A comparison of nocturnal upper trapezius muscle activity between chronic neck pain patients with sleep disturbance and healthy participants.

BACKGROUND: Sleep disturbances frequently occur in patients with chronic neck pain. In these patients, upper trapezius muscle dysfunction is observed during sleep. This study aimed to evaluate the trapezius muscle activity during sleep among patients with chronic neck pain and sleep disturbances for comparison with healthy subjects.  STUDY DESIGN: Cross-sectional study. METHODS: Patients with chronic neck pain and healthy subjects participated in the study. Two overnight polysomnography recordings were conducted for each subject. Surface electromyography was utilized to record the nocturnal activity of the right and left upper trapezius muscles throughout the night. The nocturnal upper trapezius activity recording was divided into the following parts: wakefulness, rapid eye movement sleep (REM), and non-rapid eye movement sleep (NREM). The nocturnal activity during NREM sleep was further divided into three parts (stage I NREM sleep, stage II NREM, and stage III NREM. Normalization of EMG signals was performed. The normalized value of nocturnal activity was derived for analysis. RESULTS: Among 15 patients with chronic neck pain and 15 healthy subjects, statistically significant differences were observed in the nocturnal activity of the upper trapezius. Compared to healthy subjects, the nocturnal activity of the upper trapezius was significantly higher during wakefulness, REM sleep, and NREM II and III sleep in patients with chronic neck pain and sleep disturbances. CONCLUSION: There was higher nocturnal upper trapezius activity in patients with chronic neck pain compared to healthy controls. The findings suggest a possible pathophysiological mechanism that may relate to chronic neck pain. TRIAL REGISTRATION: CTRI/2019/09/021028.

A polysomnographic study of sleep disruptions in individuals with chronic neck pain.

Various lines of evidence suggest that a bidirectional relationship exists between poor sleep quality and chronic pain, with each condition tending to promote and exacerbate the other. This has led to the hypothesis that the two conditions may be linked by common underlying mechanisms. It has thus been suggested that inadequate sleep and chronic pain may share neurophysiological and molecular pathways that are similar or overlapping. Some studies based on self-report measures have tended to support the inference that chronic neck pain may promote sleep disturbance, but this association has not, until now, been investigated with quantitative measures. The present study is the first to evaluate the sleep quality of patients with chronic neck pain through the use of polysomnography. The study sought to identify the sleep characteristics of patients with chronic neck pain and then to determine whether these characteristics were associated with the severity of their neck pain. Laboratory testing with polysomnography was carried out on 32 males who had complaints of chronic neck pain and on 12 healthy participants who served as controls. Compared to the control subjects, patients with chronic neck pain were found to have significantly shorter times spent in sleep (p = 0.015), longer latencies to sleep onset (p = 0.015) and rapid eye movement (REM) sleep (p < 0.05), longer durations spent in Stage 1 (p < 0.05), and shorter durations spent in both Stage 2 (p = 0.001) and REM sleep (p = 0.00). The severity of discomfort was related negatively to the amount of time spent in REM sleep. The present study's quantitative measures corroborate the view that patients with chronic neck pain have poor sleep quality. These findings confirm long-held clinical observations that the sleep quality of patients with chronic neck pain is compromised, and that, in this clinical group, poor sleep is at least a correlate of and may be an amplifier of perceived pain.

Effect of Increased Lumbar Lordosis on Lumbar Multifidus and Longissimus Thoracis Activation During Quadruped Exercise in Patients With Chronic Low Back Pain: An EMG Study.

The objective was to investigate the electromyographic activity of the lumbar multifidus (MF) muscle and longissimus thoracis muscle, along with their activity ratio (MF longissimus thoracis ratio), during quadruped stabilization exercise performed with neutral posture and with increased lumbar lordosis in patients with chronic low back pain (CLBP). A total of 23 patients with CLBP (12 females and 11 males) were recruited based on inclusion and exclusion criterion. Each patient performed 4 exercises in random order, with surface electromyography electrodes and an electrogoniometer attached. A cross-sectional study design was used to measure the amplitude of muscle activation (as a percentage of maximum voluntary contraction) in each patient across the 2 muscles (MF and longissimus thoracis) during quadruped stabilization exercise with neutral posture and with increased lumbar lordosis. A 2-way analysis of variance was conducted, which demonstrated a statistically significant increase in the recruitment of MF with increased lumbar lordosis in patients with CLBP during quadruped exercise. An increase of 9.7% and 16.9% maximum voluntary contraction in MF electromyographic activity was observed in lumbar lordosis posture during the quadruped leg raise and quadruped leg-arm raise exercise, respectively (P < .01), when compared to the neutral posture. The increased recruitment of MF with lumbar lordosis in the quadruped position has strong implications in the assessment and management of patients with CLBP.

Correction to: Effect of physical activity on sleep problems in sedentary adults: a scoping systematic review.

[This corrects the article DOI: 10.1007/s41105-023-00494-w.].

Effect of physical activity on sleep problems in sedentary adults: a scoping systematic review.

This systematic review was steered forward with the aim of analyzing how different forms of exercise could influence the objective and subjective sleep outcome among sedentary adults with sleep problems. A pre-detailed study protocol (PROSPERO ID: CRD42021229649) was used to search for RCTs through five databases. The methodological quality of the included RCTs was assessed by PEDro and studies were included if they scored > 5. Effect size of all outcome measures were calculated using Cohen's d. Of the 4154 studies, 19 studies met the inclusion criteria and underwent quality assessment using 11-point PEDRO scale. 9 studies with PEDro score > 5 were finally included in this systematic review out of which, participants of 4 studies had insomnia (nrange = 37-48, agerange = 44-60 years), 3 studies had poor sleep quality (nrange = 80-275, agerange = 52-70 years) and 2 studies had obstructive sleep apnea syndrome (nrange = 26-68, agerange = 51 years). Majority of studies revealed that physical activity seems to have greater improvement with a large effect size on subjective sleep outcomes among sedentary adults with sleep problems like insomnia, poor sleep quality and OSAS, whereas limited studies and non-significant results were observed on objective sleep outcomes. Physical activity improves sleep outcomes especially among sedentary middle-aged and older adults. More research is needed to examine the effect of physical activity programs on objective sleep outcomes especially in younger sedentary adults with different sleep problems. Supplementary Information: The online version contains supplementary material available at 10.1007/s41105-023-00494-w.

Sleep quality and its association with anxiety, stress, sleep-related beliefs and attitudes and postural control in young adults: a cross-sectional study.

OBJECTIVES: Adequate sleep is essential for young adults, as this age group primarily consists of students, job seekers, and working people constantly managing a hectic lifestyle. Poor quality of sleep, which is essential for physical and mental well-being in the short and long term, can result in impaired overall health. However, there exists a gap in the literature regarding the factors affecting sleep among young adults. Hence, the objective of this study was to find the prevalence of sleep-related parameters (sleep health, hygiene, and sleep-related beliefs and attitudes) and potential risk factors for sleep quality and to investigate the association between sleep and postural control in young adults. METHODS: This prospective, cross-sectional, analytical study included 181 young adults, 113 (62.43 %) females, and 68 (37.57 %) males, with a mean age of 23.82 ± 2.88 years. Sleep quality, health, beliefs, hygiene, stress, anxiety, and depression were assessed using questionnaires. Postural control was assessed using center of pressure (COP) indices. RESULTS: The overall prevalence of poor sleep quality was 79.01 % among young adults. Multiple linear regression showed that predictors explained 44 % of sleep quality variance (adjusted R square=0.44, f (12,168) = 20.91, p<0.05). Poor sleep-related beliefs and attitudes (95 % CI [0.037, 0.679], p=0.029), higher perceived stress (95 % CI [0.005, 0.219], p=0.039), higher anxiety severity (95 % CI [0.108, 0.526], p=0.003), and poor COP stability index A/P (95 % CI [4.986, 11.248], p=0.00) were found to be significant predictors of poor sleep quality. CONCLUSIONS: High anxiety and stress, and poor dysfunctional beliefs and attitudes about sleep are predictors of poor sleep quality in young adults. These factors may significantly affect sleep quality and the experience of restful sleep among young adults. Also, poor sleep quality is associated with reduced postural control (decreased stability in the A/P direction). These findings are crucial for improving young adults' overall health and well-being, as poor sleep is highly prevalent among this age group.

Predictors of Cardiac Autonomic Dysfunction in Obesity-Related Hypertension.

INTRODUCTION: Cardiac Autonomic Dysfunction (CAD) is an overlooked cardiovascular risk factor in individuals with obesity-related hypertension. Despite its clinical significance, there is a notable lack of clarity regarding the pathophysiological correlates involved in its onset and progression. AIM: The present study aimed to identify potential predictors of CAD in obesity-related hypertension. METHODS: A total of 72 participants (34 men and 38 women) were enrolled. Comprehensive evaluations were conducted, including cardiac autonomic function assessments, body composition estimation and biochemical analysis. Participants were categorized as CAD-positive or CAD-negative based on Ewing's criteria for autonomic dysfunction. Univariate logistic regression analysis was performed to identify potential predictors for CAD. Multivariate logistic regression models were further constructed by adjusting clinically relevant covariates to identify independent predictors of CAD. RESULTS: Multivariate logistic regression analysis revealed that resting heart rate (HRrest), (odds ratio, confidence interval: 0.85, 0.78-0.93; p = 0.001) and percentage body fat (BF%), (odds ratio, confidence interval: 0.78, 0.64-0.96; p = 0.018) were significant independent predictors of CAD. Receiver Operating Characteristic curve analysis depicted optimal cut-off values for HRrest and BF% as > 74.1 bpm and > 33.6%, respectively. Multicolinearity analysis showed variance inflation factors (VIF) below the cautionary threshold of 3. CONCLUSIONS: The HRrest and BF% emerged as significant independent predictors of CAD in obesity-related hypertension. Therapeutic strategies should target HRrest < 74.1 bpm and BF% < 33.6% to mitigate CAD risk in this population. Future trials are required to establish causal relationships and may consider additional confounding variables in obesity-related hypertension.

Exploring the role of respiratory intervention as an effective adjunct tool in the management of chronic low back pain: A scoping systematic review.

BACKGROUND: Individuals with chronic low back pain (CLBP) are usually prescribed manual therapy and exercise programs. Respiratory exercise interventions are also recommended by some researchers for CLBP. However, the evidence for the relative effectiveness of these treatments is limited, and the question of which sort of intervention is most suited remains unanswered. OBJECTIVE: This systematic review aims to evaluate the effectiveness of respiratory interventions in CLBP. METHODS: A systematic search was performed using databases: PubMed, Web of Science, PEDro, Cochrane Library, and Science Direct. The review was registered in PROSPERO (CRD42021233739). RESULTS: Seven studies met the inclusion criteria. Out of these, one was of poor, three were of fair, and three were of good qualities. A total of 293 subjects were included in seven studies, the mean age of subjects ranged from 21 to 53 years. The largest effect size was reported for pain (d = 1.5) and maximum inspiratory pressure (d = 1.38). No detrimental effects were reported for any of the intervention programs. CONCLUSIONS: Since most of the research has been done on pain and MIP, and both of these parameters have revealed significant changes with large effect size, therefore it can be concluded that respiratory interventions improve pain and MIP in CLBP. Owing to the limited number of studies available, a definitive outcome could not be documented for other parameters. Thus, further research is needed to provide a more robust piece of evidence and understanding.

Dose dependent effects of extracorporeal shockwave therapy on pain and function in osteonecrosis of femoral head: A systematic review.

Purpose: To investigate the effectiveness of different dosages of extracorporeal shockwave therapy (ESWT) on pain, function and radiographic outcomes in patients with osteonecrosis of femoral head (ONFH). Procedure: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analysis) guidelines were followed to conduct this review. The systematic literature search was done by using six different electronic databases include MEDLINE (assessed by Pubmed) CENTRAL (Cochrane Library Central Register of Controlled Trials), Web of Science, PEDro (Physiotherapy Evidence Database), Scopus and Science Direct. Retrospective and prospective cohort studies; case control study, randomized clinical trials were included. Screening conducted by two independent authors along with inclusion and exclusion criteria of included studies. The methodological quality assessment for cohort studies and randomized clinical trials was done by using Structured Effectiveness Quality Evaluation Scale (SEQES) and Newcastle-Ottawa Scale for case control study. Result: Total 1410 articles were found from various databases. After duplicates removed 450 articles remained. Followed by title and abstract screening 53 articles eligible for full text reading, out of them 13 articles met the inclusion criteria and included in this review. Conclusion: High energy flux densities of ESWT found to be more effective followed by low and moderate energy flux densities in earlier course of the disease compared to later stages in terms of pain relief, functional improvement and disease progression. Due to high variability among study design, ESWT dosages, patient characteristics and considering the paucity of well conducted studies, the present study cannot be conclusive.

Effect of Whole-Body Vibration on Balance or Proprioception in Nonspecific Chronic Low Back Pain: A Systematic Review.

Objective: This systematic review aimed to investigate the effect of whole-body vibration (WBV) on balance or proprioception for patients with nonspecific chronic low back pain (NSCLBP). Methods: A comprehensive search was conducted using 5 databases-PubMed, Web of Science, Cochrane Library, Science Direct, and Physiotherapy Evidence Database-from inception to January 2022. Randomized clinical trials that examined the efficacy of WBV on balance or proprioception in patients with NSCLBP were incorporated. The methodological quality of each included study was assessed using the Physiotherapy Evidence Database scale. Results: Our search strategy yielded 5309 articles, of which 7 published randomized clinical trials (313 patients) met the inclusion criteria. Three of the 4 included studies that investigated balance reported significant improvements after WBV, of which 2 were of high methodological quality. The remaining 3 studies investigating proprioception also showed significant improvements after WBV intervention. Conclusion: Although some studies seem to provide promising results regarding the efficacy of WBV or WBV combined with exercise in improving balance and proprioception in patients with NSCLBP, at present, no definite conclusions can be drawn due to article heterogeneity and lack of clinical trials.

Predictors of persistent pain in patients with acute neck pain treated with physical therapy: A prospective study with 2 years follow up.

BACKGROUND: Clinicians specialising in musculoskeletal medicine have observed that patients with neck pain often seek repeat consultations because of recurring neck pain. Despite this pattern, there is a lack of research exploring the persistence nature of neck pain. Understanding potential predictors of persistent neck pain could help clinicians develop effective treatment approaches to prevent the chronicity of these conditions. OBJECTIVE: The current study investigated the potential predictors of persistent neck pain over a 2-year period among patients with acute neck pain treated with physical therapy. METHODS: A longitudinal study design was employed. Data were collected at baseline and at 2-year follow-up from 152 acute neck pain patients aged (29.2 ± 6.7). Patients were recruited from physiotherapy clinics. Logistic regression was used for analysis. At 2-year follow-up, participants were reassessed for their pain intensity (Dependent variable) and categorised as recovered or reporting persistent neck pain. Baseline acute neck pain intensity, sleep quality, disability, depression, anxiety, and sleepiness were used as potential predictors. RESULTS: Among 152 participants, 51 (33.6%) patients with acute neck pain reported persistent neck pain at 2-year follow-up. 43% of the variation in the dependent variable was explained by the model. Despite the strong correlations between persistent pain at follow-up with all potential predictors, only sleep quality 95% CI (1.1,1.6), and anxiety 95% CI (1.1,1.4) were the significant predictors of persistent neck pain. CONCLUSION: Our results suggest that poor sleep quality and anxiety may serve as potential predictors of persistent neck pain. The findings highlight the importance of a comprehensive approach to managing neck pain that addresses both physical and psychological factors. By targeting these co-morbidities, healthcare providers may be able to improve outcomes and prevent the progression of the case.

Effect of Adding Diaphragmatic Breathing Exercises to Core Stabilization Exercises on Pain, Muscle Activity, Disability, and Sleep Quality in Patients With Chronic Low Back Pain: A Randomized Control Trial.

Objective: The purpose of this study was to test the effect of adding diaphragmatic breathing exercises (DBEs) to core stabilization exercises (CSEs) for patients with chronic low back pain (CLPB). Methods: Twenty-two patients with CLPB were randomly allocated to the experimental (DBE + CSE) or control group (CSE only). They were given 12 treatment sessions 3 times a week for 4 weeks. Patients were evaluated before and after the 12 sessions. Surface electromyography of transverse abdominis, Oswestry Disability Index, Fear Avoidance Belief Questionnaire, Pittsburgh Sleep Quality Index, Numeric Pain Rating Scale, and chest expansion were used as outcome measures for pain, muscle activity, disability, and sleep quality. Results: The outcome measure scores showed statistical significance of (P = .01) in time effect on muscle activity, sleep quality, disability score, pain score, fear-avoidance belief of patients and chest expansion; and group effect on Fear Avoidance Belief Questionnaire and physical activity parameter (P = .05). An interaction effect (time x group) on muscle activity for right transverse abdominus during tuck in (P = .01) and chest expansion (P = .01) was also found; however, no significant difference was found related to other parameters. Conclusion: The combination of DBE and CSE interventions compared to CSE alone showed improvement in the measured parameters for patients with CLBP. Incorporating DBE with CSE also improved muscle activation and chest expansion.

Effects of scapular stabilization and upper limb proprioception as an adjunct to cervical stabilization in chronic neck pain patients: A randomized controlled trial.

BACKGROUND: Chronic neck pain is a prevalent health condition and a leading cause of disability worldwide. Prompt therapeutic measures are required to overcome this condition. OBJECTIVES: To evaluate the efficacy of incorporation of scapular stabilization and upper limb proprioceptive exercises to cervical stabilization exercises in patients with chronic neck pain (CNP). DESIGN: A single-blinded randomized controlled design. METHODS: A sample of convenience was deployed to recruit twenty-eight patients having CNP (18-45 years) and was randomized into two groups: group A (cervical stabilization exercises group) and group B (scapular stabilization and upper limb proprioceptive exercises group + cervical stabilization exercises). Pain intensity, disability, sleep quality, quality of life, scapular muscles strength and proprioception were assessed at 4 weeks follow up to determine the efficacy of the intervention. RESULTS: A mixed model ANOVA was used. A statistically significant (p < 0.05) group by time interaction for pain intensity (p = 0.000), scapular muscles strength of all muscles (p = 0.000) was observed. Significant group interaction for absolute error (p = 0.00), for pain (p = 0.001), disability (p = 0.04) and scapular muscle's strength (p = 0.000) was also demonstrated. CONCLUSION: The results indicated that scapular stabilization and upper limb proprioceptive exercises when combined with cervical stabilization exercises are more beneficial in alleviating pain and disability and improving scapular muscle strength and proprioception in patients with CNP.

Effects of surface variability in whole-body vibration platform on knee osteoarthritis: A scoping review.

INTRODUCTION: Whole body vibration (WBV) has received much attention in recent years but there is a lack of consensus as far as its effects are concerned. It is usually applied on the stable surface but its effects on the unstable surface are also being explored. However, only a few studies have described the efficacy of using the unstable surface on WBV platform in knee osteoarthritis (KOA) and this lack of information generates uncertainties regarding the efficacy of stable and unstable WBV training in KOA. OBJECTIVE: To identify the efficacy of stable and unstable surface WBV training in KOA. METHODS: Comprehensive searches, combining "whole body vibration", "knee osteoarthritis", and "unstable surface" were conducted on PubMed, Web of Science, Science Direct, Cochrane library, and Google Scholar. Randomized control trials focusing on outcomes of muscle activity, strength, proprioception, balance, and pain using unstable and stable platform WBV in KOA were included. Data were charted and narrative synthesis was applied. RESULTS: 17 studies were included. There is no consensus on the effects of stable surface WBV in KOA. Only limited studies used unstable platform WBVT in KOA. Majority of studies in KOA either using stable or unstable surface WBV failed to provide the exact mechanism of WBV. CONCLUSIONS: Stable surface WBV improve strength, balance, sEMG activity, proprioception, and provide a mild degree of instability while higher degree of instability would be given when WBV is performed on an unstable surface and may positively stress the neuromuscular system to a greater extent than the stable WBV by various mechanisms.

Muscle activation patterns around knee following neuromuscular training in patients with knee osteoarthritis: secondary analysis of a randomized clinical trial.

OBJECTIVE: To compare the effects of neuromuscular training (NMT) to a quadriceps strength training (QT) program on co-contraction index (CCI) of knee muscles in patients with knee osteoarthritis (OA). METHODS: Sixty-six knee OA patients with varus malalignment were recruited from the physiotherapy outpatient department of the university. After baseline measurements, they were randomly assigned into two groups: NMT (n = 33) and QT (n = 33). Patients in NMT group received neuromuscular exercises whereas QT group received conventional strengthening exercises for a period of 12 weeks, three times per week. Electromyographic (EMG) activity of quadriceps, hamstring and gastrocnemius muscle was evaluated during treadmill walking before and after 12 weeks of intervention period and CCI of medial quadriceps-medial hamstring (med QH), lateral quadriceps-lateral hamstring (lat QH), medial quadriceps-medial gastrocnemius (med QG) and, lateral quadriceps and lateral gastrocnemius (lat QG) was calculated. RESULTS: There was a significantly greater reduction in CCI of med QH (p = 0.02) and lat QH (p = 0.01) in the NMT group than the QT group. Whereas both NMT and QT led to statistically similar reductions in CCI of med QG (p = 0.08) and lat QG (p = 0.66). CONCLUSION: Findings of this study suggest that NMT led to a greater reduction in CCI of knee muscles than QT which indicates that enhanced sensori-motor control attained by NMT could reduce knee loading in knee OA patients with varus malalignment.

Is poor sleep quality associated with a deterioration in postural control?

OBJECTIVE: The primary aim was to investigate whether any association exists between poor sleep quality and deterioration in postural control among university student population. MATERIALS AND METHODS: A case-control study was conducted in which sleep quality of 119 university students from different departments of Jamia Millia Islamia University, New Delhi, India was assessed using Pittsburgh sleep quality index (PSQI) following which the participants postural control, or dynamic balance was measured using the Y balance test (YBT). The participants were divided into two groups (A and B) based on their PSQI cut off scores. The YBT data was then evaluated for the dynamic balance assessment of the participants. RESULTS: The mean age of the participants was 22.23±2.29 out of which 86 were female and 33 were male. The mean BMI of the participants was 21.58±3.66. Group A included 63 participants who had "good" sleep quality (global PSQI score < 5) whereas group B included 56 participants who had "poor" sleep quality (global PSQI score ≥ 5). Group comparisons based on t-test revealed a significant difference (p<0.05) between means of the two groups, with the mean balance of group A being greater than that of group B. Also, chi-square testing showed no significant association between the BMI and dynamic balance scores for the participants (p<0.10). CONCLUSION: The findings of the study conclude that poor sleep quality is associated with a deterioration of postural control in university students. The study also revealed that there was no association between BMI and dynamic balance in this population.

Psychometric analysis of Epworth Sleepiness Scale and its correlation with Pittsburgh sleep quality index in poor sleepers among Indian university students.

Background The Epworth Sleepiness Scale (ESS) is an 8-item scale to detect excessive daytime sleepiness. Although its psychometric properties are well established on a number of populations the same has not been done for an Indian population, hence this study was designed to cover this knowledge gap. Aims The purpose of this study was to establish the test-retest reliability, validity and internal consistency of the ESS and its correlation with the Pittsburgh Sleep Quality Index (PSQI) in poor sleepers in India. Materials and methods Twenty-five poor sleepers were randomly chosen from a university population. All the subjects were administered the two scales on the test day and the same was repeated after 1 week, which was the retest. Statistical analysis Intraclass coefficient (ICC) and standard error of measurement (SEM) were calculated for the reliability which was further supported by the Bland-Altman graph and a scatterplot. Cronbach's alpha and Pearson's coefficient were calculated for internal consistency and correlation, respectively. Results Twenty-five poor sleepers with mean age 25.24 ± 7.04 years were recruited. The test-retest reliability for ESS displayed good reliability (ICC2,1: 0.86) which was supported by the Bland-Altman graph and the scatterplot. Cronbach's alpha was reported as 0.86 and Pearson's coefficient was r: 0.62, p-value: 0.001. Conclusion The results suggest that the ESS has good internal consistency and test-retest reliability for a university population of poor sleepers in India.

Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature.

OBJECTIVE: The purpose of this review was to explore the association between forward head posture, rounded shoulders, and increased thoracic kyphosis. METHODS: The PubMed, ERIC, and Cochrane databases were searched using the key words posture, head, shoulder, forward scapular posture, and thoracic kyphosis through December 2016. RESULTS: Our initial search yielded 6840 research studies, 6769 of which were excluded because they either were duplicates or did not satisfy the inclusion criteria. After the abstracts of the remaining studies were read, 15 were assessed for eligibility, and only 4 papers were included in the present review. Cervical lordosis values were found to be significantly associated with thoracic kyphosis values. Also, there were significant correlations between rounded shoulders and increased thoracic kyphosis. CONCLUSION: Forward head posture, rounded shoulders, and increased thoracic kyphosis can exist alone or in any combination.

Photogrammetric Assessment of Upper Body Posture Using Postural Angles: A Literature Review.

OBJECTIVE: The purpose of this paper was to review the literature regarding the measurement properties of various angles used for postural assessment of the head, neck, shoulder, and thorax and to discuss the utility of these measures. METHODS: The inclusion criteria for this literature review were use of postural angles to assess posture, measurement of upper body posture, and research studies conducted in last 3 decades that had free full-text available online entirely in the English language. The exclusion criteria were review articles; studies involving subjects having obesity, visual problems, any history of surgery, respiratory, cardiovascular, neurologic, or congenital pathology or disease; and research studies in which postural angles were measured with respect to vertical only. The following databases were searched: PubMed Central, PubMed, ResearchGate, Springer Link, ScienceDirect, Google Scholar and Scielo through February 20, 2016. RESULTS: A total of 21 studies that were found to be best suited to explain the craniovertebral (CV) angle, sagittal head tilt, sagittal shoulder-C7 angle, coronal head tilt, coronal shoulder angle, and thoracic kyphosis angle were included in this review. Craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, coronal head tilt, and coronal shoulder angle possess moderate to high intrarater reliability. Craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle and thoracic kyphosis angle possess high interrater reliability (except for sagittal head tilt when measured using the goniometer). Craniovertebral angle, sagittal head tilt, and sagittal shoulder-C7 angle have been proved to be valid measures of posture when compared with similar angles measured on radiographs. None of the studies reported intrarater reliability of thoracic kyphosis angle, interrater reliability of coronal head tilt and coronal shoulder angle, and validity of coronal angles and thoracic kyphosis angle. CONCLUSIONS: We found several reliable methods to measure the postures of the head, neck, shoulder, and thoracic regions by measuring the CV angle, sagittal head tilt, sagittal shoulder-C7 angle, and thoracic kyphosis angle, respectively. Standardization of methods for angular measurement is recommended so that there is uniformity among studies regarding camera height, participant-camera distance, and type of software to generate normative data for postural angles.

Validity and reliability of insomnia severity index and its correlation with pittsburgh sleep quality index in poor sleepers among Indian university students.

OBJECTIVE: Insomnia severity index (ISI) is a widely used scale in various demographic groups but its psychometric properties have not been established in a sample of Indian subjects. This study was conducted as a preliminary study to extend and confirm the applicability of ISI to an Indian population of university students and to establish its correlation with the Pittsburgh Sleep Quality Index (PSQI). MATERIALS AND METHODS: The study was conducted among the student population of Jamia Millia Islamia, New Delhi, India, with due approval by the institutional ethical committee. Twenty-five poor sleepers with a mean age of 25.24±7.04 years and a BMI of 24.2±2.5 kg/m2 were recruited for the study from the university population. They were administered ISI and PSQI on test day and the same was repeated after 1 week. RESULTS: The test-retest reliability for ISI (intra-class correlation coefficient, ICC2,1-0.84) was excellent. It was further established by the Bland-Altman graph and scatter plot. The results also showed that ISI (Pearson's coefficient r-0.45) had a strong positive correlation with PSQI. Internal consistency for the ISI (Cronbach's α-0.84) was excellent. CONCLUSION: The study findings suggest that ISI has excellent internal consistency, test-retest reliability and validity for the university population of poor sleepers in India. Hence, it can prove to be a good tool for screening insomnia in the current population.