RESUMEN
The aim of the present study was to identify the different interventions for hamstring flexibility among university students with hamstring tightness and to determine the better treatment method. Design: Systematic review and network meta-analysis. An electronic search of the databases: Medline, Pubmed, Cochrane, EMBASE, CINAHL, Physiotherapy Evidence Database (PEDro) was conducted. A total of 11 articles were included in the review. Of these articles, 02 were case-control studies, 02 were interventional pre-post studies and 07 were RCTs. The 07 RCTs were included for network meta-analysis. The findings of the initial network meta-analysis (NMA) which compared control i.e., no intervention with other interventions revealed that all the physical therapy interventions: stretching, electrotherapy combined with stretching, massage, dry needling and neurodynamic exercises combined with stretching and neurodynamics alone were superior to control. Since most studies included stretching as an intervention, a second NMA was conducted to compare the different physical therapy interventions with stretching. The results suggested that US-guided neuromodulation (WMD: -5.80, CI: -12.11, 0.51) had large effects on hamstring flexibility compared to stretching and stretching combined with electrotherapy i.e., cryotherapy and ultrasound (WMD: 0.25, CI: -1.14 to 1.64), MET (WMD: 3.10, CI: -3.28 to 9.48) and massage (WMD: 8.05, CI: -11.90 to 27.18) were inferior to stretching. To further investigate the effects of these interventions three meta-analysis were performed. The results revealed that stretching was more effective (SMD 2.27, 95% 0.72 to 3.81, p < 0.01) compared to control (no intervention). Neurodynamic exercises combined with stretching and neurodynamics alone were found to be superior to stretching alone ((SMD -0.69, 95% -1.35 to -0.03, p < 0.01) and stretching combined with electrotherapy was not significantly better than stretching alone ((SMD -0.07, 95% -1.00 to 0.87, p=0.88). Neurodynamic exercises combined with stretching and neurodynamics alone showed to be superior to the other physical therapy interventions in improving hamstring flexibility for hamstring tightness among university students, however, the reliability of the evidence is low.
RESUMEN
BACKGROUND: Work-related musculoskeletal disorders (WMSDs) are highly prevalent among people who work in sedentary jobs. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) is a valid tool to assess WMSDs, but is not available in the local language of Sri Lanka (Sinhala). OBJECTIVE: To cross-culturally adapt the original CMDQ from English to Sinhala and evaluate its psychometric properties. METHODS: The linguistic and cultural adaptation of the CMDQ to the Sinhala (Si-CMDQ) language followed international guidelines. The adapted pre-version was tested for comprehensibility among 32 subjects from different educational and occupational backgrounds. The Content Validity Index (CVI) was computed with ratings from five experts. The questionnaire was validated further by 111 security guards employed at the university. The tool was validated with reference to the Numeric Rating Scale. Test-retest reliability was assessed at two time points one week apart and internal consistency was tested. RESULTS: The Si-CMDQ showed adequate cross-cultural, content and construct validity, internal consistency, and test-retest reliability. The Kappa coefficient showed excellent agreement between NRS and Si-CMDQ frequency scale. Spearman's correlation coefficients showed a moderate to a strong significant positive correlation between NRS and the severity scale of Si-CMDQ. The Kappa values for test-retest reliability were moderate to excellent for the three scales of CMDQ. The internal consistency was high. CONCLUSION: The Si-CMDQ fulfilled the psychometric requirement for questionnaires. This tool will be beneficial to assess WMSDs among sedentary workers in different occupations in Sri Lanka.
