Outcomes of Mulligan Concept Applications in Obese Individuals with Chronic Mechanical Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: Various treatment modalities have been employed for mechanical low back pain (MLBP), but evidence of their efficacy varies greatly. Objective: This randomized controlled trial aimed to assess the outcomes of Mulligan concept applications, including sustained natural apophyseal glides (SNAGS) and natural apophyseal glides (NAGS), in obese patients with MLBP. METHODS: The study, conducted between January 2021 and June 2022 at a tertiary hospital, involved randomizing patients into two groups. Both groups underwent six sessions of stretching and strengthening exercises every other day. The Mulligan group received additional intervention with SNAG and NAGS techniques. Measurements were made regarding the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score and range of motion (ROM) for the patients' MLBP level. RESULTS: Post-interventions, both groups exhibited positive changes in flexion ROM, extension ROM, right and left rotation ROM, right and left lateral flexion ROM, VAS score, and ODI score compared to pre-intervention (p < 0.001 for both groups and variables). The Mulligan group showed a higher increase in ROM and a more significant decrease in VAS and ODI scores. Conclusions: Mulligan mobilization techniques prove significantly beneficial for enhancing ROM in all directions, reducing pain levels, and alleviating disability in obese individuals with MLBP.

The Coping Strategies Questionnaire: Translation, cultural adaptation, reliability and validity in Turkish-speaking patients with chronic musculoskeletal pain.

BACKGROUND: The use of pain coping questionnaires is advantageous when selecting cognitive and behavioral targets for chronic pain management. The objective of this study was to investigate adaptation, validity, and reliability of the Coping Strategies Questionnaire (CSQ) in Turkish population with chronic musculoskeletal pain. METHODS: The Turkish version of the questionnaire (CSQ-T) was checked in terms of reliability and validity with a convenience sample of 123 patients with chronic musculoskeletal pain. Reliability (test-retest) analyses were conducted by means of a retest 48 hours later with a sub-group of 40 patients. Construct validity of the CSQ was checked through convergent validity with the Hospital Anxiety and Depression Scale (HADS) and the Short Form-36 (SF-36) health survey. RESULTS: Cronbach's alpha of the subscales ranged from 0.814 to 0.934 and the test-retest reliability ranged from 0.800 to 0.944. Neither floor nor ceiling effects (15%) were found in the subscales (13.8%) and the total score (4.1%) of the CSQ-T. Factor analysis indicated that the scale had two factors. The total CSQ-T score was correlated with both the HADS (r: -0.636/-0.549) and the SF-36 (r: 0.701/0.768). CONCLUSION: The CSQ-T is a reliable and valid measure for assessing patients with chronic musculoskeletal pain.

Reliability and validity of the Turkish version of the Core Outcome Measures Index for the neck pain.

PURPOSE: The Core Outcome Measures Index (COMI) is a short and multidimensional scale covering all domains recommended to be included in outcome measures for patients with neck pain. The purpose of the present study was to translate and cross culturally adapt the COMI into Turkish and to test its reliability and validity in patients with neck pain. METHODS: One hundred and six patients with a complaint of chronic neck pain (> 3 months) were enrolled in the present study. Participants completed a questionnaire booklet containing the COMI-neck, Neck Disability Index (NDI), Neck Pain and Disability Scale (NPDS), Short Form-36 (SF-36), and pain Numeric Rating Scale (NRS). The validation of the COMI included the assessment of its construct validity and reliability. RESULTS: Cronbach's alpha value of the questionnaire was found to be 0.774 indicating a high internal consistency. Intraclass correlation coefficient values for test-retest reliability were found to be in the range of 0.817-0.986, which indicates a sufficient level of test-retest reliability. Pearson's correlation coefficient values of the COMI with SF-36, NDI, NPDS, and NRS ranged between 0.417 and 0.700, indicating a good correlation. CONCLUSION: Considering the analyses, it was concluded that the Turkish version of the COMI is a valid and reliable scale for chronic neck pain patients. These slides can be retrieved under Electronic Supplementary Material.

Cross-cultural adaptation, validity, and reliability of the Turkish version of the Patient-Rated Elbow Evaluation.

INTRODUCTION: The Patient-Rated Elbow Evaluation (PREE) is a joint-specific, self-administered outcome measure used to determine the level of pain and disability in patients with various elbow pathologies. The aim of this study was to cross-culturally adapt the PREE into Turkish (PREE-T) and to test its reliability and validity. METHODS: Fifty-nine patients with elbow disorders were included in the present study. The original version of the PREE was translated and culturally adapted into Turkish by following standard procedure. Test-retest reliability and internal consistency were determined using intraclass correlation coefficient and Cronbach's alpha, respectively. Construct validity of PREE-T was determined with Disabilities of the Arm, Shoulder, and Hand (DASH) and Short Form-36 (SF-36) questionnaires by using Pearson's correlation coefficient analysis. Floor and ceiling effects were also analyzed. RESULTS: A high internal consistency (Cronbach's alpha of 0.959) and an excellent test-retest reliability (the intraclass correlation coefficient of 0.970) indicated that the PREE-T was reliable. Neither floor nor ceiling effects were observed in sub-parameters (0-1.7%) and the total score (0%) of PREE-T. Correlation coefficients between the PREE-T total score and DASH disability/symptom and work sub-parameters were 0.636 and 0.461, respectively. PREE-T pain and function sub-parameters correlated with related sub-parameters of the SF-36 bodily pain (r = - 0.721) and physical functioning (r = - 0.263). CONCLUSION: The Turkish version of the PREE is a valid and reliable outcome measure for assessing patients with elbow disorders. It is recommended to be used in research and clinical settings. Key Points • The Turkish version of the Patient-Rated Elbow Evaluation was successfully translated into Turkish and validated in a population with various elbow pathologies according to established guidelines • The Turkish version of the Patient-Rated Elbow Evaluation has high internal consistency and test-retest values • The Turkish version of the Patient-Rated Elbow Evaluation is valid and reliable.

Translation, cultural adaptation, reliability, and validity of the Turkish version of the Penn Shoulder Score.

PURPOSE: The purpose of this study is to translate the Penn Shoulder Score into Turkish and to establish its cultural adaptation, reliability, and validity in patients with shoulder dysfunctions. METHODS: The Penn Shoulder Score was translated and culturally adapted from English into Turkish. Subsequently, the Penn Shoulder Score, the Constant Score, the American Shoulder and Elbow Score, and the Western Ontario Rotator Cuff Index were completed by 97 patients with shoulder dysfunctions. To determine the test-retest reliability, 30 patients completed the Penn Shoulder Score again on day 3. Intraclass correlation coefficient and Cronbach alpha were calculated to assess reliability. The validity of the questionnaire was assessed in terms of convergent validity with Pearson Correlation Coefficient using the Constant Score, the American Shoulder and Elbow Score, and the Western Ontario Rotator Cuff Index. RESULTS: Internal consistency was good, with a Cronbach alpha of 0.81. The Intraclass correlation coefficient was 0.90 (95% confidence interval: 0.78, 0.90), demonstrating good test-retest reliability. Pearson correlation coefficients of the Penn Shoulder Score in relation with the Constant Score, the American Shoulder and Elbow Score, and the Western Ontario Rotator Cuff Index were 0.65, 0.78, and -0.77, respectively. CONCLUSION: The Turkish version of the Penn Shoulder Score is a reliable and valid measure for assessing patients with shoulder dysfunctions. Implications for Rehabilitation The Turkish version of the Penn shoulder score is valid and reliable outcome measure for assessing patients with shoulder dysfunctions. The Turkish version of the Penn shoulder score could be easily performed by patients and it is easy to score by clinicians. It is recommended to use in clinical settings and in research.

Western Ontario Shoulder Instability Index: cross-cultural adaptation and validation of the Turkish version.

One way to measure the effectiveness of a specific treatment is to utilize measurements designed specifically for the disorder. Western Ontario Shoulder Instability Index (WOSI) is a subjective self-report scale indicating the latest condition of the patients with shoulder instability. The objective is to study the cultural adaptation, validity, and reliability of WOSI in Turkish population with shoulder disability. First, WOSI was translated and culturally adapted from English into Turkish. Afterward, in order to determine the level of reliability, internal consistency and test-retest analyses were conducted. Reliability (test-retest) analyses were conducted by means of retest 72 h later with a sub-group of 30 patients. Construct validity of the WOSI was checked through convergent validity with Disabilities of Arm, Shoulder and Hand Scale, Rowe Score Questionnaire, Oxford Shoulder Instability Questionnaire, and Western Ontario Rotator Cuff Index by 60 patients with shoulder instability. The Turkish version of the questionnaire displayed high internal consistency (0.77-0.91) with a Cronbach's Alpha value of 0.91. As for the test-retest reliability, the ICC value was found to be high (95% CI 0.97). Floor and ceiling effects (15%) were observed neither in sub-parameters (0-4.9%) nor in total score (0%). WOSI total score was found to have a negative good correlation with the Rowe Score (r = -0.57) and a very good-excellent correlation with other questionnaires (r = 0.67-0.89). The Turkish version of WOSI is a valid and reliable scale for use in studies to evaluate the final condition of the patients with shoulder disabilities.

Relationship between scapular muscle and core endurance in healthy subjects.

BACKGROUND: Scapular muscle endurance and core endurance reportedly influence shoulder injury risk. The exact relationship between scapular muscle endurance and core endurance, and how they impact one another in the healthy subjects remain unclear. OBJECTIVE: To investigate the relationship between scapular muscle endurance and core endurance in healthy subjects. METHODS: Fifty healthy volunteers (23 males, 27 females; mean age 20.42 ± 1.04 years) were participated in this study. Endurance of the serratus anterior and trapezius muscles was assessed using the scapular muscle endurance test. Sorensen test (endurance of trunk extensor muscles), trunk flexor endurance test, and side bridge test (endurance of lateral core muscles) were conducted to assess the core endurance. Pearson's product moment correlations examined relationships between scapular muscle endurance and each of the core endurance tests scores. RESULTS: Scapular muscle endurance test scores showed a positive correlation with the side bridge test scores (r = 0.414; p = 0.003). No significant correlation was found between scapular muscle endurance test scores and the other core endurance tests scores (p > 0.05). CONCLUSIONS: There appears to be a link between the scapular muscle endurance and lateral core muscles in healthy subjects; however, more research is needed to provide a definitive answer on the nature of this relationship. Further studies involving patients with shoulder pathology are warranted.

Cross-cultural adaptation, reliability and validity of the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.

BACKGROUND: Low back pain is among the most common musculoskeletal system disorders. Outcome measures are needed for the measurement of function, to establish a treatment program, and for monitoring the improvement in low back pain. There exist several questionnaires enquiring about function in low back pain. One of these is Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, whose reliability and validity were previously established. Other than the original version of the questionnaire, only its Persian version exists. The present study aims to investigate the cross-cultural adaptation, reliability and validity of the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. METHODS: The study included 103 patients with low back pain. For reliability assessment of the questionnaire, test-retest and internal consistency analyses were performed. The results of test-retest analysis were assessed by Intraclass Correlation Coefficient method. For internal consistency, Cronbach Alpha value was used. Validity analyses of the questionnaire were performed by construct validity. For construct validity, convergent validity was tested. Convergent validity of the questionnaire was calculated via its correlation with suitable subscales of the Short Form-36 and the total score of the Oswestry Disability Index by using Pearson's correlation coefficient. RESULTS: Intraclass Correlation Coefficient values for test-retest reliability were found to be in the range of 0.765-0.924, which indicate a sufficient level of test-retest reliability. Cronbach's Alpha value was found to be 0.804 indicating a high internal consistency. Pearson's correlation coefficient between Japanese Orthopaedic Association Back Pain Evaluation Questionnaire to Short Form-36 and Oswestry Disability Index values were ranged between 0.424 and -0.810, indicating a good correlation. CONCLUSIONS: Considering all these data, it was concluded that the Turkish version of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire is valid and reliable.

Effect of manual lymph drainage on removal of blood lactate after submaximal exercise.

[Purpose] It has been well-established that exercise-induced muscle damage occurs following intense exercise. Massage is commonly used to manage muscle damage resulting from exercise. However the effect of massage after exercise is still not clear. The purpose of this study was to examine the effect of manual lymph drainage on muscle damage and on the removal of blood lactate following submaximal exercise (SE), as part of a solution to the challenging problem in sports medicine of muscular recovery after exercise. [Subjects and Methods] Eighteen healthy male students, with moderate exercise training, were randomly assigned to either receive manual lymph drainage (MLD) or serve as controls. Both groups were subjected to a graded exercise test, performed on a treadmill ergometer, to determine each subject's individual anaerobic threshold (IAT). Seven days later, all subjects were made to run for 30 minutes on the same treadmill ergometer, at a running speed equivalent to the IAT. One group received MLD treatment, while the control subjects received no treatment. [Results] Following an increase immediately after exercise, lactic acid (LA) and lactate dehydrogenase (LDH) serum levels dropped rapidly and significantly at the end of MLD application and two hours after SE in the subjects receiving MLD. The course of creatine kinase (CK) and myoglobin levels was comparable, and with myoglobin showing a significant difference at 2 h after SE, and CK at 24 h after SE. [Conclusion] Manual lymph drainage after SE correlated with a more rapid fall in LA and of the muscular enzymes of LDH, CK and myoglobin, and may have resulted in an improvement in the regenerative processes elicted by structural damage to the muscle cells.