The effect of whole-body vibration on glucose and lipid profiles in type-2 diabetes: a systematic review and pairwise and network meta-analyses of randomized trials.

Whole-body vibration (WBV), a training method based on the stimulation of muscle contraction by mechanical vibration generated in a vibrating platform, is claimed to be effective in diabetes management. This meta-analysis evaluated WBV effects against other exercises, placebo, or no intervention in type-2 diabetes. Medline, Scopus, and Web of Science databases were systematically searched through June 2023. Randomized controlled trials reported the effect of WBV on glucose (hemoglobin A1C and fasting blood glucose), and lipid profiles (total cholesterol, triglycerides, high, and low-density lipoprotein) were included. Two researchers independently extracted the characteristics of the studies, participants, WBV intervention and comparisons, and the outcomes from the included articles. The Physiotherapy Evidence Database (PEDro) scale assessed trial quality. In this review, all articles had no high risk of bias according to the PEDro scale, with studies achieving optimal, excellent, and good scores. Network meta-analysis revealed that WBV was effective for reducing hemoglobin A1C when compared with conventional (mean difference: - 1.58%, 95%CrI: - 2.51, - 0.47) and resistance exercise (mean difference: - 1.32%, 95%CrI: - 1.96, - 0.33). WBV had also a desirable but insignificant effect on hemoglobin A1C compared to stretching and balance exercises, placebo, and no intervention. The current pairwise meta-analysis did not show that WBV favors fasting blood glucose and lipids. WBV may have potential advantages for glycemic control in type-2 diabetes. However, uncertainties in the findings remain due to the limited number of studies and their heterogeneity.

Different montages of transcranial direct current stimulation on postural stability in chronic low back pain patients: A randomized sham-controlled study.

BACKGROUND: Impairment in both the motor and cognitive aspects of postural control is a critical issue in patients with chronic low back pain (CLBP) who experience high pain anxiety (HPA). OBJECTIVE: This study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on postural control during cognitive postural tasks in CLBP patients with HPA. METHODS: This study included 66 patients randomly assigned to three groups: DLPFC a-tDCS, DLPFC c-tDCS, and sham tDCS. All groups received 20 minutes of tDCS, but the stimulation was gradually turned off in the sham group. Postural stability indices were assessed using the Biodex Balance System. RESULTS: Both the a-tDCS and c-tDCS groups showed a significant reduction in most postural stability indices at static and dynamic levels after the interventions (immediately, 24 hours, and one-week follow-up) during the cognitive postural task (P< 0.01). Additionally, there was a significant improvement in postural balance in the a-tDCS and c-tDCS groups compared to the sham tDCS group (P< 0.01). Furthermore, the a-tDCS group showed significantly greater improvement than the c-tDCS group (P< 0.01). CONCLUSION: Based on the results, both a-tDCS and c-tDCS over the DLPFC had positive effects on postural control during cognitive postural tasks in CLBP patients with HPA.

Effect of Functional Electrical Stimulation on Muscle Mass, Fatigue, and Quality of Life in Older Patients With COVID-19: A Randomized Clinical Trial Study.

OBJECTIVE: This study aimed to evaluate the effects of functional electrical stimulation (FES) on muscle strength, fatigue, muscle mass, and quality of life (QoL) in older patients with COVID-19. METHODS: Older patients with COVID-19 were randomly divided into the following 2 groups: real FES (intervention group, n = 20) and sham FES (control group, n = 20). These patients received FES concurrent with the voluntary contraction of muscles for 10 consecutive sessions. Ultrasound imaging, pressure biofeedback, Chalder fatigue scale, and QoL were utilized to measure muscle mass, muscle strength, chronic fatigue, and QoL, respectively. Evaluations were performed at the beginning, immediately, and 1 month after the end of intervention. RESULTS: All variables showed statistically significant improvement immediately and 1 month after the intervention in the real FES group (P < .05). However, the tibialis anterior muscle mass and fatigue significantly improved immediately after the intervention in the sham FES group. However, the tibialis anterior and rectus femoris muscles strength and rectus femoris muscle mass were not significantly changed immediately and 1 month after the intervention (P > .05). There were significant differences in muscle mass, physical fatigue, muscle strength, and QoL between groups with more efficacy of real FES (P < .05). CONCLUSION: For this sample of patients, FES improved fatigue, muscle strength, muscle mass, and QoL in older adults with COVID-19.

Consumer Segmentation Based on Location and Timing Dimensions Using Big Data from Business-to-Customer Retailing Marketplaces.

Consumer segmentation is an electronic marketing practice that involves dividing consumers into groups with similar features to discover their preferences. In the business-to-customer (B2C) retailing industry, marketers explore big data to segment consumers based on various dimensions. However, among these dimensions, the motives of location and time of shopping have received relatively less attention. In this study, we use the recency, frequency, monetary, and tenure (RFMT) method to segment consumers into 10 groups based on their time and geographical features. To explore location, we investigate market distribution, revenue distribution, and consumer distribution. Geographical coordinates and peculiarities are estimated based on consumer density. Regarding time exploration, we evaluate the accuracy of product delivery and the timing of promotions. To pinpoint the target consumers, we display the main hotspots on the distribution heatmap. Furthermore, we identify the optimal time for purchase and the most densely populated locations of beneficial consumers. In addition, we evaluate product distribution to determine the most popular product categories. Based on the RFMT segmentation and product popularity, we have developed a product recommender system to assist marketers in attracting and engaging potential consumers. Through a case study using data from massive B2C retailing, we conclude that the proposed segmentation provides superior insights into consumer behavior and improves product recommendation performance.

Does Multisession Cathodal Transcranial Direct Current Stimulation of the Left Dorsolateral Prefrontal Cortex Prime the Effects of Cognitive Behavioral Therapy on Fear of Pain, Fear of Movement, and Disability in Patients with Nonspecific Low Back Pain? A Randomized Clinical Trial Study.

Many studies have shown that low back pain (LBP) is associated with psychosomatic symptoms which may lead to brain changes. This study aimed to investigate the effect of the concurrent application of cognitive behavioral therapy (CBT) and transcranial direct electrical stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on fear of pain, fear of movement, and disability in patients with nonspecific LBP. This study was performed on 45 LBP patients (23 women, 22 men; mean age 33.00 ± 1.77 years) in three groups: experimental (2 mA cathodal tDCS (c-tDCS)), sham (c-tDCS turned off after 30 s), and control (only received CBT). In all groups, CBT was conducted for 20 min per session, with two sessions per week for four weeks. Fear of pain, fear of movement, and disability were evaluated using questionnaires at baseline, immediately after, and one month after completion of interventions. Results indicated that all three different types of intervention could significantly reduce fear and disability immediately after intervention (p > 0.05). However, improvement in the experimental group was significantly higher than in the other groups immediately after and at the one-month follow-up after interventions (p < 0.05). DLPFC c-tDCS can prime the immediate effects of CBT and also the lasting effects on the reduction in the fear of pain, fear of movement, and disability in LBP patients.

Effects of Photobiomodulation Therapy on Lung Function and Inflammatory Factors in Patients with COVID-19 During Acute Stage.

Objective: We aimed to evaluate the effects of photobiomodulation therapy on the respiratory function and laboratory parameters in COVID-19 participants with respiratory involvement. Methods: A randomized, double-blind controlled design was used. This study was conducted at Koosar Hospital. Thirty participants with COVID-19 who were hospitalized met the inclusion criteria and were randomly assigned to two groups. Patients were treated with a program of five sessions of high-power photobiomodulation (intervention group) and placebo photobiomodulation (control group). Both groups received standard treatment. Outcomes were assessed before and after the intervention (two sessions), according to the immune system function and laboratory tests for the respiratory rate (RR), oxygen saturation, and inflammatory factors, including C-reactive protein (CRP), white blood cells, and interleukin-6 (IL-6), as well as complete blood count (CBC), hematocrit, hemoglobin, and ferritin. Results: Findings indicated that the values of ferritin, erythrocyte sedimentation ratio, CRP, IL-6, O2 saturation, and RR were significantly improved after the intervention in both groups (p < 0.05). Independent T-test analyses also indicated significant differences in the CRP, IL-6, and O2 saturation in the photobiomodulation group compared with the control group after the five-session intervention (p < 0.05). Conclusions: Application of photobiomodulation is recommended for treatment of respiratory problems in patients with COVID-19 to improve clinical signs and control inflammatory factors. Clinical Trial Registration: IRCT2017070934969N1.

Transcranial direct current stimulation over dorsolateral prefrontal cortex improves postural stability in non-specific chronic low back pain patients with high fear of pain: A randomized sham-controlled trial.

Deficits in postural stability in response to environmental challenges are seen in chronic low back pain (CLBP) patients with high fear of pain (HFP). Hence, it is essential to follow effective approaches to treat postural stability deficits and improve the health status of these patients. The current study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on postural stability in non-specific CLBP patients with HFP. In this randomized clinical trial study, 75 patients were randomly assigned to left DLPFC a-tDCS, left DLPFC c-tDCS and sham stimulation groups (n = 25 in each group). All groups received a single-session 2 mA tDCS for 20 min, but the stimulation was slowly turned off after 30 s in the sham group. Before, immediately, 24 h and 1 week after the interventions, postural stability indices were assessed using a Biodex Balance System. A significant reduction in most indices was shown in both a-tDCS and c-tDCS groups after interventions (immediately, 24 h and 1 week follow-up) during static and dynamic postural tasks compared with the sham tDCS group (p < .01). In addition, some tests showed a significant difference between a-tDCS and c-tDCS (p < .05). The findings indicated positive effects of both a-tDCS and c-tDCS on the left DLPFC, with more efficacy of a-tDCS on postural stability in LBP patients with HFP.

Box-Behnken modeling and optimization of visible-light photocatalytic removal of methylene blue by ZnO-BiFeO3 composite.

Box-Behnken experimental design was utilized to model and optimize the photocatalytic removal of methylene blue (MB) using ZnO-BiFeO3 composite under visible light (LED). Three catalysts with different ZnO:BiFeO3 molar ratios (2:1, 1:2, and 1:1) were synthesized successfully using the hydrothermal method. The structural, morphological, and optical properties of the synthesized photocatalysts were analyzed by X-ray diffraction (XRD), Field Emission Scanning Electron Microscope (FESEM), Energy Dispersive X-ray Spectroscopy (EDX), Fourier Transform Infrared Spectra (FT-IR), Ultraviolet Visible Spectrometer (UV-vis), Transmission Electron Microscopy(TEM), High-Resolution Transmission Electron Microscopy (HR-TEM), and Photoluminescence (PL) Spectrophotometry. FESEM showed the relatively uniform distribution of BiFeO3 crystalline particles on ZnO ones. UV-vis analysis showed that the photocatalytic performance of pure ZnO and BiFeO3 under visible light irradiation is weak, while ZnO-BiFeO3 with a 2:1 molar ratio composite with a bandgap of about 2.37 eV showed high performance. This improved photocatalytic activity may be due to the heterogeneous synergistic effect of the p-n junction. In order to optimize the experimental conditions, four factors of initial MB concentration (5 to 20 mg/L), pH (3 to 12), catalyst dosage (0.5 to 1.25 mg/L), and light intensity (4 to 18 W) were selected as independent input variables. Box-Behnken experimental design method (BBD) suggested a quadratic polynomial equation to fit the experimental data. The results of the analysis of variance (ANOVA) confirmed the goodness of fit for the suggested model (predicted- and adjusted-R2 0.99). The optimum conditions for maximizing the photocatalytic MB degradation were found to be an initial MB concentration of 11 mg/L, pH of 11.7, catalyst dosage of 0.716 mg/L, and light intensity of 11.4 W. Under the optimum conditions, the highest photocatalytic MB degradation of 62.9% was obtained, which is in reasonable agreement with the predicted value of 69%.

Concurrent multi-session anodal trans-cranial direct current stimulation enhances pelvic floor muscle training effectiveness for female patients with multiple sclerosis suffering from urinary incontinence and pelvic floor dysfunction: a randomized clinical trial study.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence following a pelvic floor muscle (PFM) dysfunction is a common disorder in women with multiple sclerosis (MS). Concurrent anodal transcranial direct current stimulation (a-tDCS) of the primary motor cortex (M1) may prime the effects of PFM training (PFMT) in MS patients. This study was aimed at investigating the effects of M1 a-tDCS on the effectiveness of PFMT in the treatment of female MS patients with urinary incontinence and PFM dysfunctions. METHODS: In a randomized double-blinded, control trial study, 30 women with MS were divided into two groups (experimental group: concurrent active M1 a-tDCS and PFMT; control group: concurrent sham M1 a-tDCS and PFMT). Over the course of 8 weeks, these patients received 20-min interventions three times a week. As an indication of PFM function, the bladder base displacement was measured by ultrasonography before, during the 4th week, immediately, and 1 month after the intervention ended. Urinary incontinence was also measured by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF) before, immediately, and 1 month after the intervention ended. RESULTS: A significant improvement in PFM function occurred in the 4th week of intervention and remained 1 month after the intervention in the experimental group when compared with the control group (p<0.05). Compared with baseline, both groups reported significant improvements in PFM function at 8 weeks (p<0.05). Also, both groups were found to have decreased ICIQ-UIS scores after the intervention and at 1-month follow-up (p<0.05). CONCLUSIONS: In MS patients, M1 a-tDCS can significantly enhance the effects of PFMT on the PFM function and urinary incontinence.

Priming Effects of Anodal Transcranial Direct Current Stimulation on the Effects of Conventional Physiotherapy on Balance and Muscle Performance in Athletes With Anterior Cruciate Ligament Injury.

CONTEXT: In athletes, postural control impairment and knee muscle dysfunction are the most common disorders following anterior cruciate ligament (ACL) injury. Because of functional changes in the motor cortex following ACL injury, physiotherapy (PT) is not enough for treatment and using neuromodulators, such as trans-cranial direct current stimulation (tDCS) may be necessary. The present study focused on the effects of anodal tDCS (a-tDCS) over the primary motor cortex (M1) concurrent with PT on postural control and muscular performance in the athletes with ACL injury. DESIGN: In this study, 34 athletes with ACL injury were randomly assigned in 2 groups of intervention group (active M1 a-tDCS concurrent with PT, n = 16) and control group (sham M1 a-tDCS concurrent with PT, n = 16). METHODS: The participants of all groups received 20-minute 2 mA M1 a-tDCS with PT during 10 sessions, while tDCS was turned off after 30 seconds in the sham group. Before, immediately following, and 1 month after the interventions, the center of pressure and the average of power of flexor and extensor muscles at 2 velocities of 30°/s and 60°/s were measured by force plate and isokinetic devices, respectively. RESULTS: One month after treatment, the displacement of center of pressure was decreased in the intervention group (P < .05), while there were no changes in the control group. Y-axis of center of pressure decreased in the intervention group relative to the control group, although average of power of flexor and extensor muscles increased immediately in both groups, but the rise in the intervention group was larger than that in the control group (P < .05). CONCLUSION: The findings indicated that M1 a-tDCS can induce the efficacy of PT, which has a lasting effect on the improvement of the postural control in athletes with ACL injury.

The comparative effects of anodal and cathodal trans-cranial direct current stimulation on balance and posture: A systematic review of literature and meta-analysis.

Application of anodal trans-cranial direct current stimulation (a-tDCS) versus cathodal tDCS (c-tDCS) can influence the physiological results of tDCS intervention on postural control and balance in patients or healthy adults. According to the evidence, some studies demonstrated that postural control or balance is facilitated by the application of the a-tDCS more than the c-tDCS. On the other hand, some studies indicated that there were no significant differences between a-tDCS and c-tDCS. In contrast, other studies have shown a more significant effect of c-tDCS than a-tDCS on postural control and balance. This study aimed to systematically review the studies which investigated the effectiveness of a-tDCS and c-tDCS intervention on postural control and balance. The search was performed from databases in Google Scholar, PubMed, Elsevier, Medline, Ovid, and Science Direct with the keywords of balance, balance test, postural control, postural stability, postural sway, posture, postural balance, trans-cranial direct current stimulation, tDCS, neuromodulator, neurostimulation, tDCS, a-tDCS or anodal tDCS, c-tDCS or cathodal tDCS from 2000 to 2022. The results confirmed that the study population was a key factor in determining the study's findings. Data meta-analysis showed no significant differences between active tDCS and sham tDCS on postural control in healthy individuals (P > 0.05). In addition, the results indicated the efficacy of both a-tDCS over the affected motor cortex (M1) and c-tDCS over unaffected M1 as compared to sham tDCS on postural improvement in patients with stroke (P < 0.05), however, there were no differences between the two techniques on posture and balance in these patients.

Cross-cultural adaptation, validity and reliability of the Persian version of Fremantle Knee Awareness Questionnaire.

BACKGROUND: & Objective: There is strong evidence regarding impaired knee self-perception in patients with chronic knee osteoarthritis (OA). Currently, the Fremantle Knee Awareness Questionnaire (FreKAQ) has been developed to evaluate knee self-perception. This study aimed to evaluate validity and reliability of the Persian version of FreKAQ in patients with chronic knee OA. MATERIALS AND METHODS: The FreKAQ was translated via forward-backward translation. In total, 312 patients with chronic knee OA completed the questionnaire, and the construct validity of the instrument was evaluated using exploratory and confirmatory factor analyses (EFA and CFA). Moreover, its reliability was confirmed using internal consistency and Cronbach's alpha coefficient. In addition, intra-class correlation coefficient and standard error measurement (SEM) and minimal detectable change (MDC) were used to assess its relative and absolute consistency. Therefore 50 patients, completed the questionnaire twice at one-week intervals. RESULTS: In EFA, Kaiser-Meyer-Olkin (0.705) and Bartlett's tests were significant (P < 0.001), and CFA also indicated acceptable fitting with three factors. Moreover, the indices of PNFI = 0.57, PCFI = 0.60, χ2/DF = 1.14, AGFI = 0.95, GFI = 0.97, and RMSEA = 0.027 confirmed the goodness of fit of the model. The Cronbach's alpha and repeatability were estimated at 0.817 and 0.874, respectively, and the SEM and MDC was 2.13, 4.91. CONCLUSION: According to the results, the Persian version of FreKAQ had proper construct validity and reliability to evaluate the impairment of knee self-perception in patients with chronic knee OA.

Priming of postural training with cerebellar anodal transcranial direct current stimulation for its effects on postural balance and fear of falling in patients with multiple sclerosis: A randomized, double-blind, sham-controlled study.

Postural impairment is one of the most disorders in patients with multiple sclerosis (MS), while fear of falling can exacerbate it in these patients. One of the leading causes of postural impairment and fear of falling in patients with MS is the cerebellum region's abnormalities, which may be modulated by cerebellar anodal transcranial direct current stimulation (a-tDCS). The present study aimed to investigate the effects of cerebellar a-tDCS concurrent with postural training (cerebellar a-CSC-PT) on postureand fear of falling in patients with MS. Thirty-seven patients with MS were assessed to randomly assign into cerebellar a-tDCSC-PT, shamtDCSC-PT, and postural training alone groups. All groups received 10-session postural training, while 20-minute cerebellar a-tDCS was added in the tDCS groups. Before, immediately and one month after the intervention, posture, balance and fear of falling were assessed using Biodex Balance System, Berg Balance Scale (BBS), and Fall Efficacy Scale-International (FES-I), respectively. Postural stability indices, BBS, and FES-I scores improved immediately and one month after the intervention in the cerebellar a-tDCSC-PT group (p < 0.001). Postural stability indices were immediately improved after intervention in the control groups (P < 0.05), while the changes were not maintained one month after intervention (P > 0.05). However, FES-I was not changed after the intervention in the control groups (P > 0.05). Cerebellar a-tDCS induces the effects of postural training on posture and balance and controls the fear of falling. This knowledge helps the physicians/therapists plan tDCS interventions to improve the balance, posture, and fear of falling in MS patients.

The effects of concurrent M1 anodal tDCS and physical therapy interventions on function of ankle muscles in patients with stroke: a randomized, double-blinded sham-controlled trial study.

One of the most common symptoms in stroke patients is spasticity. The aims were to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the affected primary motor cortex (M1) on ankle plantar flexor spasticity and dorsiflexor muscle activity in stroke patients. The design of this study was a randomized sham-controlled clinical trial. Thirty-two participants with stroke were randomly assigned to three groups (experimental, sham, control groups). Participants in the experimental and sham groups received 10-session 20-min M1 a-tDCS concurrent with physical therapy (PT), while the control group only received 10-session PT. All groups were instructed to perform home stretching exercises and balance training. Berg Balance Scale (BBS), Modified Ashworth Scale (MAS) of plantar flexors, and EMG activity of lateral gastrocnemius (LG) and tibialis anterior (TA) were recorded during active and passive ankle dorsiflexion immediately and 1 month after interventions. A significant reduction was shown in MAS and EMG activity of LG during dorsiflexion, immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). BBS also significantly increased only in the M1 a-tDCS group (p <0.001). In addition, EMG activity of TA during active dorsiflexion increased immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). However, in the sham and control groups, EMG activity of TA increased immediately (p<0.001), while this was not maintained 1 month after intervention (p >0.05). PT concurrent with M1 a-tDCS can significantly prime lasting effects of decreasing LG spasticity, increasing TA muscle activity, and also balance in stroke patients.

Does forward head posture change subacromial space in active or passive arm elevation?

Objectives: Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.Methods: Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP. The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.Results: The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three. In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly. Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.Conclusions: The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.

Does anodal trans-cranial direct current stimulation of the damaged primary motor cortex affects wrist flexor muscle spasticity and also activity of the wrist flexor and extensor muscles in patients with stroke?: a Randomized Clinical Trial.

Spasticity is a common symptom in stroke survivors. This study is double-blinded, sham-controlled randomized, clinical trial with three parallel arms. The aim of the study was to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the damaged primary motor cortex (M1) on spasticity of the wrist flexor and also the activity of wrist flexor and extensor muscles in sub-acute stroke patients. This study was performed on 32 stroke patients. The patients are assigned to three groups (intervention, sham, and control). All participants in the first two groups received 20-min concurrent M1 a-tDCS or sham tDCS and functional electrical stimulation (FES) for 10 sessions (5 sessions per week), while participants in control group were given only 20-min FES for 10 sessions. Modified Ashworth scale of wrist flexors and also electromyography (EMG) activity of flexor carpi radialis (FCR) and extensor carpi radialis (ECR) were recorded before, immediately, and 1 month after the interventions. A significant reduction was shown in the MAS and EMG activity of FCR muscle at passive rest position of the wrist, immediately and 1 month after the intervention in M1 a-tDCS compared to sham and control groups (p < 0.001). Also, the EMG activity of FCR and ECR muscles during active wrist flexion and extension increased immediately and 1 month after intervention in M1 a-tDCS compared to the other groups, respectively (p < 0.001). M1 a-tDCS can significantly decrease the spasticity of wrist flexor muscle and also increase the wrist flexor and extensor muscles activity in stroke patients during active flexion and extension.

Cognitive Behavioral Therapy With Stabilization Exercises Affects Transverse Abdominis Muscle Thickness in Patients With Chronic Low Back Pain: A Double-Blinded Randomized Trial Study.

OBJECTIVE: Nonspecific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms, such as fear-avoidance behaviors. This study aimed to evaluate the effect of cognitive behavioral therapy (CBT) associated with stabilization exercise (SE) on thickness of transverse abdominis (TrA) muscle in patients with NCLBP. METHODS: Forty patients with NCLBP were randomly assigned into experimental CBT associated with SE (n = 20) and control groups without SE (n = 20). Transverse abdominis muscle thickness was assessed during abdominal drawing in maneuver (ADIM) and active straight leg raise (ASLR) of the right lower limb using ultrasound imaging. Fear-avoidance belief and disability were evaluated using a fear-avoidance belief questionnaire (FABQ) and a Roland-Morris disability questionnaire (RMDQ) before and after intervention. RESULTS: Mixed-model analysis of variance indicated that the effect of time was significant for the right and left TrA contraction thickness during ADIM and left TrA contraction thickness during ASLR (P < .05). However, the experimental group exhibited higher right and left TrA muscle thickness compared with the control group during ADIM (P = .001). Moreover, there were no significant differences between groups in the thickness of TrA muscle during ASLR (P > .05). The effect of time was significant for FABQ (P = .02) and RMDQ (P = .01); however, the effect of group was significant for the FABQ after intervention (P = .04). CONCLUSIONS: Stabilization exercise associated with CBT is more effective than SE alone in improving fear avoidance belief and in increasing the thickness of the TrA muscle during ADIM task.

Multi-session anodal transcranial direct current stimulation enhances lower extremity functional performance in healthy older adults.

The aim of this study was to examine the effects of 5 days of anodal-transcranial direct current stimulation (a-tDCS) over the primary motor cortex (M1) on lower extremity functional performance in healthy elderly people. This was a randomized, double-blinded, sham-controlled study whereby 32 healthy older individuals participated in two groups. The intervention group received 20 min of a-tDCS (1 mA) over the M1 on five consecutive days. The sham group received the same stimulation, but the tDCS device was turned off after 30 s of stimulation. Participants were asked to perform the Timed Up and Go (TUG), 30-s Chair Stand Test (30-s CST), and a Modified Figure of Eight Walk Test (MFEWT) on the first day before tDCS application, immediately, 30 min, and 1 week after the last session of stimulation. Results of the a-tDCS group showed that most of the test values had significant changes in post-test assessments compared to the pre-test (p < 0.05). When comparing the anodal and sham tDCS groups, the results showed a significant improvement in TUG and time-MFEWT immediately after (p = 0.02, p = 0.01), 30 min after (p = 0.04, p = 0.01) and 1 week after the last session of stimulation (p = 0.01, p = 0.01). Improvements in performance of the 30-s CST and the number of steps-MFEWT were not significant, except at 1 week after the last session for the steps-MFEWT (p = 0.04). The application of 20 min a-tDCS over the M1 for 5 consecutive days improves lower extremity functional performance in the healthy older participants.

Comparing the effects of multi-session anodal trans-cranial direct current stimulation of primary motor and dorsolateral prefrontal cortices on fatigue and quality of life in patients with multiple sclerosis: a double-blind, randomized, sham-controlled trial.

OBJECTIVE: To compare the effects of anodal trans-cranial direct current stimulation (a-tDCS) over primary motor and dorsolateral prefrontal cortices on Fatigue Severity Scale and its lasting effect on fatigue reduction and improvement in quality of life in patients with multiple sclerosis. DESIGN: A randomized, double-blinded, sham-controlled parallel clinical trial study. SETTING: Neurological physiotherapy clinics. SUBJECTS: Thirty-nine participants were randomly assigned to three groups: dorsolateral prefrontal cortex a-tDCS, primary motor a-tDCS (experimental groups) and sham a-tDCS. Finally, 36 participants completed the whole study (n = 12 in each group). INTERVENTIONS: Participants in the experimental groups received six-session a-tDCS (1.5 mA, 20 minutes) during two weeks (three sessions per week). The sham group received six sessions of 20-minute sham stimulation. MAIN MEASURES: The Fatigue Severity Scale and quality of life were assessed before, immediately and four weeks after the intervention. RESULTS: Findings indicated a significant reduction in the Fatigue Severity Scale and a significant increase in the quality of life in both experimental groups, immediately after the intervention (P < 0.001), while Fatigue Severity Scale and quality of life changes were not significant in the sham a-tDCS group (P > 0.05). In addition, improvement of the variables remained four weeks after the intervention in dorsolateral prefrontal cortex a-tDCS (mean differences (95% confidence interval): 0.03 (-0.63 to 0.68) as compared to primary motor (-0.62 (-0.11 to -1.14) and sham a-tDCS groups (-0.47 (-1.37 to 0.43)). CONCLUSION: Both primary motor and dorsolateral prefrontal cortex a-tDCS as compared to sham intervention can immediately improve fatigue and quality of life. However, the effects last up to four weeks only by the dorsolateral prefrontal cortex a-tDCS.

Does M1 anodal transcranial direct current stimulation affects online and offline motor learning in patients with multiple sclerosis?

OBJECTIVE: Multiple Sclerosis (MS) is one of the most common neurological diseases in the world. Due to structural and functional changes in central nerves system, the patients with MS may affected by sensory-motor learning deficits. The aims of the current study was to assess the effect of primary motor cortex (M1) anodal transcranial direct current stimulation (a-tDCS) on online and offline motor learning in patients with MS. MATERIALS AND METHODS: Thirty-nine patients with MS were randomly assigned in three groups: concurrent M1 a-tDCS and serial response time test (SRTT) (n=13), concurrent sham a-tDCS and SRTT (n=13) and SRTT-only control (n=13). The participants in all groups were asked to concurrently perform 20 minutes of SRTT. M1 a-tDCS group received 20-minute M1 a-tDCS (2 mA) concurrent with SRTT, while the a-tDCS was turned off after 30 seconds in the sham a-tDCS group. Response time (RT) and error rate (ER) during SRTT were assessed prior, during and 48 hours after the intervention. RESULTS: Online learning happened in all groups (P < 0.05), with more significant learning in M1 a-tDCS group as compared to the other groups (P < 0.05). However, offline learning was occurred only in M1 a-tDCS group (P < 0.05). CONCLUSIONS: The findings indicate offline motor learning impairment in patients with MS. M1 a-tDCS may be used for enhancement of motor learning especially offline learning in patients with MS.