Effects of modified long stick exercise on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis.

BACKGROUND: Hyperkyphosis is a condition often seen in older women. This condition causes muscle imbalance in the upper back of the body and impacts balance control. Long stick exercise (LSE) is an exercise programme for the elderly that improves muscle strength and balance control. OBJECTIVE: This research was designed to investigate the effects of a modified LSE on hyperkyphosis, muscle imbalance and balance control in elderly community-dwelling women with hyperkyphosis. METHODS: Twenty-eight elderly women with hyperkyphosis were divided into experimental and control groups. The experimental group was assigned to practice the modified LSE programme 30-40 minutes/day, 3 days/week, for 12 weeks. Hyperkyphosis, pectoralis minor length, muscle strength, functional reach test (FRT) and timed up and go test (TUG) were obtained at baseline, after 6 weeks and after 12 weeks of exercise. RESULTS: The experimental group demonstrated improved hyperkyphosis, pectoralis minor length, muscle strength, FRT, and TUG after 12 weeks of training. Moreover, the experimental group exhibited significantly greater improvements in all outcomes than the control group (p< 0.05). CONCLUSION: The modified LSE programme is an alternative exercise that is easy and low-impact for improving hyperkyphosis, muscle imbalance, and balance control in elderly community-dwelling women with hyperkyphosis.

Standardised 25-Step Traditional Thai Massage (TTM) Protocol for Treating Office Syndrome (OS).

Traditional Thai massage (TTM) is a unique form of whole body massage practiced to promote health and well-being in Thailand since ancient times. The goal of the present study was to create a standardised TTM protocol to treat office syndrome (OS) diagnosed based on the identification of the palpation of at least one so-called myofascial trigger point (MTrP) in the upper trapezius muscle. The new 90 min TTM protocol, which was developed following appropriate review of the literature and in consultation with relevant experts, has 25 distinct steps (20 pressing steps, 2 artery occlusion steps, and 3 stretching steps). Eleven TTM therapists treated three patients each using the new 90 min TTM protocol. All of the therapists reported scores greater than 80% in respect to their satisfaction and confidence to deliver the protocol, and all of the patients gave the treatment a satisfaction score of greater than 80%. The treatment produced a significant reduction in pain intensity measured on a Visual Analogue Scale (VAS), with minimum and maximum values of 0 and 10 cm, of 2.33 cm (95% CI (1.76, 2.89 cm), p < 0.001) and significant increase in pain pressure threshold (PPT) of 0.37 kg/cm2 (95% CI (0.10, 0.64 kg/cm2), p < 0.05). The protocol was revised based on the feedback and the results obtained, and the new standardised TTM protocol will be applied in a randomised control trial (RCT) to compare the efficacy of TTM and conventional physical therapy (PT) for treating OS.

The 7th cervical vertebra wall distance (C7WD) identifies balance control, functional mobility and the risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis.

BACKGROUND: Thoracic hyperkyphosis is common in the elderly, especially in women, and results in impaired balance control, impaired functional mobility and an increased risk of multiple falls. The 7th cervical vertebra wall distance (C7WD) is a practical method for evaluating thoracic hyperkyphosis. OBJECTIVE: This study calculated C7WD cut-off scores that may identify impaired balance control, impaired functional mobility and an increased risk of multiple falls in elderly community-dwelling women with thoracic hyperkyphosis. This study also explored the correlation between C7WD, balance control and functional mobility. METHODS: Sixty participants were assessed for thoracic hyperkyphosis using the C7WD, balance control using the functional reach test (FRT), functional mobility using the timed up-and-go test (TUG) and a history of falls using their personal information. RESULTS: The data indicated that a C7WD of at least 7.95 cm, 8.1 cm and 8.8 cm had a good to excellent capability of identifying impaired balance control, impaired functional mobility and an increased risk of multiple falls, respectively. The C7WD results were significant and correlated with balance control (rs=-0.68) and functional mobility (rs= 0.41). CONCLUSIONS: The C7WD may be utilised as a screening tool for these three impairments in this population.

Agreement between clinical measures to classify foot posture in asymptomatic adults.

BACKGROUND: Various clinical measures of static foot posture have been developed and used. However, consensus among clinical measures to classify foot posture remains to be established. Therefore, this study aimed to determine the level of agreement as a reliability component between two common clinical methods in asymptomatic adults: the normalised navicular height truncated (NNHt) and the Foot Posture Index-6 (FPI-6). METHODS: The NNHt and FPI-6 were conducted on 102 asymptomatic adults. The measurement sequence was randomly arranged for each participant. Weighted Kappa (Kw) was used to determine the agreement between the methods. RESULTS: Both the NNHt and FPI-6 achieved similar foot posture distributions: approximately 40-50% of the participants had a normal foot, approximately 40% had a pronated foot and approximately 10-20% had a supinated foot. The agreement between the methods to classify foot posture was excellent (Kw = 0.84). CONCLUSIONS: The present study found excellent agreement between two commonly used clinical measures. This finding highlights the NNHt and FPI-6 consensus for foot posture classification in asymptomatic adults.

Prevalence of Thai People with Lumbar Instability and Associated Factors: A Cross-Sectional Study.

Background: Lumbar instability has been extensively reported; however, the risk factors for lumbar instability remain poorly defined, and understanding this condition better would help health professionals and their patients. Proposal: To determine the prevalence of lumbar instability in Thai people with chronic low back pain (CLBP) and explore the factors associated with lumbar instability in these patients. Patients and Methods: Using multistage random sampling methods, 1762 participants with CLBP were enrolled in the study from six regions of Thailand. Data were collected using a paper-based questionnaire. Participants were interviewed by physical therapists in the hospital they attended. They were classified as having lumbar instability when they attained ≥7/14 items on the lumbar instability screening tool. Univariate and multivariate regression analysese were used to determine the possible factors associated with lumbar instability. Results: There were 961 (54.54%) participants with lumbar instability and 801 (45.46%) participants without. The eight factors associated with lumbar instability were: (i) age ≥40 years (AOR: 1.36; 95% CI: 1.09-1.69); (ii) body mass index ≥25 kg/m2 (AOR: 1.42; 95% CI: 1.16-1.74); (iii) having an underlying disease (AOR: 1.32; 95% CI: 1.06-1.65); (iv) frequent lifting ≥5 kg in occupational habits (AOR: 1.69; 95% CI: 1.36-2.09); (v) prolonged walking ≥4 hours per day (AOR: 1.31; 95% CI: 1.04-1.64); (vi) gardening in leisure time (AOR: 1.37; 95% CI: 1.10-1.71); (vii) other area of pain (AOR: 1.24; 95% CI: 1.01-2.52): and (viii) other area of numbness (AOR: 1.85; 95% CI: 1.50-2.27). When considering only women, prior pregnancy was associated with lumbar instability with OR of 1.76 (95% CI: 1.36-2.22), p-value <0.0001. Conclusion: When treating patients with CLBP who are suspected to have lumbar instability, healthcare professionals should consider associated factors that might be modifiable targets for interventions to improve outcomes.

Development and validation of the dizziness symptoms questionnaire in Thai-outpatients / Desenvolvimento e validação do questionário de sintomas de tontura em pacientes tailandeses

Abstract Introduction "Dizziness" is a common complaint in clinical practice that can occur with anyone. However, since the symptom is caused by a wide range of disorders, a general clinician usually faces some difficulty to detect the cause. Objective This study aimed to formulate and validate a simple instrument that can be used to screen and predict the most likely cause of dizziness in Thai outpatients. Methods This study was divided into two phases. Phase I included 41 patients diagnosed with common causes of dizziness to determine the algorithm and construct the "structural algorithm questionnaire version 1". In addition, to test and retest its content validity and reliability until the instrument had an acceptable level of both. Phase II of the study pertained to evaluating its accuracy in clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their medical appointment. Results The degree of agreement between the algorithm results and clinical diagnoses was within an acceptable level (κ = 0.69). Therefore, this algorithm was used to construct the structural algorithm questionnaire version 1. The content validity of the structural algorithm questionnaire version 1 evaluated by seven experts. The content validity index values of the questionnaire ranged from 0.71 to 1.0. The Cohen's kappa coefficient (κ) of intra-rater reliability of the structural algorithm questionnaire version 1 was 0.71. In clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their appointment. The overall agreement between their questionnaire responses and final diagnoses by specialists showed a moderate degree of clinical accuracy (κ = 0.55). Conclusions The structural algorithm questionnaire version 1 had a well-developed design and acceptable quality pertaining to both validity and reliability. It might be used to differentiate the cause of dizziness between vestibular and non-vestibular disorders, especially of outpatients with dizziness symptoms.

Resumo Introdução "Tontura' é uma queixa comum na prática clínica que pode ocorrer com qualquer pessoa. No entanto, como o sintoma pode ser causado por uma grande quantidade de distúrbios, o clínico geral normalmente enfrenta alguma dificuldade em detectar sua causa. Objetivo Formular e validar um instrumento simples que pode ser usado para rastrear e predizer a causa mais provável de tontura em pacientes ambulatoriais tailandeses. Método Este estudo foi dividido em duas fases. A fase I consistiu em determinar o algoritmo, usaram‐se 41 pacientes com diagnóstico de causa comum de tontura, depois construir o questionário de algoritmo estrutural versão 1 (structural algorithm questionnaire version 1) e testar e retestar a validade de seu conteúdo e sua confiabilidade até que o instrumento apresentasse um nível aceitável de ambos. A fase II do estudo consistiu em avaliar a precisão do instrumento em ensaios clínicos, 150 pacientes com tontura foram pessoalmente entrevistados enquanto aguardavam o atendimento médico. Resultados O grau de concordância entre os resultados do algoritmo e os diagnósticos clínicos ficou dentro de um nível aceitável (κ = 0,69). Portanto, esse algoritmo foi usado para construir o questionário de algoritmo estrutural versão 1. A validade de conteúdo do questionário foi avaliada por sete especialistas. Os valores do índice de validade de conteúdo do questionário variaram de 0,71 a 1,0. O coeficiente kappa de Cohen (κ) de confiabilidade intraexaminador foi de 0,71. Em estudos clínicos, 150 pacientes com tontura foram pessoalmente entrevistados enquanto aguardavam a consulta com o médico. A concordância geral entre as respostas ao questionário e os diagnósticos finais dos especialistas mostrou um grau moderado de acurácia clínica (κ = 0,55). Conclusões O questionário de algoritmo estrutural versão 1teve um desenho bem desenvolvido e qualidade aceitável no que diz respeito à validade e confiabilidade. Pode ser usado para diferenciar a causa da tontura entre distúrbios vestibulares e não vestibulares, especialmente em pacientes ambulatoriais com sintomas de tontura.

A 6-Week Nine-Square Exercise Programme for Collegiate Athletes with Chronic Ankle Instability: A Randomised Controlled Trial.

Background: Individuals with chronic ankle instability (CAI) have poor postural stability, functional limitations and low quality of life. Although nine-square exercise can improve postural control, there is limited evidence demonstrating whether it can function as an alternative CAI rehabilitation programme. This study aimed to determine the effects of nine-square exercise on postural stability and self-reported outcomes in individuals with CAI. Methods: Eighteen male collegiate athletes with CAI participated in either a 6-week nine-square exercise or a control group (n = 9 per group). At baseline and post-intervention, the participants undertook clinical tests to measures dynamic and static postural control, and self-reported outcomes regarding ankle stability and function. Results: Within-group differences, the nine-square exercise group experienced improved dynamic postural control (P = 0.004), static postural control (P = 0.001) and self-reported outcomes (P < 0.05). For the control group, only static postural control improved (P = 0.018). Post-intervention, the nine-square exercise group experienced significant improvements in dynamic postural control (P < 0.001), ankle stability (P = 0.002) and functional ability (P < 0.05) relative to the control group. Conclusion: These findings suggest that the nine-square exercise can offer an alternative rehabilitation programme for improving postural control, self-perceived ankle stability and functional ability in CAI.

Translation, cross-cultural adaptation, and psychometric properties of the Thai version of the Identification of Functional Ankle Instability (IdFAI-THAI) questionnaire.

BACKGROUND: This study developed a Thai version of the Identification of Functional Ankle Instability (IdFAI-THAI) questionnaire. METHODS: To determine construct validity, 200 participants with a history of lateral ankle sprain completed the IdFAI-THAI, the Modified Thai Lower Extremity Functional Scale (LEFS), the Visual Analog Scale of Instability (VAS-I), and the Thai Foot and Ankle Ability Measure (FAAM). Eight days later, 100 randomly selected participants refilled the IdFAI-THAI to assess test-retest reliability and internal consistency. RESULTS: The IdFAI-THAI moderate correlated with the LEFS (rs = -0.62), the VAS-I (rs = 0.62), and the FAAM (rs = -0.63 and -0.69 for the activities of daily living and sports subscales, respectively). The IdFAI-THAI had good test-retest reliability (ICC2,1 = 0.89) and excellent internal consistency (Cronbach's alpha = 0.94). Ceiling and floor effects were absent. CONCLUSION: The valid and reliable IdFAI-THAI can identify chronic ankle instability among Thai speakers in clinical and research settings.

Development and validation of the dizziness symptoms questionnaire in Thai-outpatients.

INTRODUCTION: "Dizziness" is a common complaint in clinical practice that can occur with anyone. However, since the symptom is caused by a wide range of disorders, a general clinician usually faces some difficulty to detect the cause. OBJECTIVE: This study aimed to formulate and validate a simple instrument that can be used to screen and predict the most likely cause of dizziness in Thai outpatients. METHODS: This study was divided into two phases. Phase I included 41 patients diagnosed with common causes of dizziness to determine the algorithm and construct the "structural algorithm questionnaire version 1". In addition, to test and retest its content validity and reliability until the instrument had an acceptable level of both. Phase II of the study pertained to evaluating its accuracy in clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their medical appointment. RESULTS: The degree of agreement between the algorithm results and clinical diagnoses was within an acceptable level (κ = 0.69). Therefore, this algorithm was used to construct the structural algorithm questionnaire version 1. The content validity of the structural algorithm questionnaire version 1 evaluated by seven experts. The content validity index values of the questionnaire ranged from 0.71 to 1.0. The Cohen's kappa coefficient (κ) of intra-rater reliability of the structural algorithm questionnaire version 1 was 0.71. In clinical trials, 150 patients with dizziness had a face-to-face interview while they were waiting for their appointment. The overall agreement between their questionnaire responses and final diagnoses by specialists showed a moderate degree of clinical accuracy (κ = 0.55). CONCLUSIONS: The structural algorithm questionnaire version 1 had a well-developed design and acceptable quality pertaining to both validity and reliability. It might be used to differentiate the cause of dizziness between vestibular and non-vestibular disorders, especially of outpatients with dizziness symptoms.

The Cut-Off Score of Four Clinical Tests to Quantify Balance Impairment in Individuals with Chronic Ankle Instability.

BACKGROUND: Balance impairment is a common consequence of chronic ankle instability (CAI). This study aimed to assess the discriminative validity of four clinical tests for quantifying balance impairment in individuals with CAI. METHODS: Participants were screened for their balance using the single-leg balance test (SLBT) and were assigned to either the positive or the negative SLBT groups. Fifty-four individuals with CAI (N = 27 per group) were recruited and completed four clinical tests including the foot-lift test (FLT), the time-in-balance test (TIBT), the modified star excursion balance test in the posteromedial (mSEBT-PM) direction and the side-hop test (SHT). The receiver operating characteristics (ROC) curve coupled with Youden index were calculated to determine the optimal cut-off scores of each test. RESULTS: We found significant differences in balance between groups for all tests, with good to excellent values for the area under the ROC curve (AUC). All four tests reached good to excellent sensitivity and specificity values and had significant cut-off scores to discriminate balance performance among CAI participants. CONCLUSION: All four clinical tests can be conducted with their respective cut-off scores to quantify balance impairment in individuals with CAI.

Ergonomic arm support prototype device for smartphone users reduces neck and shoulder musculoskeletal loading and fatigue.

Smartphone use is a risk factor for both neck and shoulder musculoskeletal disorders. The objective of this study was to evaluate an ergonomic arm support prototype device, which may help improve posture while using a smartphone, by determining its effect on muscle activity, muscle fatigue, and neck and shoulder discomfort. Twenty-four healthy young adult smartphone users performed 20 min of smartphone game playing under two different conditions, smartphone use with support prototype device (i.e. intervention condition) and without (i.e. control condition), while neck and shoulder posture were controlled at 0° neck flexion and 30° shoulder flexion. Activity and fatigue of four muscles were measured using surface electromyography (sEMG), these were: anterior deltoid (AD), cervical erector spinae (CES), upper trapezius (UT) and lower trapezius (LT). The intervention condition showed significantly decreased activity of all muscles. Fatigue of all muscles, except LT, significantly increased over time compared to the start point in the control condition. There was no significant difference in muscle fatigue between each time point in the intervention condition. In conclusion, the ergonomic arm support prototype device can be used as ergonomic intervention to reduce neck and shoulder muscle loading and fatigue.

Influence of timing protocols and distance covered on the outcomes of the 10-meter walk test.

Background: The 10-meter walk test (10MWT) is commonly used to reflect a walking speed, health status, and functional ability of many individuals. However, the test is currently applied using various timing protocols and distance covered that may affect data interpretation with a standard value, and comparisons among the studies. Objective: This study investigated the influence of timing protocols and distance covered on the outcomes of the 10MWT in 78 participants who walked at various speeds, including healthy adults (n = 33), healthy elderly (n = 29), and clinical samples with impaired walking ability (walked slower than 0.8 m/s, n = 16). Methods: The participants were timed while they walked (1) over a 10-meter walkway using static and flying starts; and (2) over 4 and 10 meters using a flying start. The comparisons for outcomes of the timing protocols (static and flying starts), and distance covered (4 and 10 meters) for each group of participants was executed using the dependent samples t-test. Results: A walking speed using a static start was slower than that using a flying start approximately 0.05-0.11 m/s for each group (p < 0.001). On the contrary, the outcomes of a flying start over 4 and 10 meters showed no significant differences (p > 0.05). Conclusions: The findings clearly confirmed the influence of timing protocols on the outcomes of the 10MWT in individuals with various walking speeds, and a flying start over 4 meters in the middle of a 10-meter walkway can be applied as an alternative protocol of the 10MWT when area limits.

Progressive decrease in leg-power performance during a fatiguing badminton field test.

[Purpose] This study aimed to evaluate the changes in leg-power generation that accompany competitive badminton, as simulated in a badminton field test (FT). [Participants and Methods] Fifteen male badminton players with 1-2 years of experience performed five repetitions of an FT involving rapid and randomly assigned shuttle-run movements between markers distributed around a badminton court. Repetitions were separated by a 1-minute rest period. Peak mechanical power, obtained from the serial vertical jump tests, was used to estimate fatigue and performance reduction. [Results] Decreases in distance and time were significantly different in each of the five FT repetitions while maintaining the same speed for the condition. The peak mechanical power and fatigue index significantly declined. The reduction in the peak mechanical power percentage (11.78-35.49%) was in the acceptable peak mechanical power range for each FT set. These results were confirmed by the significant increase in the participants' blood lactate concentration levels, the rating of perceived exertion, and heart rate. [Conclusion] Leg-power generation could gradually be decreased in badminton competition as indicated by a badminton field test.

Reliability of novice and experienced physiotherapists using the normalized navicular height truncated and the foot posture index-6 for classifying static foot posture in adults.

[Purpose] To investigate the reliability of novice and experienced physiotherapists using the normalized navicular height truncated and the foot posture index-6 for classifying foot posture in healthy adults. [Participants and Methods] Thirty asymptomatic adults participated in this study. After brief training, inter-rater reliability was performed by an expert and inexperienced rater (the novice physiotherapist). On the same day, both raters independently performed the normalized navicular height truncated and the foot posture index-6. For intra-rater reliability, the inexperienced rater repeated data collection on the 8th day after the first assessment. Intraclass correlation coefficients (ICCs) and Cohen's Weighted Kappa (Kw ) were used for continuous and categorical data, respectively. [Results] The normalized navicular height truncated and the Rasch-converted foot posture index-6 scores demonstrated an excellent inter- and intra-rater reliability (ICCs=0.98-0.99). For classifying foot posture, the normalized navicular height truncated and the total foot posture index-6 scores represented more than 90% inter- and intra-rater agreement with Kw values ranging from 0.92-0.94, while each item of foot posture index-6 demonstrated inter- and intra-rater agreement ranging from substantial to almost perfect (Kw =0.71-0.94). [Conclusion] The normalized navicular height truncated and the foot posture index-6 are simple and reliable methods that can be used by the inexperienced rater.