Effect of Core Stabilization Exercises on Pain, Functional Disability, and Quality of Life in Pregnant Women With Lumbar and Pelvic Girdle Pain: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to assess the effect of adding core stability to usual care for pregnant women with lumbar and pelvic girdle (LPG) pain. METHODS: This was a repeated-measures design randomized controlled trial with blinded outcome assessors. Thirty-five pregnant women with LPG pain were recruited from prenatal health care providers. They were allocated to 2 study groups to receive either usual prenatal care (control group, n = 17) or usual care with core stability exercises focusing on the pelvic floor muscles and deep abdominal muscles (exercise group, n = 18) for 10 weeks. The visual analog scale, score on the Oswestry Disability Index, and the World Health Organization's Quality of Life Brief Version (WHOQOL-BREF) were evaluated with analysis of variance at pre-intervention, post-intervention, at the end of pregnancy, and 6 weeks after childbirth. RESULTS: There was a statistically significant interaction of group and time for all outcome measures except for the Social category (P = .18) in the WHOQOL-BREF questionnaire. The analysis of the group within time showed that mean scores in the exercise group were substantially improved at the post-intervention, end of pregnancy, and 6-week follow-up evaluation, except in the Environment category (end of pregnancy: P = .36; 6-week follow-up: P = .75) in the WHOQOL-BREF questionnaire. CONCLUSION: The results of this study indicate that the addition of core stability exercises was more effective than the usual care alone in pain relief, improving disability, and quality of life of pregnant women with LPG pain.

Comparison of the Dynamic Postural Control During Lifting and Lowering an External Load in Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: This study aimed to compare dynamic postural control between individuals with and without chronic low back pain (LBP) through load lifting and lowering. METHODS: This cross-sectional study included 52 male patients with chronic LBP (age: 33.37 ± 9.23 years) and 20 healthy male individuals (age: 31.75 ± 7.43 years). The postural control parameters were measured using a force plate system. The participants were instructed to stand barefoot (hip-width apart) on the force plate and lift a box (10% of the weight of the participants) from the waist height to overhead and then lower it from overhead to waist height. The interaction between the groups and tasks was determined using a 2-way repeated-measures analysis of variance. RESULTS: There was no significant interaction between the groups and tasks. Regardless of the groups, postural control parameters including amplitude (P = .001) and velocity (P < .001) in anterior-posterior (AP) direction, phase plane in medial-lateral (ML) direction (P = .001), phase plane in AP-ML direction (P = .001), and the mean total velocity (P < .001) were lesser during the lowering compared with lifting. The results indicated that, regardless of the tasks, the postural control parameters including velocity (P = .004) and phase plane in AP direction (P = .004), velocity in ML direction (P < .001), phase plane (AP-ML) (P = .028), and mean total velocity (P = .001) in LBP were lesser compared with the normal group. CONCLUSION: Different tasks affected postural control differently in patients with LBP and healthy individuals. Moreover, postural control was more challenged during the load-lowering than the load-lifting task. This may have been a result of a stiffening strategy. It may be that the load-lowering task might be considered as a more influential factor for the postural control strategy. These results may provide a novel understanding of selecting the rehabilitation programs for postural control disorders in patients.

Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome in the upper extremities. Acupuncture is often used as a treatment method in CTS and numerous studies consider it effective. However, no study has yet compared the efficacy of physical therapy including bone and neural mobilization, exercise and electrotherapy with and without acupuncture in CTS patients. PURPOSE: comparing the effect of physiotherapy plus acupuncture with physiotherapy alone on pain, disability and grip strength in CTS patients. METHOD: Forty patients with mild to moderate CTS were randomly divided into two equal groups. Both groups received exercise and manual techniques for 10 sessions. Patients in the physiotherapy plus acupuncture group also received 30 min of acupuncture in every session. The visual analog scale (VAS) score, the score on the Boston carpal tunnel questionnaire for functional status and symptom severity, shortened disability of arm, shoulder, hand (Quick-DASH) score and grip strength were evaluated at pre-test and post-test. RESULTS: According to ANOVA results, there is a significant interaction between group and time for VAS, BCTQ and Quick-DASH parameters. At the post-test, while the parameters of VAS, BCTQ and Quick-DASH in the physiotherapy plus acupuncture group had a statistically significant difference compared to the physiotherapy group, no significant difference was observed between the two groups in the pre-test. Moreover, there is no significant difference between groups in grip strength improvement. CONCLUSION: This study shows preliminary evidence that physiotherapy plus acupuncture, was more effective than physiotherapy alone in pain relief and improving disability of patients suffering from CTS.

Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle.

OBJECTIVE: The purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle. METHOD: Ninety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position. RESULTS: A 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005). CONCLUSION: The craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.

Traditional physical therapy exercises combined with sensorimotor training: The effects on clinical outcomes for chronic neck pain in a double-blind, randomized controlled trial.

OBJECTIVE: This study examined the effects of combining traditional physical therapy exercises with sensorimotor training on joint position sense, pain, muscle endurance, balance and disability in patients with chronic, non-specific neck pain. DESIGN: Double-blind, randomized controlled trial. SUBJECTS: A total of 53 patients with chronic non-specific neck pain were randomized to either traditional or combined exercise groups. INTERVENTIONS: All patients received 12 sessions of supervised intervention 3 times per week. The traditional group performed traditional exercises, and the combined exercise group performed sensorimotor training in addition to traditional exercises. OUTCOME MEASURES: Joint position sense, pain, neck flexor muscle endurance test, 10 Meter Walk Test, step test, and the Neck Disability Index. RESULTS: The combined exercise group showed significantly greater improvement compared to the traditional group in joint position sense during extension, flexion, right rotation, the 10 m walk test with head turn, and the step test. Pain intensity, muscle endurance, and disability improved in both groups. Additionally, there was a higher degree of effect on muscle endurance in the combined exercise group compared to a moderate effect in the traditional group. CONCLUSIONS: A combination of sensorimotor training with traditional physical therapy exercises could be more effective than traditional exercises alone in improving joint position sense, endurance, dynamic balance and walking speed.

Responsiveness of postural performance measures following balance rehabilitation in multiple sclerosis patients.

INTRODUCTION: Evaluating responsiveness has an important role in design and interpretation of the interventional studies. The aim was to estimate the responsiveness and minimally important difference (MID) of postural performance measures following balance rehabilitation in patients with Multiple Sclerosis (MS, n = 38). METHODS: Postural measures were evaluated at baseline and after 4 weeks intervention. Laboratory-based measures were center of pressure parameters. Clinically-based measures were Activities-specific Balance Confidence (ABC), Berg Balance Scale (BBS), Functional Gait Assessment (FGA); and walking measures 2 Minute Walk (2 MW), 10 Meter Timed Walk (10 MTW) and Timed Up and Go (TUG) performed under single and dual-task conditions. To evaluate responsiveness, we calculated the Receiver Operating Characteristics (ROC) and the Area Under the ROC Curve (AUC). The optimal values for the MID were the cutoffs corresponding to the upper left corner of the ROC curve. RESULTS: The AUCs for mean and standard deviation of sway velocity were above the cutoff of 0.50 in most conditions. For the clinically-based measures, the highest AUCs were found for the ABC, and cognitive-2MW, followed by the BBS and 10 MTW. CONCLUSIONS: In this preliminary study, the most appropriate postural performance measures and the MID values for detecting meaningful changes in MS undergoing balance rehabilitation have been provided.

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.

Massage therapy and exercise therapy in patients with multiple sclerosis: a randomized controlled pilot study.

OBJECTIVE: The primary aim was to investigate the comparative effects of massage therapy and exercise therapy on patients with multiple sclerosis. The secondary aim was to investigate whether combination of both massage and exercise has an additive effect. DESIGN: Randomized controlled pilot trial with repeated measurements and blinded assessments. SETTING: Local Multiple Sclerosis Society. SUBJECTS: A total of 48 patients with multiple sclerosis were randomly assigned to four equal subgroups labelled as massage therapy, exercise therapy, combined massage-exercise therapy and control group. INTERVENTIONS: The treatment group received 15 sessions of supervised intervention for five weeks. The massage therapy group received a standard Swedish massage. The exercise therapy group was given a combined set of strength, stretch, endurance and balance exercises. Patients in the massage-exercise therapy received a combined set of massage and exercise treatments. Patients in the control group were asked to continue their standard medical care. MAIN MEASURES: Pain, fatigue, spasticity, balance, gait and quality of life were assessed before and after intervention. RESULTS: Massage therapy resulted in significantly larger improvement in pain reduction (mean change 2.75 points, P = 0.001), dynamic balance (mean change, 3.69 seconds, P = 0.009) and walking speed (mean change, 7.84 seconds, P = 0.007) than exercise therapy. Patients involved in the combined massage-exercise therapy showed significantly larger improvement in pain reduction than those in the exercise therapy (mean change, 1.67 points, P = 0.001). CONCLUSIONS: Massage therapy could be more effective than exercise therapy. Moreover, the combination of massage and exercise therapy may be a little more effective than exercise therapy alone.

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.

Effect of expertise in shooting and Taekwondo on bipedal and unipedal postural control isolated or concurrent with a reaction-time task.

It was hypothesized that training in 'static balance' or 'dynamic balance' sports has differential effects on postural control and its attention demands during quiet standing. In order to test this hypothesis, two groups of female athletes practicing shooting, as a 'static balance' sport, and Taekwondo, as a 'dynamic balance' sport, and a control group of non-physically active females voluntarily participated in this study. Postural control was assessed during bipedal and unipedal stance with and without performing a Go/No-go reaction time task. Visual and/or support surface conditions were manipulated in bipedal and unipedal stances in order to modify postural difficulty. Mixed model analysis of variance was used to determine the effects of dual tasking on postural and cognitive performance. Similar pattern of results were found in bipedal and unipedal stances, with Taekwondo practitioners displaying larger sway, shooters displaying lower sway and non-athletes displaying sway characteristics intermediate to Taekwondo and shooting athletes. Larger effect was found in bipedal stance. Single to dual-task comparison of postural control showed no significant effect of mental task on sway velocity in shooters, indicating less cognitive effort invested in balance control during bipedal stance. We suggest that expertise in shooting has a more pronounced effect on decreased sway in static balance conditions. Furthermore, shooters invest less attention in postures that are more specific to their training, i.e. bipedal stance.