Construct validity, test-retest reliability, and responsiveness of the Arabic version of the upper limb functional index.

BACKGROUND: The upper limb functional index (ULFI) is a widely used self-report outcome measure questionnaire with robust psychometric properties to assess the upper limb musculoskeletal disorders (UL-MSDs). This study aimed to investigate the psychometric properties of the Arabic version of ULFI (ULFI-Ar). METHODS: In this observational study, 139 patients (87 male, 52 females with mean age of 38.67 ± 13.04 year) with various UL-MSD's, completed the ULFI-Ar, Disability of Arm, Shoulder, and Hand questionnaire (DASH-Arabic), and numeric pain rating scale (NPRS-Arabic). All participants determined the factor structure, and the construct validity. A subgroup of the participants determined test-retest reliability (n = 46) and responsiveness (n = 27). RESULTS: The ULFI-Ar construct validity obtained by the expletory factor analysis as one-factor structure, demonstrated an excellent test-retest reliability [intraclass correlation coefficient (ICC2:1) = 0.95], measurement error [standard error of measurement (SEM) = 4.43%; minimal detectable change at 90% confidence interval (MDC90) = 10.34%], medium internal responsiveness [Cohen's d = 0.62 and standard response of mean (SRM) = 0.67], strong external responsiveness DASH-Arabic (r =-0.90; p < 0.001), and negative strong correlation with NPRS-Arabic (r =-0.75, p < 0.001). CONCLUSIONS: The ULFI-Ar is a valid, reliable, and responsive self-report questionnaire to assess UL-MSDs in Arabic speaking patients.

Pain: Is It All in the Brain or the Heart?

PURPOSE OF REVIEW: Scientists have reported that pain is always created by the brain. This may not be entirely true. Pain is not only a sensory experience, but also can be associated with emotional, cognitive, and social components. The heart is considered the source of emotions, desire, and wisdom. Therefore, the aim of this article was to review the available evidence about the role of the heart in pain modulation. RECENT FINDINGS: Dr. Armour, in 1991, discovered that the heart has its "little brain" or "intrinsic cardiac nervous system." This "heart brain" is composed of approximately 40,000 neurons that are alike neurons in the brain, meaning that the heart has its own nervous system. In addition, the heart communicates with the brain in many methods: neurologically, biochemically, biophysically, and energetically. The vagus nerve, which is 80% afferent, carries information from the heart and other internal organs to the brain. Signals from the "heart brain" redirect to the medulla, hypothalamus, thalamus, and amygdala and the cerebral cortex. Thus, the heart sends more signals to the brain than vice versa. Research has demonstrated that pain perception is modulated by neural pathways and methods targeting the heart such as vagus nerve stimulation and heart-rhythm coherence feedback techniques. The heart is not just a pump. It has its neural network or "little brain." The methods targeting the heart modulate pain regions in the brain. These methods seem to modulate the key changes that occur in the brain regions and are involved in the cognitive and emotional factors of pain. Thus, the heart is probably a key moderator of pain.

The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial.

BACKGROUND: Few studies have investigated the effects of mobilization with movement (MWM) in patients with knee osteoarthritis (OA) compared to other procedures. Sham procedures are generally more appropriate control than using no or usual treatments. Moreover, studies investigating the widespread hypoalgesic effects of MWM in patients with knee OA are lacking. The aim was to investigate the effect of MWM on function and pain in patients with knee OA compared to sham MWM. METHODS: This is a randomized double-blind (patients and assessor) controlled trial. Forty adult patients with knee OA of grade II and above were recruited to receive either MWM treatment or sham MWM for the knee. The outcome measures included the following: a visual analogue scale (VAS) for pain, the pressure pain threshold (PPT) test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the timed up and go (TUG) test, knee strength and knee range of motion (ROM). The measurements were taken at baseline, immediately after intervention and 2 days later. RESULTS: Compared with sham MWM, MWM resulted in greater immediate improvement in pain [mean difference (95% CI): - 2.2 (- 2.8, - 1.6)], PPT at both the knee [176 (97, 254)] and shoulder [212 (136, 288)], TUG time [- 1.6 (- 2.1, - 1.1)], knee flexor strength [2.0 (1.3, 2.7)] and extensor strength [5.7 (4.1, 7.2)] and knee flexion ROM [12.8 (9.6, 15.9)] (all, p < 0.001) but not knee extension ROM [- 0.8 (- 1.6, 0.1)] (p = 0.067). After 2 days of intervention, patients who received MWM also demonstrated a greater improvement in pain [- 1.0 (- 1.8, - 0.1)], PPT at the shoulder [107 (40, 175)], TUG time [- 0.9 (- 1.4, - 0.4)], knee flexor strength [0.9 (0.2, 1.7)] and extensor strength [2.9 (2.1, 3.9)] and knee flexion ROM [8.3 (4.7, 11.9)] (all, p ≤ 0.026). However, WOMAC scores and knee extension ROM showed no evidence of change at any stage after intervention (p ≥ 0.067). CONCLUSIONS: MWM provided superior benefits over sham MWM in terms of local and widespread pain, physical function (walking), knee flexion and extension muscle strength and knee flexion ROM for at least 2 days in patients with knee OA. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT02865252 ), registered on August 12, 2016.

Cross-cultural adaptation and validation of the STarT Back Tool for Arabic speaking adults with low back pain in Saudi Arabia.

BACKGROUND: The STarT Back Tool (Subgrouping for Targeted Treatment; SBT) was developed and validated in the United Kingdom for adults with non-specific low back pain (LBP) to provide risk stratification groups. An Arabic version has not yet been developed. Consequently, our objectives were: First, to cross-culturally adapt the SBT for use in Arabic speaking adults (SBT-Ar) with LBP. Second, to assess the face, content and construct validity of SBT-Ar against relevant reference standards. METHODS: This was a prospective, cross-sectional study carried out in the outpatient department in a tertiary care hospital. A total of 59 participants (aged 18-60) with LBP able to read Arabic completed the questionnaire. SBT cross-cultural adaptation was performed according to published guidelines. Face and content validity were explored by individual interviews. Construct validity was assessed using pre-hypothesized correlations with relevant reference standards. RESULTS: Following 48 individual interviews the SBT final version was reached and demonstrated face and content validity. The SBT-Ar total score and psychosocial sub-scale had acceptable internal consistency and no redundancy (Cronbach α = 0.7). Moderate Spearman's correlations were found between the SBT-Ar total score and reference standards (Arabic Pain Numeric Rating Scale NRS-Ar r = 0.50 and Arabic Oswestry Disability Index ODI-ar r = 0.51). As expected the SBT-Ar psychosocial subscale had medium to high correlations with the psychosocial reference measures (Arabic Fear-Avoidance Beliefs Questionnaire Physical Activity FABQPA-Ar r = 0.41, Arabic Hospital Anxiety and Depression Scale-Anxiety HADSA-Ar r = 0.58, Arabic Hospital Anxiety and Depression Scale-Depression HADSD-Ar r = 0.45 and Arabic Pain Catastrophizing Scale PCSAr r = 0.69).The SBT-Ar showed no significant floor or ceiling effects. CONCLUSION: This study culturally adapted and preliminary validated SBT into Arabic. STUDY DESIGN: Prospective, Cross-sectional.

Musculoskeletal disorders of the upper and lower limb: Prevalence among patients in Eastern province, Saudi Arabia.

OBJECTIVES: To determine the prevalence of upper and lower limb musculoskeletal (MSK) disorders among adult patients referred to physical therapy. METHODS: Data were retrospectively analyzed from electronic health records of patients referred to physical therapy between April 2021 and April 2023. MSK disorders were categorized based on the affected body region (upper or lower limb). RESULTS: A total of 11,243 patients were referred to physical therapy, of whom 4,156 (37%) had MSK disorders. The 4 most commonly affected regions were the knee (27.7%), followed by the shoulder (26.9%), the ankle/foot (14.9%), and the wrist/hand (11.8%). Within each region, the most prevalent disorders were as follows: knee (arthritis [26.5%], sprain/strain [20.1%], pain [10.1%]); shoulder (pain [20.2%], rotator cuff-related syndrome [18.5%], adhesive capsulitis [8.5%]); ankle/foot (sprain/strain [23.3%], fracture [14.3%], pain [8.9%]); and wrist/hand (fracture [24.1%], pain [8.9%], sprain/strain [7.6%]). Cramer's V analysis revealed a strong association between age and the region of MSK disorders (Cramer's V=0.234, p<0.001) and between patient sex and the region of MSK disorders (Cramer's V=0.189, p<0.001). CONCLUSION: This study demonstrates the prevalence of upper and lower limb MSK disorders among adult patients referred to physical therapy. Further research involving larger, representative samples is warranted to fully understand the prevalence and risk factors of MSK disorders in Saudi Arabia.

Prevalence and Burden of Musculoskeletal Pain among Cardiac Sonographers in Eastern Province of Saudi Arabia: A Cross-Sectional Study.

Background: Cardiac sonographers are at a high risk for work-related musculoskeletal pain (WMSP), a major occupational health problem. With limited research on WMSP prevalence among this population in Saudi Arabia, this study aimed to investigate the prevalence and impact of WMSP in cardiac sonographers in the Eastern Province of Saudi Arabia compared to a control group of healthcare professionals. Methods: An electronic survey was administered to cardiac sonographers (study group) and other healthcare professionals (control group) exposed to different occupational hazards, including allied healthcare professionals, physicians, and nurses. Modified versions of the Nordic, QuickDASH, and QuickDASH work questionnaires were used. The χ2 test was performed for comparisons. Results: A total of 168 participants completed the survey (mean age: 31.6 ± 7.7 years). Among them, 127 (76.1%) were females, comprising 61 (36.3%) sonographers and 107 (63.7%) controls. Overall, WMSP was more common (82% versus 65%, p = 0.020) and severe (p = 0.041) in cardiac sonographers than in controls. The most affected body regions in cardiac sonographers were the shoulders (72.0% versus 29.0%), followed by the hands (56.0% versus 24.6%), compared to those of the control participants. Pain experienced by cardiac sonographers significantly interfered with social and work-related activities (p < 0.05 for all). A higher number of cardiac sonographers planned to change their profession than control participants (41% versus 15.2%; p < 0.0001) owing to pain. Conclusions: WMSP was more common and severe in cardiac sonographers than in control participants of other healthcare professions in the Eastern province of Saudi Arabia and interfered significantly with their social and work-related activities and future employment plans. Therefore, preventive interventional studies are required in the future.

Prevalence and trends in physical therapy interventions for erectile dysfunction: A Scopus-based bibliometric analysis (1989-2022).

BACKGROUND: Erectile dysfunction (ED) is a condition that affects many males. Physical therapy (PT) is the one potential treatment for ED that may improve blood flow, muscle strength, and other factors that may contribute to the issue. Data on the prevalence and trends of research on PT for ED are lacking. OBJECTIVE: This study aimed to evaluate the literature trends in PT for ED via bibliometric and visualized analysis. METHODS: Data on publications were collected from Scopus covering the period between 1989 and 2022. To refine the data, bibliometric analyses were conducted using Microsoft Access, Microsoft Excel, an online visualization platform, and BiblioAnalytics. Power BI and Bibliomaster were used to generate figures and tables, while Biblioshiny and VOSviewer were used for visualization. RESULTS: A total of 494 documents were identified. The year 2019 generated the largest number of publications, with a total of 54. These studies have received 12,917 citations related to PT for ED. The most common document type was the original article with 283 publications. The University of California, USA, was the most productive institution on this topic, with 21 publications and 2,035 citations. The USA led all countries with 114 publications on the topic. The Journal of Sexual Medicine secured the top ranking with an h-index of 18. The main topics studied were erectile dysfunction, shockwave therapy, and physiotherapy. CONCLUSION: The number of publications on PT for ED has demonstrated an upward trend over the last three decades.

Corridor and real-time 6-minute walk tests in healthy young adults: A randomized cross-over study.

Objective: Cardiopulmonary endurance is important for comfortably participating in activities of daily living. Exercise tests, such as the 6-minute walk test (6MWT), are commonly used to evaluate cardiopulmonary endurance. We investigated the effects of the Gait Real-Time Analysis Interactive Lab (GRAIL)- and corridor-based 6MWTs on functional performance. Methods: Thirty healthy men were randomly divided into two groups. Group A participants performed a corridor-based 6MWT, followed by a washout period (1 h). Subsequently, they performed the GRAIL-based 6MWT. Group B participants performed the tests in the reverse order of that performed by Group A participants. Results: The corridor-based 6MWT resulted in significantly higher 6MW distance and 6MW speed than the GRAIL-based 6MWT. No significant differences were observed between the two groups in any of the following secondary outcomes: systolic blood pressure, diastolic blood pressure, oxygen saturation, heart rate, dyspnea, and overall fatigue. A strong positive correlation was observed between the 6MW distance and 6MW speed. Conclusion: The corridor- and GRAIL-based 6MWT should not be used interchangeably.

Prevalence of Pain and Its Relationship with Age and Sex among Patients in Saudi Arabia.

BACKGROUND: Studies investigating the prevalence of patients with pain referred for physical therapy in Saudi Arabia are scarce. This study aimed to estimate the period prevalence of pain that led to referrals for physical therapy and to evaluate the association between pain and patient age and sex. METHODS: This retrospective study used data from the electronic health record system of a hospital for adult patients referred for physical therapy. RESULTS: In total, 7426 (26.0%) patients (mean (±SD) age, 51.4 ± 15.0 years) experienced pain, the majority of whom were female (65.8%). The back (30.7%) was the most commonly reported pain region, followed by the neck (13.2%), shoulders (12.1%), and knees (11.8%). The referring physician(s) identified pain in a specific body region in 5894 of the 7426 (79.4%) patients. A moderate correlation was found between sex and pain region (Cramer's V = 0.151, p < 0.001) and between age group and pain region (Cramer's V = 0.10, p < 0.001). CONCLUSIONS: Pain was prevalent among adult patients referred for physical therapy and was moderately associated with sex and age. Further research examining the prevalence of pain and its risk factors in a larger, representative sample of the population is warranted.

The short-term effects of instrument-based mobilization compared with manual mobilization for low back pain: A randomized clinical trial.

BACKGROUND: Despite being used as a manipulation technique, no studies have examined the effectiveness of physiotherapy instrument mobilization (PIM) as a mobilization technique on pain and functional status in patients with low back pain (LBP). OBJECTIVE: To investigate the effectiveness of PIM in patients with LBP and to compare it with the effectiveness of manual mobilization. METHODS: This is a double blind, randomized clinical trial. Thirty-two participants with LBP were randomly assigned to one of two groups. The PIM group received lumbar mobilization using an activator instrument, stabilization exercises, and education; and the manual group received lumbar mobilization using a pisiform grip, stabilization exercises, and education. Both groups had a total of 4 treatment sessions over 2-3 weeks. The following outcomes were measured before the intervention, and after the first and fourth sessions: Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI) scale, Pressure pain threshold (PPT), lumbar spine range of motion (ROM), and lumbar multifidus muscle activation. RESULTS: There were no differences between the PIM group and the manual group in any outcome measures. However, over the period of study, there were improvements in both groups in NPRS (PIM: 3.23, Manual: 3.64 points), ODI (PIM: 17.34%, Manual: 14.23%), PPT (PIM: ⩽ 1.25, Manual: ⩽ 0.85 kg.cm2), lumbar spine ROM (PIM: ⩽ 9.49∘, Manual: ⩽ 0.88∘), and/or lumbar multifidus muscle activation (percentage thickness change: PIM: ⩽ 4.71, Manual: ⩽ 4.74 cm; activation ratio: PIM: ⩽ 1.17, Manual: ⩽ 1.15 cm). CONCLUSIONS: Both methods of lumbar spine mobilization demonstrated comparable improvements in pain and disability in patients with LBP, with neither method exhibiting superiority over the other.

Cross-cultural adaptation of the upper limb functional index in Arabic.

BACKGROUND AND AIM: The upper limb functional index (ULFI) is a widely used self-reported outcome measure questionnaire with robust psychometric properties to assess the upper limb musculoskeletal disorders (UL-MSDs). This study aimed to adapt the ULFI cross-culturally in Arabic (ULFI-Ar) and to examine its face validity, content validity, internal consistency, criterion validity, and interpretability. METHODS: In this observational cross-sectional study, the English version of ULFI was cross-culturally adapted to the Arabic language through double forward and backward translations, following the recommended guidelines. Interviews with participants and reviews by experts were used to assess the face and content validity of the prefinal version of ULFI-Ar. Internal consistency was determined by Cronbach's alpha coefficient (a). Criterion validity was analyzed by correlating the ULFI-Ar with the Arabic version of the Disabilities of the Arm, Shoulder, and Hand (DASH-Arabic) using Pearson's correlation coefficients. RESULTS: A total of 54 participants reported no major language barriers or difficulties in completing the ULFI-Ar. The participants' interview demonstrated adequate face validity. The review by experts showed that the content validity was excellent (content validity index = 0.81 - 1.00 for each item and 0.96 for the scale). The ULFI-Ar showed high internal consistency (a = 0.88). For criterion validity, there was strong correlation with the DASH-Arabic (r = -0.802, p < 0.0001) and moderate correlation with NPRS-Arabic (r = -0.502, p < 0.0001). CONCLUSIONS: The ULFI-Ar was easy to complete with no linguistic difficulties. The results demonstrate the suitability of using the ULFI-AR for Arabic-speaking patients with UL-MSD.

Sciatic nerve excursion during neural mobilization with ankle movement using dynamic ultrasound imaging: a cross-sectional study.

PURPOSE: Ankle movement is used as a sensitizing maneuver for sciatica during neurodynamic techniques. In vivo studies on the sciatic nerve biomechanics associated with ankle movement during different positions of neighboring joints are scarce. The aim of this study was to investigate sciatic nerve excursion during ankle dorsiflexion in different positions in a healthy population. METHODS: This is a cross-sectional study. High-resolution dynamic ultrasound imaging was used to measure longitudinal excursion of the sciatic nerve in the posterior thigh of 27 healthy participants during ankle dorsiflexion in six positions of the neck, hip, and knee. Both the long and short distance of the nerve excursion were measured. Wilcoxon signed-rank tests were used for data analysis, and Eta squared (r) was used to quantify the effect size. RESULTS: Ankle dorsiflexion resulted in distal sciatic nerve excursion that was significantly higher in positions in which the knee was extended (median 0.7-1.6 mm) than in positions in which the knee was flexed (median 0.5-1.4 mm) (P ≤ 0.049, r ≥ 0.379). There were no significant differences in nerve excursion between positions where the neck was neutral compared with positions where the neck was flexed (P ≥ 0.710, r ≤ 0.072) or between positions where the hip was neutral compared with positions where the hip was flexed (P ≥ 0.456, r ≤ 0.143). CONCLUSION: The positions of adjacent joints, particularly the knee, had an impact on the excursion of the sciatic nerve in the thigh during ankle movement.

Outcomes of scapulothoracic mobilisation in patients with neck pain and scapular dyskinesis: A randomised clinical trial.

OBJECTIVES: The perceived outcomes of scapulothoracic mobilisation with movement (MWM) in patients with neck pain and scapular dyskinesis remain unclear. This study aimed to examine the effects of adding scapulothoracic MWM to the corrective exercise and taping regimen in patients with neck pain and scapular dyskinesis. METHODS: Forty participants with neck pain and scapular dyskinesis were randomly assigned to one of two 3-week regimens: experimental (scapulothoracic MWM + corrective exercises + tape) or comparison (corrective exercises + tape). The visual analogue scale, pressure pain threshold (PPT), cervical and scapular range of motion (ROM), and neck disability index (NDI) were measured at the start and after the third and sixth sessions. RESULTS: Pain decreased after the sixth session in both experimental (mean difference: 3.1; 95% confidence interval [CI]: 2.1-4.1) and comparison (mean difference: 1.8; 95% CI: 0.81-2.8) groups. Although there was no change in PPT and scapular ROM, scapular upward rotation decreased significantly only in the comparison group in the sixth session (p = 0.014). The ROM for neck extension, right rotation, and right and left side bending improved significantly (p ≤ 0.031) in both groups. The NDI improved in both the experimental (mean difference: 7.2-10.6; 95% CI: 2.5-15.7) and comparison (mean difference: 5.9-10.3; 95% CI: 1.2-15.4) groups. There were no significant differences in outcomes between the groups. CONCLUSIONS: In this study, the addition of scapulothoracic MWM to the corrective exercise and taping regimen over a 3-week period did not increase pain or improve function in patients with neck pain and scapular dyskinesis.

Effect of manual therapy with exercise in patients with chronic cervical radiculopathy: a randomized clinical trial.

BACKGROUND: Research that has examined the effects of cervical spine mobilization on hypoesthesia and hypersensitivity characteristics in patients with cervical radiculopathy is scarce. The aim of this study was to examine the short-term effects of vertebral mobilization on the sensory features in patients with cervical radiculopathy. METHODS: Twenty-eight participants with chronic cervical radiculopathy were randomly allocated to (1) an experimental group [cervical vertebral mobilization technique and exercise] or (2) a comparison group [minimal superficial circular pressure on the skin and exercise]. Participants received a total of 6 sessions for 3-5 weeks. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), pressure pain threshold (PPT), heat/cold pain threshold (HPT/CPT), and active cervical range of motion (ROM) were measured at baseline immediately after the first session and after the sixth session. RESULTS: The experimental group showed improvements from baseline to session 6 in NPRS [mean difference 2.6; 95% confidence interval: -4.6, -0.7], NDI [14; -23.3, -4.3], and active cervical ROM in extension [14°; 2.3, 25.5], rotation [16°; 8.8, 22.5], and lateral flexion to the affected side [10°; 2.3, 16.8]. Improvements were also found in PPT at the neck [124 kPa; 57, 191.1] and C7 level at the hand [99 kPa; 3.6, 194.9]. There were no changes in the HPT and CPT at any tested area (P>0.050). CONCLUSIONS: Cervical vertebral mobilization for patients with chronic cervical radiculopathy reduced localized mechanical, but not thermal, pain hypersensitivity. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT03328351 ). Registered on November 1, 2017, retrospectively registered.

Standing and Walking Balance in Patients with Chronic Shoulder Pain: A Case-control Study.

BACKGROUND: Patients with shoulder pain may have proprioceptive and balance deficits. However, studies on balance in patients with shoulder pain are scarce. OBJECTIVE: This study aims to investigate if patients with chronic shoulder pain demonstrate deficits in standing and walking balance and to study the relationship between outcome measures of balance and age and body mass index (BMI). MATERIALS AND METHODS: This case-control study was conducted at Dammam Medical Complex, Dammam, Saudi Arabia, between March and November 2018. The study recruited patients (n = 15) with chronic shoulder pain (>4 months) and healthy controls (n = 15) matched for age, gender and BMI. Standing balance was tested using a Challenge Disc test, the Romberg test and timed unipedal stance test (UPST). Walking balance was assessed using the timed up and go (TUG) test, stance phase duration and center of pressure (COP) deviation. Independent t-tests were used to investigate the differences between the two groups in demographic data and all the outcome measurements. Pearson correlation coefficients were used for correlation analysis. RESULTS: No statistically significant differences were found between the two groups in any outcome of the standing balance (P ≥ 0.095) or walking balance (P ≥ 0.160). However, medium effect sizes were found for the UPST (η2: ≥0.06), Challenge Disc (η2: 0.06), TUG (Cohen's d: 0.54) and COP deviation (Cohen's d: 0.53). There was a moderate correlation between BMI and Challenge Disc (P = 0.025) and between age and Challenge Disc (P = 0.012) in both the groups. CONCLUSION: Patients with chronic shoulder pain had lower balance measurements compared with healthy people, although this difference was not statistically significant.

Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial.

OBJECTIVE: The aim of this study was to investigate the short-term effect of slider and tensioner exercises on pain and range of motion (ROM) of straight leg raise (SLR) and slump tests in patients with low back-related leg pain with peripheral nerve sensitization. METHODS: In this prospective, controlled trial, 51 patients with low back-related leg pain with peripheral nerve sensitization were divided into 3 treatment groups: slider (slider neural mobilization exercise + transcutaneous electric nerve stimulation [TENS]), tensioner (tensioner neural mobilization exercise + TENS), and control (only TENS). Each patient received 6 sessions over 2 weeks. The following outcomes were measured at baseline and after the first, third, and sixth sessions: visual analog scale (VAS) for pain and ROM of SLR and slump tests were performed for the symptomatic side. RESULTS: Compared with controls, patients receiving the slider and tensioner exercises showed a greater decrease in pain at the third and sixth sessions (mean difference: ≥1.54 cm; 95% CI, 0.1-3.9). There was a significant difference in the ROM of the SLR test between the slider and controls at only the sixth session (mean difference: 16.7°; 95% CI, -29.2 to -4.3). Patients in the slider and tensioner groups demonstrated greater improvements in the ROM of slump test at all sessions compared with controls (mean difference: ≥12.5°; 95% CI, -32.1 to -6.4). There were no significant differences between the slider and tensioner groups in any outcome at any session. CONCLUSION: Patients in both slider and tensioner neural mobilization exercise groups demonstrated improvements in pain and ROM in patients with low back-related leg pain with peripheral nerve sensitization compared to those in the control group.

Girth, strength, and flexibility of the calf muscle in patients with knee osteoarthritis: A case-control study.

OBJECTIVES: Reduced strength and girth in thigh muscles such as the quadriceps and the hamstrings have been observed in patients with knee osteoarthritis (OA). However, studies on the characteristics of calf muscles in these patients are lacking. This study aimed to evaluate the girth, strength, and flexibility of the calf muscle of patients with knee OA. METHODS: In this case-control study, we recruited 15 patients with knee OA and 15 healthy control participants. The girth, strength, and flexibility of the calf muscle were evaluated in one session using a flexible non-elastic tape measure (centimetre), a handheld dynamometer (Newton), and a standard goniometer (degree) to measure ankle dorsiflexion. RESULTS: Strength of the calf muscle strength was significantly lower in the patients with knee OA comapred with the control group (-42.03; 95% CI: -73.9, -10.1; p = .012). No significant differences in calf muscle girth (.27; 95% CI: -2.63, 3.16; p = .852) or flexibility (-1.93; 95% CI: -4.8, .93; p = .177) were found between the two groups. CONCLUSION: In our study, patients with knee OA demonstrated reduced calf muscle strength. We recommend that the management of patients with knee OA include strengthening the calf muscles.

Psychometric properties of an Arabic version of the fatigue severity scale in patients with stroke.

Background: Post-stroke fatigue is a common symptom which needs to be assessed by a psychometrically sound tool. Objectives: To investigate the psychometric properties of an Arabic version of the fatigue severity scale (FSS-A) in patients with stroke. Methods: An observational, cross-sectional design was applied to 147 survivors of first-time stroke and 70 healthy participants. Internal consistency was measured by Cronbach's α, while test-retest reliability was measured by intraclass correlation coefficients (ICCs). To assess validity, the FSS-A was correlated with the Fatigue Visual Analogue Scale (VAS-F), the Short Form 36 (SF-36) and its vitality domain (SF-36V), the stroke specific quality of life (SSQOL-A) and its energy domain (SSQOL-A-E), and the Beck Depression Inventory II (BDI-II). Results: The FSS-A showed excellent internal consistency (Cronbach's α = 0.934) and test-retest reliability (ICC = 0.920, 95% confidence interval (CI): 0.85-0.96). Exploratory factor analysis confirmed that the FSS-A is unidimensional. The FSS-A had high positive correlation with VAS-F, moderate positive correlation with BDI-II, high negative correlation with SSQOL-A-E and moderate negative correlations with SF-36, SF-36V, and SSQOL-A. It differentiated patients from healthy participants with a sensitivity of 78.4% and a specificity of 77.1%. The minimal detectable change with 95% CI was 1.02 (22.4%). Conclusions: The FSS-A showed good psychometric properties suggesting its usefulness as a fatigue evaluation tool in patients diagnosed with stroke.

Longitudinal excursion and strain in the median nerve during novel nerve gliding exercises for carpal tunnel syndrome.

Nerve and tendon gliding exercises are advocated in the conservative and postoperative management of carpal tunnel syndrome (CTS). However, traditionally advocated exercises elongate the nerve bedding substantially, which may induce a potentially deleterious strain in the median nerve with the risk of symptom exacerbation in some patients and reduced benefits from nerve gliding. This study aimed to evaluate various nerve gliding exercises, including novel techniques that aim to slide the nerve through the carpal tunnel while minimizing strain ("sliding techniques"). With these sliding techniques, it is assumed that an increase in nerve strain due to nerve bed elongation at one joint (e.g., wrist extension) is simultaneously counterbalanced by a decrease in nerve bed length at an adjacent joint (e.g., elbow flexion). Excursion and strain in the median nerve at the wrist were measured with a digital calliper and miniature strain gauge in six human cadavers during six mobilization techniques. The sliding technique resulted in an excursion of 12.4 mm, which was 30% larger than any other technique (p

Biomechanical evaluation of two clinical tests for plantar heel pain: the dorsiflexion-eversion test for tarsal tunnel syndrome and the windlass test for plantar fasciitis.

BACKGROUND: Plantar heel pain may result from several conditions such as tarsal tunnel syndrome (TTS) and plantar fasciitis. The dorsiflexion-eversion test is used to diagnose TTS, whereas the windlass test is used for plantar fasciitis. Given the similarity between both tests, the purpose of this study was to evaluate whether these tests are able to selectively load the structures which they aim to examine. METHODS: Both tests were evaluated in six cadavers by measuring strain in the plantar fascia, tibial nerve, lateral plantar nerve (LPN), and medial plantar nerve (MPN) using miniature displacement transducers. Longitudinal excursion of the nerves was measured with a digital caliper. RESULTS: With the dorsiflexion-eversion test, dorsiflexion and eversion of the ankle in combination with extension of the metatarsophalangeal (MTP) joints significantly increased strain in the tibial nerve (+1.1%), LPN (+2.2%), and MPN (+3.3%) but also in the plantar fascia (+1.2%) (all: p=0.016). Both components (dorsiflexion-eversion and MTP extension) resulted in significant increases. With the windlass test, extension of all MTP joints significantly increased strain in the plantar fascia (+0.4%, p=0.016), but also in the tibial nerve (+0.4%, p=0.016), LPN (+0.8%, p=0.032) and MPN (+2.0%, p=0.016). Excursion of the nerves was always in the distal direction but only reached significance for the tibial nerve (6.9 mm, p=0.016) and LPN (2.2 mm, p=0.032) during the dorsiflexion-eversion test. CONCLUSIONS: Both tests mechanically challenge various structures that have been associated with plantar heel pain. This questions the usefulness of the tests in the differential diagnosis of plantar heel pain.