The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain.

Background: The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls. Methods: Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability. Results: The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data. Conclusion: This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

Reliability of Knee Flexion-Extension Lyapunov Exponent in People With and Without Anterior Cruciate Ligament Deficiency.

OBJECTIVES: The current study assessed the intrasession and intersession reliability of the knee flexion-extension Lyapunov exponent in patients with anterior cruciate ligament deficiency and healthy individuals. STUDY DESIGN: University research laboratory. METHODS: Kinematic data were collected in 14 patients with anterior cruciate ligament deficiency and 14 healthy individuals walked on a treadmill at a self-selected, low, and high speed, with and without cognitive load. The intraclass correlation coefficient, standard error of measurement, minimal metrically detectable change, and percentage of coefficient of variation were calculated to assess the reliability. RESULTS: The knee flexion-extension Lyapunov exponent had high intrasession reliability, with intraclass correlation coefficients ranging from .83 to .98. In addition, the intersession intraclass correlation coefficient values of these measurements ranged from .35 to .85 regardless of group, gait speed, and dual tasking. In general, relative and absolute reliability were higher in the patients with anterior cruciate ligament deficiency than in the healthy individuals. CONCLUSIONS: Although knee flexion-extension Lyapunov exponent demonstrates good intrasession reliability, its low intersession reliability indicates that changes of these measurements between different days should be interpreted with caution.

Underlying pathway of factors leading to mental health in Iranian young adolescents: A structural equation modeling.

BACKGROUND: The present study aimed to provide a field-tested model of constituting factors affecting mental health in young Iranian adolescents. MATERIALS AND METHODS: In this cross-sectional study, a conceptual model was proposed based on an extensive literature review. A total of 254 young adolescents aged 11-14 years were recruited from north, south, east, and west regions of Tehran megacity by a random cluster sampling procedure, of whom 244 adolescents participated. The adolescents and their mothers altogether completed eight questionnaires pertaining to the proposed conceptual model: (1) Strengths and Difficulties Questionnaire (SDQ), (2) Childhood Experience of Care and Abuse Questionnaire, (3) Child Exposure to Domestic Violence Scale, (4) Drug Abuse Screening Test-10, (5) Baumrind Parenting Style Questionnaire, (6) Conflict Behavior Questionnaire, (7) General Health Questionnaire-28, and (8) Garmaroodi Socioeconomic Status Questionnaire. The statistical analysis was performed using structural equation modeling. RESULTS: This study demonstrated that parent mental health (b = -0.111), experience of father's care (b = -1.112), conflict with mother (b = 0.309), conflict with father (b = 0.135), and exposure to domestic violence (b = 0.217), as well as age (b = 0.93) and gender (b = 0.139), had direct effect on adolescent mental health (all P < 0.05). Further, the results showed that exposure to domestic violence and conflict with mother had the greatest direct impact on adolescent mental health among all other family-related factors, followed by conflict with father and parent mental health. Conflict with mother and conflict with father also affected adolescent mental health indirectly through experience of domestic violence and had a mediating effect for the influence of several other factors on adolescent mental health, thus playing an important role in the pathway leading to young adolescent mental health status in the Iranian population. CONCLUSION: Overall, the final model proved to be fit and the factors constituting the final model were able to predict 88% of the variations in the mental health of Iranian adolescents. This model can guide clinical psychologists, psychiatrists, and other mental health workers in a more realistic and effective prevention or treatment planning for their young clients. Moreover, it may help in arriving at a comprehensive preventive policymaking for mental health policymakers.

Attention demands of postural control in non-specific chronic low back pain subjects with low and high pain-related anxiety.

Impaired postural control in chronic low back pain (CLBP) has been attributed to deficits in sensory and motor functions. However, it is not known if pain-related anxiety affects motor and cognitive function of postural control. The aim of this study was to compare the interactive effects of postural and cognitive function in CLBP patients with high and low pain-related anxiety and healthy subjects. Thirty-eight patients with nonspecific CLBP (19 with low and 19 with high pain-related anxiety levels) and 20 asymptomatic subjects participated. Postural control was assessed by center of pressure (COP) parameters including mean total sway velocity, area, anterior-posterior (A-P), and medial-lateral (Med-Lat) range. Postural task was assessed during four conditions (eyes open with and without ankle vibration-eyes closed with and without ankle vibrations). Participants performed the postural task with or without auditory Stroop task. Average reaction time and error ratio of auditory Stroop test were calculated as measures of the cognitive task performance. Significantly reduced sway area was observed in CLBP patients with high pain-related anxiety and control subjects during the dual-task condition as compared with the single task. In addition, A-P range was significantly reduced in CLBP patients with high pain-related anxiety during dual tasking when eyes were closed with ankle vibration. In addition, only the CLBP subjects with high pain-related anxiety showed significantly longer reaction times by increasing the difficulty of standing postural task. Pain-related anxiety may influence the postural cognitive interactions in CLBP patients. Furthermore, it may be considered as a contributing factor for postural strategies adopted by CLBP patients.

Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain.

OBJECTIVES: Low back pain (LBP) is a common musculoskeletal disorder among different age groups, including adolescents. The purpose of this study was to compare the abdominal muscle thickness between healthy adolescents and those with LBP. METHODS: One hundred sixty healthy high school adolescents and 80 high school adolescents with LBP participated in the study. All participants were asked to complete a demographic questionnaire and also a visual analog scale and the Oswestry Disability Questionnaire to evaluate the pain intensity and functional disability. Then abdominal muscle thickness was examined with ultrasonography. RESULTS: The healthy high adolescents included 80 boys and 80 girls, and the adolescents with LBP included 40 boys and 40 girls. The results showed a significant difference between healthy adolescents and those with LBP in terms of abdominal muscle thickness (P < .05). Patients with LBP had smaller abdominal muscles compared with healthy adolescents. No significant difference was found between the groups in terms of the subcutaneous fat dimension (P > .05). CONCLUSIONS: The thickness of abdominal muscles was lower in adolescents with LBP. Future studies with a larger sample and a wider age range are recommended to support the results of this study.

Comparing Levels of Mastery Motivation in Children with Cerebral Palsy (CP) and Typically Developing Children.

INTRODUCTION: The present study aimed to compare motivation in school-age children with CP and typically developing children. MATERIAL AND METHODS: 229 parents of children with cerebral palsy and 212 parents of typically developing children participated in the present cross sectional study and completed demographic and DMQ18 forms. The rest of information was measured by an occupational therapist. Average age was equal to 127.12±24.56 months for children with cerebral palsy (CP) and 128.08±15.90 for typically developing children. Independent t-test used to compare two groups; and Pearson correlation coefficient by SPSS software applied to study correlation with other factors. RESULTS: There were differences between DMQ subscales of CP and typically developing groups in terms of all subscales (P<0.05). The lowest motivation scores of subscales obtained in gross motor persistence (2.4870±.81047) and cognitive-oriented persistence (2.8529±.84223) in children with CP. Motivation was correlated with Gross Motor function Classification System (r= -0.831, P<0.001), Manual ability classification system (r=-0.782, P<0.001) and cognitive impairment (r=-0.161, P<0.05). CONCLUSION: Children with CP had lower mastery motivation than typically developing children. Rehabilitation efforts should take to enhance motivation, so that children felt empowered to do tasks or practices.

The Persian Version of the "Life Satisfaction Scale": Construct Validity and Test-Re-Test Reliability among Iranian Older Adults.

After forward-backward translation, the LSS was administered to 334 Persian speaking, cognitively healthy elderly aged 60 years and over recruited through convenience sampling. To analyze the validity of the model's constructs and the relationships between the constructs, a confirmatory factor analysis followed by PLS analysis was performed. The Construct validity was further investigated by calculating the correlations between the LSS and the "Short Form Health Survey" (SF-36) subscales measuring similar and dissimilar constructs. The LSS was re-administered to 50 participants a month later to assess the reliability. For the eight-factor model of the life satisfaction construct, adequate goodness of fit between the hypothesized model and the model derived from the sample data was attained (positive and statistically significant beta coefficients, good R-squares and acceptable GoF). Construct validity was supported by convergent and discriminant validity, and correlations between the LSS and SF-36 subscales. Minimum Intraclass Correlation Coefficient level of 0.60 was exceeded by all subscales. Minimum level of reliability indices (Cronbach's α, composite reliability and indicator reliability) was exceeded by all subscales. The Persian-version of the Life Satisfaction Scale is a reliable and valid instrument, with psychometric properties which are consistent with the original version.

Translation, cross-cultural adaptation and factor analysis of the Persian version of ankle instability instrument.

Background: Ankle Instability Instrument (AII) is a questionnaire for determination of ankle stability status. The aim of this study is to cross-culturally translate and investigate the reliability and validity of AII in a sample of Persian-speaking Iranians, suffering from ankle sprain. Methods: One hundred twenty persons with a history of ankle sprain were recruited in the study. All participants completed the Persian version of Ankle Instability Instrument, Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure (FAAM) and Foot and Ankle Outcome Score (FAOS) at the baseline. Out of them, 60 randomly selected subjects completed the questionnaires once more, one week later. Face validity, Test-retest reliability, internal consistency, standard error of measurement, minimal metric detectable change, spearman's correlation coefficient and confirmatory factor analysis of AII measured. We used Lisrel v 8.80 software with significant level of p<0.05. Results: Persian version of AII is clear and unambiguous and its qualitative face validity was confirmed in the pilot study on the 20 subjects with a lateral ankle sprain. The interclass correlation coefficient, Cronbach's alpha, standard error of measurement and minimal metric detectable change were 0.93, 0.87, 0.81 and 2.25 (95% confidence interval, 0.85-0.96). The Spearman correlations coefficients between AII, and CAIT, FAAM and FAOS measures were 0.91, 0.71 and 0.69 respectively. The original three factor structure of AII was replicated based on the confirmatory factor analysis. Which showed an adequate fit of the model to the data and goodness-of-various fit indices. Conclusion: The Ankle Instability Instrument Persian Version (AII-PV) is a reliable and valid measure for assessing the ankle stability status.

Effects of narrow-base walking and dual tasking on gait spatiotemporal characteristics in anterior cruciate ligament-injured adults compared to healthy adults.

PURPOSE: The present experiment was conducted to examine the hypothesis that challenging control through narrow-base walking and/or dual tasking affects ACL-injured adults more than healthy control adults. METHODS: Twenty male ACL-injured adults and twenty healthy male adults walked on a treadmill at a comfortable speed under two base-of-support conditions, normal-base versus narrow-base, with and without a cognitive task. Gait patterns were assessed using mean and variability of step length and mean and variability of step velocity. Cognitive performance was assessed using the number of correct counts in a backward counting task. RESULTS: Narrow-base walking resulted in a larger decrease in step length and a more pronounced increase in variability of step length and of step velocity in ACL-injured adults than in healthy adults. For most of the gait parameters and for backward counting performance, the dual-tasking effect was similar between the two groups. CONCLUSIONS: ACL-injured adults adopt a more conservative and more unstable gait pattern during narrow-base walking. This can be largely explained by deficits of postural control in ACL-injured adults, which impairs gait under more balance-demanding conditions. The observation that the dual-tasking effect did not differ between the groups may be explained by the fact that walking is an automatic process that involves minimal use of attentional resources, even after ACL injury. Clinicians should consider the need to include aspects of terrain complexity, such as walking on a narrow walkway, in gait assessment and training of patients with ACL injury. LEVEL OF EVIDENCE: III.

Dual-Tasking Effects on Dynamic Postural Stability in Athletes With and Without Anterior Cruciate Ligament Reconstruction.

PURPOSE: To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls. METHODS: Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded. RESULTS: Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions. CONCLUSIONS: The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.

Reliability of dynamic balance simultaneously with cognitive performance in patients with ACL deficiency and after ACL reconstructions and in healthy controls.

PURPOSE: To determine the intra- and inter-session reliability of balance and cognitive performance in anterior cruciate ligament-deficient (ACLD) and ACL-reconstructed (ACLR) and matched athletes. METHODS: Using SMART EquiTest, recovery reactions of the groups were assessed during single-leg standing, following medium and large forward perturbations with and without performing a cognitive (Stroop) task. The outcomes included reaction time (RT), latency and amplitude for balance and error ratio (ER) and RT for cognitive performance. The participants of each group repeated the tests 2-7 days after the first session. Intraclass correlation coefficient (ICC) and standard error of measurement were computed in order to assess relative and absolute reliability, respectively. RESULTS: Single- and dual-task balance measures had moderate to very high reliability in ACLD (ICC = 0.63-0.88), ACLR (ICC = 0.62-0.93) and control (ICC = 0.69-0.98) athletes. The ICCs for RT of Stroop were between 0.87 and 0.90 in ACLD, between 0.70 and 0.74 in ACLR and between 0.66 and 0.70 in controls and for ER of Stroop were between 0.36 and 0.90 in ACLD, between 0.42 and 0.49 in ACLR and between 0.41 and 0.51 in controls. CONCLUSIONS: Balance measures and RT of the cognitive task in single- and dual-task conditions have acceptable reliability and may be incorporated into the evaluation of physical and mental function of athletes following ACL injury and reconstruction. ER of the cognitive task is less reliable which needs to be considered in future research. LEVEL OF EVIDENCE: Prognostic study, case-control, Level III.

Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain.

OBJECTIVE: The purpose of this study was to compare the effect of dual tasking on postural and cognitive performance between participants with and without nonspecific chronic low back pain. METHODS: In this 3-factor mixed-design study, dynamic postural stability was assessed in 15 patients with chronic nonspecific low back pain and 15 age-, sex-, and size-matched asymptomatic participants. Bilateral stance on a Biodex Balance System was investigated at 3 levels of postural task difficulty (different platform stabilities levels with eyes open and closed) and 2 levels of cognitive task difficulty (with or without auditory Stroop test). We measured anterior-posterior, medial-lateral, and overall indices for postural performance. Average reaction time and error ratio of a modified auditory Stroop test were calculated as measures of the cognitive task performance. RESULTS: Mixed-design 3-way analyses of variance revealed significant interactions. Post hoc 2-way analyses of variance showed significant group by cognitive task difficulty for anterior-posterior (P < .001), medial-lateral (P = .003), and overall stability indices (P < .001) on a stiffness level of 5 with eyes closed. At this level, there were significant differences between single- and dual-task conditions for anterior-posterior (P < .001), medial-lateral (P = .02), and overall stability indices (P < .001) only in the chronic low back pain group. Also, at the most difficult postural conditions, participants with chronic low back pain increased their error ratio (P = .002), whereas matched asymptomatic individuals increased their reaction time (P < .01) of the auditory Stroop test. CONCLUSION: Postural task performance is attenuated by cognitive loading at a moderate level of postural task difficulty. Therefore, to observe the effect of attentional demands of postural control, task difficulty should be considered.

Intrasession and intersession reliability of postural control in participants with and without nonspecific low back pain using the Biodex Balance System.

OBJECTIVE: The purpose of this study was to evaluate the reliability of the Biodex Balance System (BBS) (Biodex Medical Systems, Shirley, NY) in chronic low back pain (CLBP) patients and healthy individuals in various conditions of postural and cognitive difficulty. METHODS: In this methodological study, using the BBS, dynamic balance of 15 CLBP patients and 15 healthy matched individuals was assessed during bilateral stance in combined conditions of visual feedback (eyes open and eyes closed) and platform stability (levels 5 and 3), either isolated or concurrent with performing cognitive task (auditory Stroop task). The Overall stability index, anterior-posterior stability index, and medial-lateral stability index, provided by BBS as measures of postural performance, were recorded. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation were used to determine intersession and intrasession reliability of postural and cognitive measures. RESULTS: Biodex Balance System stability indices were more reliable in the CLBP (compared with healthy) group. The intersession ICCs in CLBP group for anterior-posterior stability index ranged from 0.60 to 0.88, for medial-lateral stability index from 0.64 to 0.94, and for OASI from 0.63 to 0.91. The intersession ICCs in healthy group for anterior-posterior stability index ranged from 0.42 to 0.86, for medial-lateral stability index from 0.56 to 0.89, and for OASI from 0.54 to 0.84. Biodex Balance System stability indices were more reliable in eyes-closed (compared with eyes-open) condition and platform stability level 5 (compared with level 3). CONCLUSION: Biodex Balance System stability indices appear to be reliable measures of postural control in the CLBP patients especially in more challenging conditions, such as when standing with eyes closed.

The Effect of Leg Dominance and Group Difference in Star Excursion Balance Test between Individuals with Chronic Ankle Instability, Ankle Sprain Copers and Healthy Controls.

Objectives: To evaluate patients with chronic ankle instability (CAI), copers who had a sprain without instability, and healthy controls using the Star Excursion Balance Test (SEBT). In addition, the reach distance was assessed between the both legs in terms of dominant and non-dominant in all groups. Methods: A total of 75 subjects (25 healthy, 25 CAI, and 25 Coper) participated. The maximum reach distance in SEBT was assessed in anterior (ANT), postero-medial (PM), and postero-lateral (PL) directions in both legs for each subject. All data were analyzed by SPSS version 21. Tukey post hoc test was used to compare all groups. Paired T-test was used to compare dominant and non-dominant legs in each group. Results: In 75 subjects have participated in the data collection, no significant differences were reported among all groups for age and BMI measurements. Significant lower reach distance in scores of ANT in the dominant leg of the CAI was demonstrated when compared with the control and the coper groups (P=0.008). No statistical significant difference was determined between the dominant and non-dominant legs in each group (P>0.05). Conclusion: It seems that relevant strategies for postural control should be taken into account in the rehabilitation setup of individuals with CAI.

Altered muscle strength and flexibility among a subgroup of women with chronic nonspecific low back pain: Cross-sectional case-control study.

OBJECTIVE: To compare muscle strength and flexibility among a subgroup of women with extension-related chronic nonspecific low back pain (CNLBP) with healthy controls. METHODS: In this case-control study, 32 subjects with and without extension-related CNLBP were tested (n = 16 in each group). Gluteal, abdominal, paravertebral, and hamstring strength, along with hip flexor flexibility and hamstring flexibility were compared between groups. Data were analyzed using the Mann-Whitney test (p < .007). RESULTS: The CNLBP subgroup displayed significantly lower strength of all muscles analyzed (p < .007), with the exception of gluteus medius. The flexibility of the hip flexors and hamstrings were not significantly reduced among the women with CNLBP (p > .007). DISCUSSION: The present study showed that alterations in muscle strength, but not flexibility, partly consistent with those previously hypothesized but not objectively reported, were present among a subgroup of women with extension-related CNLBP. These results may have implications for the selection of therapeutic exercises among this subgroup of people with CNLBP.

The interaction between the location of lower extremity muscle fatigue and visual condition on unipedal postural stability.

The purpose of this study was to investigate the effects of unilateral muscle fatigue induced on the hip flexors/extensors or the ankle plantar/dorsiflexors on unipedal postural stability under different visual conditions. Twenty-four healthy young women completed 2 testing sessions 1 week apart with a randomized order assigned according to the muscles tested. During each session, one set of muscle groups was fatigued using isokinetic contractions: ankle plantar/dorsi flexors or hip flexor/extensors. Postural stability was assessed during trials of unilateral stance on a force plate before and after the fatigue protocol. 10 s into the trial, subjects were asked to close their eyes. Mean velocity, the area of the 95% confidence ellipse, and standard deviation of velocity in anteroposterior and mediolateral directions of center of pressure displacements were calculated for two periods of 5 s, immediately before and 1 s after the eyes closure. The results of the repeated measures ANOVAs showed a significant fatigue-by-fatigue segment by visual condition interaction for the CoP parameters. When the vision was removed, the interaction between fatigue and fatigue segment was significant for the CoP parameters. In conclusion, fatigue in both proximal and distal musculature of the lower extremity yielded decreased postural stability during unipedal quiet standing in healthy young women. This effect was more accentuated when visual information was eliminated. Withdrawing vision following fatigue to the proximal musculature, led to a significantly greater impairment of postural stability compared to the fatigue of more distal muscles.

Static and dynamic postural control in competitive athletes after anterior cruciate ligament reconstruction and controls.

PURPOSE: To evaluate the test-retest reliability and compare the static and dynamic postural control values in competitive athletes following anterior cruciate ligament (ACL) reconstruction and controls. METHODS: Thirty athletes, 8.4 ± 1.8 months after ACL reconstruction, and thirty healthy matched controls were asked to execute single-leg stance and single-legged drop jump tests onto a force plate. Amplitude and velocity in anteroposterior and mediolateral directions, and mean total velocity were measured for static evaluation. Peak vertical ground reaction force (PVGRF) during landing and takeoff and loading rate were measured for dynamic evaluation. To evaluate test-retest reliability, 15 participants of each group repeated the tests 6-8 days after the first session. Mixed model of analysis of variance was used to determine differences between the involved, uninvolved, and control limbs. The test-retest reliability was measured using intraclass correlation coefficient and standard error of measurement. RESULTS: Greater postural sway has been observed in the operated leg of ACL-reconstructed athletes compared with the non-operated side (P < 0.01) and the matched limb of the control group (P < 0.01). During landing, PVGRF and loading rate on the uninvolved limb of the athletes who had undergone ACL reconstruction were greater in comparison with those of the control group (P < 0.001). Both static and dynamic postural measures have high test-retest reliability, ranging from 0.73 to 0.88. CONCLUSIONS: Static and dynamic postural measures are reliable tests to evaluate functional performance of athletes following ACL reconstruction. Eight months postsurgery, competitive athletes still demonstrated postural asymmetries, compared to matched controls, which might result in their susceptibility to future ACL injury. LEVEL OF EVIDENCE: Prognostic study, case-control, Level III.

Reliability of Center of Pressure measures of Postural Stability in Anterior Cruciate Ligament Reconstructed Athletes: Effect of Vibration and Cognitive Load.

Background: To evaluate intra and intersession reliability of the Center of Pressure (COP) parameters in Anterior Cruciate Ligament Reconstructed (ACLR) athletes with and without ankle vibration using a dual-task paradigm. Methods: Postural sway of 14 ACLR individuals was assessed during a single-leg stance on a force platform. COP parameters were assessed with manipulating sensory inputs via vision and ankle vibration under single and dual-task conditions. The outcome variables included COP displacement in medial-lateral (ML) and anterior-posterior (AP) range, mean velocity (mV), and area. During dual-task conditions, the auditory Stroop Task was applied. Intraclass correlation coefficient (ICC) values and standard error of measurement (SEM) were assessed for relative and absolute reliability. Results: The COP measures had moderate to very high intrasession reliability (ICC range: 0.51-0.93) for conditions with vibration and cognitive task, with the highest ICCs for mV and the lowest for area, regardless of eyes being open or closed. The intersession reliability was moderate to high for mV (ICC range: 0.60-0.82) and little to very high (ICC range: 0.21-0.97) for the range of ML and AP, as well as an area in conditions with vibration and cognitive task. Conclusion: The mV is the most reliable COP parameter for assessing postural control under ankle vibration and dual-task conditions for both operated and non-operated sides. During closed-eye conditions, the application of vibration affected the intersession reliability with decreased ICCs on the operated side and increased ICCs on the non-operated side.

Persian version of the LANSS and S-LANSS questionnaires: A study for cultural adaptation and validation.

The aim of this study was to culturally adapt and validate Leeds assessment of neuropathic symptoms and signs (LANSS) and self-report LANSS (S-LANSS) tools. Patients with chronic pain (n = 206) were categorized into neuropathic pain (NeP) (n = 101) or non-NeP (n = 105). After the translation process, both questionnaires and the Persian Douleur Neuropathique 4 (P-DN4) were administered to patients to assess the clinometric properties. The mean overall score of both tools was significantly higher in the NeP group (p < 0.01). Test-retest reliability analysis of the overall score of the Persian (P)-LANSS and PS-LANSS were 0.99 and 0.98, respectively. α-Cronbach value for P-LANSS and PS-LANSS were 0.64 and 0.61, respectively. Factor analysis of both questionnaires yielded two components explaining most of the observable variance. The P-LANSS was significantly correlated with PS-LANSS and P-DN4 (ρ = 0.92, p = 0.01, for both). PS-LANSS was also significantly correlated with P-DN4 (ρ = 0.79, p = 0.01). Both tools successfully diagnosed NeP patients at the cutoff point of ≥12 with 88.12% sensitivity and 76.19% specificity for P-LANSS and 83.17% sensitivity and 95.24% specificity for PS-LANSS. P-LANSS and PS-LANSS are reliable and valid tools to identify NeP component in chronic pain patients. PS-LANSS was found to be an acceptable alternative for P-LANSS.

Psychometric properties of the Persian version of the pain anxiety symptom scale (PASS-20) in chronic non-specific neck pain patients.

OBJECTIVES: Pain-related anxiety has been linked to avoidance behaviour, maintenance of pain and disability. A valid and reliable tool is required to evaluate pain-related anxiety among Persian speaking adults with chronic non-specific neck pain (CNSNP). This study aimed to evaluate psychometric properties of the Persian pain anxiety symptom scale-20 (PASS-20) according to the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist in Iranian adults with CNSNP. METHODS: 198 individuals with CNSNP completed the PASS-20. The factorial structure (confirmatory factor analysis (CFA), exploratory factor analysis (EFA)), test-retest reliability (intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC)), internal consistency (Cronbach's alpha), and construct validity (convergent and known-group validity) were assessed. The correlation between PASS-20 with pain catastrophizing scale (PCS), Tampa Scale for Kinesiophobia (TSK), neck disability index (NDI), Beck Depression Inventory (BDI), visual analog scale (VAS) (Spearman's rank correlation) were examined. Known-group validity of PASS-20 was evaluated by comparing the difference between the PASS-20 scores of the known groups based on level of disability, pain intensity and gender using non-parametric tests. RESULTS: The CFA showed almost the best fit with the original version. The subscales and total score demonstrated good internal consistency (Cronbach's α: 0.70-0.92) and high test-retest reliability (ICC: 0.94-0.97). PASS-20 had significant moderate correlations with PCS, TSK, NDI, VAS and a significant low correlation with BDI. Regarding known-group validity, the total score of Persian PASS-20 was higher in CNSNP with higher levels of pain and disability and in the female gender. CONCLUSIONS: The Persian PASS-20 has acceptable psychometric properties in adults with CNSNP. The results of the factor analysis supported the four-factor structure comparable to the original version. ETHICAL COMMITTEE NUMBER: 921672004.