Prevalence and risk factors of work-related musculoskeletal disorders among physical therapists in Ho Chi Minh City, Vietnam.

BACKGROUND: Understanding risk factors linked to work-related musculoskeletal disorders (WMSDs) is crucial for enhancing health promotion and ensuring workplace safety among healthcare professionals particularly physical therapists (PTs). However, in Vietnam, there has been lack of an investigation. Therefore, this study was to determine whether potential risk factors contributed to the occurrence of WMSDs among PTs in Ho Chi Minh City. METHOD: An online self-reported questionnaire for WMSDs comprising the Nordic Musculoskeletal Questionnaire (NMQ), Job-risk and Environmental factors, the Perceived Stress Scale (PSS-4) and the coping strategies, were distributed to PTs. They were enrolled if they had: age ≥ 22 years, graduated from PT program, a full-time job with ≥1 year of experience. Unadjusted and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were determined using Logistic regression. RESULTS: Our study found that within the past 12 months, the prevalence of WMSDs was 76.4% (n = 204/267): neck 58.4% and lower back 57.3%. PTs aged 22-29 years, < 4 years of education, and < 7 years of working experience were more likely to have WMSDs 2-3 times than those who did not. After adjusting for age, education, and work experience, PTs who engaged in manual techniques/exercises, lifting/transferring patients, and maintaining awkward postures were 5-7 times more likely to have WMSDs in the neck and lower back than those who did not. Environmental and psychological factors, such as number of treatment tables, size of electrotherapy rooms, using PTs modalities, and stress were significantly associated with WMSDs. More than 50% of PTs used modified positions and new treatment/techniques that did not aggravate their symptoms, as coping strategies. CONCLUSIONS: This study indicates potential risk factors associated with WMSDs, affecting the neck and lower back among PTs in Vietnam. These risk factors should be addressed to improve overall PTs health, retain skilled workers, and encourage them to continue working.

Factors associated with reduced risk of musculoskeletal disorders among office workers: a cross-sectional study 2017 to 2020.

BACKGROUND: Prolonged sitting at work should be avoided to reduce the risks of either noncommunicable diseases (NCDs) or musculoskeletal disorders (MSDs) among office workers. A short duration of breaks in sitting every hour can reduce cardiometabolic risk factors contributing to NCDs. However, the recommendation for a break from sitting at work to reduce the risks of MSDs has not been identified. Therefore, this study aimed to determine whether breaking by changing position at work, physical activity, physical fitness, stress and sleep were associated with MSDs among office workers. METHODS: A cross-sectional study was conducted from 2017 to 2020. Participants aged 20-59 years and using a computer at work ≥ 4 days/week were recruited. Data were collected using an online self-reporting questionnaire for computer users and 5 domains of physical fitness tests. Odds ratio (OR) with 95% confidence interval (CI) and multivariate logistic regression were used for statistical analysis. RESULTS: Prevalence of MSDs was 37.9% (n = 207/545) and the most area of complaint were the neck, shoulders and back. A nonsignificant association between physical fitness and MSDs among office workers was obtained. After adjusting for age, sex, body mass index, and comorbidity, moderate-to-vigorous intensity physical activity (MVPA) ≥ 150 min/week and sitting at work ≥ 4 h/day were MSDs risk factors (OR = 1.57, 95%CI = 1.04-2.37). Frequently changing positions from sitting to standing or walking at work every hour could reduce the risks of MSDs by more than 30%. The risks of MSDs increased among office workers who commuted by staff shuttle bus and personal car and had high to severe stress and slept < 6 h/day (1.6 to 2.4 times). CONCLUSION: Our findings indicated MVPA and prolonged sitting were MSD risk factors. We recommend office workers change position from sitting to standing or walking during work every hour and sleep ≥ 6 h/day to reduce risks of MSDs.

PHYSICAL ACTIVITY, SELF-ESTEEM, AND QUALITY OF LIFE AMONG PEOPLE WITH PHYSICAL DISABILITY.

Physical activity (PA) can improve health and quality of life (QOL) of healthy people. However, the association between PA and QOL among people with physical disability (PWPD) is inconclusive. This study was conducted to determine the relationships between factors including intensity of PA, activitiy in daily living (ADL), stress, and self-esteem that influences self-reported QOL among PWPD. The relationships were further explored using the in-depth interview method to find out whether the intensity of PA, stress, and self-esteem are related to QOL perception in PWPD. One hundred sixty PWPD aged 18-48 years who studied at a vocational school were enrolled. A mixed method case study was conducted: cross-sectional survey and in-depth interview. Five questionnaires, including the Barthel Index, Perceived Stress Scale (PSS), Rosenberg Self-Esteem Scale (RSES), and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) were distributed. QOL was measured using the WHOQOL_BREF. Multiple linear regression was used to determine factors for QOL prediction. For in-depth interview, ten persons from each group (poor-to-fair and good QOL) volunteered to explore further about life satisfaction related to physical disability. One hundred forty-six (91%) subjects completed all questionnaires. One hundred fourteen (77%) reported poor-to-fair QOL. QOL was explained by self-esteem and ADL (adjusted R² 34.7%, p < 0.001) after adjusted for age, stress, and PA. Although PA could not explain QOL in PWPD, good QOL reported high activities (28.40 ± 30.20 MET hour/day) compared to poor and fair QOL (17.94 ± 22.06 and 21.70 ± 17.75 MET hour/day). Those who had good QOL reported that they were proud to be independent and did not feel inferior. PA participation among people with disabilities should therefore be encouraged.

Trunk Extensor, Flexor and Lateral Flexor Endurance Time in Sedentary Workers Aged 20-49 Years.

OBJECTIVE: The purposes of this study were to (1) quantify trunk endurance times according to subjects' age and sex; and (2) identify factors affecting the endurance times. MATERIALS AND METHOD: Endurance times ofsedentary workers aged 20-49 years were determined by an extensor endurance, aflexor endurance, and right and left side bridge (trunk lateral flexor) tests. Each test was performed once in random order with a resting period of 10 minutes between tests. RESULTS: Of 137 workers, Two-way analysis ofvariance indicated that age had no effect on these 4 isometric trunk endurance tests. Sex had an effect on the extensor endurance test, and right and left side bridge tests. Females had longer endurance times than males for the trunk extensor muscle, whereas males had longer endurance times thanfemales for right and left lateral flexor trunk muscles. Low negative but significant Pearson ' correlations (r = -0.233 to -0.377, p = 0.047 to 0.001) were found between extensor endurance times vs. body weight and abdominal skinfold thickness in both sexes. Only in males, both right and left side bridge endurance times correlated with abdominal skinfold thickness (r = -0.296 and r = -0.382, respectively, p<0.05 both). CONCLUSION: Sex, weight and abdominal skinfold thickness factors should be considered when trunk muscle endurance is evaluated.

Correlation of Short Form-36, Energy Expenditure and Six-Minute Walk Test in Post Coronary Artery Bypass Graft and Post Percutaneous Coronary Intervention Patients.

OBJECTIVE: To investigate the correlation between Short Form-36 (SF-36) and exercise capacity including: (1) metabolic equivalents measured by an exercise stress test (METs of EST), (2) peak oxygen consumption (VO2 peak), and (3) walking distances measured by a six-minute walk test (6MWT). MATERIAL AND METHOD: SF-36, EST and 6MWT were estimated at the sixth week after coronary artery bypass graft (n=17) and percutaneous coronary intervention (n=13) patients. Pearson product-moment correlation was used to evaluate the relationship ofparameters. RESULTS: Physicalfunctioning scale ofSF-36showed moderate correlation with METs (r = 0.55, p<0.01),fair correlation with VO2 peak of 6MWT (r = 0.46, p<0.05) and walking distance (r = 0.43, p<0.05). Bodily pain showed fair correlation with METs (r = 0.40, p<0.05) and walking distance (r = 0.45, p<0.05). Socialfunctioningshowedfair correlation with METs (r = 0.38, p<0.05). Report-health transition showed fair correlation with METs (r = 0.38, p<0.05) and walking distance (r = 0.41, p<0.05). CONCLUSION: The physical domain ofSF-36 that comprised physicalfunction, role-physical, bodily pain and general health correlated with physical capacity ofthese post-operation groups (r = 0.49, p<0.001). Therefore, clinicians can use the SF-36 and 6MWTto evaluate functional capacity in addition to ESTand indirect calorimetry conveniently.

Effects of Thai Dancing on Median Neurodynamic Response During 4-Hour Computer Use.

OBJECTIVE: To investigate the effects of Thai dancing on median neurodynamic response during 4-hour computer use. MATERIAL AND METHOD: Twenty-four healthy participants aged 20-30 years performed 5 minutes of Thai dancing including Prom See Na, Yoong Fon Hang, Sod Soy Mala, Lor Keaw and Cha Nee Rai Mai during a 10-minute break of 4-hour computer use. All participants were assessed for nerve tension by elbow range of motion ofupper limb neurodynamic test 1 (ULNT1) and components of quick test. The discomfort was measured by visual analogue discomfort scale (VADS). These measurements were assessed before and after computer work. The statistical analyses employed paired t-test for continuous outcome and Friedman's test. RESULTS: The median nerve tension (indicated by elbow range of motion) was significantly reduced at before and after work, when 5 minutes of Thai dancing was introduced during the break. While components of the quick test emphasized that Thai dance immediately helped reduce the median nerve tension. The VADS in eight body areas increased over the period of 4 hours, but decreased after performing Thai dancing (p<0.05). CONCLUSION: Thai dancing helped relieve median nerve tension and body discomfort. It may be recommended as an exercise during break for computer users who continuously work to prevent WMSDs.

Trunk Muscle Performance and Work-Related Musculoskeletal Disorders among Manual Lifting with Back Belt Wearing Workers.

OBJECTIVE: to determine the effects ofback belt use on trunk muscle performance and the association between those performance outcomes with Work-Related Musculoskeletal Disorders (WMSDs). MATERIAL AND METHOD: All manual lifting workers in one grocery distribution, warehouse center were interviewed about the history of illness, back injury, WMSDs, lifting manner and experience of back belt use. They were assessedfor trunk muscles performance including the flexion (F), the extension (E) and the right and left side bridge (RSB and LSB) endurance test and Exercise Level of Lumbar Stabilization test (ELLS). Pearson s correlation and Spearman's rank correlation statistics were used to determine the association. RESULTS: One hundred and seven males, aged 18 to 42 years participated in the study. Most participants had ELLS at levels 2 (31.1%) and 3 (30.2%). The mean F, E, RSB and LSB endurance times were 62.33, 88.62, 77.17 and 77.33 seconds, respectively. The greatest area of WMSDs was the lower back (53.33%). Significant correlations were found between the ELLS and RSB (r = 0.244, p = 0.012) and between the ELLS and LSB (r = 0.199, p = 0.041). Significant correlations were found between pain scale of backpain and ELLS (r = -0.299, p = 0.016). Significant correlations were found between the number of WMSD areas and trunkflexion endurance (r = -0.263, p = 0.007), right trunk endurance (r,= -0.195, p = 0.044), left trunk endurance (r = -0.325, p = 0.001) and endurance ratio of RSB/LSB (r(s) = 0.224, p = 0.022). Furthermore, most participants (84.1%) had imbalanced endurance of RSB/LSB. Duration andfrequency ofback belt use did not correlate with any trunk muscle performance. This may have been because few participants did not wear belts (10.1%) or wore belts sometimes (26.6%). CONCLUSION: Low correlation was found between back belt use and WMSDs. To prevent back injury, the lifting workers should be trained to balance their trunk muscles endurance, especially right and left trunk muscles and to stabilize their lower back while lifting.

Muscle Activity of Abdominal and Back Muscles during Six Starting Positions in Untrained Individuals.

OBJECTIVE: This study aimed to investigate the electromyography (EMG) activity amongfive abdominal and back muscles at six starting positions in untrained individuals. MATERIALS AND METHOD: Twenty-five healthy individuals aged 20.9 +/- 3.9 years, who were inexperienced with lumbar stabilization exercise, were recruited. They were asked to perform maximum voluntary isometric contraction (MVIC), and then six starting positions in random order EMG data ofeach starting position were normalized as a percentage of MVIC. Friedman two-way analysis of variance (ANOVA) and Wilcoxon signed-ranks tests were used for data analysis. RESULTS: Significant differences in EMG activity of five abdominal and back muscles were found in all six starting positions (p<0.001). The highest EMG activity ofthe transversus abdominis/internal abdominal oblique (TrA/IO) was found in crook lying, with right leg lifted (CLR), and of multifidus (MF) in four-point kneeling with straight right leg lifted horizontally (4p-SRL). CONCLUSION: The results suggested that CLR and sitting on a gym ball (SG) were able tofacilitate TrA/IO activity with minimal activity from the rectus abdominis (RA), while CL, 4p-SRL, andSG were able tofacilitate MF activity with minimal activity from erector spinae (ES).

Cross-Cultural Adaptation of the Compendium of Physical Activity: Thai Translation and Content Validity.

OBJECTIVE: To translate the compendium physical activity (compendium) proposed by Ainsworth to Thai and to validate the Thai translated version. MATERIAL AND METHOD: Five steps of cross-cultural adaption were conducted as follows: (1) forward translation, (2) group review, (3) backward translation, (4) group review and final decision and (5) a pilot study. Eight hundred and twenty-one activities ofthe compendium were translated to Thai by two independents translators. Thai translated version was considered by 23 persons who have studied physical activity for at leastfive years. Backward translation was carried out by two bilingual translators. The research team completed the final Thai translation by comparing original and translated versions. For pilot study the Thai translated version was validated by 22 allied health persons. Data was analyzed by multi-rater agreement (Fleiss's kappa) and qualitative analysis. RESULTS: For translations and group review, recommendations included; (a) changing to lay language with the same meaning, (b) converting the U.S. customary unit to the metric unit, and (c) using consistent language. More than 80% of 22 persons accepted the Thai translation and the Kappa agreement rangedfrom 0.187 to 0.694. Some activities demonstratedpoor multi-rater agreement and required additional definitions. CONCLUSION: Thai translated compendium physical activity was constructed to reduce the language barrier and promote physical activity in Thailand. The poor to moderate agreement of each major heading of translation may partly be due to Western culture. Many activities in the compendium were assembled but they were not recognized by Thais. Hence, Thai compendium physical activity should to be developed in afuture study.

Immediate effects of breathing re-education on respiratory function and range of motion in chronic neck pain.

OBJECTIVE: Neck pain is associated with certain breathingpatterns and may lead to altered respiratory function. Moreover the altered breathing patterns may cause neck pain symptoms. This study has determined the effects of respiratory muscle reeducation on neck pain symptoms and respiratory function. MATERIAL AND METHOD: Subjects with chronic neck pain (n = 36) were re-educated with three breathing patterns for 30 min. The pain intensity at rest and at the end-of-range of each neck movement, the cervical range of motion (CROM) measured from photographic images and the chest expansion during full inhalation and exhalation recorded using videography were evaluated before and after breathing re-education. Upper trapezius, anterior scalene, and sternocleidomastoid activity were evaluated during normal and deep breathing using surface electromyography, and the respiratory function measured by a spirometer was also evaluated during the same period. RESULTS: The pain intensity and the muscle activity were significantly decreased after re-education. The CROM and chest expansion at lower rib cage were significantly increased after re-education. CONCLUSION: Breathing re-education can change breathing patterns and increase chest expansion. This change leads to an improvement in CROM Positive consequences may result from the improvement in diaphragm contraction or reduced activity of accessory muscles.

Trunk stabilizer muscle activity during manual lifting with and without back belt use in experienced workers.

OBJECTIVE: The present study evaluated the changes in trunk-stabilizer electromyography (EMG) activities during manual lifting with and without a back belt in experienced back belt users. MATERIAL AND METHOD: Eighteen participants from a warehouse and distribution center in Thailand, aged 22 to 44 years, were assessed for trunk stabilizer muscle EMG activity including the rectus abdominis (RA), external abdominal oblique (EO), transversus abdominis (TrA), internal abdominal oblique (IO), erector spinae (ES), and multifidus (MF). The EMG data were recorded during (1) rest and (2) the initial phase of manual lifting in a dynamic semi-squat posture. For both conditions, the data were compared with and without wearing a back belt. RESULTS: The results showed that wearing a back belt significantly decreased TrA/IO activity during rest (p<0.01) and significantly increased RA activity during the lifting period (p<0.05) as compared with the condition of no back belt. CONCLUSION: The present study does not recommend healthy workers wear a back belt as a protective device for lower back injury, particularly without any lifting activity. However the back belt can be applied during lifting as it can enhance RA activity, which may help improve abdominal pressure and is less likely cause weakness of the TrA.

Respiratory muscle strength explained by age and weight in female and male.

OBJECTIVE: To determine the relationship between respiratory muscle strength and age, sex, height and weight. MATERIAL AND METHOD: Maximal inspiratory mouth pressure (MIP) and maximal expiratory mouth pressure (MEP) were assessed in 249 subjects aged 30-70 years using a mouth pressure meter MIP was performed 10 times at residual volume, whereas MEP was performed 12 times at total lung capacity. Pearson's correlation was used to assess the association between respiratory muscle strength and characteristics data. Multiple linear regressions were used to establish the prediction equation of respiratory muscle strength. RESULTS: MIP decreased at ages beyond 60 years (p<0. 05) but age had no effect on MEP in both sexes. MIP was correlated with age, weight and height in males, and with age and weight only in females; whereas, MEP was not correlated with age, height and weight in either sex. Predicted MIP regression equations are MIP(female), = 77.57-0.59 age+0.62 weight (r2 = 0.164, p = 0.004), MIP(male) = 124.39-0.91 age+0.63 weight (r(2) = 0.175, p = 0.08). CONCLUSION: Sex, age and weight factors should be considered for MIP measurement.

Substrate utilization during and after high intensity exercise in healthy lean and obese men.

OBJECTIVE: To compare lipid and carbohydrate use during and after a high-intensity endurance exercise bout between lean and obese subjects. MATERIAL AND METHOD: Lean and obese healthy male subjects with energetic physical activity and stable body weight were recruited to participate in the present study. The respiratory exchange ratio (RER), lipid and carbohydrate oxidation, and lipid and carbohydrate energy expenditure during resting condition, high-intensity exercise and 180 min after exercise were determined by indirect calorimetry RESULTS: Ten lean and ten obese healthy male subjects, aged 26+/-4 years, completed a 300-kcal high-intensity exercise session. Resting energy expenditure and lipid energy expenditure in the obese group were significantly higher than those of the lean group. The RER, lipid oxidation, and carbohydrate oxidation were not significantly different between groups throughout the exercise period. The total energy expenditure and total lipid and carbohydrate energy expenditure were also not significantly different between lean and obese groups. During the 180-minute post exercise period, both lean and obese subjects showed a declination in RER and carbohydrate oxidation and an increase in lipid oxidation. CONCLUSION: Substrate use during and after high-intensity exercise between healthy lean and obese subjects was not significantly different. Both groups used carbohydrates and lipids as the main substrate sources during and after high-intensity exercise, respectively.

Metabolic equivalent of exercise stress test explained by six-minute walk test in post coronary artery bypass graft and post percutaneous coronary intervention patients.

OBJECTIVE: To investigate the relationship among metabolic equivalents of an exercise stress test (METs of EST), demographic parameters (age, body weight, height, BMI), peak oxygen consumption (VO(2) peak), and six-minute walk distances (6MWD) determined from a six-minute walk test (6MWT). MATERIAL AND METHOD: Exercise capacity was estimated by a 6MWT and EST at the sixth week post operation in post coronary artery bypass graft (post CABG n = 17) and post percutaneous coronary intervention (post PCI, n = 13)patients. RESULTS: METs of EST showed: high correlation (p

Online self-report questionnaire on computer work-related exposure (OSCWE): validity and internal consistency.

OBJECTIVE: To develop an online, self-report questionnaire on computer work-related exposure (OSCWE) and to determine the internal consistency, face and content validity of the questionnaire. MATERIAL AND METHOD: The online, self-report questionnaire was developed to determine the risk factors related to musculoskeletal disorders in computer users. It comprised five domains: personal, work-related, work environment, physical health and psychosocial factors. The questionnaire's content was validated by an occupational medical doctor and three physical therapy lecturers involved in ergonomic teaching. Twenty-five lay people examined the feasibility of computer-administered and the user-friendly language. The item correlation in each domain was analyzed by the internal consistency (Cronbach's alpha; alpha). RESULTS: The content of the questionnaire was considered congruent with the testing purposes. Eight hundred and thirty-five computer users at the PTT Exploration and Production Public Company Limited registered to the online self-report questionnaire. The internal consistency of the five domains was: personal (alpha = 0.58), work-related (alpha = 0.348), work environment (alpha = 0.72), physical health (alpha = 0.68) and psychosocial factor (alpha = 0.93). CONCLUSION: The findings suggested that the OSCWE had acceptable internal consistency for work environment and psychosocial factors. The OSCWE is available to use in population-based survey research among computer office workers.

Different Sagittal Angles and Moments of Lower Extremity Joints during Single-leg Jump Landing among Various Directions in Basketball and Volleyball Athletes.

[Purpose] The purpose of this study was to assess the sagittal angles and moments of lower extremity joints during single-leg jump landing in various directions. [Subjects] Eighteen male athletes participated in the study. [Methods] Participants were asked to perform single-leg jump-landing tests in four directions. Angles and net joint moments of lower extremity joints in the sagittal plane were investigated during jump-landing tests from a 30-cm-high platform with a Vicon™ motion system. The data were analyzed with one-way repeated measures ANOVA. [Results] The results showed that knee joint flexion increased and hip joint flexion decreased at foot contact. In peak angle during landing, increasing ankle dorsiflexion and decreasing hip flexion were noted. In addition, an increase in ankle plantarflexor moment occurred. [Conclusion] Adjusting the dorsiflexion angle and plantarflexor moment during landing might be the dominant strategy of athletes responding to different directions of jump landing. Decreasing hip flexion during landing is associated with a stiff landing. Sport clinicians and athletes should focus on increasing knee and hip flexion angles, a soft landing technique, in diagonal and lateral directions to reduce risk of injury.

Vibrotactile -Feedback Device for Postural Balance Among Malocclusion Patients.

Multiple studies have suggested that some associations exist between occlusal factors and postural alterations. OBJECTIVES: This study aimed to evaluate the effectiveness of a vibrotactile posture trainer device, comprised a wearable device containing an accelerometer sensor to measure the angle of the neck flexion (input) and provided real-time vibrotactile biofeedback (output) for postural balance among patients with malocclusion. METHODS: Twenty-four subjects were divided in 3 groups based on occlusion and using Angle's classification. Each group consisted of 8 patients for class I, II and III malocclusion. The Posture Trainer System was used for feedback concerning neck flexion angles when higher than 15 degrees. A 4-week training program to adjust posture balance in 2 axes (flexion-extension, lateral-flexion) was applied in activities for daily living. The assessments in this study were comprised of neck flexion angles from the Posture Trainer System and the center of pressure ([Formula: see text]) using a force plate. The effects of a vibrotactile posture trainer (baseline vs. post-training test) were evaluated using the paired t-test and were assumed to be significant at p < 0.05 (two-side). All analyses were conducted using the Statistical Package for Social Sciences, Version 21.0 (SPSS, Chicago, IL, USA). RESULTS: Neck flexion angles and center of pressure significantly decreased post-training by the Posture Trainer System among patients with class II malocclusion. No changes in the above parameters post-training were found in class I and class III. CONCLUSION: The results demonstrated that patients with class II malocclusion training by the Posture Trainer System lowered neck flexion angles and COP compared with pre-training. Clinical Impact: Feedback by the Posture Trainer System can help improve the postural balance in class II malocclusion.

The Effects of Ramp Gradients and Pushing-Pulling Techniques on Lumbar Spinal Load in Healthy Workers.

BACKGROUND: Many tasks in industrial and health care setting are involved with pushing and pulling tasks up or down on a ramp. An efficient method of moving cart which reduces the risk of low back pain should be concerned. This study aimed to investigate the effects of handling types (HTs) and slope on lumbar spinal load during moving a cart on a ramp. We conducted a 2 × 2 × 4 factorial design with three main factors: 2 HTs, 2 handling directions of moving a cart and 4 degrees of ramp slope. METHODS: Thirty healthy male workers performed 14 tasks consist of moving a cart up and down on the ramp of 0°, 10°, 15°, and 20° degrees with pushing and pulling methods. Joint angles from a 3D motion capture system combined with subject height, body weight, and hand forces were used to calculate the spinal load by the 3DSSPP program. RESULTS: Our results showed significant effect of HT, handling directions and slope on compression and shear force of the lumbar spine (p < 0.001). When the ramp gradient increased, the L4/5 compression forces increased in both pushing and pulling (p < 0.001) Shear forces increased in pulling and decreased in pushing in all tasks. At high slopes, pulling generated more compression and shear forces than that of pushing (p < 0.01). CONCLUSION: Using the appropriate technique of moving a cart on the ramp can reduce the risk of high spinal load, and the pushing is therefore recommended for moving a cart up/down on ramp gradients.

Effect of lower extremity exercise on muscle strength and physical capacity in COPD patients.

OBJECTIVE: Investigate the effect of lower extremity exercise on maximum lower extremity muscle strength and physical capacity in COPD patients. MATERIAL AND METHOD: Twenty moderate to very severe COPD patients were allocated into trained and control groups. The trained group received eight weeks of lower extremity functional exercise including forward step up, lateral step up, heel raise, and lunge at home. Maximum muscle strength and Six Minute Walk Distance (6MWD) assessments were performed at pre-training, week 4, and week 8 in hospital settings. RESULTS: There was no significant difference between trained and control groups in maximum muscle strength and 6MWD at the beginning of the program. However, there was a significant improvement in 6MWD after eight weeks of training, whereas there were no significant differences in the control group. CONCLUSION: Functional exercise may improve physical capacity in moderate to very severe COPD patients. It is beneficial and easy to perform at home.

Lumbar Multifidus and Erector Spinae Muscle Synergies in Patients with Nonspecific Low Back Pain During Prone Hip Extension: A Cross-sectional Study.

BACKGROUND: Prone hip extension is used to clinically assess movement control in patients with nonspecific low back pain (LBP). Excessive lumbopelvic movements and altered muscle activation patterns are common in patients with nonspecific LBP. However, no evidence exists regarding lumbar multifidus and lumbar erector spinae muscle synergy patterns in patients with nonspecific LBP during this clinical test. OBJECTIVE: To determine the difference in lumbopelvic motion and change in muscle synergy between patients with nonspecific LBP and healthy individuals. DESIGN: A cross-sectional study design. SETTING: University physical therapy clinic and laboratory. PARTICIPANTS: Seven patients with nonspecific LBP (age [mean ± SD] 29 ± 5 years, 43% female, body mass index [BMI] of 25 ± 2 kg/m2 , Numeric Pain Rating Scale 6 ± 2; Oswestry Disability Index 20% ± 8%) and seven age-, sex-, and BMI-matched healthy individuals (mean age 28 ± 5 years, 43% female, BMI of 22 ± 2 kg/m2 ) were recruited. METHODS: Each participant performed six repetitions of prone hip extension on each side; kinematic and electromyographic data were collected simultaneously. MAIN OUTCOME MEASUREMENTS: Kinematic data were used to represent lumbopelvic motion, whereas electromyography (EMG) data were used to represent muscle activity. A paired t-test was used to determine the difference in lumbopelvic motion. Principal component analysis and two-way repeated-measures analysis of variance were used to extract muscle synergies and identify differences in muscle synergy patterns between and within groups. RESULTS: Results demonstrated no significant group difference (P > .05) in amount of lumbopelvic motion. However, healthy individuals synergistically activate lumbar multifidus and lumbar erector spinae with 81.0% variance accounted for (VAF). Patients with nonspecific LBP had an altered synergy with independent activation of lumbar multifidus on the painful side with 32.0% VAF and the lumbar multifidus on the nonpainful side, and both lumbar erector spinae with 52.2% VAF synergistically activated. CONCLUSIONS: These findings suggest that clinicians should focus on muscle activation patterns rather than the amount of lumbopelvic motion during clinical observation of prone hip extension. LEVEL OF EVIDENCE: Level III.