or postsurgery than for those planning surgery. Satisfaction was better for the brace and postsurgery subgroups than for the observation or presurgery subgroups. Statistically significant mean differences between subgroups were all larger than 0.5, which is within the range of minimal clinically important differences recommended for each of the 5-point SRS-22 domain scoring scales. Pain and mental health were worse for those with Cobb angles of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 degrees than with Cobb angles of 30 degrees to 50 degrees. Self-image and total scores were worse for those with Cobb angles of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50 degrees than both other subgroups. Using discriminant analysis, self-image was the only SRS-22 domain score selected to classify subjects within curve severity subgroups. The percentage of patients accurately classified was 54% when trying to classify within 3 curve severity subgroups. The percentage of patients accurately classified was 73% when classifying simply as those with curves larger or smaller than 50 degrees . Pain, self-image, and satisfaction scores could discriminate among management subgroups, but function, mental health and total scores could not. The total score and all domain scores except satisfaction discriminated among curve-severity subgroups. Using discriminant analysis, self-image was the only domain retained in a model predicting curve-severity categories.

Research paper thumbnail of SCORE DISTRIBUTION OF THE SCOLIOSIS RESEARCH SOCIETY-22 QUESTIONNAIRE IN PATIENTS WITH IDIOPATHIC SCOLIOSIS

Spine, 2008

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home &gt; March 1, ...

Research paper thumbnail of Beyond Minimally Important Change

Spine, 2009

Study Design. Prospective, longitudinal cohort study Objective. To examine the validity of a thre... more Study Design. Prospective, longitudinal cohort study Objective. To examine the validity of a threshold that has been used to define a successful outcome for patients with low back pain (LBP), undergoing nonsurgical rehabilitation based on a 50% improvement on the Modified Oswestry disability index (ODI).

Research paper thumbnail of Brace treatment for adolescent idiopathic scoliosis – Protocols of the Canadian Spinal Deformity Study Group Surgeons

Research paper thumbnail of Spinal landmark depth in relation to body mass index

Manual Therapy, 2011

Identifying spinal landmarks by palpation is a prerequisite to many manual therapy procedures. Un... more Identifying spinal landmarks by palpation is a prerequisite to many manual therapy procedures. Understanding if landmark depth changes with a subject's body mass index (BMI) may help clinicians attribute importance to their palpation findings.

Research paper thumbnail of Reliability of 2 Ultrasonic Imaging Analysis Methods in Quantifying Lumbar Multifidus Thickness

Journal of Orthopaedic & Sports Physical Therapy, 2013

research report ] T T CONCLUSION: Both RUSI methods yielded high reliability estimates for multif... more research report ] T T CONCLUSION: Both RUSI methods yielded high reliability estimates for multifidus muscle measurements. Using an average of 2 measures obtained optimal measurement precision. Overall, video RUSI is a reliable surrogate for static RUSI for multifidus muscle measurements and has the additional advantage of requiring shorter data collection time.

Research paper thumbnail of Clinical Prediction for Success of Interventions for Managing Low Back Pain

Clinics in Sports Medicine, 2008

Research paper thumbnail of Letter to the editor concerning: "active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial" by Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S (...

European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2014

Research paper thumbnail of Feasibility and three months preliminary results of an RCT on the effect of Schroth exercises in adolescent idiopathic scoliosis (AIS)

Research paper thumbnail of Within- and between-day reliability of spinal stiffness measurements obtained using a computer controlled mechanical indenter in individuals with and without low back pain

Manual Therapy, 2013

Instrumented spinal stiffness measurements have shown high test-retest reliability. However, fact... more Instrumented spinal stiffness measurements have shown high test-retest reliability. However, factors that may affect reliability have yet to be investigated. The objective of this study was to compare the: 1) within- and between-day reliability of a mechanical indentation device (MID) in measuring spinal stiffness, 2) measurement precision of averaging multiple measurements, and 3) reliability of stiffness measurements between individuals with and without low back pain (LBP). The spinal stiffness of 26 volunteers with and without LBP was measured 3 times by MID in each of two visits 1-4 days apart. Two stiffness measures were calculated from the resulting force-displacement data: global stiffness and terminal stiffness. Intraclass correlation coefficients (ICCs) were used to estimate reliability. Measurement precision was measured by minimal detectable changes, bias and 95% limits of agreement. Using the mean of three spinal stiffness measurements, the measurement precision was improved by 33.7% over a single measurement. Averaging three measurements, the within- and between-day reliability point estimates of both global and terminal stiffness were 0.99 and 0.98, respectively. The reliability estimates of spinal stiffness measurement using MID were not significantly altered by the participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; LBP status across all circumstances (95% confidence intervals overlapped). With our experimental protocol, averaging three spinal stiffness measurements using MID produces reliable stiffness measurements regardless of individuals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; LBP status.