Cervico-cephalalgiaphobia: a subtype of phobia in patients with cervicogenic headache and neck pain? A pilot study.

OBJECTIVES: The term 'cephalalgiaphobia' was introduced in the mid-1980s and defined as fear of migraine (attacks). We hypothesized that a specific subtype of cephalalgiaphobia affects patients with cervicogenic headache (CEH). This study aimed to: (1) define the term 'cervico-cephalalgiaphobia'; (2) develop a set of indicators for phobia relevant to patients with CEH; and (3) apply this set to a practice test in order to estimate the frequency of cervico-cephalalgiaphobia in the Dutch primary care practice of manual physical therapy. METHODS: A systematic approach was used to develop a definition and potential indicators for cervico-cephalalgiaphobia. An expert group appraised the definition and the set of indicators (score per indicator: never; sometimes; often/always). An invitation to participate in the practice test was sent to Dutch manual physical therapy practices (n = 56) representing 134 manual physical therapists (MPTs). The cut-off point for percentages of scores for coverage of the indicators was set at ≥ 60%. RESULTS: The expert group agreed with the proposed definition of cervico-cephalalgiaphobia. A set of eight indicators for cervico-cephalalgiaphobia was selected from 10 initial indicators. Thirty-six MPTs provided data from 46 patients diagnosed with CEH. The coverage of 'often/always' was substantial for the indicators, 'Short-term positive results in previous manual physical therapeutic treatment', 'Shorter interval between treatment sessions', 'Fear of "locked facet joints" of the neck', 'More frequent manipulation', and 'Fear of increase in headaches'. Coverage was also substantial for 'never' regarding 'Long-term positive results in previous manual physical therapeutic treatment'. 'Confirmation of "locked facet joints" of the cervical spine by MPT as a cause for increase of CEH' scored 'often/always' in all patients. Coverage for 'Increased use of medication with insufficient effect' was substantial, scoring as 'sometimes' in 39 (84.8%) patients. DISCUSSION: Cervico-cephalalgiaphobia was defined and a set of eight indicators formulated based on the literature and clinical expertise. The practice test provides valuable information on the frequency of indicators for cervico-cephalalgiaphobia in the Dutch manual physical therapy practice, suggesting that cervico-cephalalgiaphobia is common in patients with CEH.

Manual physical therapists' use of biopsychosocial history taking in the management of patients with back or neck pain in clinical practice.

OBJECTIVE: To develop and evaluate process indicators relevant to biopsychosocial history taking in patients with chronic back and neck pain. METHODS: The SCEBS method, covering the Somatic, Psychological (Cognition, Emotion, and Behavior), and Social dimensions of chronic pain, was used to evaluate biopsychosocial history taking by manual physical therapists (MPTs). In Phase I, process indicators were developed while in Phase II indicators were tested in practice. RESULTS: Literature-based recommendations were transformed into 51 process indicators. Twenty MTPs contributed 108 patient audio recordings. History taking was excellent (98.3%) for the Somatic dimension, very inadequate for Cognition (43.1%) and Behavior (38.3%), weak (27.8%) for Emotion, and low (18.2%) for the Social dimension. MTPs estimated their coverage of the Somatic dimension as excellent (100%), as adequate for Cognition, Emotion, and Behavior (60.1%), and as very inadequate for the Social dimension (39.8%). CONCLUSION: MTPs perform screening for musculoskeletal pain mainly through the use of somatic dimension of (chronic) pain. Psychological and social dimensions of chronic pain were inadequately covered by MPTs. Furthermore, a substantial discrepancy between actual and self-estimated use of biopsychosocial history taking was noted. We strongly recommend full implementation of the SCEBS method in educational programs in manual physical therapy.

Preliminary results, methodological considerations and recruitment difficulties of a randomised clinical trial comparing two treatment regimens for patients with headache and neck pain.

BACKGROUND: Headache is a highly prevalent disorder. Irrespective of the headache diagnosis it is often accompanied with neck pain and -stiffness. Due to this common combination of headache and neck pain, physical treatments of the cervical spine are often considered. The additional value of these treatments to standard medical care or usual care (UC) is insufficiently documented.We therefore wanted to compare the treatment effects of UC alone and in combination with manual therapy (MT) in patients with a combination of headache and neck pain. UC consisted of a stepped treatment approach according to the Dutch General Practitioners Guideline for headache, the additional MT consisted of articular mobilisations and low load exercises.Due to insufficient enrolment the study was terminated prematurely. We aim to report not only our preliminary clinical findings but also to discuss the encountered difficulties and to formulate recommendations for future research. METHODS: A randomised clinical trial was conducted. Thirty-seven patients were included and randomly allocated to one of both treatment groups. The treatment period was 6 weeks, with follow-up measurements at weeks 7, 12 and 26. Primary outcome measures were global perceived effect (GPE) and the impact of the headache using the Headache Impact Test (HIT-6). Reduction in headache frequency, pain intensity, medication intake, absenteeism and the use of additional professional help were secondary outcome measures RESULTS: Significant improvements on primary and secondary outcome measures were recorded in both treatment groups. No significant differences between both treatment groups were found. The number of recruited patients remained low despite various strategies. CONCLUSION: It appears that both treatment strategies can have equivalent positive influences on headache complaints. Additional studies with larger study populations are needed to draw firm conclusions. Recommendations to increase patient inflow in primary care trials, such as the use of an extended network of participating physicians and of clinical alert software applications, are discussed. TRIAL REGISTRATION NUMBER: NCT00298142.

The dynamic postural control is impaired in patients with chronic ankle instability: reliability and validity of the multiple hop test.

OBJECTIVE: To investigate the reliability and validity of a clinical evaluation method for the assessment of the dynamic postural control in patients with chronic ankle instability (CAI). DESIGN: Cross-sectional study. SETTING: All tests were conducted at the practice room of the Physical Therapy Department. PARTICIPANTS: Twenty-nine healthy subjects and 29 patients with CAI were selected. INTERVENTIONS: Participants performed twice a multiple hop test within a 1-week time interval. Subjects hopped on 10 different tape markers while trying to avoid any postural correction. MAIN OUTCOME MEASURES: The number and type of balance errors were documented by analyzing the digital video images. RESULTS: Test-retest reliability of the number of balance errors was excellent in patients (intraclass correlation coefficient, ICC = 0.83; standard errors of measurement = 2.6) and moderate in healthy subjects (ICC = 0.64; standard errors of measurement = 2.8). The intra-observer and inter-observer reliability was excellent (ICC > 0.90). Both for the test (P = 0.000) and for the retest (P = 0.000), the number of balance errors in patients was significantly higher (17.9 +/- 6.6) when compared with healthy subjects (10.9 +/- 4.6). On both test occasions, patients with CAI used significantly more a change-in-support strategy (test: P = 0.000; retest: P = 0.000). The number of balance errors was significantly correlated with the time needed to perform the test (r = 0.60; P = 0.000) and the perceived difficulty of the hop test as rated on a visual analogue scale (r = 0.44; P = 0.014). CONCLUSIONS: The multiple hop test is a reliable and valid test for detecting an impaired dynamic postural control in patients with CAI.

Reliability and discriminative validity of sudden ankle inversion measurements in patients with chronic ankle instability.

BACKGROUND: Studies investigating peroneal muscle reaction times in chronically unstable ankle joints present conflicting results. The degree of reliability and accuracy of these measurements is unknown in patients with chronic ankle instability (CAI). METHODS: 40 patients with CAI and 30 healthy subjects were tested using a sudden ankle inversion of 50 degrees while standing on a trapdoor device. Sudden ankle inversion measurements were registered using electromyography, accelerometry and electrogoniometry. For reliability testing, intra-class coefficients (ICCs; model 3,1) and standard errors of measurements of the latency time, motor response time and electromechanical delay of the peroneus longus muscle, the time and angular position of onset of decelerations, the mean and maximum inversion speed and the total inversion time were calculated in 15 patients with CAI. To assess between-group differences, t-tests for independent samples (p<.05) were used. RESULTS: ICCs ranged from .20 (angular position of onset of the second deceleration) to .98 (electromechanical delay of the peroneus longus muscle). Significant between-group differences were observed in only 2 of the 12 variables (for the electromechanical delay of the peroneus longus muscle, p=.001; time of onset of the second deceleration, p=.040). CONCLUSIONS: The latency time and motor response time of the peroneus longus muscle, the total inversion time and the mean inversion speed demonstrate acceptable reliability in healthy subjects and patients. The latency time and motor response time of the peroneus longus muscle are not delayed in patients with CAI. Ankle inversion measurements are not discriminative for CAI.

Developmental changes and predictability of static strength in individuals of different maturity: a 30-year longitudinal study.

This longitudinal study analyses the development and predictability of static strength and their interactions with maturation in youth. Of 515 children followed annually from age 6 to 18 years, 59 males and 60 females were measured again at age 35. Early, average, and late maturity groups were established. Body height and mass were assessed. Static strength was measured using handgrip dynamometry. Pearson correlations were used as tracking coefficients. From 6 to 12 years of age, no static strength differences were found to exist between the maturity groups of both sexes. Static strength is significantly higher in early than in average and late maturing boys (age 13-16). In girls, a dose-response effect exists (age 11-14). Adult static strength predictability is low in early maturing boys and late maturing girls. It is moderate to high (50-76%) in the other maturity groups up to age 14. Predictors for adult static strength are childhood and adolescent handgrip dynamometry (in females only), medicine ball throw, sit-up, hockey ball throw, and 25-m sprint. Handgrip is a fair predictor of adult static strength at most ages in early and average maturing females; in average maturing males, it is a predictor at age 11. Other indicators of strength (e.g. hockey ball throw) are predictors in males.

Specific associations between types of physical activity and components of mental health.

Findings of previous studies suggest that the relationship between physical activity and mental health may change across different domains of physical activity, different dimensions of mental health, and different population subgroups. The present study examined associations between five types of physical activity with different contents: housework, leisure active transportation, biking to/from work, walking to/from work, and sports participation, and two dimensions of mental health: perceived stress and psychological distress, in 1919 participants aged 20-65 years, using the data from the Flemish Policy Research Centre Sport, Physical Activity and Health. Multiple logistic regression analyses were performed with the total sample, and with the sample stratified by gender, age, and occupational category. Further, separate models were used in the gender and age subgroups of each occupational category. Sports participation was the only type of physical activity inversely associated with both stress (OR=0.375; CI: 0.200-0.704) and distress (OR=0.480; CI: 0.253-0.910). Sports participation related to less distress in unemployed mid-aged adults, and to less stress in unemployed women, unemployed young adults, and young adults with blue-collar jobs. Housework was associated with more stress and more distress in women with blue-collar jobs. In young adults with white-collar jobs, however, an inverse association between housework and distress was found. Biking to and from work was associated with more stress in men with blue-collar jobs. Results invite consideration for the utility, and perhaps the necessity, of differentiated health recommendations for physical health and for mental health in different population subgroups.

The chronic ankle instability scale: clinimetric properties of a multidimensional, patient-assessed instrument.

OBJECTIVE: To construct the chronic ankle instability scale (CAIS) and evaluate its clinimetric properties. DESIGN/SETTING: Validation study. The test procedure was conducted at the University Hospital of the Vrije Universiteit Brussel, Brussels, Belgium. PARTICIPANTS: Twenty-nine patients with chronic ankle instability (CAI) were selected. MAIN OUTCOME MEASURES: Content validity, test-retest reliability, internal consistency, floor-ceiling effects, construct validity and the minimal detectable change of the CAIS were investigated. RESULTS: After final item reduction, the CAIS contains 14 items. Weighted kappa coefficients of the items ranged from .50 to .94. The intraclass correlation coefficient for the total score was .84 (p<.05). The standard error of measurement of the total score was 2.7 points; the minimal detectable change 4.7 points. Cronbach alpha coefficients for the subscales ranged from .62 to .80. The "impairments" subscale score of the CAIS did not correlate significantly with talar tilt values (Rho respectively -.05 and -.07; p>.05). The "disabilities" subscale score of the CAIS correlated significantly with both the timed test performance (Rho respectively -.38 and -.40; p<.05) and the perceived difficulty of the multiple hop test (Rho respectively -.41 and -.49; p<.05). CONCLUSION: The CAIS is a valid and reliable instrument for quantifying the multidimensional profile of patients with CAI. Future research should investigate the responsiveness of the CAIS and determine its minimally clinical important difference.

Changes of skin characteristics during and after local Parafango therapy as used in physiotherapy.

BACKGROUND/AIMS: In physiotherapy, fango (mud) application is a frequently used heat therapy. The main therapeutic effects are due to the elevated temperature of the different tissues with a significant redistribution of blood towards the heated area. This may influence several cardiovascular parameters. There is only limited information on the effect of fango application on skin characteristics. It was the aim of the present study to evaluate the effects of fango application on skin temperature, perfusion of the microcirculation and skin colour. At the same time, cardiovascular parameters such as heart rate, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded. METHOD: Eighteen healthy subjects (age 23.7+/-3.8 years) entered the study. The skin characteristics and cardiovascular parameters were measured before, during and after a 21-min fango application at 44.5 degrees C. RESULTS: Skin temperature and perfusion of the microcirculation increased significantly during fango application: from 35.5+/-0.4 degrees C to 44.3+/-1.2 degrees C for skin temperature and from 23.2+/-8.8 to 197+/-41 p.u. for the skin microcirculation. These two parameters remained elevated during the fango application and decreased slowly to baseline values within 21 min after fango removal. Skin colour (CIELAB, a(*) parameter) increased from 11.0+/-2.5 to 17.9+/-1.9 when comparing pre- with post-treatment values. At the end of the measuring period, the a(*) parameter did not return to baseline values (15.8+/-2.1). Heart rate increased with 8 bpm during the fango therapy and returned to baseline within 3 min after removal of the fango. SBP and DBP varied slightly during the fango application. They returned to baseline values within 21 min after fango removal. CONCLUSION: The skin parameters indicate a transient temperature effect with an increased perfusion of the microcirculation and a flooding of the superficial capacitance system. The cardiovascular parameters were only slightly influenced and remained in the physiological range. Fango application seems not to be too demanding for the cardiovascular system in healthy subjects.

Functional performance deficits in patients with CAI: validity of the multiple hop test.

OBJECTIVES: To investigate the reliability and validity of a functional performance test in patients with chronic ankle instability (CAI). DESIGN: Cross-sectional study. SETTING: All tests were conducted in the practice room of the physical therapy department of the Vrije Universiteit Brussel. PARTICIPANTS: Twenty-nine healthy subjects and 29 patients with CAI were selected. For the main outcome measurements, participants performed a multiple hop test two times, within a 1-week time interval. Subjects hopped on 10 different tape markers and had to try to avoid making any postural correction. Only when subjects stood still were they allowed to continue hopping. The time needed to complete the test and VAS scores for the perceived difficulty were assessed. RESULTS: In unstable ankles, ICCs of time values were >0.90 (SEM = 2.3 seconds); Spearman rho values of VAS scores were >0.80. When hopping on their unstable ankles, patients (41.1 +/- 12.6 seconds) needed significantly more time to complete the test than healthy subjects (31.4 +/- 5.0 seconds; test: P = 0.000; retest: P = 0.002) or when compared with their unaffected contralateral ankles (38.0 +/- 7.1 seconds; test: P = 0.047; retest: P = 0.009). Only with respect to the dominant ankles, patients (median = 64 mm) perceived the test as significantly more difficult than did healthy subjects (median = 37 mm; test: P = 0.018; retest: P = 0.002). VAS scores of unstable ankles in patients (median = 50 mm) were significantly higher than their contralateral, unaffected ankles (median = 30 mm; test: P = 0.001; retest: P = 0.002). CONCLUSIONS: The multiple hop test is a reliable test demonstrating functional performance deficits in patients with CAI.

Lipid profile in men and women with different levels of sports participation and physical activity.

OBJECTIVE: The purpose of the present study was to analyse the lipid profile in men and women differentiated according to energy expenditure during sports participation (EE(SPORT)), energy expenditure during active leisure time (EE(ALT)) and overall energy expenditure (EE(TOTAL)). DESIGN: The subjects were grouped by sex, age, EE(SPORT), EE(ALT) and EE(TOTAL). Group differences were analysed using analyses of covariance with BMI and alcohol consumption as covariates. SETTING: Physical activity was assessed using the Flemish Physical Activity Computerised Questionnaire. Fasting blood samples were taken to measure total cholesterol (TC), TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and the ratio TC:HDL-C. SUBJECTS: The study sample consisted of 1170 Flemish men and women between 18 and 75 years of age. RESULTS: Differences in lipid profile were observed in the younger age group (<45 years), all in favour of the most active group. More specifically, when differentiating by EE(ALT) and EE(TOTAL), men had a healthier lipid profile for TAG, HDL-C and TC:HDL-C. Differentiation according to EE(SPORT) revealed the same significant results except for TAG. In women significant results for HDL-C, LDL-C and TC:HDL-C were found when differentiated by EE(SPORT). CONCLUSIONS: Men and women <45 years of age with higher levels of energy expenditure due to sport show a better lipid profile than their sedentary counterparts. When differentiating subjects according to energy expenditure during active leisure time or overall energy expenditure, only in men was a healthier lipid profile observed in favour of the most active subjects.

Reliability and validity of the Flemish Physical Activity Computerized Questionnaire in adults.

The purpose of this study was to investigate the test-retest reliability and concurrent validity of the Flemish Physical Activity Computerized Questionnaire (FPACQ) in employed/unemployed and retired people. The FPACQ was developed to assess detailed information on several dimensions of physical activity and sedentary behavior over a usual week. A triaxial accelerometer, the RT3 Triaxial Research Tracker (RT3), in combination with a written 7-day activity record, was used as the objective criterion measure. In employed/unemployed people, 2-week test-retest reliability for several activity variables calculated from the FPACQ was good to excellent with intraclass correlations (ICCs) ranging from .67 to .99. In retired people ICCs were lower but, except for time spent eating, still fair to excellent, ranging from .57 to .96. Except for time spent in leisure time activities for men and the average energy expenditure related to sports participation in women, correlations between the RT3 and the FPACQ generally supported the relative validity of the FPACQ for employed/unemployed people (r ranging from .37 to .88). Values for retired people were somewhat lower (r ranging from .15 to .85), but most variables still reached at least moderate correlations. Concerning absolute validity, the FPACQ generally overestimated physical activity and underestimated sedentary behavior compared to the RT3. From this study, it can be concluded that the FPACQ is a reliable and reasonably valid questionnaire for assessing different dimensions of physical activity and sedentary behavior.

Dietary factors associated with obesity indicators and level of sports participation in Flemish adults: a cross-sectional study.

BACKGROUND: Obesity develops when energy intake continuously exceeds energy expenditure, causing a fundamental chronic energy imbalance. Societal and behavioural changes over the last decades are held responsible for the considerable increase in sedentary lifestyles and inappropriate dietary patterns. The role of dietary fat and other dietary factors in the aetiology and maintenance of excess weight is controversial. The purposes of the present study were to investigate the dietary factors associated with body mass index (BMI) and waist circumference (WC), and to analyse whether dietary intake varies between subjects with different levels of sports participation. METHODS: Data for this cross-sectional study, including anthropometric measurements, 3-day diet diary and physical activity questionnaire, were collected by the Flemish Policy Research Centre Sport, Physical Activity and Health (SPAH) between October 2002 and April 2004. Results of 485 adult men and 362 women with plausible dietary records were analysed. Analyses of covariance were performed to determine the differences in dietary intake between normal weight, overweight and obese subjects, and between subjects with different levels of sports participation. RESULTS: Total energy intake, protein and fat intake (kcal/day) were significantly higher in obese subjects compared to their lean counterparts in both genders. Percentage of energy intake from fat was significantly higher in obese men compared to men with normal weight or WC. Energy percentages from carbohydrates and fibres were negatively related to BMI and WC in men, whereas in women a higher carbohydrate and fibre intake was positively associated with obesity. Alcohol intake was positively associated with WC in men. Subjects participating in health related sports reported higher intake of carbohydrates, but lower intake of fat compared to subjects not participating in sports. CONCLUSION: This study supports the evidence that carbohydrate, fat, protein and fibre intake are closely related to BMI and WC. The sex differences for dietary intake between obese men and women might reflect the generally higher health consciousness of women. Alcohol intake was only associated with WC, emphasizing the importance of WC as an additional indicator in epidemiological studies. Besides enhancing sports and physical activity, it is necessary to improve the knowledge about nutrition and to promote the well-balanced consumption of wholesome food.

Test-retest reliability of sudden ankle inversion measurements in subjects with healthy ankle joints.

CONTEXT: Sudden ankle inversion tests have been used to investigate whether the onset of peroneal muscle activity is delayed in patients with chronically unstable ankle joints. Before interpreting test results of latency times in patients with chronic ankle instability and healthy subjects, the reliability of these measures must be first demonstrated. OBJECTIVE: To investigate the test-retest reliability of variables measured during a sudden ankle inversion movement in standing subjects with healthy ankle joints. DESIGN: Validation study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: 15 subjects with healthy ankle joints (30 ankles). INTERVENTION(S): Subjects stood on an ankle inversion platform with both feet tightly fixed to independently moveable trapdoors. An unexpected sudden ankle inversion of 50 degrees was imposed. MAIN OUTCOME MEASURE(S): We measured latency and motor response times and electromechanical delay of the peroneus longus muscle, along with the time and angular position of the first and second decelerating moments, the mean and maximum inversion speed, and the total inversion time. Correlation coefficients and standard error of measurements were calculated. RESULTS: Intraclass correlation coefficients ranged from 0.17 for the electromechanical delay of the peroneus longus muscle (standard error of measurement = 2.7 milliseconds) to 0.89 for the maximum inversion speed (standard error of measurement = 34.8 milliseconds). CONCLUSIONS: The reliability of the latency and motor response times of the peroneus longus muscle, the time of the first and second decelerating moments, and the mean and maximum inversion speed was acceptable in subjects with healthy ankle joints and supports the investigation of the reliability of these measures in subjects with chronic ankle instability. The lower reliability of the electromechanical delay of the peroneus longus muscle and the angular positions of both decelerating moments calls the use of these variables into question.

Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy.

OBJECTIVE: To study the endogenous sex hormone levels in natural postmenopausal women and their association with the presence of internal carotid artery (ICA) atherosclerosis. DESIGN: Case-control study METHODS: We compared 56 patients with severe ICA atherosclerosis referred for carotid artery endarterectomy (CEA) with 56 age-matched control subjects free of severe atherosclerotic disease. The presence of atherosclerosis was determined by high-resolution B-mode ultrasound. Metabolic parameters and sex hormones were measured or calculated: total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, quantitative insulin sensitivity check index, insulin resistance index, IGF-I, DHEA, DHEA sulfate (DHEA-S), free testosterone, total testosterone, estrone, estradiol, androstenedione, and sex hormone-binding globulin. RESULTS: The cases had statistically significant lower levels of both total testosterone (0.23 +/- 0.12 vs 0.31 +/- 0.20 microg/l, P = 0.043) and free testosterone (3.42 +/- 1.94 vs 4.59 +/- 2.97 ng/l, P = 0.009) and significantly lower levels of androstenedione (625.3 +/- 168.7 vs 697.0 +/- 211.9 ng/l, P = 0.017) when compared with controls. Multivariate linear regression analysis, adjusted for traditional cardiovascular risk factors, baseline and physiologic characteristics, showed a significant inverse relationship between both serum free testosterone (beta = -0.234, P = 0.028) and androstenedione (beta = -0.241, P = 0.028) levels with the presence of severe atherosclerosis of ICA. CONCLUSIONS: The study provides evidence of a positive association between low serum androgen levels and severe ICA atherosclerosis in postmenopausal women. It suggests that higher, but physiological, levels of androgens in postmenopausal women have a protective role in the development of atherosclerosis of ICA.

Reproducibility of postural control measurement during unstable sitting in low back pain patients.

BACKGROUND: Postural control tests like standing and sitting stabilometry are widely used to evaluate neuromuscular control related to trunk balance in low back pain patients. Chronic low back pain patients have lesser postural control compared to healthy subjects. Few studies have assessed the reproducibility of the centre of pressure deviations and to our knowledge no studies have investigated the reproducibility of three-dimensional kinematics of postural control tests in a low back pain population. Therefore the aim of this study was to assess the test-retest reproducibility of a seated postural control test in low back pain patients. METHODS: Postural control in low back pain patients was registered by a three dimensional motion analysis system combined with a force plate. Sixteen chronic low back pain patients having complaints for at least six months, were included based on specific clinical criteria. Every subject performed 4 postural control tests. Every test was repeated 4 times and lasted 40 seconds. The force plate registered the deviations of the centre of pressure. A Vicon-612-datastation, equipped with 7 infra-red M1 camera's, was used to track 13 markers attached to the torso and pelvis in order to estimate their angular displacement in the 3 cardinal planes. RESULTS: All Intraclass Correlation Coefficients (ICC) calculated for the force plate variables did not exceed 0.73 (ranging between 0.11 and 0.73). As for the torso, ICC's of the mean flexion-extension and rotation angles ranged from 0.65 to 0.93 and of the mean lateral flexion angle from 0.50 to 0.67. For the pelvis the ICC of the mean flexion-extension angle varied between 0.66 and 0.83, the mean lateral flexion angle between 0.16 and 0.81 and the mean rotation angle between 0.40 and 0.62. Consecutive data suggest that the low test-retest reproducibility is probably due to a learning effect. CONCLUSION: The test-retest reproducibility of these postural control tests in an unstable sitting position can globally be considered as rather moderate. In order to improve the test-retest reproducibility, a learning period may be advisable at the beginning of the test.

Management of headache disorders: design of a randomised clinical trial screening for prognostic patient characteristics.

BACKGROUND: Treatment of headache disorders is not always optimal. Patients are treated in multiple ways, and the lack of scientific arguments for referral and the insufficient implementation of guidelines result in unclear treatment strategies. The coexistence of headache and neck pain can lead to the referral to a musculoskeletal physiotherapist. This treatment can only be successful if an underlying cervical segmental dysfunction is present. In such cases a physical treatment can be a valuable option that should be considered. The aim of this study is to identify prognostic therapeutic patient characteristics and to increase the number of correct physiotherapy referrals. METHODS/DESIGN: This trial is designed to identify patient characteristics which can influence the prognosis of the patient. Patients with recurrent headache and co-existent neck pain are recruited via a multicenter setup. After screening for eligibility, subjects are tested at baseline and randomly allocated to one of two treatment groups. Testing includes the administering of questionnaires (a Headache Diagnosis Questionnaire, Headache Inventory List and the Headache Impact Test (HIT-6)) and physical tests (Thermal Stimuli, Manual Cervical Spine Examination and Pressure Algometry). Treatment groups are a usual care group (UC) administered by the General Practitioner (GP) and a usual care plus musculoskeletal physiotherapy treatment group (UCMT). UC is based on the Dutch GP Guideline for Headache. UCMT consists of the UC plus a combination of exercises and spinal cervical mobilisations. Follow-up measurements consist of the completion of the Headache Inventory List, the HIT-6 and scoring of the global perceived effect (GPE). The latter allowing the distinction between responders (positive effect) and non-responders (no effect or worse). Logistic regression analysis will be used to identify the specific patient characteristics of the responders and the non-responders. The additional value of the musculoskeletal physiotherapy will be examined. Follow-up measurements up to 52 weeks are scheduled. DISCUSSION: This trial aims to identify prognostic patient characteristics, in order to supply a useful diagnostic tool for all health care workers, dealing with headache sufferers.

Secular trends in anthropometric characteristics, physical fitness, physical activity, and biological maturation in Flemish adolescents between 1969 and 2005.

In this study, secular trends in anthropometric characteristics, physical fitness, physical activity, and biological maturity over the past 25-35 years in Flemish adolescents were investigated. Representative cross-sectional samples of 12-18-year-old secondary school children (11,899 assessments in boys in 1969-1974, 4,899 girls in 1979-1980, 1,429 boys and 1,772 girls in 2005) and parent-offspring pairs tested at approximately the same age during adolescence (55 father-son pairs, mean age fathers = 15.47 years, mean age sons = 15.38 years; 62 mother-daughter pairs, mean age mothers = 16.63 years, mean age daughters = 15.01 years) were used. The cross-sectional data were analyzed in 6 yearly age-categories using Wilcoxon rank sum tests. For the parent-offspring data paired t-tests, simple linear regressions to adjust for parent-offspring differences in chronological age and multiple linear regressions to adjust for parent-offspring differences in chronological and skeletal age were conducted. The cross-sectional study generally revealed an increase in weight, stature, BMI, skinfolds and trunk-extremity index, and a decrease in the performance on several physical fitness tests. In the parent-offspring study, only sons were maturationally advanced compared to fathers. Even after adjustment for parent-offspring differences in chronological age and in chronological and skeletal age, results for stature, trunk-extremity index and physical fitness were generally similar to the cross-sectional study. No secular trend was observed for sports participation. The fact that the positive secular trends in weight, BMI, and skinfolds of the cross-sectional study were not entirely confirmed in the parent-offspring study is probably due to higher similarity in genetic and familial background, higher socio-economic status, and more health-consciousness of the latter.

Measuring activity patterns using actigraphy in multiple sclerosis.

Multiple sclerosis (MS) is a demyelinating disease resulting in impairments in motor and mental performance and restrictions in activities. Self-report instruments are commonly used to measure activity patterns; alternatively, actigraphs can be placed on several parts of the body. The aims of this study were to evaluate the superiority and specificity of actigraph placement (wrist vs. ankle) in subjects with MS and healthy controls and explore the relationship between self-report and objective activity patterns. A total of 19 subjects with definite MS and 10 healthy volunteers wore actigraphs on the non-dominant wrist and ankle for three days while they kept a log to register performed activities every .5 h. Wrist and ankle actigraphs produced similar activity patterns during the most active hours (09:00-20:30 h) (ANOVA, timexlocation interaction: F=.901, df=23, p=.597) in individuals with MS and healthy controls (between subjects factor F=3.275, p=.083). Wrist placement of the actigraphs was better tolerated than ankle placement. Wrist actigraph data corresponded to a higher degree with self-reported activities of the upper limbs in the early afternoon, whereas ankle data seem to reflect better whole body movements in the later afternoon/early evening. Overall, actigraph data correlated moderately with self-reported activity (r=.57 for ankle and r=.59 for wrist). The regression model revealed that self-reported activities explained 44% of the variance in ankle and 50% of wrist data. Wrist and ankle actigraphs produce similar activity patterns in subjects with MS and in healthy controls; however, the placement of actigraphs on the wrist is better tolerated. Ankle actigraphs reflect general movement but underestimate upper body activity. Subjective registration of activity level partly matches with objective actigraph measurement. A combination of both objective and subjective activity registration is recommended to evaluate the physical activity pattern of subjects with MS.