A clinical practice guideline for the management of the foot and ankle in rheumatoid arthritis.

Rheumatoid arthritis causes progressive joint destruction in the long term, causing a deterioration of the foot and ankle. A clinical practice guideline has been created with the main objective of providing recommendations in the field of podiatry for the conservative management of rheumatoid arthritis. Thus, healthcare professionals involved in foot care of adults with rheumatoid arthritis will be able to follow practical recommendations. A clinical practice guideline was created including a group of experts (podiatrists, rheumatologists, nurses, an orthopaedic surgeon, a physiotherapist, an occupational therapist and patient with rheumatoid arthritis). Methodological experts using GRADE were tasked with systematically reviewing the available scientific evidence and developing the information which serves as a basis for the expert group to make recommendations. Key findings include the efficacy of chiropody in alleviating hyperkeratotic lesions and improving short-term pain and functionality. Notably, custom and standardized foot orthoses demonstrated significant benefits in reducing foot pain, enhancing physical function, and improving life quality. Therapeutic footwear was identified as crucial for pain reduction and mobility improvement, emphasizing the necessity for custom-made options tailored to individual patient needs. Surgical interventions were recommended for cases which were non-responsive to conservative treatments, aimed at preserving foot functionality and reducing pain. Moreover, self-care strategies and education were underscored as essential components for promoting patient independence and health maintenance. A series of recommendations have been created which will help professionals and patients to manage podiatric pathologies derived from rheumatoid arthritis.

Joint position sense testing at the wrist and its correlations with kinesiophobia and pain intensity in individuals who have sustained a distal radius fracture: A cross-sectional study.

BACKGROUND: Sensorimotor impairment following distal radius fracture (DRF) has been associated with a significant decline in function. Joint position sense (JPS) testing is a meaningful and responsive way to assess sensorimotor impairment for individuals who have sustained a DRF; however, there are factors that may influence the results of JPS testing, including kinesiophobia and pain intensity. PURPOSE: This study aimed to evaluate the influence kinesiophobia may have on wrist JPS testing and if pain intensity impacts kinesiophobia and JPS in individuals with a DRF. STUDY DESIGN: This was a cross-sectional study. METHODS: Participants referred from two medical centers with a diagnosis of DRF treated with at least 3 weeks of immobilization were enrolled in the study. Data were collected at 1 week and 6 weeks postimmobilization period. Demographics were summarized with descriptive statistics, and linear relationships between kinesiophobia, pain intensity, and wrist JPS were examined using Pearson correlation coefficient. RESULTS: Forty-eight participants were included in this study (mean age 42.9 years). Significant positive correlations were found between the Tampa Scale for Kinesiophobia (TSK) and Numeric Rating Scale (NRS; r = 0.951, p < 0.001), TSK and JPS error (r = 0.942, p < 0.001), as well as NRS and JPS error (r = 0.898, p < 0.001). These correlations indicate that higher levels of kinesiophobia are associated with increased pain intensity and greater JPS error. T-tests reveal no significant difference between male and female for the TSK, NRS, or JPS scores. CONCLUSIONS: There is an association for individuals with high levels of kinesiophobia and both greater pain and errors with JPS testing.

A global proprioception concept after hand injury-Patient report.

Hand therapist should take into consideration the importance of hand proprioception in long-term functional outcomes and its potential impairment due to various factors. Rehabilitation programs should focus on proprioceptive training for hand injuries but also consider broader aspects such as global proprioception, plantar support, posture, and balance. Patient's experience after a significant hand and forearm injury resulting from a sports accident, multiple surgeries, and the challenges of recovery emphasizes the importance of holistic approaches to rehabilitation, considering both physical and mental aspects, and praises the role of the physiotherapist in providing comprehensive support and building confidence.

The predictive value of self-efficacy in the evolution of rheumatoid arthritis and its relationship with pain and function.

BACKGROUND AND OBJECTIVES: Rheumatoid arthritis (RA) primarily affects the upper limbs and can cause disturbances in the performance of daily activities. The main objective of this study was to establish the relationship between self-efficacy, pain intensity, and duration of symptoms in patients with RA and analyse how each influences functional disability, and to determine the predictive value of self-efficacy over the other variables. METHODS: Cross-sectional study with a sample of 117 women diagnosed with RA. The endpoints were the visual analogue scale (VAS), Quick-DASH questionnaire and the Spanish scale of self-efficacy in rheumatic diseases. RESULTS: The most significant model for function (R2 = 0.35) includes function and pain, therefore, there is a relationship between self-efficacy, pain intensity, and upper limb functionality. DISCUSSION AND CONCLUSIONS: Our results agree with previous studies where a relationship between self-efficacy and functional disability is established, as well as self-efficacy and its relationship with physical functions, demonstrating that a low level of self-efficacy implies a decrease in functionality; however, no variable is more predictive than another.

Effectiveness of proprioception training in functional recovery of thumb osteoarthritis. Single, multicenter, non-blind randomized clinical trial.

BACKGROUND AND OBJECTIVES: Osteoarthritis at the base of the thumb (CMC-1 OA) is a pathology that mainly affects postmenopausal women. The main symptoms including pain, decreased hand-thumb strength and fine motor capacity. Although a proprioceptive deficit has already been demonstrated in people with CMC-1 OA, there is insufficient evidence regarding the effects of proprioceptive training. The main objective of this study is to determine the effectiveness of proprioceptive training in functional recovery. MATERIALS AND METHODS: A total of 57 patients were included in the study, 29 in the control group and 28 in the experimental group. Both groups underwent the same basic intervention programme, but the experimental group included a proprioceptive training protocol. Variables of the study were pain (VAS), perception of occupational performance (COMP), sense position (SP) and force sensation (FS). RESULTS: Statistically significant improvement was observed in the experimental group in pain (p < .05) and occupational performance (p < .001) after 3 months of treatment. No statistical differences were found in sense position (SP) or sensation of force (FS). DISCUSSION AND CONCLUSIONS: The results concord with previous studies focussing on proprioception training. The incorporation of a proprioceptive exercise protocol reduces pain and significantly improves occupational performance.

Impact of Social Isolation Due to COVID-19 on Daily Life Activities and Independence of People over 65: A Cross-Sectional Study.

The mandatory confinement caused by the COVID-19 pandemic has significantly affected the older adult population. The main objective of this study is to assess independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADDL) of people over 65 years of age during social, preventive, and compulsory isolation due to COVID-19, identifying and quantifying the activities of personal independence that present difficulties in their execution. DESIGN: A cross-sectional study. SETTINGS: Private's health insurance Hospital, Córdoba, Argentina. PARTICIPANTS: A total of 193 participants with mean age of 76.56 years (121 women and 72 men) who met inclusion criteria were included in the study. INTERVENTIONS: A personal interview was conducted between July and December 2020. Sociodemographic data were collected, and perceived independence was assessed. OUTCOMES MEASURES: The Barthel index and the Lawton and Brody scale were used to assess independence of basic and instrumental activities of daily living. RESULTS: Minimal limitations were noted with function. The activities that represented the greatest difficulties were going up and down stairs (22%) and moving around (18%), and the greatest difficulties in instrumental activities of daily living were shopping (22%) and preparing food (15%). CONCLUSIONS: COVID-19 has caused isolation, leading to functional limitations for many, especially older adults. Perceived declines in function and mobility may lead to decreased independence and safety for the older adult; therefore, preventative planning and programming should be considered.

Proprioceptive Neuromuscular Facilitation Protocol for Thumb Osteoarthritis: A Pilot Study.

BACKGROUND: Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint often presents with joint instability and proprioceptive deficits. Proprioception has been found to play an important role in the rehabilitative process. The purpose of this study was to evaluate the effectiveness of a proprioceptive training program on pain and function in individuals with early-stage thumb Carpometacarpal joint OA. METHODS: A double-blind experimental trial using a 2-group pretest/posttest design was used in this pilot study. Participants had a diagnosis of grade I and II thumb CMC joint OA in their dominant hand and a pain rating of >4/10 on Visual Analogue Scale. Participants received either standard treatment (control group) or standard treatment plus a proprioceptive training program (experimental group). Outcome measures were lateral pinch strength, pain intensity during activities, and proprioceptive response via joint position sense (JPS) testing. RESULTS: Twelve individuals (average age of 66.25 years) participated. Both groups had a statistically significant decrease in pain and increase in lateral pinch strength, all occurring with a large effect size but no statistically significant difference between groups. The experimental group experienced a large effect size for JPS testing, whereas the control group experienced a trivial effect size, and there was a statistically significant difference between groups for JPS testing. CONCLUSIONS: Individuals who completed the proprioceptive training program in this study had an improvement in proprioceptive functioning. This program shows potential for routine inclusion in hand therapy for thumb CMC joint OA; however, additional high-level studies with larger sample sizes are required.

Clinical effects of proprioceptive thumb exercise for individuals with carpometacarpal joint osteoarthritis: A randomized controlled trial.

STUDY DESIGN: Randomized Control Trial. INTRODUCTION: Thumb CMC joint OA is a common diagnosis. Currently there is no evidence available to under if proprioceptive neuromuscular training is an effective intervention for this population. PURPOSE OF THE STUDY: To establish the effectiveness of a proprioceptive training program as a complementary therapy for patients with thumb CMC joint OA. METHODS: Standard conservative thumb CMC joint OA treatments were received by both the control (n = 26) and experimental groups (n = 26) for a period of 12 weeks. The experimental group received a proprioceptive training program during the same intervention period. Outcome measures included severity of pain with activity according to the numerical rating scale (NRS), QuickDASH, Canadian Occupational Performance Measure (COPM), and proprioception via joint position sense (JPS). RESULTS: Fifty-two females participated in the study. Both the experimental and control group made both clinically and statistically significant changes in the mean VAS and COPM scores over time. Only the experimental group achieved a statistically and clinically significant change in JPS error score over time. DISCUSSION: Experimental group achieved a statistically significant change in JPS over time in concordance with previous investigations. Changes in pain scores differed from prior investigations and the between-group comparison was not statistically significant. Changes in the Quick DASH was similar to previous findings. CONCLUSION: Proprioceptive training in addition to a traditional rehabilitation program decreased error scores on the joint position sense test.

The Effect of Proprioception Training on Pain Intensity in Thumb Basal Joint Osteoarthritis: A Randomized Controlled Trial.

A randomized controlled trial of forty-five females over 18 years of age with diagnosis of thumb basal osteoarthritis in their dominant hand and with a minimum pain rating of 4/10 on the Visual Analogue Scale (VAS) during activities of daily living (ADLs) were recruited from March to June 2021. The group receiving proprioception training was compared to routine conservative physiotherapy treatment. The main purpose of this clinical trial is to test the effect of proprioception training on pain intensity in subjects with thumb osteoarthritis. Primary outcome was joint position sense (JPS) for the assessment of CMC proprioception and secondary outcomes were Visual Analogue Scale (VAS) and Canadian Occupational Performance Measure (COPM) for the assessment of patient satisfaction and the Quick-DASH which assessed upper limb function. A block randomization was carried out for the control group (n = 22) and experimental group (n = 23). Participants and evaluator were blinded to the group assignment. Proprioception training produced a statistically significant reduction in pain post intervention, but this reduction was small (d = 0.1) at the 3-month follow-up. JPS accuracy demonstrated statistically significant differences between the groups (p = 0.001) post-intervention and at the 3-month follow-up (p < 0.003). Statistically significant differences between means were found in both the Quick-Dash and COPM post intervention (both, p < 0.001), as well as at the 3-month follow-up (both, p < 0.001). There was a significant time factor for the reduction of pain intensity over time but effect sizes between groups was small at the 3-month follow-up period. Proprioceptive training improves thumb JPS accuracy; however, it does not contribute to a reduction in pain intensity in the long term. The inclusion of a proprioceptive program may be beneficial for improving individuals with thumb CMC OA sensorimotor performance. The study was registered at ClinicalTrials.gov NCT04738201. No funding was provided for this study.

Effects of Ischemic Compression on Trigger Points in the First Dorsal Interosseous Muscle in Patients with Thumb Carpometacarpal Osteoarthritis.

BACKGROUND: Thumb carpometacarpal osteoarthritis (CMC OA) is a common disorder that interferes with the ability to perform the activities of daily life. The purpose of this study was to investigate the immediate effects of ischemic compression on myofascial trigger points (MTrPs) in the first dorsal interosseous (FDI) muscle in patients with the diagnosis of thumb CMC OA. METHODS: In a quasi-experimental clinical trial, thirty-one patients, 87% female (age: 82 ± 9.4 years), with thumb CMC OA, were consecutively assigned to either an experimental treatment that included the ischemic compression of the FDI MTrP or a sham treatment of the FDI MTrP for one session. The main outcome considered in the study was the pressure pain threshold (PPT). Measurements were taken pre- and post-treatment and at a 1-week follow-up period. RESULTS: The PPT over the right (affected) FDI muscle showed statistically significant differences between groups at 1-week follow up (F = 3.518; p = 0.04) in favor of the experimental group. CONCLUSIONS: The ischemic compression of FDI-MTrPs is an appropriate part of a multimodal treatment to decrease local pain sensitivity in patients with CMC OA.

Effects of Neurodynamic Mobilizations on Pain Hypersensitivity in Patients With Hand Osteoarthritis Compared to Robotic Assisted Mobilization: A Randomized Controlled Trial.

OBJECTIVE: To evaluate the effectiveness of the neurodynamic mobilization techniques compared with passive robotic physiologic movement in patients with hand osteoarthritis (OA). METHODS: We conducted a randomized controlled trial. A total of 72 patients (mean ± SD age 71 ± 11 years) with dominant symptomatic hand OA were randomized in 2 groups, and both received 12 treatment sessions over 4 weeks. The experimental group received neurodynamic mobilization of the median, radial, and ulnar nerves, and the control group received robotic-assisted passive movement treatment. Both groups also participated in a program of hand stability exercises. Outcome measures included pain intensity, pressure pain thresholds (PPTs), and strength measurements. Group-by-time effects were compared using mixed-model analyses of variance. RESULTS: After the intervention, the experimental group had statistically significant, higher PPTs than the control group at the thumb carpometacarpal joint by 0.7 kg/cm2 (95% confidence interval [95% CI] 0.6, 0.8), the median nerve by 0.7 kg/cm2 (95% CI 0.6, 0.7), and the radial nerve by 0.5 kg/cm2 (95% CI 0.3, 0.6); however, the difference was not statistically significant at 3 months postintervention. Although mean values in the experimental group were higher than in the control group at all PPT sites at both assessments, these differences were not statistically significant. The experimental group experienced a statistically significant reduction in pain immediately postintervention, but this was not present at the 3-month follow-up. There were no statistically significant differences in pinch or grip strength between groups. CONCLUSION: We found that neurodynamic mobilizations decreased hypersensitivity in patients with hand OA immediately after the intervention; however, differences were no longer present at 3 months. The results suggest that these techniques may have some limited value in the short term but do not have lasting effects.

Pressure algometry and palpation of the upper limb peripheral nervous system in subjects with hand osteoarthritis are repeatable and suggest central changes.

STUDY DESIGN: Case-control study. INTRODUCTION: A subset of patients with hand osteoarthritis (OA) shows evidence of central pain phenotypes. PURPOSE OF THE STUDY: To examine whether differences exist in experimental pain responses in the affected and nonaffected sides of patients with unilateral hand OA. To investigate the test-retest reliability of pressure algometry and manual digital palpation in patients with unilateral hand OA. METHODS: The hand OA group consisted of 20 patients, and the control group consisted of 20 healthy subjects. Pressure pain threshold (PPT) measurements were made 2 times, consisting of 3 repeat trials, each using computerized algometry and manual digital palpation. Grip and key strength (dynamometer), pain (visual analog scale), and function (Disabilities of the Arm, Shoulder and Hand [short version]) were also measured. The 2-way analysis of variance was conducted to determine the differences between sides and groups. Intraclass correlation coefficient (ICC) and standard error of measurement were calculated. RESULTS: Patients with hand OA had decreased PPTs over the thumb carpometacarpal joint as well as radial and median nerves compared with controls (all P < .01). No significant group effect by side interaction was detected for any measure. The minimal detectable change values needed to detect change in subjects with hand OA were C5-C6 joint (0.3-0.5 kg/cm2), carpometacarpal joint (0.3-0.5 kg/cm2), hamate bone (0.2-0.4 kg/cm2), radial nerve (0.2-0.8 kg/cm2), median nerve (0.3-0.6 kg/cm2), and ulnar nerve (0.2-0.4 kg/cm2) for PPT. Test-retest reliability was calculated for both hands of participants with OA (ICC, 0.98-0.99) and healthy participants (ICC, 0.74-0.99). DISCUSSION: Although pressure algometry and manual digital palpation are techniques already used in previous studies and have been shown to be reproducible and moderately reliable for joint palpation, this current study suggests that pressure algometry and manual digital palpation could also be reliable methods of determining nerve sensitivity of the radial, ulnar and median nerves in subjects with hand OA. CONCLUSIONS: Hyperalgesia in patients with hand OA might be associated with clinical measures, and bilateral signs in unilateral OA could suggest central changes.

Tendencies in the Post-surgical Approach for Carpal Tunnel Syndrome. Current Clinical Practice. / Tendencias en el abordaje posquirúrgico del síndrome del túnel del carpo. Práctica clínica actual.

BACKGROUND AND OBJECTIVES: Evidence and specific interventions after carpal tunnel release are limited. The main purpose of this study was to elucidate the current practice patterns of professionals from around the world after carpal tunnel release. MATERIAL AND METHODS: A 15-item English survey was designed and distributed via email and through social networks to professionals from different countries. A descriptive study of the items was carried out comparing them with the published evidence. RESULTS: In our study, we identified a great variety in the post-surgical approach of carpal tunnel syndrome in 23 different countries. DISCUSSION AND CONCLUSIONS: There are no common criteria in the techniques used after surgical decompression of the median nerve.

Effects of High-Intensity Laser Therapy on Pain Sensitivity and Motor Performance in Patients with Thumb Carpometacarpal Joint Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVE: To examine the effects of high-intensity laser therapy (HILT) on pain sensitivity and motor performance in patients with thumb carpometacarpal (CMC) osteoarthritis (OA). DESIGN: Prospective, triple-blinded, randomized, placebo-controlled trial. SETTING: Private practice, Malaga, Spain. SUBJECTS: Forty-three patients (mean ± SD age = 71 ± 12 years) with a diagnosis of thumb CMC OA grade 1-2 were randomized to the control group (N = 21) or experimental group (N = 22). METHODS: The experimental group (ExpG) received high-intensity laser therapy (HILT), and the control group (ConG) received a placebo treatment. The outcome measures were pain intensity (visual analog scale) and key pinch strength measurements (dynamometer). All outcome measures were collected at baseline, immediately following the intervention, at four weeks, and at 12 weeks following the intervention. RESULTS: Analysis of variance revealed a group × time interaction (F = 40.8, P < 0.001) for pain intensity, with those patients receiving LT experiencing a greater reduction in pain compared with those receiving placebo therapy at the end of the intervention (P < 0.001), as well as at 12 weeks after the intervention. Although mean values in the ExpG were higher than in the ConG for key pinch at assessment, these differences were not statistically significant. CONCLUSIONS: HILT effectively diminishes pain intensity when used as an isolated treatment for patients with thumb CMC OA, but the effect of treatment decreases after 12 weeks.

Platelet-rich plasma for thumb carpometacarpal joint osteoarthritis in a professional pianist: case-based review.

Thumb carpometacarpal osteoarthritis (TCMC-OA) is a progressively disabling, debilitating condition presenting with thumb base pain and hand functional impairment. Platelet-rich plasma has been used widely for the management of musculoskeletal pathologies, OA being among them. To our knowledge, only a few cases have been previously reported on this topic until now. A 59-year-old male professional pianist presented with chronic, mild onset of right thumb base pain involving a progressive lack of pinch strength in his right hand, and severe difficulties with playing. Three PRP injections were administered to the TCMC joint on a 1-week interval regime. Clinical outcomes were assessed by using the visual analog scale (VAS) for pain, grip and pinch strength, and the Quick-DASH Questionnaire. Functional outcome was excellent according to patient's capability with daily living activities and specific playing demands. At 12 months follow-up, no recurrences or complications were identified, with the musician returning to his previous level of performance 2 weeks before the end of this period. Patient self-reported satisfaction was high and he reported to return to his routine piano activity with no limitations. This case-based review study documents the clinical efficacy of PRP treatment from both functional and perceived-pain perspectives in a professional pianist. Presenting this case, our aim is to draw attention of healthcare providers dealing with TCMC-OA to PRP as a safe, beneficial therapy for this condition which needs further assessment in randomized controlled trials.

Prevalence of Myofascial Trigger Points in Poststroke Patients With Painful Shoulders: A Cross-Sectional Study.

BACKGROUND: In patients with stroke, hemiplegic shoulder pain can be a major problem. One source of shoulder pain can be myofascial trigger points (MTrPs). OBJECTIVE: To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between MTrPs and pain and function in patients presenting with shoulder pain following a stroke. DESIGN: Cross-sectional study. SETTING: Department of Physical Therapy. PATIENTS: Fifty patients with stroke with shoulder pain. INTERVENTION: Not applicable. MAIN OUTCOME MEASUREMENTS: The prevalence of the MTrPs located in infraspinatus, supraspinatus, teres minor, and upper trapezius was studied, using the diagnosis criteria recommended by Simons et al. The pressure pain threshold was also evaluated. Pain and function were assessed with the Visual Analogue Scale (VAS) and the Disability of the Arm, Shoulder and Hand (DASH) scale, respectively. RESULTS: The prevalence of latent MTrPs was 68%, 92%, 40%, and 62% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. The prevalence of active MTrPs was 34%, 50%, 12%, and 20% for supraspinatus, infraspinatus, teres minor, and upper trapezius muscle, respectively. Pain was moderately correlated with the prevalence of latent MTrPs (r = 0.35; P = .01) and active MTrPs (r = 0.31; P = .03) in the supraspinatus muscle. Disability was measured with the DASH scale and was moderately correlated with latent MTrPs in the infraspinatus (r = 0.31; P = .03) and active MTrPs of the supraspinatus (r = 0.32; P = .02). CONCLUSIONS: This study shows that the prevalence of MTrPs is high in patents following a stroke. MTrPs in this population are moderately associated with pain and function. LEVEL OF EVIDENCE: II.

Outcome measurement of hand function following mirror therapy for stroke rehabilitation: A systematic review.

STUDY DESIGN: Systematic review. INTRODUCTION: Mirror therapy is a treatment used to address hand function following a stroke. Measurement of outcomes using appropriate assessment tools is crucial; however, many assessment options exist. PURPOSE OF THE STUDY: The purpose of this study is to systematically review outcome measures that are used to assess hand function following mirror therapy after stroke and, in addition, to identify the psychometric and descriptive properties of the included measures and through the linking process determine if the outcome measures are representative of the International Classification of Functioning, Disability and Health (ICF). METHODS: Following a comprehensive literature search, outcome measures used in the included studies were linked to the ICF and analyzed based on descriptive information and psychometric properties. RESULTS: Eleven studies met inclusion criteria and included 24 different assessment tools to measure hand or upper limb function. Most outcome measures used in the selected studies (63%) were rated by the evaluating therapist. Thirteen outcome measures (54%) linked to the ICF body function category and 10 measures (42%) linked to activities and participation. One outcome measure was linked to not defined, and all other ICF categories were not represented. A majority of outcome measures have been assessed for validity, reliability, and responsiveness, but responsiveness was the least investigated psychometric property. DISCUSSION: Current studies on mirror therapy after stroke are not consistent in the assessment tools used to determine hand function. Understanding of study outcomes requires analysis of the assessment tools. The outcome measures used in the included studies are not representative of personal and environmental factors, but tools linking to body functions and activities and participations provide important information on functional outcome. CONCLUSIONS: Integrating a combination of measures that are psychometrically sound and reflective of the ICF should be considered for assessment of hand function after mirror therapy after stroke.

Linking hand therapy outcome measures used after carpal tunnel release to the International Classification of Functioning, Disability and Health: A systematic review.

INTRODUCTION: The goal of hand therapy after carpal tunnel release (CTR) is restoration of function. Outcome assessment tools that cover the concepts contained in the International Classification of Functioning, Disability and Health (ICF), a framework for describing functioning and disability, are appropriate for hand therapy treatment of this diagnosis. PURPOSE OF THE STUDY: To identify and review outcome measures used in studies on rehabilitation after CTR and link these to the concepts contained in the ICF. METHODS: A comprehensive literature search was conducted. Outcome measures in the included studies were linked to the ICF. For data calculation purposes, outcome measures were linked to the specific ICF category, which matched the majority of assessment items if there were components that fit into more than 1 category. The quality of the studies was evaluated, and effect sizes for the treatment interventions were calculated for a comprehensive systematic review. RESULTS: Seven studies met the inclusion criteria. Eleven outcomes (68.75%) were linked to body function, 1 (6.25%) to body structure, 3 (18.75%) to activity and participation, and 1 (6.25%) to environmental factors. No outcomes were associated with environmental factors or personal factors. Structured Effectiveness for Quality Evaluation of Study scores of the included studies ranged from 23 to 43/48. DISCUSSION: The predominant outcome tools in the current research on rehabilitation after CTR are impairment measures and are linked to the category of body structures and body functions. CONCLUSIONS: Functional measures, associated with the activity and participation category, are only modestly represented, and there is a lack of representation of environmental and personal factors for outcome measures used following CTR.

The Spanish Version of the Functional Rating Index in Patients With Low Back Pain: Preliminary Results of the Validation Study.

OBJECTIVE: To assess the reliability, validity, and the psychometric properties of the Spanish version of the Functional Rating Index (Sp-FRI) in a preliminary cohort of patients with low back pain (LBP). DESIGN: Prospective observational multicenter study. SETTING: Outpatient physical therapy clinics and units from public and private settings. PARTICIPANTS: Patients with LBP (N=22; 52.5±12.5y) entered the study. INTERVENTIONS: The translation and cross-cultural adaptation were performed following international guidelines through a 5-step procedure. MAIN OUTCOME MEASURES: The Sp-FRI was administered along with the Spanish version of Roland-Morris Disability Questionnaire (Sp-RMDQ) and numeric pain rating scale (NPRS) index. Preliminary testing included readability, comprehensibility, ceiling and floor effects, reliability, and validity. Statistical analysis was based on the Fernandez-Huerta index, and the calculation of Cronbach alpha, intraclass correlation coefficient (ICC), and Spearmans correlation coefficient, respectively. All patients completed the Sp-FRI again after 1-2 days to assess its test-retest reliability. RESULTS: None of the participants requested clarification of any of the items at the time of completion. The test-retest reliability of the FRI score was substantial (ICC 0.77). Cronbach alpha was 0.859. Spearman correlation coefficient between Sp-FRI and Sp-RMDQ was 0.66; P<.0001, and between Sp-FRI and NPRS was 0.66; P<.0001. No ceiling or floor effects were detected. CONCLUSIONS: In light of these preliminary data, the Sp-FRI appears to be linguistically accurate and has been adapted to the Spanish-speaking population. It demonstrated reliability and validity and is suitable for clinical and research use among Spanish patients with LBP, with an acceptable degree of internal consistency and concurrent validity.