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Daniel KY Zheng,1 Gregory N Kawchuk,2 André E Bussières,3,4 Fadi M Al Zoubi,1 Jan Hartvigsen,5 Siu Ngor Fu,1 Katie de Luca,6 Debra K Weiner,7,8 Jaro Karppinen,9,10 Dino Samartzis,11 Manuela L Ferreira,12 Jinlong Wu,13 Liz Dennett,2 Arnold YL Wong1 1Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China; 2University of Alberta, Edmonton, Canada; 3Université McGill, Montreal, Canada; 4Université du Québec à Trois-Rivières, Trois‑Rivières, Canada; 5University of Southern Denmark, Odense, Denmark; 6Central Queensland University, Brisbane, Australia; 7University of Pittsburgh, Pittsburgh, PA, USA; 8VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; 9Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland; 10Rehabilitation Services of South Karelia Social and Health Care District, Lappeenranta, Finland; 11Rush University Medical Center, Chicago, IL, USA; 12The University of Sydney, Sydney, Australia; 13Southwest University, Chongqing, People’s Republic of ChinaCorrespondence: Arnold YL Wong, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, People’s Republic of China, Tel +852 2766 6741, Email arnold.wong@polyu.edu.hkAbstract: Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of research targeting LBP-O and LBP-W over the last three decades. Peer-reviewed LBP-O and LBP-W articles published between 1993 and 2023 were retrieved from the Web of Science, which provided the details of annual publication volume, and prominent journals/countries/institutions. The relationship between the annual publication volumes and years was analyzed by Spearman correlation analysis. The hot topics and emerging trends were analyzed by VOSviewer and CiteSpace, respectively. A total of 4217 LBP-O-related and 50,559 LBP-W-related documents were included. The annual publication volumes of LBP-O and LBP-W articles increased over the years (r=0.995 to 0.998, p< 0.001). The United States had the highest number of prominent institutions publishing relevant articles. The most prolific journal for LBP-O (5.4%) and LBP-W-related (6.1%) papers is the journal “Spine”. Cognitive behavioral therapy, intervertebral disc (IVD) degeneration, physiotherapy, physical activity, and walking were the recent hot topics and physical activity was an emerging trend in LBP-O, while surgery and IVD degeneration (also a hot topic) were emerging trends in LBP-W. This study highlights the paucity of LBP-O-related research in the past. The United States and the journal Spine stand out in LBP research. The research trend of physical activity in LBP-O is consistent with the recognized importance of physical activity for older adults in general, and for managing LBP-O in particular. Conversely, the emerging trends of surgery and intervertebral disc degeneration in LBP-W research highlight a focus on the biomedical model of LBP despite LBP being a biopsychosocial condition.Keywords: low back pain, older adults, working-age adults, bibliometrics, intervertebral disc degeneration, physical activity, surgery

Sabina M Pinto,1 Sweta B Boghra,1 Luciana G Macedo,2 Yong-Ping Zheng,3 Marco YC Pang,1 Jason PY Cheung,4 Jaro Karppinen,5,6 Dino Samartzis,7 Arnold YL Wong1 1Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; 2School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; 3Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China; 4Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China; 5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; 6Finnish Institute of Occupational Health, Helsinki, Finland; 7Department of Orthopaedics Surgery, Rush University Medical Center, Chicago, IL, USACorrespondence: Arnold YL WongDepartment of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, ChinaTel +852 2766-6741Fax +852 2330-8656Email arnold.wong@polyu.edu.hkAbstract: Aberrant morphological changes in lumbar multifidus muscle (LMM) are prevalent among patients with low back pain (LBP). Motor control exercise (MCE) aims to improve the activation and coordination of deep trunk muscles (eg, LMM), which may restore normal LMM morphology and reduce LBP. However, its effects on LMM morphology have not been summarized. This review aimed to summarize evidence regarding the (1) effectiveness of MCE in altering LMM morphometry and decreasing LBP; and (2) relations between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Cochrane Central Register of Controlled Trials, the Physiotherapy Evidence Database, EMBASE and SPORTDiscus were searched from inception to 30 September 2020 to identify relevant randomized controlled trials. Two reviewers independently screened articles, extracted data, and evaluated risk of bias and quality of evidence. Four hundred and fifty-one participants across 9 trials were included in the review. Very low-quality evidence supported that 36 sessions of MCE were better than general physiotherapy in causing minimal detectable increases in LMM cross-sectional areas of patients with chronic LBP. Very low- to low-quality evidence suggested that MCE was similar to other interventions in increasing resting LMM thickness in patients with chronic LBP. Low-quality evidence substantiated that MCE was significantly better than McKenzie exercise or analgesics in increasing contracted LMM thickness in patients with chronic LBP. Low-quality evidence corroborated that MCE was not significantly better than other exercises in treating people with acute/chronic LBP. Low-quality evidence suggested no relation between post-MCE changes in LMM morphometry and LBP/LBP-related disability. Collectively, while MCE may increase LMM dimensions in patients with chronic LBP, such changes may be unrelated to clinical outcomes. This raises the question regarding the role of LMM in LBP development/progression.Keywords: imaging, LMM, LBP, morphometry

Arnold Y Wong,1 Dino Samartzis21Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, Special Administrative Region of China; 2Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, Special Administrative Region of ChinaThe average human life expectancy has increased significantly worldwide due to advances in medicine, health care delivery, and technology over recent years.1 The United Nations has estimated that the proportion of older individuals aged 60 or over in the world will increase threefold by the year 2050.2 However, the fast growth of the aging population is accompanied by global increase in the incidence of low back pain (LBP) complaints and associated medical costs.3

Bruce Crawford1, Richard H Stanford2, Audrey Y Wong3, Anand A Dalal2, Martha S Bayliss11Mapi Values, Boston, MA, USA; 2GlaxoSmithKline, Research Triangle Park, NC, USA; 3BioMedical Insights, San Francisco, CA, USABackground: Patient experience and preference are critical factors influencing compliance in patients with allergic rhinitis (AR) receiving intranasal corticosteroids. The Experience with Allergic Rhinitis Nasal Spray Questionnaire (EARNS-Q) was developed to measure subject experiences with and preferences for nasal sprays.Objective: To describe the psychometric validation of the EARNS-Q modules.Methods: An observational study was conducted with subjects aged 18–65 years with physician-diagnosed vasomotor, seasonal, and/or perennial allergic rhinitis who were using a prescription nasal spray. Subjects completed the experience module of the EARNS-Q and the Treatment Satisfaction Questionnaire with Medication (TSQM) at baseline and after 2 weeks. Further validation analyses were conducted in a 3-week, randomized, single-blind, crossover, multicenter clinical study in which subjects ≥18 years of age with documented seasonal AR received flunisolide and beclomethasone and completed the EARNS-Q experience module on days 1 and 8, the EARNS-Q preference module on day 22, and the TSQM on days 8 and 22.Results: The observational and clinical studies were completed by 121 and 89 subjects, respectively. Both modules demonstrated acceptable reliability (α = 0.72 experience module; α = 0.93 preference module global scores) and validity (intraclass correlation coefficient or ICC 0.64 to 0.82 test–retest validity). Correlations among the experience and preference modules were moderate (r = 0.39 to 0.79) and within internal consistency reliability estimates, indicating measurement of distinct constructs.Conclusion: The EARNS-Q is a patient-reported outcomes measure that enables reliable and valid measurement of subject experience with, and preference for, prescription intranasal corticosteroid sprays for allergic rhinitis.Keywords: EARNS-Q, allergic rhinitis, compliance, intranasal corticosteroid, patient preference, psychometric validation

Bruce Crawford1, Richard H Stanford2, Audrey Y Wong1, Anand A Dalal2, Martha S Bayliss11Mapi Values, Boston, MA, USA; 2GlaxoSmithKline, Research Triangle Park, NC, USABackground: Allergic rhinitis affects 10%–20% of the US population. Its chronic nature, combined with patients' perceptions of safety/efficacy, administration, and sensory attributes of nasal sprays (corticosteroids), impact patient adherence to therapy. The purpose of this study was to develop a measure of experience with and preference for corticosteroid therapy for treatment of allergic rhinitis.Methods: Questionnaire development was conducted through qualitative research including concept elicitation and content testing in 153 patients with allergic rhinitis. Patient focus groups (n = 66), in conjunction with content confirmation and saturation in additional groups (n = 87), provided research data. A literature-based conceptual framework was incorporated into the interview guide. An iterative process of data collection, analysis, and theory development yielded the conceptual framework.Results: Consistent comments from the focus groups combined with those from cognitive debriefing interviews led to the incorporation of 14 finalized attributes into the Experience with Allergic Rhinitis Nasal Spray Questionnaire (EARNS-Q) items. Between the first and second cognitive debriefing interviews, researchers revised the EARNS-Q for retesting. Face and content validity tests indicated that the items, responses, and instructions were understood by study participants. The EARNS-Q is comprised of two modules that measure patient experience with nasal sprays (experience module), and patient preference for a nasal spray relative to another (preference module).Conclusion: The EARNS-Q accurately measured patient experience with and preference for nasal sprays used in treating allergic rhinitis. A potential application of this questionnaire may be as a patient-reported outcomes endpoint in clinical trials of intranasal corticosteroids in patients with allergic rhinitis.Keywords: EARNS-Q, allergic rhinitis, intranasal corticosteroid, patient preference, experience, questionnaire development

Shahnawaz Anwer,1,2 Heng Li,2 Maxwell Fordjour Antwi-Afari,3 Mohammad Abu Shaphe,4 Ahmad Alghadir,1 Arnold YL Wong5 1Rehabilitation Research Chair, College of Applied Medical Science, King Saud University, Riyadh, Saudi Arabia; 2Department of Building and Real Estate, Faculty of Construction and Environment, Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative Region; 3Department of Civil Engineering, College of Engineering and Physical Sciences, Aston University, Birmingham, B4 7ET, UK; 4Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia; 5Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Special Administrative RegionCorrespondence: Shahnawaz Anwer Email Shahnawaz.anwer@connect.polyu.hkPurpose: The current study aimed to evaluate the impact of coronavirus (COVID-19) pandemic on sleep hygiene, anxiety levels, perceived stress, and research output among postgraduate research students in Hong Kong.Methods: An online survey was developed and distributed to Hong Kong postgraduate research students. The sleep hygiene, anxiety levels, and perceived stress during the outbreak of COVID-19 were assessed. Questions about COVID-19’s impact on research outputs were asked.Results: A total of 108 (response rate, 72%) full-time postgraduate students (PhD, 64%; M Phil, 8%; and Masters, 28%) participated. Approximately 83% of students reported poor sleep hygiene. Similarly, nearly 76% of students reported mild to severe levels of self-perceived anxiety levels. Most of the respondents (89%) expressed a moderate level of perceived stress. Sleep hygiene scores were moderately associated with anxiety levels (r = 0.384, p < 0.01) and perceived stress scores (r = 0.423, p < 0.01). Perceived stress was strongly correlated with anxiety levels (r = 0.601, p < 0.01). A hierarchical regression analysis revealed a significant association between respondents’ ethnicity (B = − 0.923, p = 0.003), past medical history (such as hypertension, diabetes, and musculoskeletal disorders) (B = 1.112, p = 0.005), or poor sleep hygiene (B = 0.259, p = 0.000) and high levels of perceived stress. Additionally, prior medical history (such as hypertension, diabetes, and musculoskeletal disorders) (B = 1.957, p = 0.001) and poor sleep hygiene (B = 0.312, p = 0.000) were found to be strongly related to anxiety levels among postgraduate research students.Conclusion: This is the first study that highlights poor sleep hygiene, moderate-to-severe levels of anxiety, and perceived stress during the COVID-19 pandemic in postgraduate research students in Hong Kong. These findings will help educators to prepare strategies to alleviate the stress and psychological problems in postgraduate students.Keywords: coronavirus, COVID-19 pandemic, postgraduate students, research, anxiety, sleep hygiene, stress