Lateral abdominal muscle thickness and contractile function in women with and without stress urinary incontinence.

INTRODUCTION AND HYPOTHESIS: Stress urinary incontinence (SUI) primarily results from the weakness of pelvic floor muscles, working synergistically with the abdominal muscles. The current study aimed to compare thickness and contractile function of lateral abdominal muscles in women with and without SUI. METHODS: Thirty-nine women with SUI (SUI group; age: 38.87 ± 8.96 years, body mass index (BMI): 24.03 (5.94) kg/m2) and 42 healthy women (control group; age: 36.21 ± 11.46 years, BMI: 23.90 (5.85) kg/m2) were included. Transverse abdominis (TrA) and internal oblique (IO) muscle thickness at rest and during abdominal drawing-in maneuver (ADIM) were measured with ultrasound imaging in B-mode using a Logiq S7/Expert device and a 9-11 MHz linear transducer. Percentage change in thickness and contractile function of these muscles were also calculated. RESULTS: No significant differences in the thickness of TrA and IO muscles at rest and during ADIM between the groups were found (p > 0.05). The percent change in thickness and contractile function of both right and left side TrA muscles and the right side IO muscle were lower in SUI group than control group (p < 0.05). The percentage change in thickness and the contractile function of the left side IO muscle did not change (p > 0.05). CONCLUSION: Women with SUI had a smaller percentage change in thickness and contractile function of TrA and IO muscle than women without SUI. However, there was no difference in the morphological features of these muscles between the groups. Considering the lateral abdominal muscle, training may be important for management of SUI.

Effects of spinal stabilization exercises focusing on the pelvic floor in women with overactive bladder.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the effects of spinal stabilization exercises (SSEs) focusing on the pelvic floor with regard to urinary symptoms, pelvic floor muscle strength (PFMS), core stability, quality of life (QoL), and perception of subjective improvement (PSI) in women with overactive bladder (OAB). METHODS: Patients were randomly divided into SSE (n=23) and control (n=24) groups. The SSE group received SSEs focusing on the pelvic floor for 3 days a week for 8 weeks and recommendation. The control group received only recommendation. Before (BT) and after treatment (AT), urinary symptoms were evaluated with Overactive Bladder Questionnaire-Version 8 (OAB-V8) and bladder diary. PFMS, core stability, and QoL were assessed using the Modified Oxford Scale (MOS), Sharman test, and King's Health Questionnaire (KHQ) respectively. AT, PSI with a Likert-type scale, and compliance with recommendations using a visual analog scale were assessed. RESULTS: The OAB-V8 and the KHQ scores, the number of voids per day and voids per night decreased and the MOS and the Sharman scores increased in the SSE group (p<0.05). In the control group, the OAB-V8 and incontinence effect, social limitations, emotional state, and sleep sub-dimension scores related to KHQ decreased (p<0.05). The OAB-V8, role and physical limitations, emotional state, and sleep sub-dimension scores decreased more, and the MOS, the Sharman, the PSI, and the compliance with recommendations scores increased more in the SSE group than in the control group (p<0.05). CONCLUSIONS: The SSEs focusing on the pelvic floor improved urinary symptoms, PFMS, core stability, QoL, and PSI. This exercise approach may be beneficial in the management of OAB.

Western Massage Therapies in the Management of Neck Pain: A Systematic Review.

OBJECTIVE: The purpose of this review was to compare types of Western massage therapy (MT) to other therapies, placebo, and no-treatment controls in neck pain (NP) in randomized and nonrandomized clinical trials. METHODS: An electronic, systematic search was performed in 7 English and 2 Turkish databases (PubMed, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Physiotherapy Evidence-Based Database, ULAKBIM National Medical Database, and the Reference Directory of Turkey). The search terms "NP" and "massage" were used. Studies published between January 2012 and July 2021 were searched. Methodological quality was evaluated with Downs and Black Scale and version 2 of the Cochrane risk-of-bias tool. RESULTS: A total of 932 articles were identified; 8 of them were eligible. The Downs and Black score ranged from 15 to 26 points. Two studies were rated as "fair," 3 studies as "good," and 3 studies as "excellent." According to version 2 of the Cochrane risk-of-bias tool, 3 studies had a low risk of bias, 3 studies had some concerns, and 2 studies had a high risk of bias. Fair evidence found that myofascial release therapy improved pain intensity and pain threshold compared to no intervention in the short term. Excellent evidence found that connective tissue massage with exercise improved pain intensity and pain threshold compared to exercise alone in the short term. No Western MTs were superior to other active therapies according to short-term and immediate effects. CONCLUSION: This review suggests that Western MTs (myofascial release therapy and connective tissue massage) may improve NP, but studies are limited. This review showed that Western MTs were not superior to other active therapies for improving NP. The reviewed studies reported only immediate and short-term effects of Western MT; thus, high-quality randomized clinical trials investigating the long-term effects of Western MT are needed.

Effects of pelvic floor muscle training applied with telerehabilitation in patients with multiple sclerosis having lower urinary track symptoms: A randomized controlled trial.

In this study, the researchers aimed to investigate the effects of pelvic floor muscle training (PFMT) applied with telerehabilitation on urinary symptoms, quality of life, and subjective perception of improvement and satisfaction in multiple sclerosis (MS) patients having lower urinary tract symptoms. Patients were randomly divided into PFMT (n:21) and control (n:21) groups. The PFMT group received PFMT via telerehabilitation for 8 weeks and lifestyle advice, while the control group received only lifestyle advice. Although lifestyle advice alone was not effective, PFMT applied with telerehabilitation was an effective method in the management of lower urinary tract symptoms in MS patients. PFMT applied with telerehabilitation can be considered as an alternative method.

Effects of scapulothoracic stabilization exercises on scapular function, posture, and balance in lymphedema after mastectomy: a randomized controlled trial.

This study aimed to investigate the effects of scapulothoracic stabilization exercises (SSE) on scapular function, posture, and balance in women with lymphedema after mastectomy. The patients were randomly divided into two groups as complex decongestive physiotherapy (CDP) (n: 12; age: 55.25 ± 8.17 years) and CDP+SSE (n: 13; age: 54.38 ± 9.08 years). While only CDP was applied in the CDP group, CDP and SSE were applied in the CDP+SSE group. Scapulothoracic muscle strength with dynamometer, scapular endurance with Scapular Isometric Compression Test, scapular dyskinesia with Lateral Scapular Slide Test, thoracic posture with inclinometer, general posture with New York Posture Scale, and balance with Mini-BESTest were evaluated before the 3-week treatment phase (TP), after the TP, and after the fifth week of the maintenance phase (MP). Improvements in the lower trapezius muscle strength were found in both groups after the TP (p < .05). In addition, the middle trapezius muscle strength and general posture improved more in the CDP+SSE group than in the CDP group after the TP (p < .05). In the MP, scapulothoracic muscle strength, scapular endurance, and general posture improved more in CDP+SSE group compared to the CDP group (p < .05). In upper extremity lymphedema patients, incorporating additional SSE in CDP may contribute to the improvement of posture and scapular functions.

An investigation of the relationship between cutaneous allodynia and kinesiophobia, gastrointestinal system symptom severity, physical activity and disability in individuals with migraine.

Background: To investigate the relationship between cutaneous allodynia (CA) and kinesiophobia, gastrointestinal system (GIS) symptom severity, physical activity, and disability, and to determine whether CA, pain, and disability were influencing factors for kinesiophobia, GIS symptoms, and physical activity in individuals with migraine. Methods: The study included 144 individuals with migraine. CA, kinesiophobia, GIS symptoms, physical activity level, and migraine-related disability were evaluated with the Allodynia Symptom Checklist, the Tampa Kinesiophobia Scale (TKS), the Gastrointestinal Symptom Rating Scale (GSRS), the International Physical Activity Questionnaire-7, and the Migraine Disability Assessment Scale (MIDAS), respectively. Results: The CA severity was only associated with TKS (r = 0.515; P < 0.001), GSRS-total (r = 0.336; P < 0.001), GSRS-abdominal pain (r = 0.323; P < 0.001), GSRS-indigestion (r = 0.257; P = 0.002), GSRS-constipation (r = 0.371; P < 0.001), and MIDAS scores (r = 0.178; P = 0.033). Attack frequency (P = 0.015), attack duration (P = 0.035) and presence of CA (P < 0.001) were risk factors for kinesiophobia. Attack frequency (P = 0.027) and presence of CA (P = 0.004) were risk factors for GIS symptoms. Conclusions: There was a relationship between the CA and kinesiophobia, GIS symptoms, and disability. CA and attack frequency were found to be risk factors for kinesiophobia and GIS symptoms. Migraine patients with CA should be assessed in terms of kinesiophobia, GIS, and disability. Lifestyle changes such as exercise and dietary changes and/or pharmacological treatment options for CA may increase success in migraine management.

A comparison of lumbopelvic muscle endurance, stability, mobility, and respiratory functions in children and adolescents with and without nocturnal enuresis.

BACKGROUND: Postural deterioration, delayed maturation, and accompanying respiratory diseases in children and adolescents with nocturnal enuresis have been reported in previous studies. This study aimed to compare lumbopelvic muscle endurance, stability, mobility, and respiratory functions in children and adolescents with and without nocturnal enuresis. METHODS: Children and adolescents with (n:25, nocturnal enuresis group) and without nocturnal enuresis (n:29, control group) were included. The bladder and bowel dysfunctions with the Bladder and Bowel Dysfunction Questionnaire and voiding diary, lumbopelvic muscle endurance with the McGill trunk muscle endurance tests, lumbopelvic stability with the Sahrmann test, lumbopelvic mobility with the Modified Schober test, and respiratory function with a spirometer were assessed. Independent samples t-test, Mann Whitney U test, and Chi-square tests were used for analysis. FINDINGS: Trunk flexor (p = 0.043), extension (p = 0.045), and right (p = 0.008) and left lateral flexion endurance test scores (sec) (p = 0.005), the Sahrmann test score (p = 0.005), and Modified Schober test (p < 0.001) results were lower in the nocturnal enuresis group compared to the control group. However, there were no differences between groups in terms of forced expiratory volume in 1 s (p = 0.415), forced vital capacity (p = 0.522), forced expiratory volume in 1 s/ forced vital capacity (p = 0.970), and peak expiratory flow values (p = 0.495). INTERPRETATION: The children and adolescents with nocturnal enuresis had lower lumbopelvic muscle endurance, stability, and mobility compared to those without nocturnal enuresis; however, the respiratory functions were similar. The lumbopelvic structure changes may be taken into consideration for the management of nocturnal enuresis.

Effects of interferential current stimulation in women with pelvic organ prolapse: a prospective randomized sham-controlled study.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the effects of interferential (IF) current stimulation on pelvic floor symptoms, prolapse stages, pelvic floor muscle (PFM) strength/endurance, quality of life (QoL), sexual function, perception of subjective improvement (PSI), and satisfaction in women with pelvic organ prolapse (POP). METHODS: The patients were randomly divided into the IF (n=13) and sham groups (n=12). Lifestyle advice was given in both groups. Active IF current was applied in the IF group and sham IF was applied in the sham group 3 days a week for 8 weeks. The following tools were used for data evaluation: pelvic floor symptom severity with the Pelvic Floor Distress Inventory-20 (PFDI-20), POP with the simplified POP-quantification system, PFM strength/endurance with a perineometer, QoL with the Prolapse Quality of Life Scale (P-QoL), and sexual function with the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Scale (PISQ-12). Evaluations were made before treatment (BT), mid-term (MT, 4th week), and after treatment (AT). PSI and satisfaction were evaluated AT with Likert-type scales. RESULTS: In the intergroup comparison AT, a greater increase in PFM strength/endurance, P-QoL-role limitations, P-QoL-sleep/energy scores, PSI, and satisfaction level, and a decrease in cystocele stages were observed in the IF group than in the sham group (p<0.05). Further, there was a greater increase in PFM endurance in the IF group in MT (p<0.05). CONCLUSIONS: Interferential current stimulation was effective in improving POP stage, PFM strength/endurance, and QoL in women with POP. IF current stimulation can be used as a complementary treatment method in women with POP.

The Effects of Connective Tissue Manipulation in Primary Dysmenorrhea: a Randomized Placebo-Controlled Study.

The aim of this study was to identify the effects of connective tissue manipulation (CTM) in primary dysmenorrhea (PD) in a randomized, placebo-controlled design. Thirty-eight nulliparous women with PD were randomly allocated into 3 groups: CTM (n = 13), placebo therapeutic ultrasound (US) (n = 13), and control (n = 12). The primary outcome measure was the maximum and mean menstrual pain intensity at the last menstrual period on the visual analogue scale (VAS). Secondary outcome measures were menstrual symptom frequency and distress score, the number of analgesic/anti-inflammatory drugs used during the last menstrual period, and perception of improvement in dysmenorrhea severity via interventions. The chi-square test and analysis of variance were used to determine within-group and between-group differences. Statistical significance level was determined as p < 0.05. Compared with the placebo US and control groups, it was observed that menstrual pain (VAS mean and VAS maximum), menstrual symptom frequency, and distress level decreased more after treatment (T2) and the 3-month follow-up (T3) in de CTM group (p < 0.001, p = 0.001, p = 0.014, p = 0.015, respectively). There was no difference between the groups in terms of analgesic/anti-inflammatory drugs use (p > 0.05). The rate of individuals reporting perceived improvement at the end of intervention period was higher in the CTM group than in the placebo-US and control groups (p < 0.001). In the 3rd month follow-up, there was no difference between groups in the perception of improvement (p > 0.05). CTM is superior to placebo intervention and control in improving menstrual pain and other menstrual symptoms in PD in the short-term. On the other hand, when the application is terminated, this superiority seems to disappear during the follow-up period.

Core stability-based balance training and kinesio taping for balance, trunk control, fear of falling and walking capacity in patients with multiple sclerosis: A randomized single-blinded study.

BACKGROUND: Trunk performance-based therapies are important in the Multiple Sclerosis (MS) rehabilitation process since they have been associated with balance, trunk performance, fall prevention, and walking capacity. Kinesio taping (KT) is a popular approach that has recently been used to treat a variety of musculoskeletal and neuromuscular impairments. Therefore, the aim of this single-blind, randomized controlled study was to investigate the effects of KT combined trunk stabilization-based balance training on balance, trunk control, walking capacity, and fear of falling in patients with MS. MATERIAL AND METHODS: Thirty patients diagnosed with MS were randomly assigned to the KT group or the control group. The control group received core stability-based balance training and the KT group was treated with KT applied on global trunk muscles in addition to core stability-based balance training. Balance was measured with the Mini BESTest, trunk control with the Trunk Impairment Scale, fear of falling with the Falls Efficacy Scale and walking capacity with the 2-minute walk test. RESULTS: Balance, trunk control, fear of falling, and walking capacity of all the patients improved after treatment (p < 0.05). No superiority was found between the groups in terms of treatment efficacy (p > 0.05). CONCLUSION: In conclusion, core stability-based balance training was effective in patients with MS, and the addition of KT had no additional effect in terms of balance, trunk control, fear of falling, and walking capacity.

Comparison of Blood Pressure and Pulse Adaptations Between Younger and Older Patients During Balneotherapy With Physiotherapy.

Objective: This study aimed to investigate the blood pressure and pulse adaptation characteristics between younger and older patients with musculoskeletal disorders during acute and recovery responses at the first and 10th sessions of balneotherapy added to physiotherapy. Methods: Forty-six participants (n = 22, between 18 and 35 years of age as young adults; n = 24, more than 65 years of age as older adults) with musculoskeletal disorders admitted to physiotherapy therapy sessions with balneotherapy were enrolled. The participants' immersion time was 20 minutes each during 10 sessions occurring over the course of 2 weeks. Blood pressure and pulse were measured at the baseline and the 5th minute as acute responses, and at the baseline and the 30th minute as recovery responses during the first and 10th sessions. Results: First, the group and session effect was examined. There was no significance in this part. Then, session main effect and group main effect were examined. The group main effect was significant, that is, a difference was found between groups independent of the session in terms of only pulse values (P < .001). There was no difference in sessions. The acute and recovery responses of the pulse at the first and 10th sessions of balneotherapy showed higher alterations in the young people compared with the older people (P < .008). Conclusion: Greater pulse alterations at the acute and recovery phases of the first and 10th sessions were observed in young adults.

Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study.

BACKGROUND: In women with overactive bladder (OAB), sexual dysfunctions and sexual satisfaction of their partners have been problems that are as important as urinary symptoms. AIM: To investigate the effects of pelvic floor muscle training (PFMT) on sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and pelvic floor muscle strength (PFMS) in women with OAB. METHODS: Women with OAB were randomized into 2 groups: 6-week PFMT (n = 21) (home exercise program) and a control group (n = 22) (did not receive any treatment for OAB). OUTCOMES: Sexual dysfunction, sexual satisfaction of partner, urinary symptoms, and PFMS were assessed at baseline and after 6 weeks with the Female Sexual Function Index (FSFI), a Visual Analogue Scale (VAS), the OAB-Version8 (OAB-V8), and the Modified Oxford Scale (MOS), respectively. RESULTS: After 6 weeks, there was an increase in FSFI domains [desire (95% CI: 0.18 to 0.64; P:.001, d: 0.88); arousal (95% CI: 0.42 to 1.24, P:<.001, d: 1.17); orgasm (95% CI:0.85 to 1.47; P:<.001, d:1.89); satisfaction (95% CI: 0.85 to 1.44; P:<.001, d: 2.29); sexual pain (95% CI:0.80 to 1.52; P:<.001, d:1.47); total score (95% CI: 3.70 to 5.94; P:<.001, d: 2.55)], sexual satisfaction of partners (95% CI: 1.80 to 2.85; P:<.001, d:2.83) and PFMS scores (95% CI: 1.10 to 1.55; P:<.001, d:3.18), and a decrease in the OAB-V8 score (95% CI: -13.01 to -7.10; P:<.001, d:2.19) in the PFMT group compared to the control group. There was a significant decrease in sexual dysfunction in the PFMT group compared to the control group (P:.046). CLINICAL IMPLICATIONS: In order to improve sexual function, sexual satisfaction of the partners, urinary symptoms, and PFMS in women with OAB, PFMT should be added to the rehabilitation program in clinics. STRENGTHS & LIMITATIONS: The strength of this study was that it is a randomized controlled trial investigating the effect of PFMT in improving sexual function in OAB. The limitations of our study were the lack of a long-term (6 months-1 year) follow-up and the inability to blind. CONCLUSION: PFMT was effective in improving sexual dysfunction, sexual satisfaction of partners, urinary symptoms, and PFMS in women with OAB. Celenay ST, Karaaslan Y, Ozdemir E. Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study. J Sex Med 2022;19:1421-1430.

Lumbopelvic muscle endurance, morphology, alignment, and mobility in women with primary dysmenorrhea: A case-control study.

BACKGROUND: In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure. METHODS: Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18-28), body mass index (BMI): 20.70 (17.31-28.73) kg/m2) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19-23), BMI: 20.83 (17.31-27.10) kg/m2) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively. FINDINGS: The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0-10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group. INTERPRETATION: Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea.

A comparison of Kinesio taping and external electrical stimulation in addition to pelvic floor muscle exercise and sole pelvic floor muscle exercise in women with overactive bladder: a randomized controlled study.

PURPOSE: To compare the effects of Kinesio taping® (KT) and external electrical stimulation (ES) in addition to pelvic floor muscle exercise (PFME) and sole PFME in women with overactive bladder (OAB). MATERIAL AND METHODS: Patients with OAB were randomly allocated into PFME, PFME + KT, PFME + ES groups. All treatments were carried out for 6 weeks. OAB symptoms with voiding diary and Overactive Bladder-Version8 (OAB-V8), pelvic floor muscle strength (PFMS) with perineometer, quality of life with King's Health Questionnaire (KHQ) were assessed before (BT) and after treatment (AT). AT, the perception of improvement was inquired. RESULTS: AT, OAB symptoms and KHQ scores decreased and PFMS improved in all groups (p < 0.05). The intergroup comparisons revealed a further decrease in voids/day, voids/night, OAB-V8, and some KHQ scores, and a further increase in the perception of improvement in the PFME + KT and PFME + ES groups compared to the PFME group (p < 0.05). In the PFME + ES group, there was a further decrease in numbers of incontinence compared to the PFME group, and in severity measures scores compared to the other groups (p < 0.05). CONCLUSION: KT and external ES in addition to PFME were more effective than PFME alone in the treatment of OAB.IMPLICATIONS FOR REHABILITATIONPelvic floor muscle exercise was found to be effective in reducing overactive bladder symptoms and increasing quality of life.Kinesio taping or external electrical stimulation in addition to pelvic floor muscle exercise is more effective in improving overactive bladder symptoms, quality of life, and perception of improvement than pelvic floor muscle exercise alone.Kinesio taping and external electrical stimulation can be used as a complementary application in the treatment of overactive bladder.Pelvic floor muscle exercise, pelvic floor muscle exercise + Kinesio taping, and pelvic floor muscle exercise + electrical stimulation applications should be included in conservative treatment options in patients with overactive bladder to reduce symptoms and cost, and improve quality of life.

Turkish Translation of the Patterns of Activity Measure-Pain in Patients with Chronic Low Back and Neck Pain: Validity and Reliability.

OBJECTIVE: To translate the Patterns of Activity Measure-Pain (POAM-P) into Turkish and test its validity and reliability. METHODS: A total of 252 patients with chronic low back and neck pain were included. The Turkish translation of the POAM-P (POAMP/T), which has subgroups of Avoidance, Overdoing, and Pacing, was performed in accordance with international recommendations. The POAMP/T was administered twice. Physical activity level was assessed with the International Physical Activity Questionnaire-7 (IPAQ-7), and psychologic status was assessed with the Hospital Anxiety (HADS-A) and Depression Scales (HADS-D). The internal and external construct validity, internal consistency, and test-retest reliability were analyzed. RESULTS: Three related factorial structures were defined in Confirmatory Factor Analysis. Indexes and factor loads were found to be sufficient. A negative relationship was observed between avoidance and IPAQ-7 (rho = -0.328, p < .001), HADS-D (ρ = -0.163, p = .009), and HADS-A scores (ρ = -0.164, p = .009); whereas, a positive relationship was observed between overdoing and IPAQ-7 (ρ = 0.362, p < .001), HADS-D (ρ = 0.309, p < .001), and HADS-A scores (ρ = 0.325, p < .001). A negative correlation was found between pacing and IPAQ-7 (ρ = -0.200, p = .001), HADS-D (ρ = -0.507, p < .001), and HADS-A scores (ρ = -0.509, p < .001). The Cronbach alpha values for avoidance, overdoing, and pacing were obtained as 0.941, 0.917, and 0.940, respectively. The intraclass correlation coefficient for avoidance, overdoing, and pacing was found as 0.972, 0.973, and 0.972, respectively. Test and retest scores were similar (p > .05). CONCLUSIONS: The Turkish version of the POAM-P is a valid and reliable scale for the assessment of pain-related activity patterns in patients with chronic low back or neck pain.

Comparison of Spinal Alignment and Mobility in Women With and Without Post Modified Radical Mastectomy Unilateral Lymphoedema.

INTRODUCTION: Unilateral lymphoedema and breast resection after modified radical mastectomy might create impairment of spinal alignment and mobility. The aim of this study was to compare spinal alignment and mobility in women with and without post modified radical mastectomy unilateral lymphoedema. MATERIALS AND METHODS: Twenty women with post modified radical mastectomy unilateral lymphoedema (lymphoedema group) and 18 healthy women (control group) were included in this study. The sagittal and frontal spinal alignment and mobility were assessed with a Spinal Mouse (Idiag, Fehraltorf, Switzerland). The severity of the lymphoedema was evaluated with circumferential measurements. RESULTS: In the lymphoedema group, the volume difference of the arms was 448.31 ± 78.14 mL, known as moderate severity lymphoedema. It was seen that the sagittal thoracic curvature (P = .017) and the frontal inclination angle (P = .048) were higher in the lymphoedema group in comparison with the control group. In the lymphoedema group, the frontal inclination angle changed towards the unaffected side (P < .001). No significant differences were found between groups in the other parameters related to spinal curvature and mobility (P > .05). CONCLUSION: The sagittal thoracic curvature and the frontal inclination angle towards the unaffected side increased in women with post modified radical mastectomy unilateral lymphoedema. The sagittal and frontal spinal alignment changes should be taken into consideration for the assessment and the treatment of unilateral lymphoedema.

Adding connective tissue manipulation to physiotherapy for chronic low back pain improves pain, mobility, and well-being: a randomized controlled trial.

This study aimed to evaluate the effectiveness of connective tissue manipulation (CTM) for improving pain, mobility, and well-being in chronic low back pain (CLBP). Sixty-six patients with CLBP were randomized to three groups: CTM, sham massage (SM) and control groups. The groups got standardized physiotherapy and the related applications 5 days/wk, 3 weeks. Pain intensity, mobility, and well-being (Hospital Anxiety and Depression Scale [HADS], Oswestry Disability Index [ODI], and Short Form-36 [SF-36]) were assessed before and after the applications. Pain, mobility, and disability improved in all groups (P<0.05). There were differences in resting pain, HADS, and SF-36 scores in CTM, resting pain in SM, and SF-36 scores in controls (P<0.05). Activity pain, HADS scores decreased, mobility and physical component of the SF-36 in-creased in CTM compared to SM (P<0.05). Pain, ODI, and HADS scores decreased, mobility and SF-36 increased in CTM, and ODI scores decreased in SM compared to controls (P<0.05). In conclusion, pain intensity during activity and at night and disability decreased, and spinal mobility increased in all groups. However, CTM showed superiority in improving pain, mobility, and well-being in patients with CLBP.

Effects of menstrual pain on the academic performance and participation in sports and social activities in Turkish university students with primary dysmenorrhea: A case control study.

AIM: The primary aim of this study was to investigate the pain characteristics, academic performance and participation in sports and social activities among students with primary dysmenorrhea (PD) who have different pain intensities and to compare dysmenorrhea-related life impact with pain-free students. METHODS: The present study was conducted on 471 university students with and without PD. Based on Visual Analog Scale score, participants were categorized into four groups: no-pain (n = 60), mild pain (n = 83), moderate pain (n = 165) and severe pain (n = 163). Data on the pain characteristics, impact of dysmenorrhea on university absence, class concentration, participation in sports and social activities were obtained and analyzed with the Kruskal-Wallis, Mann-Whitney U and chi-square tests. RESULTS: University absence, loss of class concentration and the impact on sports and social activities were higher in severe pain group than in no-pain, mild and moderate pain groups (P < 0.001). There were statistically significant differences in the duration of pain, the pattern of pain and the day when maximum pain is perceived among mild, moderate and severe pain groups (P < 0.05). CONCLUSION: The results of the present study present that PD negatively influences academic performance and participation in sports and social activities. Furthermore, pain characteristics differed among the patients with mild, moderate and severe pain. There is a need for further studies that improve treatment options for PD in order to minimize the influence of pain on academic performance and social activities.

A Comparison of the Effects of Stabilization Exercises Plus Manual Therapy to Those of Stabilization Exercises Alone in Patients With Nonspecific Mechanical Neck Pain: A Randomized Clinical Trial.

STUDY DESIGN: Randomized clinical trial. BACKGROUND: Little is known about the efficacy of providing manual therapy in addition to cervical and scapulothoracic stabilization exercises in people with mechanical neck pain (MNP). Objectives To compare the effects of stabilization exercises plus manual therapy to those of stabilization exercises alone on disability, pain, range of motion (ROM), and quality of life in patients with MNP. METHODS: One hundred two patients with MNP (18-65 years of age) were recruited and randomly allocated into 2 groups: stabilization exercise without (n = 51) and with (n = 51) manual therapy. The program was carried out 3 days per week for 4 weeks. The Neck Disability Index, visual analog pain scale, digital algometry of pressure pain threshold, goniometric measurements, and Medical Outcomes Study 36-Item Short-Form Health Survey were used to assess participants at baseline and after 4 weeks. RESULTS: Improvements in Neck Disability Index score, night pain, rotation ROM, and the Medical Outcomes Study 36-Item Short-Form Health Survey score were greater in the group that received stabilization exercise with manual therapy compared to the group that only received stabilization exercise. Between-group differences (95% confidence interval) were 2.2 (0.1, 4.3) points for the Neck Disability Index, 1.1 (0.0, 2.3) cm for pain at night measured on the visual analog scale, -4.3° (-8.1°, -0.5°) and -5.0° (-8.2°, -1.7°) for right and left rotation ROM, respectively, and -2.9 (-5.4, -0.4) points and -3.1 (-6.2, 0.0) points for the Medical Outcomes Study 36-Item Short-Form Health Survey physical and mental components, respectively. Changes in resting and activity pain, pressure pain threshold, and cervical extension or lateral flexion ROM did not differ significantly between the groups. Pressure pain threshold increased only in those who received stabilization exercise with manual therapy (P<.05). CONCLUSION: The results of this study suggest that stabilization exercises with manual therapy may be superior to stabilization exercises alone for improving disability, pain intensity at night, cervical rotation motion, and quality of life in patients with MNP. LEVEL OF EVIDENCE: Therapy, level 1b.

Cervical and scapulothoracic stabilization exercises with and without connective tissue massage for chronic mechanical neck pain: A prospective, randomised controlled trial.

This study was planned to assess and compare the effectiveness of cervical and scapulothoracic stabilization exercise treatment with and without connective tissue massage (CTM) on pain, anxiety, and the quality of life in patients with chronic mechanical neck pain (MNP). Sixty patients with chronic MNP (18-65 years) were recruited and randomly allocated into stabilization exercise with (Group 1, n = 30) and without the CTM (Group 2, n = 30). The program was carried out for 12 sessions, 3 days/week in 4 weeks. Pain intensity with Visual Analog Scale, pressure pain threshold with digital algometer (JTech Medical Industries, ZEVEX Company), level of anxiety with Spielberger State Trait Anxiety Inventory, and quality of life with Short Form-36 were evaluated before and after the treatment. After the program, pain intensity and the level of anxiety decrease, physical health increase in Group 1 and 2 were found (p < 0.05). Pressure pain threshold and mental health increase were detected in only Group 1 (p < 0.05). The intergroup comparison showed that significant difference in pain intensity at night, pressure pain threshold, state anxiety and mental health were seen in favor of Group 1 (p < 0.05). The study suggested that stabilization exercises with and without the CTM might be a useful treatment for patients with chronic MNP. However, stabilization exercises with CTM might be superior in improving pain intensity at night, pressure pain threshold, state anxiety and mental health compared to stabilization exercise alone.