Acute and Short-Term Effects of Dry Needling in Patients with Chronic Nonspecific Low Back Pain and Hamstring Tightness: A Pilot Study.

BACKGROUND: Chronic nonspecific low back pain (LBP) is one of the common health issues. Hamstring tightness contributes to the development of LBP. This study aimed to investigate the acute and short-term effects of deep dry needling (DN) in patients with chronic nonspecific LBP and hamstring muscle tightness. METHODS: A single-group pretest-posttest clinical study design was followed. The outcome measures were the visual analog scale (VAS), passive knee extension (PKE) test, finger-floor distance (FFD) test, and functional rating index (FRI). Patients underwent one session of deep DN of three points on both hamstring muscles, each point for one minute. Patients were assessed before (T0), immediately after (T1), and one week after DN (T2). The FRI was assessed at T0 and T2. RESULTS: Ten women with a mean age of 21.1 years (SD = 1.6) participated in the study. Significant large effect sizes in VAS pain reduction (d = 1.25) and PKE hamstring tightness were obtained (hamstring: right, d = 0.82; left, d = 0.88) at T2. Medium effect sizes were obtained for FFD (d = 0.45) and FRI (d = 0.72) at T2. CONCLUSION: A single session of deep DN improved pain and function and increased hamstring flexibility. This pilot study supports the use of DN in patients with LBP and hamstring tightness; however, future research with a rigorous study design of randomized controlled trial is required to confirm the findings. This trial is registered with IRCT20180511039612N1.

Use of a Telehealth System to Enhance a Home Exercise Program for a Person With Parkinson Disease: A Case Report.

BACKGROUND AND PURPOSE: This case addresses feasibility of a home-based telehealth system to enhance home exercise program (HEP) adherence for a patient with Parkinson disease (PD). We describe START-System for Technology-Augmented Rehabilitation and Training-and discuss outcomes after integrating START into the HEP component of an established therapy protocol, Lee Silverman Voice Technique BIG (LSVT BIG). CASE DESCRIPTION: The participant was a 67-year-old woman with PD at Hoehn and Yahr Stage II. INTERVENTION: During the first 4 weeks of a 4-month intervention, a physical therapist guided the participant through the LSVT BIG protocol. START was introduced at week 3; the participant was encouraged to complement her daily HEP through the end of the fourth month with START. OUTCOMES: Improvements in gait, endurance, balance confidence, and quality of life were observed from the start of the assessment to the end of month 1. By month 4, the participant maintained or improved with respect to these outcomes. Monitored by START, the rate of adherence to her twice-daily HEP prescription was 24%, but her daily participation rate was 78%. The participant's satisfaction with the START system was high, although autonomous feedback provided by START was a limiting concern. There were no technical issues or adverse events reported. DISCUSSION: This case supports START as a feasible HEP telehealth solution for physical therapy, given that increased long-term exercise adherence may improve health outcomes for people with PD. The outcomes of this case study support further investigation into the use of START for people with PD.Video Abstract available for more insights from the authors (see Video; Supplemental Digital Content 1, http://links.lww.com/JNPT/A192).

A Randomized Controlled Pilot Study to Investigate the Effect of Whole-Body Vibration on Lower-Extremity Fatigue.

CONTEXT: Whole-body vibration (WBV) is a type of weight-bearing exercise used in the field of sport and rehabilitation. There is no study on the effects of WBV on muscle recovery after a fatiguing activity. OBJECTIVE: To determine the effects of a single WBV session on lower-extremity fatigue. DESIGN: Randomized controlled pilot study. SETTING: University Physiotherapy Clinic. SUBJECTS: A total of 13 healthy young men volunteered to participate in this study. Subjects were randomly assigned into the WBV group (n = 7, mean age: 21 y) or control group (CG; n = 6, mean age: 20 y). INTERVENTION: Subjects in the WBV group participated in a single-session WBV (30 Hz, amplitude 4 mm, 2 min) after lower-extremity fatigue. MAIN OUTCOME MEASURES: Peak force of quadriceps muscle, single leg hop test, and Y-test were measured before inducing muscle fatigue (T0), immediately after completing the fatigue protocol (T1), after WBV (T2), and 15 min following the application of WBV (T3). The same method was applied in the CG while the WBV machine was turned off. RESULTS: Repeated-measure ANOVA revealed no significant differences between groups in any of the outcomes. CONCLUSIONS: The findings indicated that WBV was not effective in the recovery of lower-extremity fatigue in healthy young men.

Reliability and validity of the Persian adaptation of the Core Outcome Measure Index in patients with chronic low back pain.

BACKGROUND: The purpose of the study was to determine whether the Persian Core Outcome Measures Index (PCOMI) is reliable and valid in patients with chronic low back pain (CLBP). METHODS: The Persian COMI was developed using forward-backward translational method. Subjects were100 patients with CLBP. Patients completed the PCOMI, Persian functional rating index, and visual analog scale. Fifty patients completed the PCOMI for the second time after 7days to evaluate test-retest reliability. Fifty healthy subjects participated to assess discriminant validity. RESULTS: There was no ceiling or floor effect. Cronbach's alpha was 0.85. The construct validity coefficient was 0.72. The ICCagreement for test-retest reliability was 0.86. Pearson correlation for criterion validity was 0.70. The PCOMI discriminated between patients and healthy subjects. The standard error of measurement and the smallest detectable change was 0.75 and 2.1, respectively. Factor analysis extracted 1 component. CONCLUSIONS: The results support the reliability and validity of the PCOMI for assessing patients with CLBP.

Simple shoulder test and Oxford Shoulder Score: Persian translation and cross-cultural validation.

PURPOSE: To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder Score (OSS) into Persian language using a cross-sectional and prospective cohort design. METHODS: A standard forward and backward translation was followed to culturally adapt the SST and the OSS into Persian language. Psychometric properties of floor and ceiling effects, construct convergent validity, discriminant validity, internal consistency reliability, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), and factor structure were determined. RESULTS: One hundred patients with shoulder disorders and 50 healthy subjects participated in the study. The PSST and the POSS showed no missing responses. No floor or ceiling effects were observed. Both the PSST and POSS detected differences between patients and healthy subjects supporting their discriminant validity. Construct convergent validity was confirmed by a very good correlation between the PSST and POSS (r = 0.68). There was high internal consistency for both the PSST (α = 0.73) and the POSS (α = 0.91 and 0.92). Test-retest reliability with 1-week interval was excellent (ICCagreement = 0.94 for PSST and 0.90 for POSS). Factor analyses demonstrated a three-factor solution for the PSST (49.7 % of variance) and a two-factor solution for the POSS (61.6 % of variance). The SEM/SDC was satisfactory for PSST (5.5/15.3) and POSS (6.8/18.8). CONCLUSIONS: The PSST and POSS are valid and reliable outcome measures for assessing functional limitations in Persian-speaking patients with shoulder disorders.

Developing a Content Model of a Mobile-Based Application to Manage Patients with Low-Back and Neck Pain.

Introduction: As a complementary tool in health, the design of mobile applications to influence care and increase awareness of patients has grown a lot. The purpose of this study is to design and validate the content model of a mobile-based application for managing patients with low-back and neck pain. Methods: This descriptive-analytical study was conducted in two main stages to determine the content model of the application. The first stage consisted of three steps: finding the right exercise, determining the right scale to assess the pain intensity, and determining the appropriate features of the application. In the second stage, data elements collected from the previous stage were prepared in the form of a questionnaire that was given to 12 experts in physical therapy and sports medicine for validation. After collecting the questionnaire, data elements in all parts were analyzed based on the content validity ratio (CVR) and descriptive statistics indicators. Result: The content of the application was prepared in the three axes of exercises for low-back and neck pain, assessment of pain intensity, and features of the application. In the axis of sports exercises, 8 exercises for back pain and 3 exercises for neck pain were included according to the reference books. A Functional Rating Index (FRI) scale with 10 elements was selected in the axis of determining pain intensity. Also, 12 features such as the daily exercise section, using the animation, and using an audio file to explain how to do exercises were included in the model. Conclusion: According to the gaps identified in the existing applications, determining the content model of the application that is based on evidence and according to the opinion of experts is useful in improving the apps. The content model of this study was presented in 3 axes to increase the patient's willingness to do exercises, the correct way to perform exercises, conservative treatment, and check the progress of the treatment. The software developers can use these findings as a basis for designing new apps to manage low-back pain and neck pain.

Clinical assessment of ankle plantarflexor spasticity in adult patients after stroke: inter-and intra-rater reliability of the Modified Tardieu Scale.

PRIMARY OBJECTIVE: To evaluate the reliability of the Modified Tardieu Scale (MTS) in the measurement of ankle plantarflexor spasticity in patients after stroke. RESEARCH DESIGN: Inter- and intra-rater reliability study. INTERVENTIONS: Not applicable. METHODS AND PROCEDURES: Adult patients after stroke participated. Patients were tested by two raters for inter-rater reliability. Patients were re-tested by one rater at least 1 week later for intra-rater reliability. The plantarflexors on the hemiparetic side were tested. MAIN OUTCOMES AND RESULTS: The ICCs of inter and intra-rater reliability across all components of MTS were moderate and moderately high (range 0.40-0.71). Inter- and intra-rater reliability for the dynamic component of spasticity (R2-R1) were moderate (ICC = 0.57 and 0.40, respectively). The difference between the two raters for R2 was statistically significant (p = 0.001). CONCLUSIONS: The reliability of the Modified Tardieu Scale in the measurement of ankle plantarflexor spasticity in adult patients after stroke was insufficient for routine use in clinical settings and research.

Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial.

Background: : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods: : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion: : The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

Responsiveness of Persian 12-Item multiple sclerosis walking scale: a replication study.

OBJECTIVE: To re-explore the responsiveness of the Persian version of Multiple Sclerosis Walking Scale-12 (MSWS-12p) to physiotherapy intervention and determine the minimally clinically important change (MCIC). This study followed a prospective cohort design. Patients with MS (PwMS) underwent physiotherapy treatment for 10 sessions. The outcome measures were the MSWS-12p and Timed 25-Foot Walk test (T25-FW). Data was collected before and after ten sessions of physiotherapy. The effect sizes and the area under receiver operating characteristics curve (AUC) and MCIC were calculated. RESULTS: Thirty PwMS (16 female, mean age 43.07 years) participated in the study. The effect sizes for MSWS-12p were moderate (0.52, 0.64). The change scores of MSWS-12p showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (Eta coefficient test = 0.84). There was no correlation between the MSWS-12p total change scores and the T25-FW (r = - 0.14, p = 0.45). The AUC was perfect and the MCIC for the MSWS-12p was calculated 10.0 points. The MSWS-12p is responsive and demonstrates changes after physiotherapy. Changes > 10.0 points on MSWS-12p total score should be considered as true improvement after physiotherapy.

Inter- and intra-rater reliability of the modified modified ashworth scale in the assessment of muscle spasticity in cerebral palsy: A preliminary study.

PURPOSE: The aim of the study was to investigate the inter- and intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of lower extremity spasticity in children with spastic cerebral palsy (CP). METHODS: Fifteen children (10 boys) with a mean age of 8.7±3.4 years participated. Two physiotherapists rated the spasticity of the hip adductors, knee extensors, and ankle plantar flexors for inter-rater reliability. Each child was examined again by one of the physiotherapists (same physiotherapist for all of the children) for intra-rater reliability (mean interval = 7 days). A random sequence of raters and muscles tested was applied. RESULTS: The reliability of the intraclass correlation coefficients (ICC) for individual muscle groups ranged between good to excellent (ICCagreement of 0.60-0.83). The ICC values for overall inter-rater (ICCagreement = 0.82) and intra-rater reliability (ICCagreement  = 0.85) were excellent. CONCLUSION: The MMAS showed excellent reliability for the assessment of lower extremity muscle spasticity in children with cerebral palsy. However, an interpretation should be made with caution due to the small sample size and wide range of confidence interval values.

Combining clinical exams can better predict lumbar spine radiographic instability.

BACKGROUND/OBJECTIVES: Several clinical tests have been proposed to diagnose lumbar instability, but their accuracy is still in question. The primary purpose of this study was to evaluate the diagnostic accuracy of the clinical lumbar instability tests. The secondary goal was to design a model to detect lumbar instability. DESIGN: A prospective diagnostic cross-sectional study. METHOD: A sample of 202 patients with chronic low back pain were participated in the study. Five lumbar instability tests including Aberrant movement, Passive lumbar extension, Prone segmental instability, H and I and pheasant tests were compared to flexion/extension radiography as the gold standard for diagnosing lumbar instability using two by two tables. Multiple Logistic Regression analysis was applied to develop a model using demographic information as well as the patients' pain intensity, disability level, lumbar lordosis and the clinical tests. RESULTS: Among the five examined tests, Prone segmental instability, H and I and pheasant tests showed very small likelihood ratios and diagnostic odd's ratio. The largest values were for H and I test with the positive likelihood ratio of 1.28 (95% CI: 0.72 to 2.29) and diagnostic odd's ratio of 1.37 (95% CI: 0.66 to 2.83); the diagnostic accuracy measures were smaller for the other studied clinical tests. The model was developed using weight (t = 1.15, p = 0.03) and lumbar lordosis (t = 3.04, p = 0.00) (which showed a significant relationship with lumbar instability) and prone segmental instability test. The final model has the positive likelihood ratio of 2.07 (95% CI: 1.41 to 3.05) and diagnostic odd's ratio of 3.77 (95% CI: 2.03 to 7.01). CONCLUSION: Each individual test had very small to no power in discriminating patients with lumbar instability. The developed model just slightly improved the accuracy of radiological instability detection.

Reliability and validity of Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease.

BACKGROUND: Mini-BESTest and Brief-BESTest are used to assess balance in patients with a wide range of balance disorders. While there are Persian versions of Mini-BESTest and Brief-BESTest, the psychometric properties have not been thoroughly evaluated. This study aimed to assess the reliability and validity of the Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease (PD). METHODS: Three medical students rated videotaped performances of 49 individuals with PD on the Persian Mini-BESTest, Persian Brief-BESTest, and Berg balance scale (BBS). Healthy adults were matched with persons having PD in terms of age and gender. RESULTS: There were no floor and ceiling effects. Inter- and intra-rater reliability was excellent (ICC = 0.965-0.973). The minimal detectable changes were 2.37 and 3.47 for Persian versions of Mini-BESTest and Brief-BESTest, respectively. The Persian versions of Mini-BESTest and Brief-BESTest had very good correlations with BBS (r > 0.7) confirming construct validity. There was a very good correlation between the Mini-BESTest and the Brief-BESTest total scores (r = 0.78). There were significant differences between the persons with PD and healthy adults on both tests supporting discriminant validity. Significant differences in balance performances across Hoehn and Yahr stages were found which supported known-groups validity. CONCLUSION: The Persian versions of Mini-BESTest and Brief-BESTest are reliable and valid instruments for balance evaluation in persons with PD. Further study to determine the reliability and validity of both tests when examining patients in real-time in the clinic is warranted.

Effects of pulsed ultrasound on olfactory dysfunction in patients with chronic rhinosinusitis: A pilot study.

BACKGROUND: and purpose. Olfactory dysfunction is a common symptom of chronic rhinosinusitis (CRS). This study aimed to evaluate the effects of therapeutic pulsed ultrasound (PUS) on olfactory dysfunction in patients with CRS. MATERIALS AND METHODS: Patients with CRS underwent treatment with PUS for 10 sessions, three days a week. The outcome measures were the Smell Identification Test (SIT) and 20-item Sino-Nasal Outcome Test (SNOT-20). RESULTS: Fifteen patients (9 male, mean age 48.9 ± 9.7 years) with disease duration of 55.13 ± 65.4 months participated. Analyses showed olfactory dysfunction was completely resolved (Cohen's d = 5.62). The SNOT-20 scores showed significant improvement of CRS symptoms after treatment (Cohen's d = 1.55). Effects remained at one-month follow-up. CONCLUSION: Therapeutic PUS improved the olfactory dysfunction and sino-nasal symptoms in patients with CRS. The PUS can be considered as a promising strategy to target chronic rhinosinusitis.

Effect of functional electrical stimulation combined with stationary cycling and sit to stand training on mobility and balance performance in a patient with traumatic brain injury: A case report.

INTRODUCTION AND IMPORTANCE: This case study investigates the effects of functional electrical stimulation, stationary cycling, and sit-to-stand training in a patient with severe chronic traumatic brain injury. CASE PRESENTATION: The participant was a 24-year-old man with a traumatic brain injury two years prior to the intervention described in this case report. The accident caused right hemiplegia, right foot drop, aphasia, and poor coordination of movement in both upper and lower limbs. He was using a wheeled walker for functional mobility and was receiving routine rehabilitation before the initiation of treatment. A four week intervention in this study included functional electrical stimulation of the quadriceps and tibialis anterior muscles combined with stationary cycling and sit-to-stand training. CLINICAL DISCUSSION: Active and passive range of motion of right ankle dorsiflexion, strength of ankle dorsiflexor, balance performance, and mobility were measured before and after the intervention. Active range of motion of right ankle dorsiflexion increased by 8°. In addition, manual muscle test and Brief-BESTest scores increased from 3+ to 5 and from 7 to 9, respectively. Walking speed over the 10-m distance and timed up and go test score improved. CONCLUSION: Functional electrical stimulation combined with stationary cycling and sit-to-stand training resulted in increased muscle strength and range of motion, improved balance performance, and improved mobility in an individual with a traumatic brain injury.

Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study.

Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4 = male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ± 4.3; since onset of stroke: 30.8 ± 10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and 1 month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (P< .05), while ankle plantar flexors spasticity (P = .135), and knee extensors spasticity (P = .368) did not show any significant decrease. Conclusions: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors. In contrast, no significant decreases were identified in the spasticity of the ankle plantar flexors and knee extensors muscles.

A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke.

PRIMARY OBJECTIVE: To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS). RESEARCH DESIGN: A concurrent criterion-related validity study. INTERVENTIONS: Not applicable. METHODS AND PROCEDURES: Thirty patients (15 men and 15 women; mean ± SD = 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, H(max)/M(max) ratio and Hslp. MAIN OUTCOMES AND RESULTS: There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r = -0.81, p < 0.0001). CONCLUSIONS: The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia.

Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study.

The objective of the study was to develop and validate a translated and culturally adapted Mini-Mental State Examination (MMSE) for the Persian-speaking population. The MMSE was translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with Alzheimer's disease (n = 13) were studied. The difference between groups on the mean total scores of the Persian MMSE was statistically significant (control = 28.62 +/- 2.09; subjects with Alzheimer's disease = 11.77 +/- 5.66; p < .001). The cutoff score of 23 was the best cutoff score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was a significant correlation between the Persian MMSE score and the level of education (r = .46) and with age (r = -.77). There was no significant correlation between the Persian MMSE and gender. The Persian MMSE was found to be valid for discrimination of cognitive impairment in the Persian-speaking community.

Validity and reliability of the Persian ABILHAND-Kids in a sample of Iranian children with cerebral palsy.

Aim: To develop a Persian version of ABILHAND-Kids and to determine its reliability and validity in Persian-speaking children with cerebral palsy (CP).Method: The ABILHAND-Kids questionnaire was translated into Persian language and cross-culturally adapted following guidelines. The Persian ABILHAND-Kids was administered to 50 parents of CP children. Among the 50 parents of CP children, 30 of them participated in a test-retest reliability phase. Fifty parents of healthy children participated for discriminative validity.Results: The Rasch analysis indicated the unidimensionality, reliability, and global invariance of the Persian ABILHAND-Kids. The internal consistency reliability was high (Cronbach's alpha = 0.96). Floor and ceiling effects were insignificant (4%). The Intraclass Correlation Coefficients of test-retest reliability were 0.96 and 0.70 for item difficulties and children's measures, respectively. The standard error of measurement and smallest detectable change for CP measure were 11.21 and 31.07%, respectively. The discriminative validity of the Persian ABILHAND-Kids was demonstrated by statistically significant lower ABILHAND-Kids measures in CP children than in healthy children (p < 0.001). Cross-cultural validity between the Persian and original version was established for 19 out of the 21 ABILHAND-Kids items.Interpretation: The Persian ABILHAND-Kids questionnaire is reliable and valid for assessing manual ability in Persian speaking children with CP.Implications for rehabilitationThe Persian version of ABILHAND-Kids is developed and presented as a valid and reliable instrument for use by Persian-speaking clinicians and researchers.It is now possible for the Persian-speaking researchers to participate in international investigations and to compare Persian data with those from other countries.

Responsiveness and longitudinal validity of the Persian version of COMI to physiotherapy in patients with non-specific chronic low back pain.

Background and aims The Core Outcome Measures Index (COMI) is a short, self-reported questionnaire for assessing important outcomes in patients with low back pain (LBP). The present study was conducted to explore the responsiveness and longitudinal validity of the Persian COMI (COMI-P) in patients with non-specific chronic LBP. Methods In this prospective cohort study of patients with non-specific chronic LBP receiving physiotherapy, patients completed a booklet containing the COMI-P, Persian Functional Rating Index (FRI-P), and a visual analogue scale (VAS) for pain before and after the end of ten-sessions of physiotherapy. Patients also completed a global rating of change scale (GRCS) at the end of the physiotherapy. Responsiveness was examined by means of internal responsiveness methods [t-test, standard effect size (SES); standardized response mean (SRM), and Guyatt responsiveness index (GRI)] and external responsiveness methods [correlation with external criteria and receiver operating characteristics (ROC) curve]. Results Fifty patients with a mean age of 50.62 ± 13.8 years participated. The paired t-test showed significant changes in COMI-P scores (p < 0.001). The effect sizes for COMI-P were large (range 0.96-1.23). The score changes for the COMI-P revealed significant correlations with FRI-P (r = 0.67, p < 0.001), the VAS (r = 0.65, p < 0.001), and the GRCS (r = 0.34, p = 0.02). The COMI-P change scores showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (r = 0.83, p < 0.001). The ROC area under the curve for the COMI-P based on the dichotomized SDC criterion was perfect. The minimal clinically important change was estimated 2.15 points (sensitivity 94% and specificity 100%). Conclusions The COMI-P appears to have responsiveness and longitudinal validity in detecting changes after physiotherapy for non-specific chronic LBP. An improvement of 2.15 points in COMI-P total score is required to be interpreted as minimally clinically important change in individual patients.

Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity.

Patients with neurological conditions may be affected by spasticity. The Modified Modified Ashworth Scale (MMAS) is a clinical tool used to measure spasticity. The purpose of the present study was to investigate the inter-rater reliability of the MMAS during the assessment of elbow flexor spasticity in adult patients with post-stroke hemiplegia. Twenty-one adult patients with stroke (5 women, 16 men) with a median age of 60 years (interquartile range, 47-68) were tested. Elbow flexors on the affected side were examined. Inter-rater reliability for two inexperienced raters was very good. The weighted Kappa value was 0.81 (Standard Error = 0.097, 95% CI: 0.62-1.00, p = 0.0002). The weighted percentage agreement was 97.4%. The agreement between raters occurred mostly on score 1 (38.1%) followed by score 0 (23.8%). The MMAS yielded reliable measurements between raters when used on patients post-stroke with elbow flexor spasticity.