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.

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.

Kinematics of the Spine During Sit-to-Stand Movement Using Motion Analysis Systems: A Systematic Review of Literature.

CONTEXT: Clinical evaluation of the spine is commonplace in musculoskeletal therapies, such as physiotherapy, physical medicine/rehabilitation, osteopathic, and chiropractic clinics. Sit-to-stand (STS) is one of the most mechanically demanding daily activities and crucial to independence. Difficulty or inability to perform STS is common in individuals with a variety of motor disabilities, such as low back pain (LBP). OBJECTIVE: The purpose of this systematic review was to evaluate available evidence in literature to determine 2-dimensional and 3-dimensional kinematics of the spine during STS in patients with LBP and healthy young adult participants using motion analysis systems (electromagnetic and marker based). METHODS: Electronic databases (PubMed/MEDLINE [National Library of Medicine], Scopus, ScienceDirect, and Google Scholar) were searched between January 2002 and February 2017. Additionally, the reference lists of the articles that met the inclusion criteria were also searched. Prospective studies published in peer-reviewed journals, with full text available in English, investigating the kinematics of the spine during STS in healthy subjects (mean age between 18 and 50 y) or in patients with LBP using motion analysis systems, were included. Sixteen studies fulfilled the eligibility criteria. All information relating to methodology and kinematic modeling of the spine segments along with the outcome measures was extracted from the studies identified for synthesis. RESULTS: The results indicated that the kinematics of the spine are greatly changed in patients with LBP. In order to develop a better understanding of spine kinematics, studies recommended that the trunk should be analyzed as a multisegment. It has been shown that there is no difference between the kinematics of patients with LBP and healthy population when the spine is analyzed as a single segment. Furthermore, between-gender differences are present during STS movement. CONCLUSION: This review provided a valuable summary of the research to date examining the kinematics of the spine during STS.

Relationships Between Hoffman Reflex Parameters, Trait Stress, and Athletic Performance.

This study evaluated the relationships between trait stress, Hoffman reflex, and performance among 36 healthy amateur male athletes. We first obtained a trait stress questionnaire from participants and then assigned them to high- and low-stress groups. We next recorded Hoffman reflex data from the soleus and lateral gastrocnemius muscles and then examined their athletic performance on testing protocols separated by a 72-hour washout period. Performance testing utilized vertical jump height, 20 -m sprint time, and standing stork tests. There were significant correlations between (a) the standing stork test, vertical jump height, and trait stress and (b) Hmax/ Mmax ratios, threshold intensity ( Hth), the intensity of the Hmax, and the intensity of the Hlast. Hth, the intensity of Hmax, and the intensity of Hlast were significantly higher among the low-stress compared with the high-stress participant groups ( p < .05), despite participants' similar training history. We suggest that self-perceived psychological stress affects performance through neural adaptation.

What is the effect and mechanism of kinesiology tape on muscle activity?

OBJECTIVE: This study aimed to evaluate the effects of kinesiology tape, anesthesia, and kinesiology tape along with anesthesia, on motor neuron excitability. PARTICIPANTS: Participants included 20 healthy men aged 20-35 years, who were examined over 5 sessions. INTERVENTION: The five experimental sessions included: control without applying the kinesiology tape or Eutectic Mixture of Local Anesthetics (EMLA); treatment only with EMLA; only kinesiology tape application; only sham tape application; and treatment with kinesiology tape and EMLA. MAIN OUTCOME MEASURES: The H-reflex recruitment curve of the soleus and lateral gastrocnemius was recorded by a blinded assessor in the 5 separate sessions randomly assigned with 48 h washout periods. The major H-reflex parameters include: the Hmax/Mmax ratio, the H-reflex threshold stimulation intensity (Hth), the intensity of maximum H-reflex (IntensityHmax), the H-reflex ascending slope (Hslp), and the H-reflex ascending slope fixed into the first three points (first Hslp). RESULTS: The H-reflex parameters (H slope, first Hslp, Hth, and IntensityHmax) were facilitated by application of the kinesiology tape with and without EMLA; however, EMLA inhibited the H-reflex parameters (Hmax/Mmax ratio, Hslp, first Hslp, and Hth) in both the soleus and lateral gastrocnemius. The sham tape did not alter the H-reflex recruitment curve parameters. The statistical model revealed a significant difference between the kinesiology tape and the sham tape and control sessions, between kinesiology tape-EMLA and EMLA, and between kinesiology tape-EMLA and control session. CONCLUSIONS: Results suggest that the kinesiology tape facilitates the muscle activity and the underlying mechanism on the gastrosoleus motor neuron pool involves the cutaneous receptors.

Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review.

OBJECTIVE: To evaluate evidence on the effectiveness of Mulligan techniques on low back pain. DATA SOURCES: PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, and Cochrane Library were searched from inception to 31 March 2018 for randomized clinical trials reporting outcomes of pain or disability in adult patients (⩾18 years) with low back pain. REVIEW METHODS: Two authors screened the results and extracted data for use in this review. The risk of bias was evaluated using the Cochrane criteria. Basic information and treatment protocols were also extracted. In addition, the level of evidence of each study and strength of conclusion for pain and disability were determined. RESULTS: A total of 20 studies with 693 patients were included. Nine trials focused on sustained natural apophyseal glide, three on spinal mobilization with limb movement and seven on bent leg raise. The results showed that Mulligan techniques can decrease pain and disability and increase range of motion in patients with low back pain; however, the strength of conclusion for pain and disability was moderate. Furthermore, inconclusive results were observed for the effectiveness of Mulligan techniques on movement speed. In this review, eight studies were categorized as low risk of bias, while 12 studies had high risk of bias. Level of evidence analysis revealed that 17 studies were classified as level of evidence B, while three studies were classified as level of evidence A2. CONCLUSION: Current evidence is insufficient in supporting the benefits of Mulligan techniques on pain, disability, and range of motion in low back pain patients.

Gender-Related Differences in Reliability of Thorax, Lumbar, and Pelvis Kinematics During Gait in Patients With Non-specific Chronic Low Back Pain.

OBJECTIVE: To evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system. METHODS: A convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated. RESULTS: Intraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally ≤4.8°) and females (generally ≤5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements. CONCLUSION: Although ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study.

Test-retest reliability of sit-to-stand and stand-to-sit analysis in people with and without chronic non-specific low back pain.

BACKGROUND: Sit-to-stand (STD) and stand-to-sit (SIT) analysis can provide information on functional independence in daily activities in patients with low back pain (LBP). However, in order for measurements to be clinically useful, data on psychometric properties should be available. OBJECTIVES: The main purpose was to investigate intra-rater reliability of STD and SIT tasks in participants with and without chronic non-specific LBP (CNLBP). The second purpose was to detect any differences in lumbar spine and hips sagittal plane kinematics and coordination between asymptomatic individuals and CNLBP patients during STD and SIT. DESIGN: Cross-sectional study. METHOD: Twenty-three CNLBP patients and 23 demographically-matched controls were recruited. Ten markers were placed on specific anatomical landmarks. Participants were asked to perform STD and SIT at a preferred speed. Peak flexion angles, mean angular velocities, lumbar to hip movement ratios, and relative phase angles were measured. The procedure was repeated after 2 h and 6-8 days. Differences between two groups were analyzed using independent t-test. Intraclass correlation coefficient (ICC 3,k), standard error of measurement (SEM), and limits of agreement (LOAs) were also estimated. RESULTS: The ICC values showed moderate to excellent intra-rater reliability, with relatively low SEM values (≤10.17°). The 95% LOAs demonstrated that there were no differences between the measured parameters. Furthermore, CNLBP patients had limited sagittal plane angles, smaller angular velocities, and lumbar-hip dis-coordination compared to asymptomatic participants. CONCLUSIONS: The results indicated moderate to excellent test-retest reliability of STD and SIT analysis. Moreover, CNLBP patients had altered kinematics during STD and its reverse.

A new iPhone application for measuring active craniocervical range of motion in patients with non-specific neck pain: a reliability and validity study.

BACKGROUND CONTEXT: Measurement of cervical spine range of motion (ROM) is often considered to be an essential component of cervical spine physiotherapy assessment. PURPOSE: This study aimed to investigate the reliability and validity of an iPhone application (app) (Goniometer Pro) for measuring active craniocervical ROM (ACCROM) in patients with non-specific neck pain. STUDY DESIGN/SETTING: A cross-sectional study was conducted at the musculoskeletal biomechanics laboratory located at Iran University of Medical Sciences. PATIENT SAMPLE: Forty non-specific neck pain patients participated in this study. OUTCOME MEASURES: The outcome measure was the ACCROM, including flexion, extension, lateral flexion, and rotation. METHOD: Following the recruitment process, ACCROM was measured using a universal goniometer (UG) and iPhone 7 app. Two blinded examiners each used the UG and iPhone to measure ACCROM in the following sequences: flexion, extension, lateral flexion, and rotation. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. Intraclass correlation coefficient (ICC) models were used to determine the intra-rater and inter-rater reliability. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone app. Minimum detectable change at the 95% confidence level (MDC95) was also computed. RESULTS: Good intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥0.66 and ≥0.70 and the iPhone app with ICC values of ≥0.62 and ≥0.65, respectively. The MDC95 ranged from 2.21° to 12.50° for the intra-rater analysis and from 3.40° to 12.61° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r valuesof ≥0.63. The magnitude of the differences between the UG and iPhone app values (effect sizes) was small, with Cohen d values of ≤0.17. CONCLUSIONS: The iPhone app possesses good reliability and high validity. It seems that this app can be used for measuring ACCROM.

A protocol for clinical trial study of the effect of core stabilization exercises on spine kinematics during gait with and without load in patients with non-specific chronic low back pain.

Background: Non-specific chronic low back pain (NCLBP) is a major public health and global socioeconomic burden with a variety of symptoms such as gait abnormality. Trunk stiffness and deep trunk muscles dysfunction known as guarding mechanism in gait are factors leading to abnormal movement pattern of the spine. Anterior load carriage task during gait is also challenged the trunk stability and its movement pattern. It will be therefore of interest to examine the effect of a Core Stabilization Training Program (CSTP) on the trunk and pelvis kinematics including variability and peak displacement during gait with and without load in NCLBP patients. Methods: Patients with NCLBP will participate in a program containing 16 sessions of CSTP and perceived pain, disability and kinematic will be evaluated with 100 mm visual analog scale (VAS), Oswestry Disability Index (ODI) and motion analyzing system respectively before and after the intervention. Participants will be asked to walk with self-selected comfortable speed for 3 times without load and 3 times with caring a load with hands. Discussions: We will quantify the effectiveness of CSTP on the kinematic of trunk, lumbar and pelvis during gait. Comparing the kinematic pattern and movement variability using CVo and CVp can contribute to better understand the motor control strategy and movement pattern of the spine during an anterior load carriage task between patients with NCLBP and healthy. Trial registration: IRCT number: IRCT2016080829264N1; pre-result.

The Effect of Core Stabilization Exercise on the Kinematics and Joint Coordination of the Lumbar Spine and Hip During Sit-to-Stand and Stand-to-Sit in Patients With Chronic Nonspecific Low Back Pain (COSCIOUS): Study Protocol for a Randomized Double-Blind Controlled Trial.

BACKGROUND: Chronic nonspecific low back pain (CNLBP) is among the most prevalent health problems. Lumbar spine and hips kinematics and coordination can be affected in CNLBP. The effects of exercises on the kinematics and coordination of lumbar spine and hips during sit-to-stand (STS) and its reverse have not been evaluated. OBJECTIVE: The aim of this study is to investigate the effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in CNLBP patients. METHODS: COSCIOUS is a parallel randomized double-blind controlled trial. A total of 30 CNLBP patients and 15 asymptomatic participants will be included. The kinematics and joint coordination of the lumbar spine and hips will be evaluated during STS and its reverse using a motion capture system. The participants will be asked to sit in their usual posture on a stool. Reflective markers will be placed over the T12, S2, anterior and posterior superior iliac spines, greater trochanters, and lateral femoral epicondyles of both legs. The participants will be instructed to stand up at natural speed, remain in the erect posture for 3 seconds, and then sit down. Kinematic variables of the lumbar spine and hip will be computed. Afterward, the CNLBP participants will be allocated at random to receive one of 2 interventions: core stabilization or general exercise. Treatment sessions will be held 3 times per week for 16 sessions. After intervention, CNLBP participants will be assessed again. RESULTS: Funding for the study was provided in 2016 by Iran University of Medical Sciences. The study is expected to last approximately 12 months, depending on recruitment. Findings on the study's primary outcomes are expected to be finalized by December 2017. The results of the study will be published in a peer-reviewed journal. CONCLUSIONS: This investigation will evaluate the effects of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in patients with CNLBP. In addition, the effects of CNLBP on STS and its reverse will be investigated in COSCIOUS. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2016080812953N2; http://en.search.irct.ir/view/32003?format=xml (Archived by WebCite at http://www.webcitation.org/6qjTWd4Az).

Reliability and concurrent validity of a new iPhone® goniometric application for measuring active wrist range of motion: a cross-sectional study in asymptomatic subjects.

Measurement of wrist range of motion (ROM) is often considered to be an essential component of wrist physical examination. The measurement can be carried out through various instruments such as goniometers and inclinometers. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for goniometric functions. This study, for the first time, aimed to evaluate the reliability and concurrent validity of a new smartphone goniometric app (Goniometer Pro©) for measuring active wrist ROM. In all, 120 wrists of 70 asymptomatic adults (38 men and 32 women; aged 18-40 years) were assessed in a physiotherapy clinic located at the School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Following the recruitment process, active wrist ROM was measured using a universal goniometer and iPhone® 5 app. Two blinded examiners each utilized the universal goniometer and iPhone® to measure active wrist ROM using a volar/dorsal alignment technique in the following sequences: flexion, extension, radial deviation, and ulnar deviation. The second (2 h later) and third (48 h later) sessions were carried out in the same manner as the first session. All the measurements were conducted three times and the mean value of three repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Good to excellent intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥ 0.82 and ≥ 0.73 and the iPhone® app with ICC values of ≥ 0.83 and ≥ 0.79, respectively. Minimum detectable change at the 95% confidence level (MDC95 ) was computed as 1.96 × standard error of measurement × âˆš2. The MDC95 ranged from 1.66° to 5.35° for the intra-rater analysis and from 1.97° to 6.15° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r values of ≥ 0.80. From the results of this cross-sectional study, it can be concluded that the iPhone® app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that this app can be used for the measurement of wrist ROM. However, further research is needed to evaluate symptomatic subjects using this app.

Reliability and validity of an iPhone(®) application for the measurement of lumbar spine flexion and extension range of motion.

BACKGROUND: Measurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions. PURPOSE: The main purpose was to investigate the reliability and validity of an iPhone(®) app (TiltMeter(©) -advanced level and inclinometer) for measuring standing lumbar spine flexion-extension ROM in asymptomatic subjects. DESIGN: A cross-sectional study was carried out. SETTING: This study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. SUBJECTS: A convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18-55 years) was recruited between August 2015 and December 2015. METHODS: Following a 2-minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12-L1 and S1-S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone (®) app to measure lumbar spine flexion-extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion-extension ROM, the measurement from S1-S2 was subtracted from T12-L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone(®) app. Furthermore, minimum detectable change at the 95% confidence level (MDC95) was computed as 1.96 × standard error of measurement × [Formula: see text]. RESULTS: Good to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of ≥0.84 and ≥0.77 and the iPhone(®) app with ICC values of ≥0.85 and ≥0.85, respectively. The MDC95 ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively. CONCLUSIONS: The iPhone(®)app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone(®) app can be used for the measurement of lumbar spine flexion-extension ROM. LEVEL OF EVIDENCE: IIb.

Motor control exercise for symptomatic lumbar disc herniation: protocol for a systematic review and meta-analysis.

INTRODUCTION: Lumbar disc herniation (LDH) is a common condition in adults and can impose a heavy burden on both the individual and society. It is defined as displacement of disc components beyond the intervertebral disc space. Various conservative treatments have been recommended for the treatment of LDH and physical therapy plays a major role in the management of patients. Therapeutic exercise is effective for relieving pain and improving function in individuals with symptomatic LDH. The aim of this systematic review is to evaluate the effectiveness of motor control exercise (MCE) for symptomatic LDH. METHODS AND ANALYSIS: We will include all clinical trial studies with a concurrent control group which evaluated the effect of MCEs in patients with symptomatic LDH. We will search PubMed, SCOPUS, PEDro, SPORTDiscus, CINAHL, CENTRAL and EMBASE with no restriction of language. Primary outcomes of this systematic review are pain intensity and functional disability and secondary outcomes are functional tests, muscle thickness, quality of life, return to work, muscle endurance and adverse events. Study selection and data extraction will be performed by two independent reviewers. The assessment of risk of bias will be implemented using the PEDro scale. Publication bias will be assessed by funnel plots, Begg's and Egger's tests. Heterogeneity will be evaluated using the I2 statistic and the χ2 test. In addition, subgroup analyses will be conducted for population and the secondary outcomes. All meta-analyses will be performed using Stata V.12 software. ETHICS AND DISSEMINATION: No ethical concerns are predicted. The systematic review findings will be published in a peer-reviewed journal and will also be presented at national/international academic and clinical conferences. TRIAL REGISTRATION NUMBER: CRD42016038166.

Intratester and intertester reliability of the movement system impairment-based classification for patients with knee pain.

BACKGROUND: The methods to standardize the test items used for classification of patients with knee pain based on the movement system impairment (MSI) approach have been established. To our knowledge, no study has concentrated on establishing reliability for proposed classification for knee pain problems. OBJECTIVE: The aim of the study was to assess intra- and intertester reliability of the knee MSI classification in patients with knee pain. DESIGN: A cross-sectional methodological study. SETTING: Rasul Akram Hospital. PARTICIPANTS: Ninety-six subjects with knee pain aged 18-65 years. METHODS: In order to examine intertester reliability, all three testers assessed the symptoms, signs and the MSI diagnosis of subjects with knee pain simultaneously. In order to assess intratester reliability, the procedure was exactly repeated after a one-week intersession period. Kappa values and percentages of agreement were calculated to analyze the reliability level. RESULTS: The kappa values for intra- and intertester reliability of the symptom items ranged from 0.83 to 1.00 and 0.00 to 0.83, respectively. For the sign items, the kappa values ranged from 0.18 to 1.00 and 0.00 to 0.82, respectively. Finally, the kappa values of intra- and intertester reliability for patients' classification judgments ranged from 0.66 to 0.71, and 0.48 to 0.58, respectively. CONCLUSION: The results of the present study indicate that intertester reliability for the symptoms, signs and classification judgments of patients with knee pain based on the MSI approach seemed generally acceptable. However, for intratester reliability, lower levels of the system were observed, probably due to different pain levels or pain behavior between test and retest sessions.

Validation of the movement system impairment-based classification in patients with knee pain.

BACKGROUND: Categorizing patients with knee pain problems based on pathoanatomical sources has not proved to be the most effective method for directing physical therapy interventions. Movement system impairment (MSI) classification system may be an alternative in the assessment, diagnosis, and management of patients with knee pain. No previous study has been conducted to validate the proposed system in these patients. OBJECTIVE: To assess construct validity of the MSI classification system in patients with knee pain. DESIGN: A cross-sectional methodological study. SETTING: Rasul Akram Hospital. PARTICIPANTS: One hundred eighty subjects with knee pain aged 18-65 years. METHODS: The MSI classification recognizes seven categories of knee pain problems based on the findings from the symptoms and signs assessment. Three physical therapists examined subjects with knee pain. A principal component analysis (PCA) was used to derive proposed categories. Eigenvalues and a scree plot were also used to determine the factor retention. RESULTS: Four factors related to three proposed categories were extracted from the PCA. Two factors were related to tibiofemoral rotation (TFR) category. The other two factors were related to proposed categories patellar lateral glide (PLG) and tibiofemoral hypomobility (TFHypo). CONCLUSION: The results provided evidence for the construct validity of three (TFR, PLG, and TFHypo) of the seven categories proposed by MSI classification. In addition TFR was subcategorized into two groups which were named as tibial lateral rotation (TLR) and femoral adduction/medial rotation (FAdd/MR) in the present study.

The effect of core stability and general exercise on abdominal muscle thickness in non-specific chronic low back pain using ultrasound imaging.

BACKGROUND: There is a controversy regarding whether core stability exercise (CSE) is more effective than general exercise (GE) for chronic LBP. To compare different exercises regarding their effect on improving back strength and stability, performance of abdominal muscles is a useful index. Ultrasound imaging for measuring muscle thickness could be used to assess muscle performance. OBJECTIVE: The aim of this study was to compare CSE and GE in chronic LBP using ultrasound imaging for measurement of thickness of the deep stabilizing and main global trunk muscles in non-specific chronic LBP. METHODS: Each program included 16 training sessions three times a week. Using ultrasound imaging, four transabdominal muscle thickness were measured before and after the intervention. Disability and pain were measured as secondary outcomes. RESULTS: After the intervention on participants (n = 43), a significant increase in muscle thickness (hypertrophy) was seen only in right and left rectus abdominis in the GE group, but significant difference to the CSE group was only on the right side. Disability and pain reduced within the groups without a significant difference in the change between them. CONCLUSIONS: The present results provided evidence that only GE increased right and left rectus muscle thickness. The only significant difference between CSE and GE groups was the right rectus thickness. As rectus is a global muscle, the effect of GE on strength improvement (one side stronger than the other) may have a negative effect on motor control of lumbopelvic muscles and possibly increase the risk of back pain occurring or becoming worse, though this was not observed in the present study.

Does core stability exercise improve lumbopelvic stability (through endurance tests) more than general exercise in chronic low back pain? A quasi-randomized controlled trial.

INTRODUCTION: The aim was to compare core stability and general exercises (GEs) in chronic low back pain (LBP) patients based on lumbopelvic stability (LPS) assessment through three endurance core stability tests. There is a controversy about preference of core stability exercise (CSE) over other types of exercise for chronic LBP. Studies which have compared these exercises used other outcomes than those related to LPS. As it is claimed that CSE enhances back stability, endurance tests for LPS were used. MATERIALS AND METHODS: A 16-session CSE program and a GE program with the same duration were conducted for two groups of participants. Frequency of interventions for both groups was three times a week. Forty-three people (aged 18-60 years) with chronic non-specific LBP were alternately allocated to core stability (n = 22) or GE group (n = 21) when admitted. The primary outcomes were three endurance core stability tests including: (1) trunk flexor; (2) trunk extensor; and (3) side bridge tests. Secondary outcomes were disability and pain. Measurements were taken at baseline and the end of the intervention. RESULTS: After the intervention, test times increased and disability and pain decreased within groups. There was no significant difference between two groups in increasing test times (p = 0.23 to p = 0.36) or decreasing disability (p = 0.16) and pain (p = 0.73). CONCLUSIONS: CSE is not more effective than GE for improving endurance core stability tests and reducing disability and pain in chronic non-specific LBP patients.

Relationship between flexion-rotation test and ultrasound thickness measurement of the abdominal muscles.

OBJECTIVE: The purpose of this study was to investigate the relationship between flexion-rotation test and ultrasound (US) thickness measurement of the antero-lateral abdominal muscles. DESIGN: Following ethical approval, a convenience sample of 55 subjects between the ages of 20 and 30 years participated in this study. Endurance of the abdominal muscles was measured using the flexion-rotation test in all subjects. US thickness measurement for the transversus abdominis (TrA), internal oblique (IO) and external oblique (EO) muscles was performed on the right side at rest in a supine position. RESULTS: Pearson correlation coefficient between the variables of the study showed no significant relationship between the flexion-rotation test and US thickness measurements of the TrA (r = -0.03, P = 0.80), IO (r = -0.13, P = 0.32), and EO (r = -0.14, P = 0.31) muscles. The significance level of 0.05 was chosen. CONCLUSION: It seems that there is no significant relationship between the flexion-rotation test and US measurement of abdominal muscles thickness.