Doctor of Philosophy

dissertationAlthough the prognosis of patients with a lumbar disc herniation (LDH) diagnosis is generally favorable, 20% to 30% continue reporting pain, disability, and unfavorable outcome regardless of treatment received. The Fear Avoidance Model (FAM) is one among the most known models in low back pain (LBP) to explain chronic pain and disability. However, factors in this model have been mostly examined in nonspecific LBP to describe the development of chronic symptoms. The purpose of this dissertation was to study the influence of FAM factors on patients' poor outcomes following LDH surgery. We systematically searched for studies that measured any FAM factors to prospectively assess LDH surgical outcomes. We identified 13 prospective studies that used different FAM measures to predict LDH postoperative pain, disability, or sick leave. Quality assessment of the included studies was performed and reported. Heterogeneity between studies in terms of FAM predictors, outcome measures, analyses, and in other aspects were found. While pain and depression were the most measured FAM factors, some factors were not adequately assessed. There seems to be different prognostic value between preoperative leg pain and back pain. Fear, avoidance, anxiety, and pain coping seem to have negative impact on LDH surgical outcomes. We also analyzed prospective data for LDH patients undergoing discectomy surgery to study specific FAM measures and their impact on post discectomy leg pain, back pain, and disability. Fear-avoidance, pain catastrophizing, physical activity level, functional disability, and other FAM factors were measured preoperatively. The FAM measures demonstrate significant associations with each other and with preoperative functional disability. These FAM measures also explained significant amounts of the 10- week outcomes' variances. The most influential FAM factors in our data were depression and work-related fear. Many findings in this analysis were supported by previous research. In general, FAM factors seem to have a similar impact on LDH patients (pre- and postoperatively) as on nonspecific LBP patients. LDH patients with preoperative higher levels of back pain, fear-avoidance beliefs, anxiety, pain catastrophizing, passive pain coping, and depression were more likely to have unfavorable surgical outcomes. Screening for FAM factors in LDH patients and managing them accordingly during conservative therapy, before surgery, and throughout the postoperative rehabilitation is, therefore, needed to improve outcomes and minimize health care costs. i'

El perfil neuromuscular de los músculos extensores y flexores de rodilla en jugadores de fútbol profesionales en la Arabia Premier League

Purpose: The neuromuscular system of soccer players is a key factor in their competitive performance, as it determines a player's immediate force response, reactivity and running speed during matches. The neuromuscular system has recently begun to be analyzed by tensiomyography (TMG). This study's primary aim was to generate normative data of the mechanical and neuromuscular profile for the knee extensor and flexor muscles. Method: This study used a cross-sectional study of 83 professional soccer players from three Saudi Premier League teams at the start of the preseason period. TMG was used to measure the radial muscle belly displacement in the knee extensor and flexor muscles in both legs. Results: The results suggest that the highest degree of symmetry corresponded to the vastus medialis (83.7 ± 14.3%) and the lowest to the biceps femoris (76.1 ± 10.9%). No statistical difference was found between the dominant and non-dominant muscles, or between on-field player positions across all four tested muscles. Conclusion:  The study presented normative data of a convenience sample of Saudi professional soccer players and observed that the highest asymmetry was seen in the vastus medialis and the lowest asymmetry in the biceps femoris.Propósito: El sistema neuromuscular de los jugadores de fútbol es un factor clave en su desempeño competitivo, ya que determina la respuesta de fuerza inmediata de un jugador, la reactividad y la velocidad de carrera durante los partidos. Recientemente se ha comenzado a analizar el sistema neuromuscular mediante tensiomiografía (TMG). El objetivo principal de este estudio fue generar datos normativos del perfil mecánico y neuromuscular de los músculos extensores y flexores de la rodilla. Método: Este estudio utilizó un estudio transversal de 83 futbolistas profesionales de tres equipos de la Liga Premier de Arabia Saudita al comienzo del período de pretemporada. La TMG se utilizó para medir el desplazamiento del vientre del músculo radial en los músculos extensores y flexores de la rodilla en ambas piernas. Resultados: Los resultados sugieren que el mayor grado de simetría correspondió al vasto medial (83,7 ± 14,3%) y el menor al bíceps femoral (76,1 ± 10,9%). No se encontraron diferencias estadísticas entre los músculos dominantes y no dominantes, o entre las posiciones del jugador en el campo en los cuatro músculos evaluados. Conclusión: El estudio presentó datos normativos de una muestra de conveniencia de futbolistas profesionales sauditas y observó que la mayor asimetría se observó en el vasto interno y la menor asimetría en el bíceps femoral

El perfil neuromuscular de los músculos extensores y flexores de rodilla en jugadores de fútbol profesionales en la Arabia Premier League

Propósito: El sistema neuromuscular de los jugadores de fútbol es un factor clave en su desempeño competitivo, ya que determina la respuesta de fuerza inmediata de un jugador, la reactividad y la velocidad de carrera durante los partidos. Recientemente se ha comenzado a analizar el sistema neuromuscular mediante tensiomiografía (TMG). El objetivo principal de este estudio fue generar datos normativos del perfil mecánico y neuromuscular de los músculos extensores y flexores de la rodilla. Método: Este estudio utilizó un estudio transversal de 83 futbolistas profesionales de tres equipos de la Liga Premier de Arabia Saudita al comienzo del período de pretemporada. La TMG se utilizó para medir el desplazamiento del vientre del músculo radial en los músculos extensores y flexores de la rodilla en ambas piernas. Resultados: Los resultados sugieren que el mayor grado de simetría correspondió al vasto medial (83,7 ± 14,3%) y el menor al bíceps femoral (76,1 ± 10,9%). No se encontraron diferencias estadísticas entre los músculos dominantes y no dominantes, o entre las posiciones del jugador en el campo en los cuatro músculos evaluados. Conclusión: El estudio presentó datos normativos de una muestra de conveniencia de futbolistas profesionales sauditas y observó que la mayor asimetría se observó en el vasto interno y la menor asimetría en el bíceps femoral.Purpose: The neuromuscular system of soccer players is a key factor in their competitive performance, as it determines a player's immediate force response, reactivity and running speed during matches. The neuromuscular system has recently begun to be analyzed by tensiomyography (TMG). This study's primary aim was to generate normative data of the mechanical and neuromuscular profile for the knee extensor and flexor muscles. Method: This study used a cross-sectional study of 83 professional soccer players from three Saudi Premier League teams at the start of the preseason period. TMG was used to measure the radial muscle belly displacement in the knee extensor and flexor muscles in both legs. Results: The results suggest that the highest degree of symmetry corresponded to the vastus medialis (83.7 ± 14.3%) and the lowest to the biceps femoris (76.1 ± 10.9%). No statistical difference was found between the dominant and non-dominant muscles, or between on-field player positions across all four tested muscles. Conclusion: The study presented normative data of a convenience sample of Saudi professional soccer players and observed that the highest asymmetry was seen in the vastus medialis and the lowest asymmetry in the biceps femoris

Pain neurophysiology knowledge among physical therapy students in Saudi Arabia: a cross-sectional study

Abstract Background Pain is a leading cause of disability and accounts for many hospital and physical therapy visits. Current pain science understanding has evolved and changed substantially in the past 20 years; however, university health science curricula may not have progressed at the same rate. This study aimed to examine knowledge about pain neurophysiology among physical therapy students in Saudi Arabia, and to compare their knowledge across different education levels and by gender. Methods A cross-sectional study conducted to examine the pain neurophysiology knowledge among college physical therapy students in Saudi Arabia. The Revised Neurophysiology of Pain Questionnaire (12 items) was used. Descriptive statistics including frequencies and percentages were used to describe the sample. Analysis of variance and t-test were also used to examine the significant differences between scores. Results Physical therapy students (n = 202) from 18 different universities in Saudi Arabia participated in this study. The mean score of the participants on the questionnaire was 6.20 ± 2.07 (i.e., 52% ± 17%) and there was no significance difference between males and females. There was a statistically significant incremental increase in total score through the educational process (P < 0.05); however, this increase was very small comparing early- and final educational-level students (8% in RNPQ). Conclusion While final year physical therapy students showed higher levels of pain science knowledge than those at the beginning of their course, the magnitude of the difference was small and likely of little meaningful relevance. This may reflect the need for more emphasis on pain science in the physical therapy curriculum in Saudi Arabia

Are healthcare providers offering the proper education for people with low back pain? Content analysis of educational materials

BACKGROUND: Low back pain (LBP) is a prevalent disorder and leading cause of disability worldwide. In Saudi Arabia, patients with LBP are dispensed with educational materials to supposedly facilitate their recuperation. OBJECTIVE: Appraise the suitability of educational materials provided for people with LBP in Saudi Arabia to determine whether they meet the needs of patients, inform self-management, and are consistent with clinical practice guidelines. METHODS: A qualitative data collection method was used, and content analyses were conducted to analyse data based on manifest content. Educational items in English and Arabic were collected from relevant health providers in Saudi Arabia. RESULTS: Seventeen educational materials were sourced from: Ministry of Health hospitals (n= 10), military hospitals (n= 4), private hospitals (n= 2), and a multidisciplinary healthcare association (n= 1). Six identified sub-themes comprise: epidemiological/anatomical data about LBP (n= 6); causes/risk factors (n= 10); exercise (n= 14) and physical activity-related (n= 3) recommendations; treatment-related recommendations (n= 2); general health and lifestyle-related recommendations (n= 8); and postural and ergonomics-related recommendations (n= 13). A common theme emerged, that ‘the content of educational materials hindered reassurance and self-management for people with LBP.’ CONCLUSION: The reviewed educational materials fail to adequately report information that assure patients or inform their self-management among the Saudi population with LBP. Further, reviewed items are heavily influenced by the biomedical model of pain.</jats:p

Adding A Structured Educational Session to the Rehabilitation Program of Soccer Players Following Anterior Cruciate Ligament Reconstruction: A Feasibility Study

Background While a lack of psychological preparedness and fear of movement may be linked with the anterior cruciate ligament (ACL) re-injury, these variables are rarely addressed throughout the therapy stages via educational sessions. Unfortunately, in terms of reducing fear, increasing function, and returning to play, no research has been done yet on the efficacy of adding organized educational sessions to the rehabilitation programs of soccer players post-ACL reconstruction (ACLR). Therefore, the study’s aim was to assess the feasibility and acceptability of adding organized educational sessions to the rehabilitation programs post-ACLR. Methods A feasibility randomized controlled trial (RCT) was conducted in a specialized sports rehabilitation center. Participants post ACL reconstruction were randomized to either usual care with a structured educational session (intervention group) or usual care alone (control group). This feasibility study investigated three aspects: recruitment, intervention acceptability and randomization, and retention. The outcome measures included Tampa Scale of Kinesiophobia, ACL-Return to Sport after Injury, and International Knee Documentation Committee for knee function. Measurements were done at baseline and one week after the intervention. Results All of the 36 players who were undergoing rehabilitation post-ACLR at the center at the time of the study were invited to participate in the study. Thirty-five players (97.2%) agreed to participate in the study. The participants responded to some questions about the acceptability of the intervention and randomization and most of them thought they were appropriate. 30 (85.7%) participants completed the follow-up questionnaires one week after the randomization. Conclusion This feasibility research found that adding a structured educational session to the rehabilitation program for soccer players after ACLR is feasible and acceptable. Full-scale RCTs with longer follow-ups and multiple locations are recommended. </jats:sec

Adding A Structured Educational Session to the Rehabilitation Program of Soccer Players Following Anterior Cruciate Ligament Reconstruction: A Feasibility Study

# Background While a lack of psychological preparedness and fear of movement may be linked with the anterior cruciate ligament (ACL) re-injury, these variables are rarely addressed throughout the therapy stages via educational sessions. Unfortunately, in terms of reducing fear, increasing function, and returning to play, no research has been done yet on the efficacy of adding organized educational sessions to the rehabilitation programs of soccer players post-ACL reconstruction (ACLR). Therefore, the study's aim was to assess the feasibility and acceptability of adding organized educational sessions to the rehabilitation programs post-ACLR. # Methods A feasibility randomized controlled trial (RCT) was conducted in a specialized sports rehabilitation center. Participants post ACL reconstruction were randomized to either usual care with a structured educational session (intervention group) or usual care alone (control group). This feasibility study investigated three aspects: recruitment, intervention acceptability and randomization, and retention. The outcome measures included Tampa Scale of Kinesiophobia, ACL-Return to Sport after Injury, and International Knee Documentation Committee for knee function. Measurements were done at baseline and one week after the intervention. # Results All of the 36 players who were undergoing rehabilitation post-ACLR at the center at the time of the study were invited to participate in the study. Thirty-five players (97.2%) agreed to participate in the study. The participants responded to some questions about the acceptability of the intervention and randomization and most of them thought they were appropriate. 30 (85.7%) participants completed the follow-up questionnaires one week after the randomization. # Conclusion This feasibility research found that adding a structured educational session to the rehabilitation program for soccer players after ACLR is feasible and acceptable. Full-scale RCTs with longer follow-ups and multiple locations are recommended

Additional file 2: of Pain neurophysiology knowledge among physical therapy students in Saudi Arabia: a cross-sectional study

Table S2. Participants’ institutions with percentage participation from each institution. Participants’ institutions with percentage participation from each institution. (DOCX 18 kb