Psychometric properties of the Persian version of the brief illness questionnaire in Iranian with non-specific chronic neck pain.

INTRODUCTION: The Brief Illness Perception Questionnaire (BIPQ) is an instrument for assessing the illness perception. Illness perception varies between individuals based on their health status. There is no study that assess the psychometric properties of the Persian version of BIPQ in neck pain patients. The goal of this study was to evaluate the reliability, construct validity, and exploratory factor analysis of the Persian BIPQ in individuals with non-specific chronic neck pain. METHODS: This is a cross-sectional study in which 123 individuals with non-specific chronic neck pain participated. 60 participants examined after 7 days for testing reliability. Reliability was assessed by intra-class correlation coefficient, standard error of measurement, and minimal detectable change. For assessing construct validity and item-total correlation, correlation tests were used. Also, exploratory factor analysis was done to assess the factor structure of the BIPQ. RESULTS: Exploratory factor analysis' results showed that there were 2 factors with Eigenvalues >1. Factor 1 included "identity", "consequence", "timeline", and "emotional response". Factor 2 consisted of "coherence" and "treatment control". The intra-class correlation coefficient and the cronbach's alpha for the total score was 0.8 and 0.86 respectively. Results of correlation tests showed an acceptable construct validity except with SF-12 mental component. Item-total correlation tests demonstrated that the correlations were above 0.3 for all subscales except for "treatment control" and "coherence". CONCLUSION: BIPQ has an acceptable properties to assess illness perception in individuals with non-specific chronic neck pain. The results of exploratory factor analysis and item-total correlation confirmed that 2-subscale version is more acceptable.

Reliability of postural control during double-leg standing in subjects with nonspecific chronic low back pain: Dual-task paradigm and manipulated visual and somatosensory inputs.

BACKGROUND: The aim of this study is to evaluate the test-retest reliability of the Center of Pressure (COP) parameters in quiet double-leg standing in subjects with Non-Specific Chronic Low Back Pain (NSCLBP) during dual taking associated with manipulated visual and somatosensory inputs. MATERIALS AND METHODS: In this observational cross-sectional study, the static balance of thirty NSCLBP patients were assessed during a double-leg stance by using the force platform. Subjects were accosted by manipulated somatosensory and visual inputs during dual taking in eight different conditions (with and without vibration, eyes-open and eyes-closed, and with and without auditory Stroop test). The COP parameters were recorded as follows: range sideways and range fore-aft as well as mean velocity and area variables. The cognitive task parameters included the reaction time and error ratio. The intra-class correlation coefficient (ICC) was computed to assess the intersession reliability of COP parameters. RESULTS: in intersession, range sideways, range fore-aft, and mean velocity measures possessed moderate to high ICC, but area owned high ICC only in one condition (double-leg stance, eyes-close, with vibration, and with auditory Stroop test). Notably, other conditions had low ICC, and moderate to high and low to very high ICC were reported for reaction time and error ratio. CONCLUSION: Among the parameters studied in the present study, the mean velocity measure seems to be the most reliable variable of postural control in the subjects with NSLBP especially in more challenging conditions, i.e., quiet double-leg standing with eyes closed and adding vibratory inputs during dual-tasking.

Effects of Dry Needling on Connectivity of Corticospinal Tract, Spasticity, and Function of Upper Extremity in People with Stroke: Study Protocol for a Randomized Controlled Trial.

Background: Spasticity is a common motor disorder in adult stroke patients. Injury to the corticospinal tract (CST) is associated with spasticity. Dry needling (DN) has positive impacts on spasticity reduction and improvement in the range of motion (ROM) in stroke patients. This study aims to investigate the effectiveness of DN on the connectivity of the CST and the level of spasticity in adult stroke patients. Methods: This double-blind randomized controlled trial will enroll and randomly assign stroke patients to either the experimental group, for receiving three sessions of DN for the spastic wrist flexors, or the control group, for sham needling. The primary outcome measures will be diffusion tensor imaging and the Modified Modified Ashworth Scale score to assess CST connectivity and wrist flexor spasticity, respectively. The Box and Block Test and standard goniometry are the secondary outcome measures to assess hand dexterity and active and passive wrist ROM, respectively. Measurements will be taken both before and after the intervention. Discussion: The results of this study will provide important evidence of the effects of DN on CST connectivity, spasticity, and arm function in adult stroke patients. Trial registration: This trial is registered in the Iranian Registry of Clinical Trials (IRCT) (https://www.irct.ir; IRCT20191208045649N1).

Confirmatory Factor Analysis, Reliability, and Validity of the Persian Version of the Coping Strategies Questionnaire for Iranian People With Nonspecific Chronic Neck Pain.

OBJECTIVE: The purpose of this study was to assess the reliability and construct validity of, and perform confirmatory factor analysis of, the Persian version of the Coping Strategies Questionnaire (CSQ) for Iranian people with nonspecific chronic neck pain. METHODS: We performed psychometric testing of the Persian version of the Coping Strategies Questionnaire. Participants were 123 native Persian speakers with chronic neck pain lasting at least 3 months. They were between 18 and 55 years old. The CSQ was administered by self-report. After 5 to 7 days, 94 participants completed the questionnaire in the retest session. Confirmatory factor analysis was done to assess the model fit (χ2 test, comparative fit index, and root-mean-square error of approximation) of the 7-factor solution of the Persian version of the CSQ. The Cronbach α was used for internal consistency; intraclass correlation coefficient, standard error of measurement, and minimal detectable change for reliability; and nonparametric tests of group differences and correlations for construct validity. To assess the construct validity, we examined the ability of the CSQ to discriminate people based on sex, level of education, and physical activity. Correlations with the Short Form Health Survey (SF-12), Tampa Scale for Kinesiophobia, visual analog scale, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, and Neck Disability Index were also determined to test the validity. RESULTS: Confirmatory factor analysis measures-χ2 test, comparative fit index, and root-mean-square error of approximation-were 1.72, 0.76, and 0.07, respectively. Internal consistency was excellent (0.85). All intraclass correlation coefficients were above the acceptable level of 0.70, with the highest reliability obtained for the Praying subscale in both test and retest sessions. The standard error of measurement for the CSQ total score was 2.26, and the minimal detectable change was 6.25. The Cronbach α for the total score and for the subscales ranged from 0.75 to 0.93. Scores of the subscales of the CSQ and other questionnaires showed low correlation except for the physical component of the SF-12. The Catastrophizing subscale had a positive correlation with the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, and Neck Disability Index, and a negative correlation with the SF-12. CONCLUSION: The CSQ has acceptable and good measurement properties to assess coping strategies in Iranian people with nonspecific chronic neck pain. It is a reliable measure, though, for validity only The Catastrophizing subscale showed significant correlation with other scales, but the findings should be interpreted with caution because of the limitations of the study.

Attention-demand effects on respiration in chronic low back pain patients.

Increasing attention is being drawn towards the involvement of systems other than the musculoskeletal one in the presence of low back pain (LBP). Recent evidence suggests both cognitive and respiratory functions to be affected in LBP patients. The aim of this study was to compare the effect of performance of a cognitive task on the respiratory function in LBP patients with that in control participants. Capnography and spirometry parameters of 48 participants (24 in each group) were assessed under 3 cognitive loading conditions (no, easy and difficult cognitive task). The results showed that in both groups the respiratory function was significantly affected by the introduction of the cognitive task (p < 0.05) and in the same manner (p > 0.05). Capnography and spirometry variables alterations were significantly correlated in the no-LBP group (p < 0.05) but there was no significant relationship between respiratory parameters and capnography and disability indices in the LBP group (p > 0.05). The findings of the current study suggest that while performing a cognitive task affects respiratory function, the possible differences of LBP patients and control participants may not be elicited under simple non-physically demanding postural conditions.

Reliability of kinematic measures in subjects with anterior cruciate ligament deficiency during dual-task walking.

OBJECTIVE: To define the throughout within- and between-day reliability of gait parameters in single - and dual-task conditions in subjects with and without anterior cruciate ligament deficiency (ACLD). METHODS: Fourteen subjects with ACLD and 14 healthy subjects completed a walking task on a treadmill with three levels of velocity (self-selected, high and low), with or without performing an auditory Stroop task over two sessions each 3-5 days apart. The gait kinematic parameters, including maximum and minimum hip flexion, total hip range of motion, maximum and minimum knee flexion and total knee range of motion were recorded using a motion analysis system. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), and the coefficient of variation (CV) were used to determine inter- and intrasession reliability of kinematic and cognitive measures. RESULTS: ICCs for ACLD group in dual-task and single task conditions ranged between 0.50 to 0.93 and 0.53 to 0.93, respectively. ICC values for healthy groups in dual-task and single task conditions ranged between 0.36 to 0.90 and 0.39 to 0.87, respectively. When comparing relative reliability across kinematic variables in different velocities, ICC values were generally identical in all three levels of velocity. CONCLUSION: The findings suggest that dual-tasking could also be applied reliably for the assessment of functional activities in subjects with and without ACLD.

Effect of spinal stabilization exercise on dynamic postural control and visual dependency in subjects with chronic non-specific low back pain.

BACKGROUND: Motor control approach towards chronic non-specific low back pain (CNLBP) has gained increasing attention. CNLBP patients have shown to be more visually dependent for the postural control process than control subjects but no study has yet investigated the treatment programs effect on this disorder. METHODS: Forty CNLBP patients volunteered to participate in this experimental study. The subjects were randomly assigned into either stabilization exercise (SE) or control group both receiving 12 sessions of routine physiotherapy for four weeks. The SE group also received intensive stabilization exercise. Balance (in terms of overall (OSI), anteroposterior (APSI) and mediolateral stability indices (MLSI)) and functional disability were assessed by Biodex Balance System(®) (BBS) and Oswestry Low Back Disability Questionnaire, respectively prior and after the interventions. The balance tests were performed with open and closed eyes. RESULTS: Both interventions significantly decreased all stability indices but the SE group showed a more pronounced improvement in OSI and APSI. In the SE group, vision deprivation had smaller destabilizing effects on OSI and APSI as compared with the control group. The groups were not statistically different prior and after the interventions on all dependent variables. Oswestry index reduction in the SE group was more pronounced but the interaction of time and group variables were not significant on pain intensity. CONCLUSION: Both interventions effectively enhanced stability indices and functional capabilities and reduced pain intensity in CNLBP patients. The SE protocol made the patients less visual dependent perhaps via better stability. Since pain reduction was not different between the groups, more functional improvement in SE group cannot simply be interpreted via the pain interference and might be related to postural control capabilities of the patients.

Erratum to "The Use of Dry Needling and Myofascial Meridians in a Case of Plantar Fasciitis" (J Chiropr Med. 2015;13:43-48).

[This corrects the article DOI: 10.1016/j.jcm.2014.01.006.].

The use of dry needling and myofascial meridians in a case of plantar fasciitis.

OBJECTIVE: The purpose of this case report is to describe the use of dry needling based on myofascial meridians for management of plantar fasciitis. CLINICAL FEATURES: A 53-year-old man presented with bilateral chronic foot pain for more than 2 years. After 2 months of conventional treatment (ultrasound, plantar fascia and Achilles tendon stretching, and intrinsic foot strengthening), symptoms eventually improved; however, symptoms returned after prolonged standing or walking. Almost all previous treatment methods were localized in the site of pain that targeted only the plantar fascia. Initial examination of this individual revealed that multiple tender points were found along the insertion of Achilles tendon, medial gastrocnemius, biceps femoris, semimembranosus, and ischial tuberosity. INTERVENTION AND OUTCOME: Dry needling of the trigger points was applied. After 4 treatments over 2 weeks, the patient felt a 60% to 70% reduction in pain. His pressure pain threshold was increased, and pain was alleviated. The patient returned to full daily activities. The rapid relief of this patient's pain after 2 weeks of dry needling to additional locations along the superficial back line suggests that a more global view on management was beneficial to this patient. CONCLUSION: Dry needling based on myofascial meridians improved the symptoms for a patient with recurrent plantar fasciitis.

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.