Jul 15, 2018

Roland & Morris Disability Questionnaire RMDQ


Low back pain (LBP) is a common problem affecting populations in industrialized countries, and considered the most common cause of disability in people under 45 years. Pain, disability and quality of life are examples of the common subjective aspects associated with chronic low back and not easy to quantify due to their complex physical, behavioural and psychological effects. The development of tools to measure the outcomes of patients with low back pain has become a subject of increasing interest either for research purposes or for clinicians to justify the effectiveness of their interventions. Ronald and Morris (1983) developed their original questionnaire (Roland Morris Disability Questionnaire RMDQ) to measure the self-rated immobilization resulting from the back pain. It was designed for use in research (e.g. as an outcome measure for clinical trials) but has also been found useful for monitoring patients in clinical practice in primary care in the United Kingdom. It is formulated by choosing statements from the sickness impact profile (SIP) which is a 136-item health status measure covering a wide range of aspects of daily living activities related to physical and mental function. The items of the questionnaire are mainly related to physical activities in order to assess the disability caused by CLBP. It entails simple yes and no answers and can be self administered by the patient in 5 minutes. It is originally designed for administration on paper, However it has shown to be successfully administered on computer and telephone which maximize its clinical utility. A score between 0 (no disability) and 24 (maximum disability) can be easily obtained by adding up the number of checked items, this approach was selected to help clinicians to establish the baseline of the patients' disability and monitor short term changes in patients with low back pain. It could also monitor short term changes in response to treatment. The original version has been modified by Patrick et al (1995) by adding words to the statements to make them more suitable for patients with low back and sciatic pain. Stratford and Binkley (1997) have removed five items that thought to be redundant in order to improve the questionnaire responsiveness. However, the original version of Roland & Morris disability Questionnaire with 24 items are the most widely used version and has been translated to many languages.…/roland-morris-low-back-pa…




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  • info
    Jul 18, 2018

    Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline •Extrinsic risk factors(type of sport practiced) although outside of the patient, may provide a significant increase in the risk at sustaining a LAS. •When treating patients with an acute LAS, modifiable risk factors such as deficiencies in proprioception and ROM should be identified and if possible included in a prevention and/or rehabilitation programme to mitigate the risk for recurrent sprains. •Extrinsic risk factors(type of sport practised) although outside of the patient, may provide a significant increase in the risk at sustaining a LAS. *Prognostic factors Adequate attention should be directed towards the patient’s current level of pain, their workload and level of sports participation. These may all negatively influence recovery and increase the risk of future injury recurrence. *Diagnostic Regarding the clinical assessment of damage to the anterior talofibular ligament, the sensitivity (8️4%) and specificity (9️6%) of assessment using the anterior drawer are optimized if clinical assessment is delayed for between 4️ and 5️ days post injury. In case of a suspected fracture, the OAR should be applied. *Treatment •Rest Ice Compression Elevation (RICE) There is no evidence that RICE alone, or cryotherapy, or compression therapy alone has any positive influence on pain, swelling or patient function. •Non-steroidal anti-inflammatory drugs NSAIDs may be used by patients who have incurred an acute LAS for the primary purpose of reducing pain and swelling. However, care should be taken in NSAID usage as it is associated with complications and may suppress or delay the natural healing process. •Immobilization Use of functional support and exercise therapy is preferred as it provides better outcomes compared with immobilization. If immobilization is applied to treat pain or oedema, it should be for a maximum of 10 days after which functional treatment should be commenced. *Functional treatment •Functional support Use of functional support for 4–6 weeks is preferred over immobilization. The use of an ankle brace shows the greatest effects compared with other types of functional support. •Exercise Exercise therapy should be commenced after LAS to optimize recovery of joint functionality. Whether exercise therapy should be supervised or not remains unclear. •Manual mobilisation A combination with other treatment modalities, such as exercise therapy, enhances the efficacy of manual joint mobilization and is therefore advised. •Surgical therapy Despite good clinical outcomes of surgery after both chronic injuries and an acute complete lateral ligament rupture, functional treatment is still the preferred method as not all patients require surgical treatment. •Other therapies As no strong evidence exists on the effectiveness of these treatment modalities, they are not advised in the treatment of acute LAS. *Prevention •Functional support Both tape and brace have a role in the prevention of recurrent LAS (limited evidence). •Exercise therapy It is advised to start exercise therapy, especially in athletes, as soon as possible after the initial sprain to prevent recurrent LAS. Exercise therapy should be included into regular training activities as much as possible as home-based exercise. •Footwear No recommendations can be made concerning shoe wear. •Return to work To speed up return to work, a brace and immediate functional treatment in combination with a return to work schedule are advised. •Return to sports Supervised exercises focusing on a variety of exercises such as proprioception, strength, coordination and function will lead to a faster return to sport.
  • info
    Jul 17, 2018

    The aim is to reduce pain and improve function. No single treatment has proven to be totally effective, treatment selection depends on the patient's clinical picture and informed by current best evidence. 1- Advice and education: About the nature of the problem how to modify and control pain and activity till pain and function are regained. 2- Exercises: The gold standard is eccentric exercises using small weight or theraband. 3- manual therapy; Mobilization for elbow and radioulnar joints mobilization with movement: lateral glide with or without belt or pain release phenomenon (stretching or resisted wrist extension 20 seconds) mobilization of cervical (mostly C5, 6) or upper thoracic spine 4- Taping: usually in lateral direction 5- Dry needling: 6- Braces/Splints/Strap: has no clear evidence 7- electrotherapeutic modalities: like TENS, shock wave. Has mixed evidence in short term some has little evidence like ultrasound.
  • info
    Jul 17, 2018

    Tennis elbow, also known as lateral epicondylitis, is a condition in which the lateral aspect of the elbow becomes painful and tender. The pain may also extend into the posterior aspect of the forearm and grip strength may be weak. Onset of symptoms is generally gradual. Diagnosis is typically based on the symptoms with medical imaging used to rule out other potential causes. Signs and symptoms: - Pain on the lateral aspect of the elbow (lateral epicondyle). - Point tenderness over the lateral epicondyle and there may be trigger points in the wrist muscles. - Pain from gripping and movements of the wrist, especially resisted wrist/finger extension. (e.g. turning a screwdriver) and lifting movements. Pain can also be present when the muscles are stretched. Pathophysiology: Histopathological findings have displayed no evidence of an acute, or a chronic inflammatory process. Histologic studies have demonstrated that this condition is the result of tendon degeneration, which replaces normal tissue with a disorganized arrangement of collagen with formation of reparative tissue (angiofibroblastic hyperplasia) . Therefore, the disorder is more appropriately referred to as tendinopathy rather than tendinitis. Common Causes include: - Unaccustomed hand use. eg painting a fence, hammering, lots of typing. - Excessive gripping or wringing activities. - Poor forearm muscle strength or tight muscles. - pain referred from cervical spine . The most common segment that refers to lateral elbow is C5,6. Differential Diagnosis: - Radial Tunnel Syndrome - Cervical Radiculopathy - Posterior Interosseus Syndrome Outcome Measures pain: Numeric Pain Rating Scale (NPRS) or visual Analogue Scale (VAS). Self-reported functional Questionnaires: - Quick DASH (Disabilities of the Arm Shoulder and Hand) - The Upper Limb Functional Index (ULFI). - Patient Rated Tennis Elbow Evaluation (PRTEE)

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