ABSTRACT
OBJECTIVE: This study aimed to assess the intraexaminer and interexaminer reproducibility of the Downing test in sacroiliac joint evaluation in symptomatic and asymptomatic individuals. METHODS: A reliability study was conducted with a test-retest design in 54 college students of both sexes. To assess the intraexaminer reproducibility, each participant was evaluated twice by the same examiner with a 7-day interval, and to assess the interexaminer reproducibility, each participant was evaluated by 2 examiners. RESULTS: Of the 54 participants included in the study, 18 (33.3%) were asymptomatic and 36 (66.7%) were symptomatic; a total of 108 sacroiliac joints were evaluated. Sacroiliac joint diagnosis based on the Downing test presented low intraexaminer reproducibility in all participants (κ = 0.12, 95% confidence interval [CI] 0.03-0.22), in asymptomatic individuals (κ = 0.18, 95% CI 0.02-0.34), and in symptomatic individuals (κ = 0.28, 95% CI 0.17-0.39). The interexaminer reproducibility also was low in all participants (κ = 0.18, 95% CI 0.09-0.27), in asymptomatic individuals (κ = 0.22, 95% CI 0.15-0.37), and in symptomatic individuals (κ = 0.16, 95% CI 0.05-0.27). The standard error of the measurement values were not lower than smallest detectable change values considering a CI of 95% for all participants. CONCLUSION: For this group of asymptomatic and symptomatic participants, the reproducibility of the Downing test was poor. The clinical utility of this test used in isolation is not supported by the present study.
ABSTRACT
The immediate-early gene egr-1 has been shown to have an increased expression during long-term potentiation (LTP). High frequency electrical stimulation induces an increase in such expression in the dorsal horn of the spinal cord. However, evidence demonstrating the activation of this gene in the spinal cord and its relationship with LTP is still scarce. The substance P (SP) has also been associated with LTP in the dorsal horn of the spinal cord following high frequency stimulation. Here we evaluated the expression of both Egr-1 and SP in the sacrolumbar area of the spinal cord after locomotor training in adult rats. Increased neuronal Egr-1 expression was found in the spinal cord sections in rats that underwent locomotor training, especially in laminae IV and X across L3-S4 levels (p<0.05). Conversely, SP expression in synaptic terminals was not altered in the abovementioned regions. Our results suggest that locomotor training activates mechanisms in a similar way to LTP, and is involved in the synaptic plasticity in the spinal cord. The results also indicate that variations in the training protocol influence Egr-1 expression. Such events appear not to be directly influenced by SP, which suggests a plastic process that differs from those triggered by nociceptive stimuli.