Assessing healthcare professionals' perceptions of pain concepts and beliefs.

BACKGROUND: Healthcare professionals deliver pain education, yet their perception of pain experiences is not well understood, which can affect their interactions with patients in pain. OBJECTIVE: This study explored Korean healthcare professionals' perceptions of the usefulness of assessing pain concepts and beliefs and the importance of domains identified in the pain literature. METHODS: This descriptive cross-sectional study employed an online survey administered to nurses, physical therapists, and physicians, including the Neurophysiology of Pain Questionnaire, Tampa Scale for Kinesiophobia, and related optional open-ended questions. RESULTS: Most participants acknowledged the importance and usefulness of assessing understanding of pain concepts but anticipated patients' difficulty comprehending items assessing biological mechanisms underlying pain. Participants questioned the items' accuracy, indicating their limited pain knowledge and the necessity of reducing literacy demands. The critical domains of pain education were learning about pain, external factors influencing pain, and pain as a form of protection. CONCLUSION: Participants had suboptimal pain knowledge but emphasized decreasing literacy demands of pain neurophysiology items. Additionally, it is necessary to develop and implement a pain education program to improve pain-related knowledge and provide educational content for healthcare professionals encountering patients in pain.

Effect of Transcranial Direct Current Stimulation with Balance Training in a Middle-Aged Population: Randomized Double-Blind Sham-Controlled Trial.

Introduction: The first signs of deteriorated balance impairment begin during middle age. Early intervention could delay the fall risk in older populations; hence, addressing balance deficits during this age is crucial. The authors aimed to determine the effects of transcranial direct current stimulation (tDCS) combined with balance training (BT) on the improvement of static and dynamic balance in a middle-aged population, along with the participants' safety and satisfaction. Methods: Participants (n = 28) were randomized into two groups: active tDCS (active tDCS + BT) and sham tDCS (sham tDCS + BT). Both groups received the intervention thrice a week for 6 weeks. Dynamic and static balance were assessed by sway rate changes with eyes open and closed, and the functional reach test and a postintervention survey were conducted to assess participants' safety and satisfaction. Results: The active tDCS group showed significantly greater static and dynamic balance improvements in sway scores. The surveys demonstrated the safety of the program and satisfaction of 80% of the participants with the combined intervention. Conclusion: tDCS could be used in a middle-aged population as part of regular BT to improve balance and minimize the risk of balance deficits in older populations while ensuring patient safety and satisfaction. This study is a subanalysis of a larger clinical trial that included young adults as well (Clinical trial number: KCT0007414).

Effect of tDCS Combined With Physical Training on Physical Performance in a Healthy Population.

Purpose: The effectiveness of transcranial direct current stimulation (tDCS) combined with physical training has shown inconsistent results through research. Hence, a study utilizing a long-term tDCS application over the primary motor cortex and a large sample size is required to determine whether tDCS combined with physical training can increase physical performance (muscular strength, endurance, and explosive strength) in healthy adults. Material and methods: Fifty-six healthy adults were randomly distributed into two groups: active (active tDCS+ physical training) and sham (sham tDCS + physical training) and received the intervention three times per week for six weeks. Muscle strength was assessed using maximal isometric muscle strength (MIMS) by a digital dynamometer. Muscular endurance and lower limb explosive strength were assessed by using muscle fitness testing (MFT), and the Sargent jump test. Results: The active and sham groups exhibited significant improvement in all measured parameters in intragroup analyses. However, intergroup analyses revealed no significant difference between the groups. Conclusion: Our findings suggest that only physical training improved MIMS in the upper and lower extremities, MFT endurance scores, and lower limb explosive power. Thus, tDCS failed to demonstrate its effectiveness in a healthy population according to the protocol used in this study.

Cloud-based digital healthcare development for precision medical hospital information system.

Aim: This study aims to develop a cloud-based digital healthcare system for precision medical hospital information systems (P-HIS). Methods: In 2020, international standardization of P-HIS clinical terms and codes was performed. In 2021, South Korea's first tertiary hospital cloud was established and implemented successfully. Results: P-HIS was applied at Korea's first tertiary general hospital. Common data model-compatible precision medicine/medical service solutions were developed for medical support. Ultrahigh-quality medical data for precision medicine were acquired and built using big data. Joint global commercialization and dissemination/spreading were achieved using the P-HIS consortium and global common data model-based observational medical outcome partnership network. Conclusion: To provide personalized precision medical services in the future, establishing and using big medical data is essential.

The rice NUCLEAR FACTOR-YA5 and MICRORNA169a module promotes nitrogen utilization during nitrogen deficiency.

Nitrogen (N) is essential for plant growth and development. Therefore, understanding its utilization is essential for improving crop productivity. However, much remains to be learned about plant N sensing and signaling. Here, rice (Oryza sativa) NUCLEAR FACTOR-YA5 (OsNF-YA5) expression was tightly regulated by N status and induced under N-deficient conditions. Overexpression (OE) of OsNF-YA5 in rice resulted in increased chlorophyll levels and delayed senescence compared to control plants under normal N conditions. Agronomic traits were significantly improved in OE plants and impaired in knockout mutants under N-deficient conditions. Using a dexamethasone-inducible system, we identified the putative targets of OsNF-YA5 that include amino acid, nitrate/peptide transporters, and NITRATE TRANSPORTER 1.1A (OsNRT1.1A), which functions as a key transporter in rice. OsNF-YA5 directly enhanced OsNRT1.1A expression and N uptake rate under N-deficient conditions. Besides, overexpression of OsNF-YA5 also enhanced the expression of GLUTAMINE SYNTHETASE 1/2 (GS1/2) and GLUTAMINE OXOGLUTARATE AMINOTRANSFERASE 1/2 (GOGAT1/2), increasing free amino acid contents under N-deficient conditions. Osa-miR169a expression showed an opposite pattern with OsNF-YA5 depending on N status. Further analysis revealed that osa-miR169a negatively regulates OsNF-YA5 expression and N utilization, demonstrating that an OsNF-YA5/osa-miR169a module tightly regulates rice N utilization for adaptation to N status.

Pain Reduction and Posture Alignment Improvement in Older Adults with Chronic Low Back Pain: A Novel Approach Using Spinal Thermal Massage Bed and Calf Pneumatic Cell Compression.

BACKGROUND Chronic low back pain (CLBP) significantly affects the well-being of older adults, leading to diminished quality of life and heightened stress. Existing treatments have limited effectiveness and potential side effects. This study aimed to explore an integrative approach, employing a combination of spinal thermal massage bed (STMB) and intermittent pneumatic calf compression, as an alternative strategy for managing CLBP, improving body posture, reducing stress, and enhancing quality of life. MATERIAL AND METHODS Twenty-three participants aged 65-80 years completed a 4-week intervention involving eight sessions (2 per week) with the STMB device. Outcome measures included pain level assessed by the visual analog scale, trunk and pelvic tilting angles indicating spine curvature, stress level of the autonomic nervous system, Oswestry Disability Index, and EuroQol five-dimensions QoL questionnaire. RESULTS The study revealed significant reductions in pain intensity between baseline and mid-term scores (p=0.002) and between baseline and post-test scores (p=0.001). Moreover, notable improvements were observed in trunk and pelvic tilting angles (p<0.001) and stress scores between baseline and mid-term scores (p=0.037) and between baseline and post-test scores (p=0.019). However, no significant changes were observed in disability level or QoL. Participants expressed high satisfaction with the intervention, and no serious side effects were reported CONCLUSIONS This study provides compelling evidence supporting the safety and efficacy of combining STMB with intermittent pneumatic calf compression in reducing pain intensity and stress levels and improving trunk and pelvic tilting angles. Clinical trial number: KCT0008212.

Effects of electrical muscle stimulation on core muscle activation and physical performance in non-athletic adults: A randomized controlled trial.

BACKGROUND: Electrical muscle stimulation (EMS) activates muscles through electrical currents, resulting in involuntary muscle contractions. This study aimed to evaluate the immediate clinical effects of superimposing EMS on strength training compared with conventional exercise in healthy non-athletic adults. METHODS: This study was a randomised, controlled, parallel-group trial conducted at a single centre. Forty-one healthy young volunteers were recruited and randomised into two groups: strengthening with superimposed EMS (S+E) and strengthening (S) groups. All participants underwent the 30 minutes of strength training program, three times a week for 8 weeks, consisting of core muscle exercises. Additionally, the S+E group received EMS during training, which stimulated the bilateral abdominal, gluteus, and hip adductor muscles. As the primary outcome measure, we evaluated the changes in muscle thickness, including the abdominal, gluteal, and hip adductor muscles, using ultrasound. Muscle thickness was measured in both resting and contracted states. For secondary outcomes, physical performance (Functional Movement System score, McGill's core stability test, and hip muscle power) and body composition analysis were evaluated. All assessments were performed at the beginning and end of the intervention. RESULTS: 39 participants (S+E group = 20, S group = 19) completed the study. The clinical characteristics and baseline functional status of each group did not differ significantly between the groups. After completion of the training, the S+E group showed more efficient contraction in most of the evaluated muscles. The resting muscle thickness did not differ significantly between the groups; however, the contracted muscle thickness in the S+E group was higher than that in the S group (p < 0.05). Physical performance and body composition were not significantly different between the two groups. No intervention-related complications were reported during the study. CONCLUSION: EMS seems to be a safe and reasonable modality for improving physical fitness in healthy individuals.

DROUGHT-INDUCED BRANCHED-CHAIN AMINO ACID AMINOTRANSFERASE enhances drought tolerance in rice.

Plants accumulate several metabolites in response to drought stress, including branched-chain amino acids (BCAAs). However, the roles of BCAAs in plant drought responses and the underlying molecular mechanisms for BCAA accumulation remain elusive. Here, we demonstrate that rice (Oryza sativa) DROUGHT-INDUCED BRANCHED-CHAIN AMINO ACID AMINOTRANSFERASE (OsDIAT) mediates the accumulation of BCAAs in rice in response to drought stress. An in vitro enzyme activity assay indicated that OsDIAT is a branched-chain amino acid aminotransferase, and subcellular localization analysis revealed that OsDIAT localizes to the cytoplasm. The expression of OsDIAT was induced in plants upon exposure to abiotic stress. OsDIAT-overexpressing (OsDIATOX) plants were more tolerant to drought stress, whereas osdiat plants were more susceptible to drought stress compared with nontransgenic (NT) plants. Amino acid analysis revealed that BCAA levels were higher in OsDIATOX but lower in osdiat compared with in NT plants. Finally, the exogenous application of BCAAs improved plant tolerance to osmotic stress compared with that in control plants. Collectively, these findings suggest that OsDIAT mediates drought tolerance by promoting the accumulation of BCAAs.

Rice NAC17 transcription factor enhances drought tolerance by modulating lignin accumulation.

Land plants have developed a comprehensive system to cope with the drought stress, and it is operated by intricate signaling networks, including transcriptional regulation. Herein, we identified the function of OsNAC17, a member of NAC (NAM, ATAF, and CUC2) transcription factor family, in drought tolerance. OsNAC17 is localized to the nucleus, and its expression was significantly induced under drought conditions. A transactivation assay in yeast revealed that the OsNAC17 is a transcriptional activator, harboring an activation domain in the C-terminal region. Overexpressing (OsNAC17OX) transgenic plants showed drought-tolerant, and knock-out (OsNAC17KO) plants exhibited drought susceptible phenotype compared to non-transgenic plants. Further investigation revealed that OsNAC17 positively regulates several lignin biosynthetic genes and promotes lignin accumulation in leaves and roots. Together, our results show that OsNAC17 contributes to drought tolerance through lignin biosynthesis in rice.

Rice microRNA171f/SCL6 module enhances drought tolerance by regulation of flavonoid biosynthesis genes.

Plants have evolved sophisticated defense systems to enhance drought tolerance. These include the microRNA (miRNA) group of small noncoding RNAs that act as post-transcriptional regulators; however, details of the mechanisms by which they confer drought tolerance are not well understood. Here, we show that osa-MIR171f, a member of osa-MIR171 gene family, is mainly expressed in response to drought stress and regulates the transcript levels of SCARECROW-LIKE6-I (SCL6-I) and SCL6-II in rice (Oryza sativa). The SCL6 genes are known to be involved in shoot branching and flag leaf morphology. Osa-MIR171f-overexpressing (osa-MIR171f-OE) transgenic plants showed reduced drought symptoms compared with non-transgenic (NT) control plants under both field drought and polyethylene glycol (PEG)-mediated dehydration stress conditions. Transcriptome analysis of osa-MIR171f-OE plants and osa-mir171f-knockout (K/O) lines generated by clustered regularly interspaced short palindromic repeats (CRISPR/Cas9) revealed that osa-mature-miR171a-f (osa-miR171) regulates the expression of flavonoid biosynthesis genes, consequently leading to drought tolerance. This upregulation in the osa-MIR171f-OE plants, which did not occur in NT control plants, was observed under both normal and drought conditions. Our findings indicate that osa-miR171 plays a role in drought tolerance by regulating SCL6-I and SCL6-II transcript levels.

Influence of Anterior-Posterior External Surface Perturbation on Trunk Stability During Abdominal Stabilization Strategies While Sitting.

BACKGROUND Spinal and pelvic injuries during an unexpected perturbation are closely related to spinal stability, which is known to be controlled by abdominal stabilization maneuvers. This study aimed to evaluate the effects of unexpected perturbations on trunk stability and abdominal stabilization strategies in 42 sedentary adults while sitting. MATERIAL AND METHODS Abdominal stabilization strategies consisted of bracing and hollowing maneuvers. Abdominal bracing maneuvers (ABM) were focused on the abdominal wall muscles [inferior oblique (IO), exterior oblique (EO)], and abdominal hollowing maneuvers (AHM) were focused on deep muscle (TrA) activation. The subjects were instructed in abdominal stabilization maneuvers. Afterward, subjects were seated in a chair that could be moved forward or backward suddenly with the support surface. RESULTS Angular displacements of the upper thorax, lower thorax, and lumbopelvic during unexpected perturbation, with different abdominal stabilization maneuvers, were measured. During forward perturbation (d=0.71, F=10.324, P=0.001) and backward perturbation in high speed (d=0.62, F=9.265, P=0.011), there were significant differences in angular displacements of the upper thorax between hollowing and bracing maneuvers. Additionally, significant differences were found in the lumbopelvic angular displacement between the hollowing and bracing maneuvers (d=0.62, F=4.071, P=0.044). CONCLUSIONS Our findings indicate that the ABM is a better stabilizing technique for the upper thorax, and the AHM is a better stabilizing technique for the lumbopelvic region during unexpected perturbations at high speed in the seated position.

Effect of aquatic exercise on physical function and QOL in individuals with neurological disorder: A systematic review and meta-analysis.

BACKGROUND: When applying aquatic exercise program to patients with neurological disorder, quality of life (QOL) can be changed by physical function or psychological improvement. METHODS: Cochrane Database, CINAHL, Embase, Google Scholar, PEDro, PubMed, ScienceDirect, and SCOPUS were used to systematically search for relevant studies published between January 1999 and June 2019. The study quality was determined using the Physiotherapy Evidence Database (PEDro) scale. RESULTS: Eight of the 326 retrieved articles met the inclusion criteria. The results of the studies led to a general consensus: physical education program increased balance and gait and decreased pain. QOL improved as physical health, mental health, and vitality recuperated. CONCLUSIONS: The findings indicate that aquatic exercise program could be helpful when treating neurological disorders and should be considered as a means of reducing pain while increasing physical function and QOL in standard clinical research programs.

Effectiveness of Simulated Horseback Riding for Patients With Chronic Low Back Pain: A Randomized Controlled Trial.

CONTEXT: A simulated horseback riding (SHR) exercise is effective for improvement of pain and functional disability, but its comparative effectiveness with the other is unknown. OBJECTIVE: The authors aimed to demonstrate the effect of a SHR exercise in people with chronic low back pain. DESIGN: A randomized controlled trial. SETTINGS: Community and university campus. PARTICIPANTS: A total of 48 participants with chronic low back pain were divided into 2 groups, and SHR exercises (n = 24) or stabilization (STB) exercises (n = 24) were performed. INTERVENTIONS: The exercises were performed for 30 minutes, 2 days per week for 8 weeks. MAIN OUTCOME MEASURES: Numeric rating scale, functional disabilities (Oswestry disability index and Roland-Morris disability), and fear-avoidance beliefs questionnaire (FABQ) scores were measured at baseline and at 4 weeks, 8 weeks, and 6 months. RESULTS: A 2-way repeated analysis of variance identified that between-group comparisons showed significant differences in the FABQ related to work scale (F = 21.422; P = .01). There were no significant differences in the numeric rating scale (F = 1.696; P = .21), Oswestry disability index (F = 1.848; P = .20), Roland-Morris disability (F = 0.069; P = .80), and FABQ related to physical scale (F = 1.579; P = .24). In within-group comparisons, both groups presented significant differences in numeric rating scale (both SHR and STB after 4 wk), Oswestry disability index (both SHR and STB after 6 mo), and Roland-Morris disability (SHR after 6 mo and STB after 8 wk) compared with baseline values. In FABQ-related physical (SHR after 4 wk) and work scales (SHR after 6 mo), there were only significant differences in the SHR compared with baseline values. CONCLUSIONS: SHR exercise for 8 weeks had a greater effect than STB exercise for reducing work-related FABQ. The SHR exercise performed in a seated position could substantially decrease pain-related fear disability in young adults with chronic low back pain.

Effectiveness of therapeutic inflatable ball self-exercises for improving shoulder function and quality of life in breast cancer survivors after sentinel lymph node dissection.

BACKGROUND: The survival rate of breast cancer survivors (BCSs) is > 90%. Particular issues are upper arm dysfunction caused by surgery and treatments. Physical activity has been recommended to improve shoulder function and quality of life (QoL) in BCSs. However, rehabilitation programs tend not to be continuous. PURPOSE: To explore the effectiveness of therapeutic inflatable ball self-exercise for improving shoulder function and QoL in breast cancer survivors (BCSs) following breast cancer surgery. PATIENTS AND METHODS: Seventy-two BCSs were allocated to two groups, conventional self-exercise (CSE; n = 34; age, 48.9 ± 7.2 years) and therapeutic inflatable ball self-exercise (IBE; n = 38; age, 47.7 ± 8.9 years); 22 in the CSE and 23 in the IBE group completed the interventions. Both groups performed intervention for 12 weeks, three times per week and 15 min a day at least. Measurement was performed three times for shoulder range of motion (ROM), handgrip strength, Shoulder Pain and Disability Index (SPADI), and Functional Assessment of Cancer Therapy-Breast (FACT-B). RESULT: Flexion and extension of shoulder ROM showed significant differences between the two groups at 12 weeks. Flexion and extension of shoulder ROM showed significant differences for t1-t2 (p = 0.02) and t0-t1 (p = 0.04). Abduction showed a significant difference for t0-t1 (p = 0.03), t1-t2 (p = 0.02), and t0-t2 (p = 0.01). CSE (7 points) and IBE (20 points) satisfied the MDC in FACT-B total score. The MDC of the SPADI total score was 13 points in the CSE group and 9 points in the IBE group. CONCLUSION: IBE would be more appropriate to start the rehabilitation for BCSs and CSE would be effective after the pain has improved.

Noninvasive brain stimulation over dorsolateral prefrontal cortex for pain perception and executive function in aging.

OBJECTIVES: Based on the evidence that the dorsolateral prefrontal cortex (DLPFC) is the main region affected by the aging process, and that tDCS modulates cortical excitability, the aim of the study is to prove the feasibility of tDCS for pain perception and executive function of community-dwelling elderly individuals. METHODS: We performed a double-blind, single-arm trial, including a sham period. 5 consecutive anodal tDCS was applied over DLPFC of twenty-four elderly for 20 min during each intervention periods (in order of Sham-1 mA-2 mA). First, we classified chronic non-inflammatory pain sites into three domain (Neck and upper extremity, low back, lower extremity). Then, we used visual analogue scale, pain self-efficacy scale, Tampa scale for kinesiophobia, and Global perceived Effect scale to observe the change in pain perception, as well as Trailing Making Test and Timed Up and Go (dual) to observe the change in executive function. The changes in maximal grip strength and 12-item Short Form survey were measured secondarily. RESULTS: In the results, we observed significant improvement in pain perception and quality of life, while executive function and grip strength did not change significantly. CONCLUSION: Our findings demonstrated the feasibility of tDCS for aging-related pain perception and suggest that further randomized controlled trials with longer duration are necessary to examine the effects on executive function.

Noninvasive Brain Stimulation over the M1 Enhances Bimanual Force Control Ability: A Randomized Double-Blind Sham-Controlled Study.

Well-coordinated bimanual force control is common in daily life. We investigated the effects of anodal transcranial direct current stimulation (tDCS) over the primary motor cortex on bimanual force control. Under a cross-over study, young adults (n = 19; female = 6, male = 13) completed three bimanual force control tasks at 5%, 25%, and 50% of bimanual maximum voluntary force (BMVF) before and after real or sham tDCS. Real tDCS enhanced accuracy at all BMVF, reduced variability at 5% BMVF, and increased coordination at 5% BMVF. Real tDCS improved force control at 5% and 25% BMVF, and especially increased bimanual coordination at 5% BMVF. These findings might have implications for establishing interventions for patients with hand force control deficits.

Effect of myofascial trigger point therapy with an inflatable ball in elderlies with chronic non-specific low back pain.

BACKGROUND: Myofascial trigger points (MTrPs) are related to low back pain and back muscle stiffening, and secondarily to movement impairment. MTrP therapy with an inflatable ball would improve clinical outcomes for chronic non-specific low back pain (CNSLBP) after 6 weeks. OBJECTIVE: The aim of this study was to investigate the effects of MTrPs with an inflatable ball for the elderly with CNSLBP. METHODS: Fifteen elderly patients with chronic non-specific low back pain were evaluated for pain, pressure sensitivity, and physical function at baseline and 1, 3, and 6 weeks of therapy. The visual analog scale (VAS) and pressure pain threshold (PPT) were used to measure pain intensity and sensitivity, respectively. Straight-leg-raise (SLR) test, back range of motion (BROM), and Oswestry disability index were used to assess physical function. RESULTS: Significant differences were observed between the 3- and 6-week VAS scores (-34.6%; p= 0.03); baseline and 1-week (7%; p= 0.02), 1- and 3-week (-14%; p= 0.01), and 3- and 6-week PPTs (18%; p= 0.01); 3- and 6-week BROMs (Flexion, 7.1%; Extension, 41%; p= 0.048); baseline and 1-week (-6.9%; p= 0.02), 1- and 3-week (3%; p= 0.01), and 3- and 6-week active SLR test scores (7%; p= 0.011); and baseline and 1-week (-2.6%; p= 0.03), 1- and 3-week (8.34%; p= 0.01), and 3- and 6-week passive SLR test scores (5.3%; p= 0.025). CONCLUSION: Myofascial trigger point therapy with an inflatable ball relieved pain and improved physical function in the elderly with CNSLBP.

Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series.

PURPOSE: The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation. METHOD: A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation. RESULTS: The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement. CONCLUSIONS: Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program. Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.

Equine Exercise in Younger and Older Adults: Simulated Versus Real Horseback Riding.

Horseback riding is an effective exercise for improving postural control and balance. To reduce costs and improve accessibility, simulated horseback riding has been developed; but no differential effects of simulated and real horseback riding on muscle activation patterns in older adults have been studied. Thus, we compared muscle activation patterns for older and younger adults engaged in real and simulated horseback riding exercises, using surface electromyography recordings of the erector spinae, rectus abdominis, internal oblique abdominis, and rectus femoris muscles. We recorded muscle activity for three riding patterns: walk, slow trot, and fast trot. Muscle activation was uniformly higher for simulated (vs. real) horseback riding and increased from the walking pattern through slow and fast trot. There was no age effect, but among older participants, muscle activation was higher for simulated (vs. real) horseback riding across all gait types. Simulated and real riding produced a similar pattern of muscle activation of the thigh and trunk. These results demonstrate that simulated horseback riding can be an effective alternative to actual riding for increasing trunk and thigh muscle activation and improving postural control and balance, perhaps especially among older adults.

The Effectiveness of Hollowing and Bracing Strategies With Lumbar Stabilization Exercise in Older Adult Women With Nonspecific Low Back Pain: A Quasi-Experimental Study on a Community-based Rehabilitation.

OBJECTIVE: The purpose of this study was to explore the therapeutic effectiveness of hollowing lumbar stabilization exercise (HLSE) and bracing lumbar stabilization exercise (BLSE) for older adult women with nonspecific low back pain (NSLBP) in community welfare centers. METHOD: A total of 38 older adult women with NSLBP were allocated to either the HLSE group (n = 17, 70.4 ± 1.7 years) or the BLSE group (n = 21, 66.8 ± 4.4 years). Both groups performed intervention for 12 consecutive weeks, 3 times per week. Each group performed 5 lumbar stabilization exercises, including side plank exercise, bridge exercise, 4-kneeling exercise, prone plank exercise, and prone back extension exercise with hollowing and bracing strategy, respectively. The baseline and post-test values of trunk strength, low back disability (Korean Oswestry Disability Index [K-ODI] and Korean Roland Morris Disability Questionnaire [K-RMDQ]), and static balance (1-leg standing test) were compared by using per-protocol analysis. RESULTS: In trunk strength, the trunk flexor had significant difference (F = 11.10, P = .001) between groups and within groups of BLSE (t = -5.56, P = .001) and HLSE (t = -2.50, P = .024). Trunk back extensor of HLSE (t = -6.00, P = .001) and BLSE (t = -9.19, P = .001) only had significant within-group difference. However, in trunk side flexor, HLSE and BLSE had only significant difference between groups. In low back disability, K-ODI for HLSE (t = 4.50, P = .001) and BLSE (t = 4.60, P = .001) had significant within-group difference but no significant difference between groups (F = 0.28, P = .202). In K-RMDQ, HLSE only had significant within-group difference (t = 3.97, P = .001). In trunk muscle strength, the effect size of HLSE and BLSE groups for trunk flexor was HLSE -0.53 (medium) and BLSE -1.21 (large); trunk side flexor: HLSE 0.27 (small) and BLSE -0.24 (small); and trunk back extensor: HLSE 1.1 (large) and BLSE 2.00 (large), respectively. In low back disability, the effect size of both groups for K-ODI was HLSE 0.88 (large) and BLSE 1.05 (large), and K-RMDQ, HLSE 0.19 (small) and BLSE 0.40 (small), respectively. CONCLUSION: Our findings suggest that HLSE and BLSE could be recommended for community settings to improve trunk strength and low back disability in older adult women with NSLBP. Especially, HLSE and BLSE could be recommended for elderly women with NSLBP who have lower back disability and weak trunk muscle strength, respectively.