Validating the preoperative Japanese Core Outcome Measures Index for the Neck and comparing quality of life in patients with cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament by the patient-reported outcome measures.

PURPOSE: This cross-sectional study serves two main purposes. Firstly, it aims to validate the preoperative Japanese Core Outcome Measures Index for the Neck (COMI-Neck) in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Secondly, it seeks to elucidate differences in preoperative quality of life (QOL) between these two cervical pathologies using patient-reported outcome measures (PROMs). METHODS: A total of 103 preoperative patients (86 with CSM and 17 with OPLL) scheduled for cervical spine surgery were included in the study. Validated PROMs, including the Japanese COMI-Neck, Neck Disability Index (NDI), EuroQol-5 Dimension-3 level (EQ-5D-3L), and SF-12v2, were used to assess QOL. Baseline demographic and clinical data were collected, and statistical analyses were performed to compare the PROMs between CSM and OPLL groups. RESULTS: The Japanese COMI-Neck demonstrated good construct validity, with positive correlations with NDI and negative correlations with EQ-5D-3L and SF-12v2. Comparison of preoperative PROMs between CSM and OPLL groups revealed differences in age, body mass index, and EQ-5D-3L scores. The CSM group had higher NDI scores for concentration and lower EQ-5D-3L scores for self-care compared to the OPLL group. CONCLUSIONS: This study validated the preoperative Japanese COMI-Neck in CSM and OPLL patients and identified specific QOL issues associated with each condition. The findings highlight the importance of considering disease-specific QOL and tailoring treatment plans accordingly. Further research should include postoperative assessments and a more diverse population to enhance generalizability.

Construct validation of the Japanese Core Outcome Measures Index and the impact of diseases on patient-reported outcome measures in preoperative patients with lumbar spinal stenosis and disk herniation: a single-center observational study.

PURPOSE: The primary objective was to validate the construct validity of the Japanese Core Outcome Measures Index (COMI) in preoperative patients aged 60 years or older undergoing lumbar spine surgery for lumbar spinal stenosis (LSS) and lumbar disk herniation (LDH). Additionally, as a secondary aim, we explored the impact of these diseases on quality of life (QOL). METHODS: The analysis included 199 preoperative patients aged 60 and above who were scheduled for lumbar spine surgery. To assess QOL, Japanese versions of the COMI, Oswestry Disability Index (ODI), EuroQol-5 Dimension-3 Level (EQ-5D-3L), and SF-12v2 were employed. The study assessed the validity of the COMI and compared demographic and clinical characteristics between the LSS (147 cases) and LDH (52 cases) groups. It used multivariate covariance analysis (MANCOVA) to examine the impact of diseases (LSS and LDH) on each patient-reported outcome measure while considering covariates. RESULTS: Compared to the LSS group, the LDH group showed more difficulty with the COMI summary score (LSS/LDH [mean]: 6.9/8.1, p < 0.001), ODI score (46.8/57.4, p < 0.001), and EQ-5D utility (0.53/0.43, p < 0.001). The LDH group also reported more difficulties in the COMI-function, COMI-symptom-specific well-being, COMI-disability, ODI-personal care, ODI-social life, and SF-12v2-bodily pain subscales. MANCOVA demonstrated that these results were not influenced by covariates such as gender and medical history. CONCLUSIONS: This study highlights the distinct impact of LSS and LDH on preoperative QOL in older patients undergoing lumbar spinal surgery. Tailored interventions are essential to address the specific challenges posed by these conditions and improve patient-centered outcomes and postoperative recovery.

Weakening and factors of medial elbow dynamic stabilizers against elbow valgus laxity after repetitive pitching in high school baseball players.

BACKGROUND: Overhead throwing activity induces elbow valgus loading. The medial elbow dynamic stabilizers are thought important for medial elbow joint protection, but the effects of repetitive pitching on stabilizing function are largely unknown. This study aimed to investigate changes in the dynamic stabilizers during repetitive pitching, as well as factors related to dynamic stabilizing ability. Our hypothesis was that repetitive pitching would reduce dynamic stabilizer function, hence reducing the ability to minimize elbow valgus load. METHODS: Thirty high school baseball pitchers (age, 16.6 ± 0.5 years) participated. Each participant pitched 100 times (5 blocks of 20 pitches). Prior to and after 100 pitches, medial elbow joint width and strain ratios, indicating the hardness of the ulnar collateral ligament (UCL) and forearm flexor-pronator muscles (FPMs), were measured using ultrasound at rest (non-contraction) and during gripping (contraction). Pre- and post-pitching data were compared using the paired t test. Multiple regression analysis was used to investigate factors related to the change rate of medial elbow joint width during gripping. RESULTS: Medial elbow joint width during gripping significantly increased from before pitching to after pitching (P < .001). Both the UCL and FPM strain ratios after pitching significantly decreased (ie, softer tissue) compared with those before pitching (P = .001 and P = .006, respectively). The ratio of the UCL and FPM strain ratios (UCL/FPM) during gripping prior to pitching was significantly and independently correlated with the change rate of medial elbow joint width during gripping (ß = 0.44, P = .016). CONCLUSION: Pitching 100 balls induces a significant reduction in dynamic stabilizing ability against elbow valgus laxity. High school baseball pitchers should limit themselves to <100 pitches per game or should rest after 100 pitches before resuming. Furthermore, the ratio of hardness (UCL/FPM) during dynamic stabilization associated with gripping prior to pitching was significantly related to the change rate of elbow valgus laxity during dynamic stabilization. Maintaining the FPMs harder relative to the UCL during gripping prevents elbow valgus laxity associated with repetitive pitching and may protect the medial elbow joint during repetitive pitching.

Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study.

BACKGROUND: Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated. OBJECTIVE: The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months. METHODS: Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment. RESULTS: The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment. CONCLUSION: The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.

Golfers' Performance Is Improved More by Combining Foam Rolling and Dynamic Stretch to the Lead Hip Than Practice Golf Swinging.

ABSTRACT: Hamada, Y, Akasaka, K, Otsudo, T, Sawada, Y, Hattori, H, Kikuchi, Y, and Hall, T. Golfers' performance is improved more by combining foam rolling and dynamic stretch to the lead hip than practice golf swinging. J Strength Cond Res 38(7): e391-e397, 2024-Warming up is considered effective in improving performance and preventing injury. Despite this, there have been few studies investigating warm-up programs in golf and whether specific factors contribute to improved performance. The purpose of this study was to examine the immediate effects of combined foam rolling and dynamic stretch (FR + DS) to the lead hip on golf swing performance, hip range of motion (ROM), and muscle strength in amateur golfers using a randomized crossover design. The study sample comprised 22 men (mean ± SD ; age, 32.6 ± 8.5 years, body mass index (BMI), 23.4 ± 2.7 kg·m -2 ). Subjects were assigned to receive either FR + DS or repetitive golf swing practice (SW) before crossing over to the other intervention for another day. Measurements included golf swing performance (ball speed, club head speed, flight distance ["carry"], spin rate, and launch angle), hip internal rotation (IR), and external rotation (ER) ROM, as well as hip IR and ER muscle strength. Comparisons between groups were made before and after each intervention. For golf swing performance, FR + DS improved "carry" significantly more than SW ( p < 0.05). No significant differences in golf swing performance other than "carry" were found. In addition, IR ROM and IR muscle strength of the lead hip were significantly increased in the FR + DS group ( p < 0.05). FR + DS has effects on improving lead hip IR ROM and IR muscle strength, which may facilitate golfers' swing and "carry." FR + DS shows promise as a warm-up method for amateur golfers who want to improve golf performance.

Comparison of elbow valgus laxity and medial elbow stabilizer parameters during repetitive pitching between high school baseball players with and without a history of medial elbow injury.

BACKGROUND: Adolescent baseball players with a history of medial elbow injury are often reinjured during demanding practice sessions or games. The physical characteristics of baseball players with a history of medial elbow injury have been reported in several previous studies, but the nature of their medial elbow stabilizers is unknown. This study investigated the difference in characteristics of elbow valgus laxity and medial elbow stabilizer parameters between baseball players with and without a history of medial elbow injury, prior to and during repetitive pitching. METHODS: Sixteen high school baseball players with no history of medial elbow injury (No-Injury group) and 14 high school baseball players with a history of medial elbow injury (Injury History group) participated. The participants pitched 100 fastballs. Medial elbow joint-space gapping and strain ratio indicating tissue elasticity of ulnar collateral ligament (UCL) and forearm flexor-pronator muscles (FPMs) were measured by ultrasound before pitching and following each of five 20-pitch blocks. Student t tests and Mann-Whitney U tests were used to compare each parameter between groups. RESULTS: Medial elbow joint-space gapping and UCL elasticity were not significantly different between the 2 groups in each pitching block (P > .05). The strain ratio of FPMs before pitching and after 100 pitches in the Injury History group were significantly greater than that in the No-Injury group (No-Injury vs. Injury History group: before pitching, 0.47 ± 0.19 vs. 0.68 ± 0.26, P = .016; 100 pitches, 0.35 ± 0.12 vs. 0.53 ± 0.20, P = .007). In the other pitching blocks, there was no significant difference between groups, but the effect size was medium and showed a similar tendency (20 pitches, P = .069, Cohen d = 0.69; 40 pitches, P = .116, Cohen d = 0.59; 60 pitches, P = .102, Cohen d = 0.62; 80 pitches, P = .058, Cohen d = 0.72). CONCLUSIONS: The results of this study indicate that FPM elasticity at baseline and during repetitive pitching in players with a history of medial elbow injury was harder than in players without injury history. This may suggest that baseball players with a history of medial elbow injury increase support of their previously injured medial elbow by hardening FPM elasticity to counteract elbow valgus stress generated during pitching, which may lead to long-term change in the FPMs. Therefore, physical management for this change may be important to prevent reinjury in baseball players with a history of medial elbow injury.

Effects of incorporating elliptical trainer exercise during rehabilitation on physical function and self-reported outcomes after total hip arthroplasty: a randomized controlled trial.

[Purpose] To investigate the effects of incorporating elliptical trainer exercise in early rehabilitation after total hip arthroplasty on physical function and self-reported outcomes. [Participants and Methods] Participants with independent gait prior to total hip arthroplasty underwent conventional postoperative physiotherapy and were divided into two groups. The intervention group additionally underwent elliptical trainer exercise, while the control group underwent a walking program. The main outcomes were low back and hip region pain, lower limb muscle strength, single-leg stance time, Timed Up & Go Test results, 10 m walking test results, hip disability and osteoarthritis outcome score, and modified fall efficacy scale score. These outcomes were evaluated preoperatively, at discharge, and at 1 and 3 months postoperatively. [Results] Fifty participants (including 40 females; age, 68.3 ± 10.8 years) participated in this study. Physical function evaluations showed a significant improvement in hip region pain during walking at discharge. Knee extensor strength, single-leg stance time, stride length, and walking speed were significantly greater in the intervention group at discharge and at 1 and 3 months postoperatively. The modified fall efficacy scale score significantly improved in the intervention group 1 month postoperatively. [Conclusion] Elliptical trainer exercise and conventional physiotherapy in the early postoperative period contribute to improved physical function and walking ability and improvement in the fear of falling.

Chest X-ray in suspected lung cancer is harmful.

OBJECTIVES: The aim of this study was to analyse the use of the chest radiograph (CXR) as the first-line investigation in primary care patients with suspected lung cancer. METHODS: Of 16,945 primary care referral CXRs (June 2018 to May 2019), 1,488 were referred for suspected lung cancer. CXRs were coded as follows: CX1, normal but a CT scan is recommended to exclude malignancy; CX2, alternative diagnosis; or CX3, suspicious for cancer. Kaplan-Meier survival analysis was undertaken by stratifying patients according to their CX code. RESULTS: In the study period, there were 101 lung cancer diagnoses via a primary care CXR pathway. Only 10% of patients with a normal CXR (CX1) underwent subsequent CT and there was a significant delay in lung cancer diagnosis in these patients (p < 0.001). Lung cancer was diagnosed at an advanced stage in 50% of CX1 patients, 38% of CX2 patients and 57% of CX3 patients (p = 0.26). There was no survival difference between CX codes (p = 0.42). CONCLUSION: Chest radiography in the investigation of patients with suspected lung cancer may be harmful. This strategy may falsely reassure in the case of a normal CXR and prioritises resources to advanced disease. KEY POINTS: • Half of all lung cancer diagnoses in a 1-year period are first investigated with a chest X-ray. • A normal chest X-ray report leads to a significant delay in the diagnosis of lung cancer. • The majority of patients with a normal or abnormal chest X-ray have advanced disease at diagnosis and there is no difference in survival outcomes based on the chest X-ray findings.

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial.

OBJECTIVES: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis. DESIGN: A randomised controlled trial. SETTING: A general hospital. SUBJECTS: Forty adults with knee osteoarthritis (grade 1-3 Kellgren-Lawrence scale). INTERVENTIONS: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. MAIN MEASURES: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. RESULTS: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. CONCLUSION: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.

Effectiveness of Mulligan manual therapy over exercise on headache frequency, intensity and disability for patients with migraine, tension-type headache and cervicogenic headache - a protocol of a pragmatic randomized controlled trial.

BACKGROUND: Non - pharmacological management of migraine, tension-type headache (TTH), and cervicogenic headache (CGH) may include spinal manual therapy and exercise. Mulligan Manual Therapy (MMT) utilizes a protocol of headache elimination procedures to manage headache parameters and associated disability, but has only been evaluated in CGH. There is little evidence for its effectiveness in migraine and TTH. This study aims to determine the effectiveness of MMT and exercise over exercise and placebo in the management of migraine, TTH, and CGH. METHODS: This pragmatic trial is designed as a prospective, three-armed randomised controlled trial in a clinical setting provided at a general hospital physiotherapy department. Two hundred ninety-seven participants with a diagnosis of migraine, TTH or CGH based on published headache classification guidelines will be included. An assessor blind to group allocation will measure outcomes pre-and post-intervention as well as 3 and 6 months after commencement of treatment. Participants will be allocated to one of the three groups: MMT and exercise; placebo and exercise; and exercise alone. The primary outcome measure is headache frequency. Secondary outcome measures are headache duration and intensity, medication intake, pressure pain threshold (PPT), range of motion recorded with the flexion rotation test, and headache disability recorded with Headache Activities of Daily Living Index (HADLI). The intention-to-treat principle will be followed for statistical analysis. Between groups differences for all outcome measures at baseline and at reassessment points and 95% confidence intervals will be calculated using a mixed model ANOVA. Post hoc tests will be conducted to identify any significant difference between groups and over time. DISCUSSION: This pragmatic study will provide evidence for the effectiveness of MMT when compared with a placebo intervention and exercise on headache frequency, intensity, and disability. Limitations are that baseline evaluation of headache parameters may be affected by recall bias. External validity will be limited to the population with a minimum 1-year history of headache. The HADLI is not yet extensively evaluated for its psychometric properties and association between PPT and headache parameters is lacking. Performance bias is inevitable as a single therapist will be delivering all interventions. TRIAL REGISTRATION: The trial was registered prospectively under the Clinical Trial Registry India (Registration number: CTRI/2019/06/019506 , dated on 03/06/2019). .

Quality of life and life-space mobility after total knee arthroplasty in patients with rheumatoid arthritis: a pilot case-controlled study.

[Purpose] The purpose of this study was to identify factors inhibiting improvement in the quality of life after total knee arthroplasty in patients with rheumatoid arthritis. [Participants and Methods] This was a pilot case-control study. The sample comprised of five participants with rheumatoid arthritis and 11 participants with osteoarthritis, who underwent total knee arthroplasty. We compared the groups in terms of physical function, walking ability, Japanese Knee Osteoarthritis Measure, and Life-Space Assessment. Measurements were taken before surgery and at four weeks and five months post-surgery. All patients underwent rehabilitation for five months postoperatively, first as inpatients, and then as outpatients after discharge. [Results] In the period from 4 weeks to 5 months post-surgery, physical function improved similarly in both groups in terms of muscle strength and walking ability. Despite the patients with rheumatoid arthritis being younger, their self-health assessment score by the Japanese Knee Osteoarthritis Measure and measures of life-space mobility by Life-Space Assessment were lower. [Conclusion] It is important to consider exercise therapy, and gait instruction to alleviate anxiety about health status and improve the quality of life and life-space mobility in patients with rheumatoid arthritis who undergo total knee arthroplasty.

The inclusion of mobilisation with movement to a standard exercise programme for patients with rotator cuff related pain: a randomised, placebo-controlled protocol trial.

BACKGROUND: Rotator cuff related pain (RCRP) is one of the most common sources of musculoskeletal shoulder pain affecting the general population. Conservative treatment, in the form of exercise, is considered the first line approach, nonetheless, improvements seem to be modest. One therapeutic modality that might be an adjunct to the treatment of this condition is mobilisation with movement (MWM). MWM is a pain-free manual procedure that targets restricted and painful movements, commonly seen in patients with RCRP. The purpose of clinical trial is to determine whether MWM with exercise has benefits over sham MWM with exercise in RCRP. METHODS: A randomised, sham-controlled trial of 70 adults complaining of RCRP will compare the effects of MWM combined with exercise over sham MWM with exercise. Participants will be allocated to one of two groups: exercise and MWM (EG) or exercise and sham MWM (CG). Two weekly individual treatment sessions will be conducted over five weeks. All assessments will be performed by a blinded assessor. Primary outcome measures will be the shoulder pain and disability index (SPADI) and the numeric pain rating scale (NPRS), assessed at baseline, discharge and one-month follow-up. Secondary outcome measures will be active range of motion, self-efficacy and the global rating of change scale. The analyses will be conducted considering a statistically significant p-value ≤0.05. Normality will be assessed with the Kolmogorov-Smirnov test and homogeneity with the Levene's test. For the primary outcome measures (SPADI and NPRS) and self-efficacy, a 2 × 3 ANOVA with treatment group (EG versus CG) and time (baseline, end of the treatment and follow-up) factors will be performed. Separate 2 × 2 ANOVA will be used for range of motion (baseline and end of the treatment). Global rating scale of change analysis will be conducted using descriptive statistics. Intention-to-treat analysis will be adopted. DISCUSSION: As there is a paucity of longitudinal studies investigating the use of MWM in patients with RCRP, this study will help to better understand its role together with a structured exercise programme. TRIAL REGISTRATION: Clinical Trials Registry number NCT04175184 . November, 2019.

Correction to: Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer.

An amendment to this paper has been published and can be accessed via the original article.

Concurrent validity and reliability of measuring range of motion during the cervical flexion rotation test with a novel digital goniometer.

BACKGROUND: Headache is a common and costly health problem. Although the pathogenesis of headache is heterogeneous, reported contributing factors are dysfunctions of the upper cervical spine. The flexion rotation test (FRT) is a commonly used diagnostic test to detect upper cervical movement impairment. A digital goniometer may support precise measurement of movement impairment in the upper cervical spine. However, its reliability and validity is not assessed, yet. The aim of this study was to investigate the reliability and validity of the digital goniometer compared to an ultrasound-based movement analysis system. METHODS: Two separate cross-sectional studies were conducted using the digital goniometer EasyAngle (Meloq AB, Stockholm, Sweden) for a) investigating the concurrent validity of upper cervical range of motion (ROM) during the FRT and b) determining the inter- and intra-rater reliability in the target population of patients with head and neck pain. Sixty-two participants, 39 with and 23 without head and neck pain, were recruited for the concurrent validity study. For the reliability study, a total of 50 participants were recruited. Intraclass correlation coefficients (ICC) and Bland Altmann plots were used to assess validity and ICC values, Bland Altmann plots as well as Kappa coefficients were used for estimating intra-rater and inter-rater reliability. RESULTS: Concurrent validity was strong with an ICC (2,1) of 0.97 for ROM to either side (95%CI = 0.95-0.98). Bland Altman Plots revealed a mean difference between measurement systems of 0.5° for the left and 0.11° for the right side. The inter-rater ICC (2,1) was 0.66 (95%CI 0.47-0.79, p <  0.001, SEM 6.6°), indicating good reliability. The limits of agreement were between 10.25° and - 11.89°, the mean difference between both raters was - 0.82°. Intra-rater reliability for the measurement of ROM during the FRT was between 0.96 (ICC 3,1) for rater 1 and 0.94 (ICC 3,1) for rater 2. CONCLUSIONS: The digital goniometer demonstrated strong concurrent validity and good to strong reliability and can be used in clinical practice to accurately determine movement impairment in the upper cervical spine. TRIAL REGISTRATION: German Registry of Clinical Trials DRKS00013051 .

Effects of Nordic Hamstring Exercise on Hamstring Injuries in High School Soccer Players: A Randomized Controlled Trial.

We evaluated a range of physical characteristics related to hamstring injuries, as well as the Nordic Hamstring Exercise compliance rate, and whether this influenced the rate hamstring injury. Subjects comprised 259 male soccer players from seven high schools randomly clustered into two groups, a Nordic Hamstring Exercise group and a control group. Training and match time were logged, as well as details of hamstring injury, and subsequent time lost to hamstring injury recorded over a period of 27 weeks. The Nordic Hamstring Exercise compliance rate, injury rate per 10000 playing hours and time-lost-to-sport-injury rate were calculated. The relative risk and hamstring injury severity were also calculated. The hamstring injury rate was 1.04/10 000 h in the control group and 0.88/10 000 h in the intervention group. The relative risk for hamstring injury was 1.14. The time-lost to injury rate was 1116.3/10 000 h in the control group and 113.7/10 000 h in the intervention group; with relative risk 9.81. The Nordic Hamstring Exercise in high school soccer players significantly reduced hamstring injury severity compared to a control intervention. Our results indicate that the time-lost to injury rate should be taken into account when analyzing the severity of hamstring injury.

Changes in medial elbow elasticity and joint space gapping during maximal gripping: reliability and validity in evaluation of the medial elbow joint using ultrasound elastography.

BACKGROUND: Medial elbow injuries are common in baseball pitchers. This study investigated the reliability of medial elbow elastography measurement and the characteristics of the medial elbow stabilizers. METHODS: Medial elbow joint space gapping and the strain ratios of the ulnar collateral ligament (UCL) and the forearm flexor-pronator muscle (FPM) were measured at rest and during gripping in 29 healthy college students. The intraclass correlation coefficients of elastography were calculated. The data were compared between tissues and between rest and gripping. RESULTS: The intraclass correlation coefficients (ICC1,3) of the elastography measurements were 0.91 and 0.83 for the UCL and 0.80 and 0.85 for the FPM for each examiner. Medial elbow joint space gapping during gripping (3.1 ± 0.6 mm) was significantly less than that at rest (3.8 ± 0.8 mm, P < .001). The strain ratios for both the UCL and FPM during gripping were significantly greater than those at rest (17.64 ± 10.97 during gripping vs. 3.94 ± 1.92 at rest for UCL, P < .001; 1.72 ± 0.99 during gripping vs. 0.35 ± 1.92 at rest for FPM, P < .001). The strain ratio for the UCL was significantly greater than that for the FPM both at rest (P < .001) and during gripping (P < .001). CONCLUSIONS: Elastography measurements of the UCL and FPM have almost perfect reliability. Gripping reduces medial elbow joint space gapping compared with rest. For both tissues, gripping reduces their elasticity compared with rest. The elasticity of the UCL is less than that of the FPM both at rest and during gripping.

International consensus on the most useful assessments used by physical therapists to evaluate patients with temporomandibular disorders: A Delphi study.

OBJECTIVE: To identify assessment tools used to evaluate patients with temporomandibular disorders (TMD) considered to be clinically most useful by a panel of international experts in TMD physical therapy (PT). METHODS: A Delphi survey method administered to a panel of international experts in TMD PT was conducted over three rounds from October 2017 to June 2018. The initial contact was made by email. Participation was voluntary. An e-survey, according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES), was posted using SurveyMonkey for each round. Percentages of responses were analysed for each question from each round of the Delphi survey administrations. RESULTS: Twenty-three experts (completion rate: 23/25) completed all three rounds of the survey for three clinical test categories: 1) questionnaires, 2) pain screening tools and 3) physical examination tests. The following was the consensus-based decision regarding the identification of the clinically most useful assessments. (1) Four of 9 questionnaires were identified: Jaw Functional Limitation (JFL-8), Mandibular Function Impairment Questionnaire (MFIQ), Tampa Scale for Kinesiophobia for Temporomandibular disorders (TSK/TMD) and the neck disability index (NDI). (2) Three of 8 identified pain screening tests: visual analog scale (VAS), numeric pain rating scale (NRS) and pain during mandibular movements. (3) Eight of 18 identified physical examination tests: physiological temporomandibular joint (TMJ) movements, trigger point (TrP) palpation of the masticatory muscles, TrP palpation away from the masticatory system, accessory movements, articular palpation, noise detection during movement, manual screening of the cervical spine and the Neck Flexor Muscle Endurance Test. CONCLUSION: After three rounds in this Delphi survey, the results of the most used assessment tools by TMD PT experts were established. They proved to be founded on test construct, test psychometric properties (reliability/validity) and expert preference for test clusters. A concordance with the screening tools of the diagnostic criteria of TMD consortium was noted. Findings may be used to guide policymaking purposes and future diagnostic research.

Habitual posture and weekly time spent sitting do not contribute to the lumbopelvic curvature during active unilateral knee extension in sitting test.

[Purpose] To investigate whether habitual pelvic posture and time spent sitting are primary contributing factors to performance in the active unilateral knee extension in sitting test in young people. [Participants and Methods] The participants' ages ranged from 20 to 40 years. LUMOback, a wearable electronic device, was used to measure the proportion of the days spent in a neutral pelvic posture (posture score) and time spent sitting over a week. The lumbopelvic sagittal curvature from T12 to S2 (θ) during the active unilateral knee extension in sitting test was also assessed using a flexible ruler. A multiple regression analysis was performed with the primary independent variables of the posture score and time spent sitting, undertaking priori considerations of potential confounders of sex, and pain condition on the θ value. [Results] Eighty participants (21.7 ± 3.8 years) were enrolled in the study (24 males and 56 females). Neither the posture score nor time spent sitting statistically significantly contributed to the θ value. [Conclusion] Neither the proportion of the day spent with neutral pelvic posture nor time spent sitting detected by LUMOback was the primary contributing factor to the active unilateral knee extension in sitting test performance.

The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial.

OBJECTIVES: To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy. DESIGN: A double-blind randomized controlled trial. SETTING: General hospital. PARTICIPANTS: Adults (N=60; mean age 44y) with subacute lumbar radiculopathy. INTERVENTIONS: Participants were randomly allocated to receive SMWLM, exercise and electrotherapy (n=30), or exercise and electrotherapy alone (n=30). All participants received 6 sessions over 2 weeks. MAIN OUTCOME MEASURES: The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM). Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up. RESULTS: Significant and clinically meaningful improvement occurred in all outcome variables. At 2 weeks the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.0; 95% confidence interval [95% CI], 1.4-2.6) and disability (MD 3.9; 95% CI, 5.5-2.2). Similarly, at 6 months, the SMWLM group had significantly greater improvement than the control group in leg pain (MD 2.6; 95% CI, 1.9-3.2) and disability (MD 4.7; 95% CI, 6.3-3.1). The SMWLM group also reported greater improvement in the GROC and in SLR ROM. CONCLUSION: In patients with lumbar radiculopathy, the addition of SMWLM provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term.

Factors associated with low back pain in elite high school volleyball players.

[Purpose] To determine the relationship between low back pain and a range of demographic, environmental, and injury history factors to identify potential factors for the management of low back pain. [Participants and Methods] The participants were 123 elite high school male and female volleyball players. They answered an extensive questionnaire regarding demographic details, low back pain in the previous year, volleyball-specific movements, previous regional injuries, and years of volleyball experience. Questionnaire responses were analyzed. Data were analyzed using a multivariate logistic regression analysis using the presence and absence of low back pain within 1 year as the explanatory variable. [Results] Of the 123 volleyball players, 48.0% reported low back pain. The volleyball-specific movements that induced pain were diverse (e.g., spike, serve, and pass) with no common factor. The factors associated with low back pain were an ankle injury within the previous year and years of volleyball experience. [Conclusion] The associations found in this survey indicate that particular attention should be given to more experienced players with a history of ankle injury to manage low back pain in high school volleyball players.