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.

The inter- and intra-rater reliability of Modified Tardieu Scale in assessing spasticity of knee extensors in patients with multiple sclerosis.

INTRODUCTION: Spasticity is one of the most common and disabling symptoms in Multiple sclerosis (MS). The is a clinical tool for assessing spasticity. This study aimed to investigate the inter- and intra-rater reliability of the modified Tardieu scale for assessing knee extensors spasticity in MS patients. METHODS: Twenty-six patients with MS (12 females and 14 males) with a mean age of 40 ± 11.39 years participated in this study. The extensor muscles of both knees were evaluated using the MTS in two sessions. At first session, two examiners randomly assessed the knee extensor spasticity to study the inter-rater reliability and 3-4 days later the first examiner assessed the patients again, to determine intra-rater reliability. Intra-class Correlation Coefficient (ICC) analysis, two-way random effect model was used to determine the reliability of various components of the modified Tardieu scale. RESULTS: The inter-rater reliability for quality of muscle reaction of knee extensor muscles was very good (ICC = 0.89) and for the difference between the angle of muscle response (R1) and full range(R2) of movement (R2- R1), as spasticity intensity criterion, was good (ICC = 0.73). ICC values for R2-R1 and muscle response quality assessments by one rater were 0.73 and 0.82, respectively. CONCLUSION: The findings of the current study showed that the MTS has good to very good inter- and intra-rater reliability for assessing knee extensors spasticity in MS patients.

Eligibility of the movement-based classification systems in the diagnosis of patients with low back pain: A systematic review.

OBJECTIVE: To evaluate the eligibility of the movement-based classification systems in the diagnosis of patients with low back pain. METHODS: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta -Analysis guidelines. Different databases including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest and Google Scholar were searched from January 1990 to December 2017. All studies assessed the reliability and validity of the movement-based classification systems to diagnose patients with low back pain were included. The keywords used to search the studies were: "reliability", "validity", "classification", "movement impairment" and "low back pain". Study selection and data extraction were performed by two independent reviewers. RESULTS: Sixteen articles were met the inclusion criteria. Of these articles, 13 studies assessed the reliability and validity of movement-based classification systems to categorize patients with low back pain. Two out of 16 articles compared patients with low back pain and healthy subjects and one article had no control group. CONCLUSIONS: The results of the reviewed studies demonstrated that movement-based classification systems are valid and reliable enough to categorize patients with low back pain.

Responsiveness of the Persian health assessment questionnaire measures in differentiating among disease activity levels in rheumatoid arthritis patients.

OBJECTIVES: Evidence suggests that inflammation has a harmful effect on muscle strength as well as on functional disability. The purpose of the present study was to examine the association of objectively measured disease activity levels and functional disability among Iranian patients with Rheumatoid Arthritis (RA), and to analyse whether a Persian version of the health assessment questionnaire-disability index (PHAQ-DI) can distinguish between RA patients at different stages of the disease progression. MATERIALS & METHODS: 198 RA patients were requested to complete the PHAQ-DI. The disease activity score for each patient was evaluated using the disease activity score (DAS-28). The association analysis between the PHAQ-DI scores and the four levels of disease activity was measured using a Spearman correlation coefficient. A Kruskal-Wallis analysis was utilized to determine differences in PHAQ-DI scores among the levels of disease activity. The Receiver operating characteristic (ROC) curve was also utilized to determine the PHAQ-DI total score cut-off for predicting the level of disease activity. RESULTS: Spearman's correlation coefficients between the PHAQ-DI and the disease activity level ranged between 0.59 and 0.75. There were significant differences in the PHAQ-DI total score among known groups with various disease activity levels (P = 0.001); However, HAQ-DI total score could not differentiate the remission phase from low disease activity levels in patients with RA (p = 0.37). The PHAQ-DI total score cut-off for distinguishing remission-low disease activity from moderate-high disease activity was 1.19, with a specificity of 0.91 and a sensitivity of 0.615. CONCLUSION: The present findings provide evidence for the degree to which the PHAQ-DI measures identify and distinguish disease activity levels in patients with rheumatoid arthritis. The PHAQ-DI questionnaire, as a patient-administered, non-invasive, fast, inexpensive and available tool, can be used in the rheumatologist's office as a substitute for determining disease activity in patients with active RA.

Single leg landing kinematics in volleyball athletes: A comparison between athletes with and without active extension low back pain.

PURPOSE: The purpose of this study was to compare kinematics of the lower extremity and lumbar spine during a single leg landing task between female volleyball athletes with and without persistent low back pain (LBP). METHODS: In this cross sectional study, 36 volunteer female volleyball athletes with (n = 18) and without (n = 18) LBP were recruited. Two specifically trained physical therapists selected only athletes with a specific movement-based subgroup of LBP for inclusion. Three dimensional kinematic and ground reaction force data were recorded for each athlete across three single leg landing trials by utilizing a Vicon 6-camera motion capture system and one in-floor embedded Kistler force plate, respectively. Independent t-tests compared data between the two groups. RESULTS: Lumbar lordosis when standing (p = 0.046) as well as on initial contact (p = 0.025) and at the time which the maximal vertical ground reaction force occurred (p = 0.020) were significantly greater in the LBP group. There were no other significant differences. CONCLUSIONS: The tendency for this specific subgroup of athletes to consistently adopt more extended lumbar postures in both static and dynamic tasks may be worth considering by those involved in coaching, performance optimizing and injury prevention.

The Influence of Cognitive Behavioral Therapy on Pain, Quality of Life, and Depression in Patients Receiving Physical Therapy for Chronic Low Back Pain: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to investigate the effect of adding the cognitive behavioral treatment (CBT) component to routine physical therapy (PT) on pain and depression reduction, improvement in quality of life, and enhanced function in patients with chronic low back pain (CLBP). TYPE: Systematic review. LITERATURE SURVEY: Google Scholar, PubMed, Ovid, ScienceDirect, ProQuest, Scopus, Cochrane Library, and Embase electronic databases were explored for the key terms of "behavioral (or behavioural) treatment" OR "behavior (behaviour) treatment" OR "behavior (behaviour) therapy" OR "cognitive behavior (or behaviour) treatment" OR "cognitive treatment" OR "cognitive therapy" OR "operant behavior (or behaviour) treatment" OR "respondent behavior (or behaviour) treatment" AND "physical therapy" OR "physiotherapy" OR "exercise therapy" OR "electrotherapy" OR "electrical therapy" OR "manual therapy" OR "myofascial therapy" OR "rehabilitation" AND "low back pain" OR "lower back pain" OR "back pain" OR "chronic back pain" OR "chronic lower back pain", with no limitation on language, through January 2018. METHODOLOGY: All randomized controlled trials that statistically compared the effectiveness of CBT + PT and PT were included for quality analysis. Studies were rated by high to poor quality, using Hailey's classification, based on their design and performance. SYNTHESIS: Of the 10 included studies, 7 were rated as high quality and 3 as good quality. Although CBT + PT was found to be superior to PT for pain, disability, quality of life, and functional capacity variables in some of the included studies, no extra benefit from CBT was documented in other investigations. The included studies also failed to show any advantage of CBT + PT over PT in reducing depression, and PT was even found to be superior to CBT + PT in one high-quality study. CONCLUSIONS: Although appearing to be advantageous by reducing pain and disability and enhancing functional capacity and quality of life, CBT effects on depression cannot be teased out from the effects of PT. LEVEL OF EVIDENCE: I.

The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain.

PURPOSE: Hamstring strain is a common sport injury that results in pain and functional limitation. Despite its high frequency in active populations, there is no agreement regarding the best method used for early intervention of hamstring strain. The aim of the present study was to compare the effects of cryotherapy and cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. MATERIALS AND METHODS: Thirty seven elite athletes with an acute grade I or II hamstring strain were randomly assigned to either cryotherapy (n = 19) or cryostretching (n = 18) group, receiving 5 sessions of supervised treatment plus home-based intervention monitored by the therapist. Pre-treatment to post-treatment changes in pain, active and passive knee extension range of motion and functional status were compared between the two groups. RESULTS: Compared to cryotherapy, cryostretching resulted in larger improvement of function and passive knee extension range of motion. Changes in active knee extension range of motion and pain severity were not significantly different between the two groups. CONCLUSION: A rehabilitation protocol involving gentle stretching following cryotherapy is more effective than cryotherapy alone in the improvement of function and passive knee range of motion in patients with grade I and II hamstring strain.

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.

Adaptation, reliability and validity testing of a Persian version of the Health Assessment Questionnaire-Disability Index in Iranian patients with rheumatoid arthritis.

OBJECTIVE: The aim of the present study was to culturally adapt and evaluate reliability and validity of Health Assessment Questionnaire-Disability Index (HAQ-DI) in Iranian patients with rheumatoid arthritis (RA). SUBJECTS: 234 patients with RA for validation study, Eighty-six participants for reliability study. METHODS: Test-retest relative reliability and internal consistency of Persian version of HAQ-DI were examined by intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Additionally, HAQ-DI construct validity (Spearman's correlation) was examined using Persian version of Short-Form 36 Health survey (SF-36), activity and severity parameters. RESULTS: Persian version of HAQ-DI total score showed excellent test-retest reliability (ICC = 0.98) and internal consistency (Cronbach's alpha = 0.95). Spearman's correlations between the total PHAQ-DI score and activity and severity parameters were above 0.55. Correlation between PHAQ-DI and SF-36 Physical Health were higher as compared with SF-36 Mental Health. CONCLUSION: Persian version of HAQ-DI is a reliable and valid culturally-adapted instrument in order to measure functional limitations in Iranian people with RA.

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.

Reliability of force-platform measures of postural sway and expertise-related differences.

CONTEXT: Although reliability is a population-specific property, few studies have investigated the measurement error associated with force-platform parameters in athletic populations. OBJECTIVE: To investigate the skill-related differences between athletes and nonathletes in reliability of center-of-pressure (COP) summary measures under eyes-open (EO) and eyes-closed (EC) conditions. DESIGN: Test-retest reliability study. SETTING: COP was recorded during double-leg quiet standing on a Kistler force platform before and after a fatiguing treadmill exercise, with EO and EC. PARTICIPANTS: 31 male participants including 15 athletes practiced in karate and 16 nonathletes. MAIN OUTCOME MEASURES: Standard deviation (SD) of amplitude, phase-plane portrait, SD of velocity, mean total velocity, and area were calculated from 30-s COP data. Intraclass correlation coefficient (ICC), standard error of measurement, and coefficient of variation (CV) were used as estimates of reliability and precision. RESULTS: Higher ICCs were found for COP measures in the athlete (compared with the nonathlete) group, postfatigued (compared with prefatigued) condition, and EC (compared with EO) tests. CVs smaller than 15% were obtained for most of the COP measures. SD of velocity in the anteroposterior direction showed the highest reliability in most conditions. CONCLUSIONS: Tests with EC and to a lesser extent tests performed in the athlete group and in the postfatigued condition showed better reliability.

The therapeutic effect of low-level laser on repair of osteochondral defects in rabbit knee.

INTRODUCTION: Low level laser therapy (LLLT) has been shown to enhance collagen production and wound healing but its effect on cartilage repair from biomechanical point of view is not known yet. The aim of present study was to evaluate the biomechanical behaviour of repairing osteochondral defect in rabbits which received a pulsed low-level gallium-arsenide (Ga-As) laser irradiation. MATERIALS AND METHODS: Osteochondral defects with 5mm diameter and 4mm in depth induced by drilling in right femoral patellar grooves of 41 adolescent male rabbits. They were divided into experimental and control groups. Experimental group received pulsed Ga-As (890nm) laser irradiation with energy density of 4.8J/cm(2). The rabbits in control group received placebo LLLT with shut-down equipment. The control defects were allowed to heal spontaneously. Each group were divided into three subgroups: A, B and C. Subgroups A, B and C were sacrificed on 4, 8, and 16 weeks after surgery. The knee joint were removed, and the defects were examined biomechanically by in situ-indentation method. The thickness, instantaneous and equilibrium indentation stiffness was measured during the test. Data were analysed using ANOVA and independent sample t-test. RESULT: While no difference was observed in the repaired cartilage biomechanical properties among 4th, 8th, 16th weeks in study groups. The equilibrium indentation stiffness of experimental group was significantly higher in 8th week in comparison with control group. CONCLUSION: LLLT significantly enhances the stiffness of repairing tissue in the 8th week post injury in osteochondral defects in rabbits.