Physical medicine and rehabilitation clinics of North America
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Phys Med Rehabil Clin N Am · Nov 2010
ReviewFunctional anatomy and pathophysiology of axial low back pain: disc, posterior elements, sacroiliac joint, and associated pain generators.
Careful consideration of functional lumbosacral anatomy reveals the capacity for pain generation in the disc, zygapophysial joint, sacroiliac joint, and surrounding ligaments. However, the methods used to definitively implicate a particular anatomic structure in axial low back pain have limitations. ⋯ This article examines key lumbosacral anatomic structures and their functional interdependence at the macroscopic, microscopic, and biomechanical level. Particular attention is given to the capacity of each structure to generate low back pain.
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Discography is a purely diagnostic interventional procedure performed to confirm or refute the hypothesis that a specific lumbar disc is the predominant source of a patient's low back pain. In patients with severe low back pain, unresponsive to conservative care, discography is used when clinical evaluation suggests that the pain is emanating from the intervertebral disc and other sources of pain have been ruled out. The evidence for its use remains controversial. ⋯ Recently long-term side effects have been studied, and lumbar discography seems to increase disc degeneration and herniation as detected on magnetic resonance imaging. Although the clinical significance is unclear, it is an important risk to consider prior to performing discography, and changes in discography techniques may be indicated. Discography remains the only technique, however, that can be used to determine whether a patient's low back pain is emanating from the intervertebral disc and is a valid test when coupled with careful patient selection, strict adherence to standardized technique and diagnostic criteria, and consideration of possible long-term sequelae.
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Phys Med Rehabil Clin N Am · May 2010
ReviewAging with a disability: physical impairment, pain, and fatigue.
This article focuses on the role of pain and fatigue in aging people who have physical impairments and provides a brief summary of definitions, descriptions, and classifications of pain and fatigue; implications of these secondary conditions on the health and functioning; multidisciplinary assessment and treatment options; and critical gaps in knowledge and directions for future research. Central nervous system trauma, diseases of the nervous system, and degenerative muscle diseases often result in significant physical impairments and disability. People who are living and aging with these underlying medical conditions often experience pain and fatigue secondary to their physical impairment that may worsen over time, resulting in increased disability and decreased quality of life. Important areas for future research in persons who have physical impairments include identification of conditions that require age-specific considerations; identification of symptom clusters (eg, pain, fatigue, depression) and how they evolve over time; and development of interdisciplinary treatment protocols.
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Phys Med Rehabil Clin N Am · May 2010
ReviewPhysical activity, disability, and quality of life in older adults.
This article provides an overview of physical activity and its association with function, disability, and quality of life (QOL) outcomes among older adults. The rationale and the associated onset of chronic disease conditions that influence function, disability, and QOL is embedded in the "Graying of America". ⋯ Researchers should consider designing and testing programs that incorporate strategies for enhancing self-efficacy along with the promotion of physical activity as a means of preventing disablement and improving QOL among older adults. Such work will go a long way in identifying practical approaches that can be applied for improving the later years of life and is critical because many Americans will soon be affected by the aging of adults in the United States.
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Falls are a major public health problem, contributing to significant morbidity and mortality among older adults in the United States. This article summarizes and compares (1) fall prevalence rates, (2) fall risk factors, (3) consequences of falls, and (4) current knowledge about fall prevention interventions between community-dwelling older adults and people aging with physical disability. In this latter group, the article focuses on individuals with multiple sclerosis, late-effects of polio, muscular dystrophies, and spinal cord injuries.