Optimizing Pain Intensity Assessment in Clinical Trials: How Many Ratings are Needed to Best Balance the Need for Validity and to Minimize Assessment Burden?

Pain intensity is the most commonly used outcome domain in pain clinical trials. To minimize the chances of type II error (ie, concluding that a treatment does not have beneficial effects, when in fact it does), the measure of pain intensity used should be sensitive to changes produced by effective pain treatments. Here we sought to identify the combination of pain intensity ratings that would balance the need for reliability and validity against the need to minimize assessment burden. We conducted secondary analyses using data from a completed 4-arm clinical trial of psychological pain treatments (N = 164 adults). Current, worst, least, and average pain intensity in the past 24 hours were assessed 4 times before and after treatment using 0 to 10 numerical rating scale-11. We created a variety of composite scores using these ratings and evaluated their reliability (Cronbach's alphas) and validity (ie, associations with a gold standard score created by averaging 16 ratings and sensitivity for detecting between-group differences in treatment efficacy). We found that for each measure, reliability increased as the number of ratings used to create the measures increased and that ratings from 3 or more days were needed to have adequately strong associations with the gold standard. Regarding sensitivity, the findings suggest that composite scores made up of ratings from 4 days are needed to maximize the chances of detecting treatment effects, especially with smaller sample sizes. In conclusion, using data from 3 or 4 days of assessment may be the best practice. PERSPECTIVE: Composite scores made up of at least 3 days of pain ratings appear to be needed to maximize reliability and validity while minimizing the assessment burden. TRIAL REGISTRATION: clinicaltrials.gov NCT01800604.

Comparison of Hip and Knee Biomechanics during Sidestep Cutting in Male Basketball Athletes with and without Anterior Cruciate Ligament Reconstruction.

This study aimed to compare hip and knee biomechanics during sidestep cutting on the operated and non-operated sides in individuals with anterior cruciate ligament reconstruction (ACLR), and in an uninjured control group. Twenty male basketball athletes, 10 individuals with ACLR and 10 controls, were recruited. Hip and knee joint angles and angular velocities were investigated with a three-dimensional motion analysis system, and ground reaction forces (GRF) along with moments were collected during the deceleration phase of the stance limb during sidestep cutting maneuvers. We found significantly higher peak hip flexion, hip internal rotation angular velocities, and peak thigh angular velocity in the sagittal plane in the ACLR group. In addition, the peak vertical GRF and peak posterior GRF of the ACLR group were significantly higher than those of the control group. Univariate analyses indicated that the posterior GRF of the non-operated side was significantly higher than in the matched operated side in the control group. The operated and non-operated sides in male basketball athletes with ACLR showed alterations in hip and knee biomechanics compared with a control group, especially in the sagittal plane. Therefore, the emphasis of neuromuscular control training for the hip and the knee in basketball players with ACLR is required.

Effects of short foot exercise combined with lower extremity training on dynamic foot function in individuals with flexible flatfoot: A randomized controlled trial.

BACKGROUND: Flexible flatfoot has demonstrated biomechanical linkages between distal and proximal lower extremities. However, supporting evidence is required to investigate the benefits of short foot exercise (SF) and short foot exercise in combination with lower extremity training (SFLE) on dynamic foot function. RESEARCH QUESTION: This study aimed to determine the effects of a 6-week SF, 6-week SFLE, or control condition (no intervention) on dynamic foot function during gait in individuals with flexible flatfoot. METHODS: Forty-five individuals with flexible flatfoot were randomly assigned into three conditions: (1) SF, (2) SFLE, and (3) control conditions. Participants in two intervention programs performed daily training via telerehabilitation and a home-based exercise program. Foot kinematics and center of pressure excursion index (CPEI) during the gait, intrinsic foot muscle test, and navicular drop test were assessed at baseline and after the 6-week intervention program. RESULTS: Post-intervention participants in the SF and SFLE conditions showed a shorter time to the lowest medial longitudinal arch (MLA) and improved MLA motion during the stance phase compared with the baseline. In addition, participants in the SFLE conditions showed greater changes in CPEI than in the SF and control conditions. Improvements in intrinsic foot muscle and navicular drop tests were also observed in participants in both intervention programs post-intervention. SIGNIFICANCE: A major finding of the study was the improvement in dynamic foot function during gait in individuals with flexible flatfoot after the six weeks of the SF and SFLE intervention programs. Both intervention programs appear to have the potential for inclusion in a corrective program for individuals with flexible flatfoot.

Effects of radial extracorporeal shockwave therapy versus high intensity laser therapy in individuals with plantar fasciitis: A randomised clinical trial.

This study aimed to compare the effects of radial extracorporeal shockwave therapy (rESWT) to the effects of high-intensity laser therapy (HILT) in the treatment of individuals with plantar fasciitis. Thirty-two individuals with unilateral plantar fasciitis were randomized into two groups: rESWT and HILT. In each group, the individuals underwent the intervention two sessions per week, for three weeks. Outcome measures included morning pain, resting pain, pain at 80 newtons (N) pressure, skin blood flow and temperature, plantar fascia (PF) and flexor digitorum brevis (FDB) thickness, and Foot Function Index (FFI). There was no significant difference in baseline characteristics of the individuals in both groups. All outcome measures, except skin blood flow and temperature, and FDB thickness, were significantly different (p < 0.05) over time. Skin blood flow was significantly different between groups at the end of the program. Either HILT or rESWT could alleviate pain in individuals with plantar fasciitis significantly. However, HILT was better at reducing FFI (functional limitation domain) rather than rESWT. This study was a randomized clinical trial and was approved by Mahidol University-Central Institutional Review Board (MU-CIRB) following the Declaration of Helsinki, COA no. MU_CIRB 2020/207.0412, the Thai Clinical Trials Registry (TDTR) numbered TCTR2021012500.

Prevalence of scapular dyskinesis in office workers with neck and scapular pain.

Objectives. This study aimed to investigate the presence of scapular dyskinesis (SD) in office workers with neck and scapular complaints. The postural malalignment and related muscle adaptations were also explored. Methods. SD and its subtypes were determined. Postural deviations and the length of commonly reported muscle tightness were evaluated. Results. Among 99 participants, 90% of them had SD. Considering both sides or 198 scapula, 90.4% were identified as having painful scapula and 19% as having painless scapula. There was a difference in the proportion of SD on painful (93%) and painless (69%) sides. Postural deviations including rounded shoulder (100%), forward head (43.3%) and thoracic hyperkyphosis (54.5%) were prevalent. Persons with type III SD had a higher percentage of forward head than other types. There was also tightness of the pectoralis minor (100%), levator scapulae (93.0%) and upper trapezius (98.3%) muscles without different proportions among types of SD. The greatest proportion of persons with SD had tightness of the levator scapulae. Conclusions. There was a high prevalence of SD among office workers with neck and scapular complaints. SD was also associated with abnormal posture and muscle tightness. The proper management of SD and working posture is warranted.

Age progression in hypnosis for pain and fatigue in individuals with disabilities.

The purpose of this paper is to describe in detail a specific age progression approach that we use in our clinical practice and clinical trials in interventions including hypnosis for chronic pain and fatigue in individuals with disabilities. Moreover, we present preliminary evidence regarding the effects of the hypnosis sessions that use age progression suggestions compared to hypnosis sessions that provide different suggestions, as well as to sessions that did not include hypnotic procedures. Findings indicate that age progression suggestions for pain management with individuals participating in hypnosis treatment resulted in substantial immediate reductions in pain intensity, which were greater than pain reductions associated with treatments sessions providing pain education or cognitive therapy. In addition, age progression sessions provided to individuals receiving online hypnosis treatment for fatigue resulted in immediate large reductions in fatigue severity. Although the design of these two studies does not allow to report specific or long-term effects of the age progression techniques, findings indicate that including age progression suggestions to hypnosis protocols for pain and fatigue management is effective for reducing the immediate level of both symptoms. The development and continued evaluation of hypnotic interventions that increase or restore hope in, and optimism, for the future has the potential for enhancing the psychosocial well-being and quality of life of individuals with pain and fatigue.

Association among pain, disability, and functional capacity in patients with chronic non-specific low back pain: A cross-sectional study.

BACKGROUND: Patients with chronic non-specific low back pain (CNSLBP) have pain, disability, and decreased functional capacity, however, the association is still unknown. OBJECTIVE: This study aimed to examine the association between pain, disability, and functional capacity in patients with CNSLBP. METHODS: Thirty participants with CNSLBP were interviewed for demographic data and assessed for pain intensity by visual analog scale (VAS), disability level by Oswestry Disability Index (ODI), and functional capacity comprising functional reach (FR), five times sit-to-stand (5STS), and two-minute step (2MS). The association and linear regression were analyzed using the Spearman correlation coefficient, point-biserial correlation, and multiple linear regression, respectively. RESULTS: A significant association was found between VAS and ODI, VAS and 5STS, 5STS, and 2MS. For demographic data, some variables were significantly correlated to VAS and functional capacity. VAS was also correlated with sex and age, FR was correlated with height, 5STS was correlated with age, and 2MS was correlated with age, body mass index, and physical activity level. CONCLUSIONS: The association among pain intensity, disability level, functional capacity, and demographic data suggests that apart from pain and disability level, functional capacity is associated with pain, which can be recommended for objective assessment regarding some demographic variables that can contribute to clinical outcome measures.

Decreased Functional Capacity in Individuals with Chronic Non-Specific Low Back Pain: A Cross-Sectional Comparative Study.

PURPOSE: This study aimed to compare functional capacity tests between individuals with and without chronic non-specific low back pain and to investigate the effects of demographic data on functional capacity tests. METHODS: Thirty individuals with chronic non-specific low back pain (CNSLBP) and thirty healthy individuals underwent three functional capacity tests comprising functional reach test (FRT), five-time sit to stand test (5 TSST), and two-minute step test (2 MST). CNSLBP were assessed in pain intensity using a visual analog scale (VAS) and disability level using the modified Oswestry disability questionnaire (MODQ) Thai version. RESULTS: The results found significant differences in five-time sit to stand and two-minute step tests between individuals with chronic non-specific low back pain and healthy individuals. The mean differences between healthy and CNSLBP for the 5 TSST were -3.24 seconds (95% CI=-4.47--2.02) and for the 2 MST they were 13.13 steps (95% CI=2.62-23.64). Age significantly influenced the 5 TSST (P=0.004) and 2 MST (P=0.008), while gender (P=0.028) and height (P=0.002) affected the FRT. CONCLUSION: Individuals with chronic non-specific low back pain had lower functional capacity assessed by five-time sit to stand and 2-minute step tests compared to healthy individuals, and the therapeutic programs were emphasized. With increasing age, the 5 TSST and 2 MST would both be declined.

Responsiveness of pain, functional capacity tests, and disability level in individuals with chronic nonspecific low back pain.

BACKGROUND: Clinical outcomes are very important in clinical assessment, and responsiveness is a component inside the outcome measures that needs to be investigated, particularly in chronic nonspecific low back pain (CNSLBP). OBJECTIVE: This study aimed to investigate the responsiveness of pain, functional capacity tests, and disability in individuals with CNSLBP. METHODS: Twenty subjects were assessed in pain using the following methods: visual analog scale (VAS) and numeric pain rating scale (NPRS), functional capacity tests: functional reach test (FRT), five-time sit-to-stand test (5 TSST), and two-minute step test (2 MST), and disability level: modified Oswestry Disability Questionnaire (MODQ), Thai version before and after 2-week intervention session. For interventions, the subjects received education, spinal manipulative therapy, and individual therapeutic exercise twice a week, for a total of two weeks. The statistics analyzed were change scores, effect size (ES), and standardized response mean (SRM). RESULTS: The most responsive parameter for individuals with CNSLBP was pain as measured by numeric pain rating scale (NPRS) (ES -0.986, SRM -0.928) and five-time sit-to-stand test (5 TSST) (SRM -0.846). CONCLUSION: This study found that NPRS pain and 5 TSST were responsive in individuals with CNSLBP at two weeks after the beginning of interventions.

Intertester reliability of a movement impairment-based classification system for individuals with shoulder pain.

BACKGROUND: Other than pathoanatomical diagnosis, physical therapy managements need the diagnosis of movement-related impairments for guiding treatment interventions. The classification system of the Movement System Impairment (MSI) has been adopted to label the musculoskeletal disorders in physical therapy practice. However, reliability study of this classification system in individuals with shoulder pain has not been reported in the literature. OBJECTIVE: This paper investigated the intertester reliability of the diagnosis based on the MSI classification system in individuals with shoulder pain. METHODS: The patients with shoulder pain, between the ages 18-60 years, were recruited if he or she had pain between 30 and 70 on the 100 mm visual analog scale for at least three months. The examiners who were two physical therapists with different clinical experiences received a standardized training program. They independently examined 45 patients in random order. Each patient was examined by both therapists on the same day. The standardized examination scheme based on the MSI approach was used. Patients were identified to subgroup syndromes according to scapular and humeral syndromes and also determining their subcategory syndromes. Six scapular subcategory syndromes included downward rotated, depressed, abducted, wing, internal rotated/anterior tilted, and elevated. Three humeral subcategory syndromes were anterior glide, superior glide, and medial rotated. More than one subgroup and subcategory of syndromes could be identified in each patient. The test results of each session were blinded to another therapist. The percentages of agreement and kappa statistic were determined. RESULTS: The results showed that agreement levels in identifying subgroup syndromes was fair (71.11% agreement, kappa coefficient = 0.34) and classifying subcategories syndromes were poor to substantial (73.33-91.11% agreement, kappa coefficient = 0.20 - 0.66). The overall agreement and kappa value of the MSI classification of subcategory syndromes was poor (kappa coefficient = 0.11; 95% CI 0.05-0.18). The agreement level of subcategories for scapular depression and humeral superior glide syndromes was substantial. The scapular winging, depression, and downward rotation were the three syndromes that were most frequently identified by both the examiners. CONCLUSION: The intertester reliability between therapists with different experience according to the MSI approach for shoulder pain classification was generally acceptable to poor due to the nature of the classification system. The standardized procedure and intensive training can be used for inculcating novice therapists with adequate level of intertester reliability of examination.

Effect of increased relative stiffness of the lumbar spine on hamstring muscle stretching in individuals with a history of low back pain suspected to have a clinical lumbar instability: A randomized crossover design.

BACKGROUND: Theoretically, lumbopelvic stabilization techniques during hamstring muscle stretching could increase lumbar stiffness relative to hamstring muscle in individuals with a history of low back pain and suspected clinical lumbar instability. However, evidence to support this theory is limited. This study aimed to 1) determine changes in lumbopelvic, lumbar, and hip motions, and hamstring muscle length after stretching exercises with lumbopelvic stiffening or relaxing techniques, and 2) compare those changes between techniques. METHODS: This study used a randomized crossover design. Thirty-two participants with a history of low back pain and bilateral hamstring muscle tightness were recruited. The order of the first technique was randomly assigned. After a 2-day washout, participants were crossed over to the second technique. Motion data during active forward trunk bending and bilateral hamstring muscle length during passive knee extension were collected pre- and post-intervention. FINDINGS: Significant increases (P < 0.05) were found in bilateral hamstring muscle length for both techniques. However, stiffening technique demonstrated a significant decrease in lumbar motion (P < 0.05) and increase in hip motion (P < 0.05), while relaxing technique demonstrated trends showing increases in lumbar and hip motions (P = 0.134 and 0.115, respectively). The findings showed significantly greater improvement (P < 0.05) in lumbar and hip motions with stiffening technique. INTERPRETATION: The findings suggest increased relative stiffness of the lumbar spine during hamstring muscle stretching can specifically lengthen bilateral hamstring muscle and decrease excessive lumbar motion. This stiffening technique may prevent excessive movement of the lumbar spine, thereby reducing the risk of recurrent low back pain.

Immediate Effect of Hold-Relax Stretching of Iliopsoas Muscle on Transversus Abdominis Muscle Activation in Chronic Non-Specific Low Back Pain with Lumbar Hyperlordosis.

OBJECTIVE: To determine the immediate effect of hold-relax (HR) stretching of the iliopsoas muscle on pain, transversus abdominis (TrA) activation capacity, lumbar stability level, lumbar lordosis angle and iliopsoas muscle length in chronic non-specific low back pain (CNSLBP) with lumbar hyperlordosis. MATERIAL AND METHOD: Participants aged from 30-55 years with CNSLBP with lumbar hyperlordosis were divided in two groups: (Group 1) Intervention group received 10-second isometric contraction ofthe iliopsoas muscle (HR), 10-second rest, 20-second static stretch, 5 repetitions. (Group 2) control group received 15 minutes resting in supine lying. The visual analog scale, prone test with the pressure biofeedback unit, modified isometric stability test, aflexible ruler and modified Thomas test were usedforpre- and post-test. Two-way ANOVA was used for within and between-group comparisons. RESULTS: The present study consisted of 20 participants. Significant differences were found in pain, TrA activation capacity, lumbar lordosis angle and iliopsoas muscle length between intervention and control groups and between pre- and post-test for intervention group (p<0.05). Lumbar stability level showed no significant difference in within and between-group comparisons. CONCLUSION: The HR of the iliopsoas muscle reduced pain and lumbar lordosis angle, enhanced TrA activation, and increased length of hip flexor in CNSLBP with lumbar hyperlordosis.

Cross-Cultural Adaptation of the Compendium of Physical Activity: Thai Translation and Content Validity.

OBJECTIVE: To translate the compendium physical activity (compendium) proposed by Ainsworth to Thai and to validate the Thai translated version. MATERIAL AND METHOD: Five steps of cross-cultural adaption were conducted as follows: (1) forward translation, (2) group review, (3) backward translation, (4) group review and final decision and (5) a pilot study. Eight hundred and twenty-one activities ofthe compendium were translated to Thai by two independents translators. Thai translated version was considered by 23 persons who have studied physical activity for at leastfive years. Backward translation was carried out by two bilingual translators. The research team completed the final Thai translation by comparing original and translated versions. For pilot study the Thai translated version was validated by 22 allied health persons. Data was analyzed by multi-rater agreement (Fleiss's kappa) and qualitative analysis. RESULTS: For translations and group review, recommendations included; (a) changing to lay language with the same meaning, (b) converting the U.S. customary unit to the metric unit, and (c) using consistent language. More than 80% of 22 persons accepted the Thai translation and the Kappa agreement rangedfrom 0.187 to 0.694. Some activities demonstratedpoor multi-rater agreement and required additional definitions. CONCLUSION: Thai translated compendium physical activity was constructed to reduce the language barrier and promote physical activity in Thailand. The poor to moderate agreement of each major heading of translation may partly be due to Western culture. Many activities in the compendium were assembled but they were not recognized by Thais. Hence, Thai compendium physical activity should to be developed in afuture study.

Thai Version of the Kujala Patellofemoral Questionnaire in Knee Pain Patients: Cross-Cultural Validation and Test-Retest Reliability.

OBJECTIVE: To conduct a cross-cultural adaptation and determine the test-retest reliability of the Thai version of the Kujala Patellofemoral questionnaire (KPQ). MATERIAL AND METHOD: The present study comprised two phases: cross-cultural adaptation and test-retest reliability. The KPQ was first translated and cross-culturally adaptedfrom English to Thai. The content validity test was conducted, and the final version of the Thai version of Kujala Patellofemoral Questionnaire was developed. Forty knee pain patients were enrolled in this study to determine test-retest reliability ofthe final version ofthis questionnaire. All 40 subjects were patients from the Physical Therapy Center; Faculty ofPhysical Therapy, Mahidol University with a diagnosis of anterior knee pain by physical therapists. They were asked to complete the questionnaires; the 1st session after registration and 2,d session 30 minutes afterfinishing thefirst administration. For statistical analysis, the intraclass correlation coefficient (ICCa") method was used to determine test-retest reliability. RESULTS: All 40 subjects (36 women, 4 men; with age range 18-56 years) were assessed twice with 30-minute time interval. Thirteen questions indicated strong reliability, ranging from ICC2, 0.8 to 1.0 and the total score was ICC2, 0.98. CONCLUSION: The Thai version of the Kujala Patellofemoral Questionnaire was cross-culturally adapted, validated, and presented with excellent test-retest reliability. Regarding clinical implication, this questionnaire is now available for Thai physical therapists in evaluating Thai knee pain patients.

The Adaptive Patterns of Pelvic Alignment in Individuals with Adolescent Idiopathic Scoliosis.

OBJECTIVE: To investigate the adaptive pattern of pelvic alignment and to determine the correlations between pelvic alignment and Angle of Trunk Rotation (ATR) of each curve type in individuals with Adolescent Idiopathic Scoliosis (AIS). MATERIAL AND METHOD: This cross-sectional study of 31 AIS subjects was divided according to single or double curve patterns. Demographic data and A TR were collected. Five-view photos were shot before using Scion Image Software to calculate pelvic alignment. Independent t-test was used to compare pelvic alignment between groups. Pearson's correlation coefficient was used to identify the correlation between pelvic alignment and ATR. RESULTS: The subjects with single and double curves, showed significant difference in the right sagittal and transverse planes (p = 0.021). The double-curve group showed significant negative correlation of anterior-pelvic-obliquity and ATR (p = 0.037), significant positive correlations of left-pelvic-tilt and ATR (p = 0.021), and right-pelvic-tilt and ATR (p = 0.005). The major-curve group showed significant negative correlation of anterior-pelvic-obliquity and ATR (p = 0.014), significant positive correlation of right-pelvic-tilt and ATR (p = 0.021), and top-pelvic-rotation and ATR (P = 0.032). The near-pelvis-curve group showed only significant negative correlation ofanterior-pelvic-obliquity and ATR (p = 0.032). CONCLUSION: Both AIS groups showed different pelvic tilt and rotation. ATR showed the correlation with pelvic tilt and obliquity in double-curve group only. A larger curve influenced the pelvic-spinal rotation relationship more than the near-pelvic-curve. Thus, awareness ofpelvic alignment in AIS assessment and treatment is recommended.

Muscle Activity of Abdominal and Back Muscles during Six Starting Positions in Untrained Individuals.

OBJECTIVE: This study aimed to investigate the electromyography (EMG) activity amongfive abdominal and back muscles at six starting positions in untrained individuals. MATERIALS AND METHOD: Twenty-five healthy individuals aged 20.9 +/- 3.9 years, who were inexperienced with lumbar stabilization exercise, were recruited. They were asked to perform maximum voluntary isometric contraction (MVIC), and then six starting positions in random order EMG data ofeach starting position were normalized as a percentage of MVIC. Friedman two-way analysis of variance (ANOVA) and Wilcoxon signed-ranks tests were used for data analysis. RESULTS: Significant differences in EMG activity of five abdominal and back muscles were found in all six starting positions (p<0.001). The highest EMG activity ofthe transversus abdominis/internal abdominal oblique (TrA/IO) was found in crook lying, with right leg lifted (CLR), and of multifidus (MF) in four-point kneeling with straight right leg lifted horizontally (4p-SRL). CONCLUSION: The results suggested that CLR and sitting on a gym ball (SG) were able tofacilitate TrA/IO activity with minimal activity from the rectus abdominis (RA), while CL, 4p-SRL, andSG were able tofacilitate MF activity with minimal activity from erector spinae (ES).

Immediate effects of trunk stabilizer muscles training on muscle response time in individuals with non-specific chronic low back pain.

OBJECTIVE: To investigate immediate effects of biofeedback training on motor control performance in participants with nonspecific chronic low back pain. MATERIAL AND METHOD: RCT was conducted. The training group received isolated and co-contraction training of trunk stabilizers in lying on the left side, sitting on stool and sitting on a gymnastic ball, while the control group was asked to rest comfortably on a chair. Trunk muscles response time during rapid arm movement test was recorded using surface electromyography. Two-way ANOVA and Bonferroni post hoc test were used to detect changes within and between groups. RESULTS: In the training group, the trunk muscles response times were significantly decreased after training when compared with those in the control group (p<0.05). CONCLUSION: Trunk stabilizer training has a beneficial effect on motor response time of the trunk muscles. The long-term effects of exercise should be further considered with a larger sample size.

Effects of strength and endurance training of superficial and deep neck muscles on muscle activities and pain levels of females with chronic neck pain.

[Purpose] To compare muscle activities and pain levels of females with chronic neck pain receiving different exercise programs. [Subjects and Methods] One hundred females with chronic neck pain participated in this study. They were randomly allocated into 4 groups (n = 25) on the basis of the exercises performed as follows: strength-endurance exercise, craniocervical flexion exercise, combination of strength-endurance and craniocervical flexion exercise and control groups. Pain, disability levels and changes in the muscle activities of the cervical erector spinae (CE), sternocleidomastoid (SCM), anterior scalenes (AS) and upper trapezius (UT) muscles were evaluated before and after the interventions. [Results] After 12 weeks of exercise intervention, all three exercise groups showed improvements in pain and disability. The muscle activities during the typing task were significantly different from the control group in all three exercise groups for all muscles except those of the extensor muscles in the craniocervical flexion exercise group. [Conclusion] The results of this study indicate that exercises for the cervical muscles improve pain and disability. The exercise programs reduced the activities of almost all cervical muscles.

Cross-cultural adaptation of modified Oswestry Low Back Pain Disability Questionnaire to Thai and its reliability.

OBJECTIVE: The present study aimed to cross-culturally adapt the modified Oswestry Low Back Pain Disability Questionnaire (ODQ) into Thai. MATERIAL AND METHOD: The process comprised of an initial forward translations from English to Thai, synthesis of the translations, back translation, and back translation approval. The approved version of Thai ODQ was then calculated for test-retest reliability. Forty patients with LBP, aged 40.1+/-10.7 years, were recruited into a test-retest reliability study. RESULTS: The test-retest reliability, calculated by intraclass correlation coefficient, was assessed on two occasions separated by a time interval of 20-30 minutes. The values of test-retest reliability of items ranged from 0.80-1.00. The value of total score was 0.98. CONCLUSION: This finding indicated good reliability of the Thai version modified ODQ.