Reliability of ultrasonography to measure cervical multifidus, semispinalis cervicis and longus colli muscles dimensions in patients with unilateral cervical disc herniation: An observational cross-sectional test-retest study.

BACKGROUND: Ultrasonography (US) has been suggested to assess the morphology and function of cervical muscles; but little is known about the reliability of the US measures in patients with cervical disc herniation (CDH). The purpose of this study was to evaluate within-day inter and intra-rater and between-day intra-rater reliability of US to measure dimensions of deep cervical muscles in patients with unilateral CDH. METHODS: Thirty patients with unilateral CDH participated. Anterior-posterior and lateral dimension of longus colli (LC), multifidus (MF) and semispinalis cervicis (SC) were measured using B-mode ultrasound. The measurements were repeated by rater A 1 h (for within-day reliability) and one week (for between-day reliability) later. For inter-rater reliability, rater B performed all muscles measurements like rater A. RESULTS: Within-day reliability measurement for all muscles was good to excellent with IntraClass Correlation Coefficients (ICC) ranging from 0.82 to 0.96, standard error of measurement (SEM) from 0.18 to 0.46 and minimal detectable changes (MDC) from 0.43 to 1.09. Between-day reliability was good for all muscle dimensions with ICC ranging from 0.75 to 0.89, SEM from 0.30 to 0.64 and MDC from 0.71 to 1.52. Inter-rater reliability was also good with ICC ranging from 0.75 to 0.89, SEM from 0.34 to 0.65 and MDC from 0.81 to 1.55. CONCLUSIONS: US was demonstrated to have high within-day inter and intra-rater and between-day intra-rater reliability to measure muscles dimensions in patients with unilateral CDH. It can be used to assess deep cervical muscles or to monitor the effects of interventions.

The Effect of Uni-Hemispheric Dual-Site Anodal tDCS on Brain Metabolic Changes in Stroke Patients: A Randomized Clinical Trial.

Uni-hemispheric concurrent dual-site anodal transcranial direct current stimulation (UHCDS a-tDCS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) may enhance the efficacy of a-tDCS after stroke. However, the cellular and molecular mechanisms underlying its beneficial effects have not been defined. We aimed to investigate the effect of a-tDCSM1-DLPFC on brain metabolite concentrations (N-acetyl aspartate (NAA), choline (Cho)) in stroke patients using magnetic resonance spectroscopy (MRS). In this double-blind, sham-controlled, randomized clinical trial (RCT), 18 patients with a first chronic stroke in the territory of the middle cerebral artery trunk were recruited. Patients were allocated to one of the following two groups: (1) Experimental 1, who received five consecutive sessions of a-tDCSM1-DLPFC M1 (active)-DLPFC (active). (2) Experimental 2, who received five consecutive sessions of a-tDCSM1-DLPFC M1 (active)-DLPFC (sham). MRS assessments were performed before and 24 h after the last intervention. Results showed that after five sessions of a-tDCSM1-DLPFC, there were no significant changes in NAA and Cho levels between groups (Cohen's d = 1.4, Cohen's d = 0.93). Thus, dual site a-tDCSM1-DLPFC did not affect brain metabolites compared to single site a-tDCS M1.

Proposing a set of ethical guidelines for Iranian physiotherapists: results of a modified Delphi technique.

The code of ethical conduct for physiotherapy services must be compatible with the local culture. The ethical guidelines proposed here were developed through a literature review, focus group discussions, and finally a modified Delphi technique to achieve consensus after the data were analysed. At first, the collection of different ethical codes yielded 132 items. In the second stage, repetitive items were discarded, some new items were added, and the various codes were categorised into three domains. Overall, 175 items were considered in the Delphi stage. Subsequently, the items were reduced to 134 in total - 59 in the treatment domain, 41 in research, and 34 in the education domain. The resulting code of ethics will support patients, researchers, students, and teachers in the field of physical therapy with sensitivity to current Iranian legislation and culture.

Different Effects of Aerobic Exercise and Diaphragmatic Breathing on Lower Esophageal Sphincter Pressure and Quality of Life in Patients with Reflux: A Comparative Study.

BACKGROUND Gastroesophageal reflux disease (GERD) is a worldwide disorder with an increasing prevalence. The quality of life (QOL) of the patients may be influenced by reflux disease. Diaphragmatic breathing (DB), as well as aerobic exercise (AE), may improve the symptoms of reflux disease, although it remains a controversial issue. The aim of this study was to compare the effects of AE and DB on QOL and lower esophageal sphincter (LES) pressure of patients with moderate to severe reflux. METHODS This was a case-control study that was conducted for 8 weeks among patients with moderate to severe GERD. The block randomization method was designed to randomize patients into three groups (AE, DB, and control) to achieve equal sample sizes. The control group received omeprazole 20 mg once daily. The other groups, in addition to omeprazole, received AE and DB. QOL and LES pressure were measured before and after the study by Questionary and Manometry method, respectively. RESULTS 75 patients were enrolled in this study. Positive effects of DB on LES pressure was approved (p = 0.001). DB had significantly more effects on QOL than aerobic exercise (p = 0.003). AE can significantly improve QOL in patients (p = 0.02) but no significant change in LES pressure (p = 0.38). There was no change in the control group for both variables. CONCLUSION AE had no effects on LES pressure but can improve QOL of the patients. DB had more effects on QOL than AE, so injured or disable patients with reflux who cannot do AE, can benefit from DB to improve their reflux symptoms.

Reliability of B-mode ultrasonography to measure lumbar multifidus muscle dimensions in patients with unilateral lumbar disc herniation.

OBJECTIVES: To evaluate Ultrasound Imaging (USI) reliability for measurement of lumbar multifidus (LMF) muscle thickness and cross sectional area (CSA) at rest and during contraction in patients with unilateral lumbar disc herniation. SETTING: Laboratory. DESIGN: Reliability Study. PARTICIPANTS: Thirty patients, aged 25-50 years (37.55 ±â€¯9.55), with unilateral L4-L5 lumbar disc herniation participated in this study. MAIN OUTCOME MEASURES: Thickness and CSA of LMF were measured using B-mode ultrasound by two raters in prone position. RESULTS: Same day and multiple day inter-rater and same day intra-rater reliability showed good to excellent reliability (intraclass correlation coefficients ranged from 0.70 to 0.91). Also standard error of measurement and minimal detectable change for USI reliabilities ranged from 0.06 to 0.57 and 0.16 to 1.31, respectively. CONCLUSIONS: Reliability of USI for measurements of LMF muscle thickness and CSA was high, and consistent with previous studies conducted on reliability of USI to measure LMF dimensions in other populations.

The inter- and intra-rater reliability of Modified Tardieu Scale in assessing spasticity of knee extensors in patients with multiple sclerosis.

INTRODUCTION: Spasticity is one of the most common and disabling symptoms in Multiple sclerosis (MS). The is a clinical tool for assessing spasticity. This study aimed to investigate the inter- and intra-rater reliability of the modified Tardieu scale for assessing knee extensors spasticity in MS patients. METHODS: Twenty-six patients with MS (12 females and 14 males) with a mean age of 40 ± 11.39 years participated in this study. The extensor muscles of both knees were evaluated using the MTS in two sessions. At first session, two examiners randomly assessed the knee extensor spasticity to study the inter-rater reliability and 3-4 days later the first examiner assessed the patients again, to determine intra-rater reliability. Intra-class Correlation Coefficient (ICC) analysis, two-way random effect model was used to determine the reliability of various components of the modified Tardieu scale. RESULTS: The inter-rater reliability for quality of muscle reaction of knee extensor muscles was very good (ICC = 0.89) and for the difference between the angle of muscle response (R1) and full range(R2) of movement (R2- R1), as spasticity intensity criterion, was good (ICC = 0.73). ICC values for R2-R1 and muscle response quality assessments by one rater were 0.73 and 0.82, respectively. CONCLUSION: The findings of the current study showed that the MTS has good to very good inter- and intra-rater reliability for assessing knee extensors spasticity in MS patients.

Effects of Dry Needling on Connectivity of Corticospinal Tract, Spasticity, and Function of Upper Extremity in People with Stroke: Study Protocol for a Randomized Controlled Trial.

Background: Spasticity is a common motor disorder in adult stroke patients. Injury to the corticospinal tract (CST) is associated with spasticity. Dry needling (DN) has positive impacts on spasticity reduction and improvement in the range of motion (ROM) in stroke patients. This study aims to investigate the effectiveness of DN on the connectivity of the CST and the level of spasticity in adult stroke patients. Methods: This double-blind randomized controlled trial will enroll and randomly assign stroke patients to either the experimental group, for receiving three sessions of DN for the spastic wrist flexors, or the control group, for sham needling. The primary outcome measures will be diffusion tensor imaging and the Modified Modified Ashworth Scale score to assess CST connectivity and wrist flexor spasticity, respectively. The Box and Block Test and standard goniometry are the secondary outcome measures to assess hand dexterity and active and passive wrist ROM, respectively. Measurements will be taken both before and after the intervention. Discussion: The results of this study will provide important evidence of the effects of DN on CST connectivity, spasticity, and arm function in adult stroke patients. Trial registration: This trial is registered in the Iranian Registry of Clinical Trials (IRCT) (https://www.irct.ir; IRCT20191208045649N1).

Confirmatory Factor Analysis, Reliability, and Validity of the Persian Version of the Coping Strategies Questionnaire for Iranian People With Nonspecific Chronic Neck Pain.

OBJECTIVE: The purpose of this study was to assess the reliability and construct validity of, and perform confirmatory factor analysis of, the Persian version of the Coping Strategies Questionnaire (CSQ) for Iranian people with nonspecific chronic neck pain. METHODS: We performed psychometric testing of the Persian version of the Coping Strategies Questionnaire. Participants were 123 native Persian speakers with chronic neck pain lasting at least 3 months. They were between 18 and 55 years old. The CSQ was administered by self-report. After 5 to 7 days, 94 participants completed the questionnaire in the retest session. Confirmatory factor analysis was done to assess the model fit (χ2 test, comparative fit index, and root-mean-square error of approximation) of the 7-factor solution of the Persian version of the CSQ. The Cronbach α was used for internal consistency; intraclass correlation coefficient, standard error of measurement, and minimal detectable change for reliability; and nonparametric tests of group differences and correlations for construct validity. To assess the construct validity, we examined the ability of the CSQ to discriminate people based on sex, level of education, and physical activity. Correlations with the Short Form Health Survey (SF-12), Tampa Scale for Kinesiophobia, visual analog scale, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophizing Scale, and Neck Disability Index were also determined to test the validity. RESULTS: Confirmatory factor analysis measures-χ2 test, comparative fit index, and root-mean-square error of approximation-were 1.72, 0.76, and 0.07, respectively. Internal consistency was excellent (0.85). All intraclass correlation coefficients were above the acceptable level of 0.70, with the highest reliability obtained for the Praying subscale in both test and retest sessions. The standard error of measurement for the CSQ total score was 2.26, and the minimal detectable change was 6.25. The Cronbach α for the total score and for the subscales ranged from 0.75 to 0.93. Scores of the subscales of the CSQ and other questionnaires showed low correlation except for the physical component of the SF-12. The Catastrophizing subscale had a positive correlation with the Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Fear-Avoidance Beliefs Questionnaire, and Neck Disability Index, and a negative correlation with the SF-12. CONCLUSION: The CSQ has acceptable and good measurement properties to assess coping strategies in Iranian people with nonspecific chronic neck pain. It is a reliable measure, though, for validity only The Catastrophizing subscale showed significant correlation with other scales, but the findings should be interpreted with caution because of the limitations of the study.

Differential Effects of Unihemispheric Concurrent Dual-Site and Conventional tDCS on Motor Learning: A Randomized, Sham-Controlled Study.

INTRODUCTION: Based on the literature, unihemispheric concurrent dual-site anodal transcranial Direct Current Stimulation (a-tDCSUHCDS) of primary Motor cortex (M1) and Dorsolateral Prefrontal Cortex (DLPFC) would be more efficient than conventional a-tDCS of M1 to induce larger and longer-lasting M1 corticospinal excitability. The main objective of the present study was to compare the effects of a-tDCSUHCDS and conventional M1 a-tDCS on the extent and durability of the motor sequence acquisition in healthy individuals. METHODS: In this randomized sham-controlled study, healthy volunteers were randomly divided into three groups: experimental (a-tDCSUHCDS), control (M1 a-tDCS), and sham stimulation groups. The participants practiced serial response time task over three consecutive days when they simultaneously received a-tDCS. Using the skill measure, we assessed motor learning up to 4 weeks after the completion of experimental conditions. RESULTS: Data analysis revealed that all groups exhibited the improved trend over the training course (P<0.001). There were no significant differences in skill acquisition among groups at post-intervention (P>0.05), while a significant improvement was observed between experimental and sham group at the retention time (P<0.05). Moreover, there were no significant differences between the control and two other groups with regard to the retention time (P>0.05). CONCLUSION: These results revealed a significant increase in the skill acquisition by a-tDCSUHCDS technique with regard to retention issue, which could be a valuable finding in neuro-rehabilitation field.

Reliability of Real-time Ultrasound Imaging for the Assessment of Trunk Stabilizer Muscles: A Systematic Review of the Literature.

Rehabilitative ultrasound (US) imaging is one of the popular methods for investigating muscle morphologic characteristics and dimensions in recent years. The reliability of this method has been investigated in different studies. As studies have been performed with different designs and quality, reported values of rehabilitative US have a wide range. The objective of this study was to systematically review the literature conducted on the reliability of rehabilitative US imaging for the assessment of deep abdominal and lumbar trunk muscle dimensions. The PubMed/MEDLINE, Scopus, Google Scholar, Science Direct, Embase, Physiotherapy Evidence, Ovid, and CINAHL databases were searched to identify original research articles conducted on the reliability of rehabilitative US imaging published from June 2007 to August 2017. The articles were qualitatively assessed; reliability data were extracted; and the methodological quality was evaluated by 2 independent reviewers. Of the 26 included studies, 16 were considered of high methodological quality. Except for 2 studies, all high-quality studies reported intraclass correlation coefficients (ICCs) for intra-rater reliability of 0.70 or greater. Also, ICCs reported for inter-rater reliability in high-quality studies were generally greater than 0.70. Among low-quality studies, reported ICCs ranged from 0.26 to 0.99 and 0.68 to 0.97 for intra- and inter-rater reliability, respectively. Also, the reported standard error of measurement and minimal detectable change for rehabilitative US were generally in an acceptable range. Generally, the results of the reviewed studies indicate that rehabilitative US imaging has good levels of both inter- and intra-rater reliability.

The Effect of Unihemispheric Concurrent Dual-Site Transcranial Direct Current Stimulation of Primary Motor and Dorsolateral Prefrontal Cortices on Motor Function in Patients With Sub-Acute Stroke.

It is believed that unihemispheric concurrent dual-site transcranial direct current stimulation (tDCSUHCDS) of the primary motor cortex (M1) and the dorsolateral prefrontal cortex (DLPFC) causes an increase in motor cortex excitability. However, the clinical effect of this type of stimulation on patients with neurological conditions is not yet known. The aim of the present study was to assess the effect of anodal-tDCSUHCDS (a-tDCSUHCDS) on upper limb motor function in subacute stroke patients. Fifteen patients participated in this sham-controlled crossover study. The main outcome measures were the reaction time (RT) to visual stimuli, completion time of a nine-pin pegboard (9-PPB), and the scores from the Fugl-Meyer assessment (FMA) for the upper limb of the involved side before and after three brain stimulation conditions. For a-tDCSUHCDS, the anodal electrodes were placed on the M1 and the DLPFC, while for a-tDCS, the anodal electrode was placed on the M1. For the sham stimulation, the tDCS was turned off after 30 s. For brain stimulation, the selected current was 1 mA for 20 min. After a-tDCSUHCDS, there was a significant reduction in the RT and completion time of the 9-PPB compared with the times after a-tDCS and the sham stimulation: p = 0.013 and p = 0.022, respectively). However, there was no significant difference in the FMA scores after the three types of stimulations (p = 0.085). Compared with a-tDCS, a-tDCSUHCDS temporarily improved the RT and dexterity of the involved hand in subacute stroke patients. Clinical Trial Registration: Iranian Registry of Clinical Trials (IRCT), identifier IRCT2015012520787N1.

Multifidus muscle size in adolescents with and without back pain using ultrasonography.

OBJECTIVE: The purposes of this study were; a) to compare multifidus muscle cross sectional area (CSA) in male adolescents suffering from low back pain (LBP) with healthy male adolescents using ultrasonography (US), and b) to assess the correlation between multifidus muscle size and demographic variables. METHODS: A random sample of 40 healthy boys (as a control group) and 40 boys with LBP (as an experimental group) at the age range of 15-18 years was recruited in the present cohort study. Multifidus muscle dimensions including CSA, antero-posterior and medio-lateral dimensions were measured at level of L5 in both groups using US. RESULTS: The results of an independent t-test to compare multifidus muscle size between the experimental and control groups showed a significant difference between the two groups in terms of CSA, antro-posterior and medio-lateral dimensions so that the experimental group had smaller muscle size than the control group. A significant correlation was found between height, weight and body mass index (BMI) and multifidus muscle size, but no significant correlation was observed between age and muscle size. Pain intensity and functional disability index was significantly correlated with muscle size in the experimental group. CONCLUSIONS: According to the results, multifidus muscle size was decreased in 15-18 years old male adolescents suffering from LBP compared with their healthy counterparts. Further studies are needed to support the findings of the present study.

Normal values of abdominal muscles thickness in healthy children using ultrasonography.

Abdominal muscles are one of the important elements to support the lumbar spine. Evaluation of muscle thickness using ultrasonography (US) is considered to be a source of information from muscles characteristics. The purpose of this study was to demonstrate normal reference data of abdominal muscles thickness and subcutaneous fat in adolescents using US. A random sample of 160 healthy adolescents (80 boys and 80 girls) at the age range of 15-18 years was recruited. Three abdominal muscles including Transversus Abdominis (TA), Internal Oblique (IO), External Oblique (EO) and subcutaneous fat (SF) were bilaterally measured using US. The range of normal values for TA muscle thickness was between 2.31 and 2.57 mm, for IO muscle thickness was between 4.02 and 5.15 mm and for EO muscle thickness was between 2.81 and 3.17 mm. The normal patterns of abdominal muscles were found as IO > EO > TA at both sides. Boys were taller, heavier with greater body mass index (BMI) and had larger abdominal muscles thickness than girls. A weak negative correlation was found between age and muscles size [r = (-0.06) - (-0.23), p < .05], but a significant positive correlation was found between BMI and muscle size (r = 0.21-0.68, p < .05). It seems that abdominal muscles thickness in adolescents followed the same pattern of muscle size in adults. BMI appeared to be the best predictor of muscle thickness. However, further studies are recommended to support the findings of the present study.

Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain.

OBJECTIVES: Low back pain (LBP) is a common musculoskeletal disorder among different age groups, including adolescents. The purpose of this study was to compare the abdominal muscle thickness between healthy adolescents and those with LBP. METHODS: One hundred sixty healthy high school adolescents and 80 high school adolescents with LBP participated in the study. All participants were asked to complete a demographic questionnaire and also a visual analog scale and the Oswestry Disability Questionnaire to evaluate the pain intensity and functional disability. Then abdominal muscle thickness was examined with ultrasonography. RESULTS: The healthy high adolescents included 80 boys and 80 girls, and the adolescents with LBP included 40 boys and 40 girls. The results showed a significant difference between healthy adolescents and those with LBP in terms of abdominal muscle thickness (P < .05). Patients with LBP had smaller abdominal muscles compared with healthy adolescents. No significant difference was found between the groups in terms of the subcutaneous fat dimension (P > .05). CONCLUSIONS: The thickness of abdominal muscles was lower in adolescents with LBP. Future studies with a larger sample and a wider age range are recommended to support the results of this study.

Electromiography comparison of distal and proximal lower limb muscle activity patterns during external perturbation in subjects with and without functional ankle instability.

Ankle sprain is one of the most common injuries among athletes and the general population. Most ankle injuries commonly affect the lateral ligament complex. Changes in postural sway and hip abductor muscle strength may be generated after inversion ankle sprain. Therefore, the consequences of ankle injury may affect proximal structures of the lower limb. The aim is to describe and compare the activity patterns of distal and proximal lower limb muscles following external perturbation in individuals with and without functional ankle instability. The sample consisted of 16 women with functional ankle instability and 18 healthy women were recruited to participate in this research. The external perturbation via body jacket using surface electromyography, amplitude and onset of muscle activity of gluteus maximums, gluteus medius, tibialis anterior, and peroneus longus was recorded and analyzed during external perturbation. There were differences between the onset of muscles activity due to perturbation direction in the two groups (healthy and functional ankle instability). In the healthy group, there were statistically significant differences in amplitude of proximal muscle activity with distal muscle activity during front perturbation with eyes open and closed. In the functional ankle instability group; there were statistically significant differences in amplitude of proximal muscle activity with distal muscle activity during perturbation of the front and back with eyes open. There were statistically significant differences in the onset of muscle activity and amplitude of muscle activity, with-in and between groups (P<0.05). Therefore, in the presence of functional ankle instability, activation patterns of the lower limb proximal muscles may be altered.

The Effect of Scaphoid and Hamate Mobilization on Treatment of Patients with Carpal Tunnel Syndrome.

BACKGROUND: This study was to evaluate the effect of hamate and scaphoid bone mobilization alongside splinting in women with carpal tunnel syndrome. METHODS: In this randomized clinical trial, 40 participants were randomly assigned into 2 groups. The intervention group received splinting with scaphoid and hamate mobilization, while the control group received splinting only. Outcome variables were pain (based on visual analogue scale), symptom severity and functional status (based on Boston questionnaire), and nerve conduction study measured before and 10 weeks after the treatments. RESULTS: At the end of study, both groups showed an improvement in pain and symptom severity, functional status as well as median nerve conduction study. Although there was no statistically significant difference between groups regarding changes in median nerve sensory and motor distal latencies; the improvement was significantly higher in pain and symptom severity as well as functional status in mobilization group (P-Value < 0.05). CONCLUSIONS: Hamate and scaphoid mobilization can be used as an effective option in women with mild to moderate carpal tunnel syndrome. Further investigation is required for determining long-term effects and cost-effectiveness of mobilization in carpal tunnel syndrome.

Motor Learning and Movement Performance: Older versus Younger Adults.

INTRODUCTION: Motor skills play an important role during life span, and older adults need to learn or relearn these skills. The purpose of this study was to investigate how aging affects induction of improved movement performance by motor training. METHODS: Serial Reaction Time Test (SRTT) was used to assess movement performance during 8 blocks of motor training. Participants were tested in two separate dates, 48 hours apart. First session included 8 blocks of training (blocks 1-8) and second session comprised 2 blocks (blocks 9, 10). RESULTS: Analyses of data showed that reaction times in both online and offline learning were significantly shorter in older adults compared to younger adults (P<0.001). Young adults demonstrated both online and offline learning (P<0.001), but older adults only showed online learning (P<0.001) without offline learning (P=0.24). DISCUSSION: The result of the current study provides evidence that the healthy older adults are able to improve their performance with practice and learn motor skill successfully in the form of online learning.

Application of ultrasonography in the assessment of skeletal muscles in children with and without neuromuscular disorders: a systematic review.

The purpose of this study was to systematically review published studies (2000-2014) carried out on the application of ultrasonography (US) to evaluation of skeletal muscle size in children with and without neuromuscular disorders. Different databases including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest and Google Scholar were searched. The key words used were: "children," "ultrasound," "skeletal muscles," "neuromuscular disease," "neurogenic disorders," "spina bifida," "myelomeningocele" and "reliability." Eighteen articles were found to be relevant. Eight studies applied US in combination with additional methods of assessment. Four of the 18 studies did not have a control group. Ten studies applied only US in the assessment of skeletal muscles in children with and without neuromuscular diseases. In 9 studies, there were children ranging widely in age, and in 3 studies US was used to determine normal values for skeletal muscles. According to the results of these 18 reviewed articles, US is an appropriate, reliable and highly predictive method for assessment of skeletal muscles in children.

Reliability of surface electromyography in the assessment of paraspinal muscle fatigue: an updated systematic review.

OBJECTIVE: The purpose of this study was to review the literature to determine whether surface electromyography (EMG) is a reliable tool to assess paraspinal muscle fatigue in healthy subjects and in patients with low back pain (LBP). METHODS: A literature search for the period of 2000 to 2012 was performed, using PubMed, ProQuest, Science Direct, EMBASE, OVID, CINAHL, and MEDLINE databases. Electromyography, reliability, median frequency, paraspinal muscle, endurance, low back pain, and muscle fatigue were used as keywords. RESULTS: The literature search yielded 178 studies using the above keywords. Twelve articles were selected according to the inclusion criteria of the study. In 7 of the 12 studies, the surface EMG was only applied in healthy subjects, and in 5 studies, the reliability of surface EMG was investigated in patients with LBP or a comparison with a control group. In all of these studies, median frequency was shown to be a reliable EMG parameter to assess paraspinal muscles fatigue. There was a wide variation among studies in terms of methodology, surface EMG parameters, electrode location, procedure, and homogeneity of the study population. CONCLUSIONS: The results suggest that there seems to be a convincing body of evidence to support the merit of surface EMG in the assessment of paraspinal muscle fatigue in healthy subject and in patients with LBP.

Inter- and intra-examiner reliability of single and composites of selected motion palpation and pain provocation tests for sacroiliac joint.

The sacroiliac joint (SIJ) has been implicated as a potential source of low back and buttock pain. Several types of motion palpation and provocation tests are used to examine the SIJ. It has been suggested that use of a cluster of motion palpation or provocation tests is a more acceptable method than single test to assess SIJ. This study examined the inter- and intra-examiner reliability of single and composites of the motion palpation and provocation tests together. Twenty-five patients between the ages of 20 and 65 years participated. Four motion palpation and three provocation tests were examined three times on both sides (left, right) by two examiners. Kappa coefficient and prevalence-adjusted and bias-adjusted kappa (PABAK) were calculated to evaluate the reliability. PABAK for intra- and inter-examiner reliability of individual tests ranged from 0.36 to 0.84 (95% CI: -0.22 to 1.12) and 0.52 to 0.84 (95% CI: -0.18 to 1.08) which is considered fair to substantial. PABAK for intra- and inter-examiner reliability for clusters of motion palpation or provocation tests ranged from 0.44 to 0.92 (95% CI: -0.36 to 1.2) which is considered moderate to excellent reliability. PABAK for intra- and inter-examiner reliability of composites of motion palpation and provocation tests ranged from 0.44 to 1.00 (95% CI: -0.22 to 1.12) and 0.52 to 0.92 (95% CI: -0.02 to 1.32) which is considered substantial to excellent. It seems that composites of motion palpation and provocation tests together have reliability sufficiently high for use in clinical assessment of the SIJ.