Mid-term Effect of Lumbar Sustained Natural Apophyseal Glides in Patients with Non-specific Chronic Low Back Pain: A Randomized Clinical Trial.

OBJECTIVE: The objective of this study was to compare the standalone and combined mid-term effects of conventional physiotherapy and lumbar sustained natural apophyseal glides on pain, range of motion, fear avoidance belief, and functional status in patients with non-specific chronic low back pain. MATERIALS AND METHODS: This randomized clinical study was conducted in a state hospital. Fifty-five patients with non-specific chronic low back pain (mean age: 40.69 ± 6.27 years) were divided into 3 groups. Group I (n=18) received conventional physiotherapy (electrotherapy and heat application) 5 days a week for 3 weeks, group II (n=19) received lumbar sustained natural apophyseal glides 3 days a week for 3 weeks. Group III (n = 18) received conventional physiotherapy plus lumbar sustained natural apophyseal glides. Pain (visual analog scale), flexion range of motion (back range of motion II), functional status (Roland-Morris Disability Questionnaire), and fear avoidance belief (Fear Avoidance Belief Questionnaire) were assessed at baseline, third week, and 6-month follow-up. RESULTS: After 3 weeks of intervention, all outcome measures improved in groups II and III. These improve- ments remained significant until 6-month follow-up (P < .05), except fear avoidance belief (P=.06) and flexion range of motion (P=.764) scores of group III. Flexion range of motion (P=.001), functional status (P = .001), and fear avoidance belief (P = .03) differed significantly between the 3 groups at 6-month follow- up; post-hoc analysis revealed that flexion range of motion (P < .0001), functional status (P = .037), and fear avoidance belief (P = .002) scores were significantly improved in group II compared to group I. CONCLUSION: Compared with conventional physiotherapy, lumbar sustained natural apophyseal glides improved mid-term range of motion, functional status, and fear avoidance belief, but there was no differ- ence in pain. Conventional physiotherapy added to lumbar sustained natural apophyseal glides provided no additional benefit.

Long-Term Follow-Up Result of Connective Tissue Manipulation in Young Women with Primary Dysmenorrhea: Different Intervention Durations.

The purpose of this study was to reveal the effect of connective tissue manipulation (CTM) on long-term pain severity, fatigue, sleep quality, premenstrual symptom severity, general health status, anxiety, and depression in women with primary dysmenorrhea (PD). Thirty-five women with PD were divided into two groups. CTM was applied to the participants in each group on the days when they were not on menstruation between two menstrual cycles for the group 1 (n=18) and between three menstrual cycles for the group 2 (n=17). Intensity of menstrual pain, the sleep quality, and fatigue status of the participants during dysmenorrhea were evaluated by the Visual Analog Scale (VAS). Depressive symptoms and anxiety were evaluated using the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI), respectively. Also, the Premenstrual Syndrome Scale (PMSS) and the General Health Questionnaire (GHQ) were used to investigate the severity of premenstrual symptoms and mental health status during menstrual period. A significant decrease in the pain severity and fatigue of the participants was observed in both group 1 and group 2 after treatment, after 3rd, and 6th month follow-up (p=0.001). Also, this decrease lasted for 12th month follow-up after treatment in group 2 (p=0.0001). There was no statistically significant improvement in sleep quality within each group (p>0.05). Moreover, none of the parameters were significantly different between two groups (p>0.05). We can suggest that 2-cycle CTM treatment should be preferred in clinical settings to obtain long-lasting effects for decreasing pain, fatigue, and premenstrual symptoms in women with PD. CLINICAL TRIAL NUMBER: NCT04509934. Registration date: 8 November 2020.

Effects of risk factors related to computer use on musculoskeletal pain in office workers.

Purpose. Work-related musculoskeletal disorders (WMSDs) are increasing due to overuse of desktop computers. This investigation examined musculoskeletal pain in office workers. Methods. Sociodemographic factors were recorded for 362 participants (female, 50.8%; male, 49.2%; mean age 37.35 ± 8.43 years). Participants were questioned for their daily working time, computer usage time and years, whether musculoskeletal pain was related to their job and whether pain disturbed their activities of daily living (ADLs). Working postures were observed and pain severity was evaluated by visual analog scale. Results. Participants more frequently had upper back pain (69.6%), neck pain (65.2%) and lower back pain (LBP) (64.1%) during the last 12 months; 60.5% of participants reported pain after they started work. LBP (32.9%), back pain (28.2%) and neck pain (22.9%) restricted participants' daily life. We found positive correlations between daily computer use and neck/upper back, and LBP. Conclusions. The most painful areas of participants using desktop computers were the upper back, neck, lower back and shoulder, and the pain in these regions affected ADLs negatively. This pain mostly occurred after the current job and these individuals experience more intense pain. Ergonomic approaches could reduce WMSDs and make workers more independent in ADLs and prevent chronicity.

Factors affecting body awareness in older adults with chronic musculoskeletal pain.

INTRODUCTION: Chronic musculoskeletal pain (CMP) and cognitive impairment (CI) may reduce body awareness in older adults. The first aim of this study was to determine the impact of CMP and CI on body awareness in older adults. The second was to search for the factors most affecting body awareness using logistic regression analysis. MATERIAL AND METHODS: Two hundred and 65 older adults (males: 138 and females: 127) aged 65 and over (mean age; 72.27 ±6.42 years) living in their own homes were included. We used the following evaluation methods: CMP intensity (Visual Analog Scale - VAS), cognitive status (Hodkinson's Abbreviated Mental Test - HAMT), and body awareness (Body Awareness Questionnaire - BAQ). Logistic regression analysis was used to determine the factor most affecting the BAQ score. RESULTS: Eighty-five point two percent of participants (n = 265) reported CMP (lower extremity pain: 74.6%; spinal pain: 66.6%; upper extremities pain: 44.4%). CMP intensity was higher in lower extremities (mean VAS: 5.73 ±1.86 cm). Gender differences in terms of CMP were found in favor of males (p = 0.0001). Mean HAMT score was 8.16±1.65. Gender difference in favor of males was significant (p = 0.0001). Mean BAQ score was 77.61±20.90; there was no significant difference between the gender (p = 0.142). There was a significant moderate positive correlation between body awareness and cognitive status (r = 0.382, p = 0.0001). However, a weak negative correlation was found between body awareness and pain intensity (r = -0.234, p = 0.0001). Regression analysis showed that living environment (rural area), low education level, low cognition level and increased CMP intensity significantly predicted body awareness. CONCLUSIONS: The results obtained from this study indicate that cognitive impairment and pain should be reduced by improving body awareness among older adults. That is why health professionals should evaluate all related factors affecting body awareness before planning the most suitable rehabilitation program.

The Turkish version of the Neck Bournemouth Questionnaire in patients with chronic neck pain: a cultural adaptation, reliability, and validity study.

INTRODUCTION: The cultural adaptation of a self-report measurement in different languages is important for developing common strategies for evaluation and treatment. The Neck Bournemouth Questionnaire (NBQ), which was developed to evaluate patients with neck pain, was adapted from the Bournemouth Questionnaire in accordance with the International Classification of Functioning, Disability and Health (ICF) categories. The aim of this study was to conduct the Turkish cultural adaptation, validity and reliability study of the NBQ. MATERIAL AND METHODS: The study included 119 patients (93 females, 26 males; mean age: 37.2 ±11.8 years) with chronic nonspecific neck pain. The NBQ, Neck Disability Index (NDI) and Nottingham Health Profile (NHP) questionnaires were administered to all the subjects. Test-retest reliability (intraclass correlation coefficient) and the internal consistency (Cronbach's α) were the methods used for the reliability study. The relationship between NBQ, NDI and NHP was investigated for concurrent validity. Exploratory and confirmatory factor analysis was used for construct validity. RESULTS: The Neck Bournemouth Questionnaire showed good internal consistency (α = 0.87). The test-retest reliability coefficient was 0.913 (95% CI: 0.875-0.940). The correlations between NBQ and NDI and NHP were significant (p < 0.05). The questionnaire was found to have one factor and the explained variance was 59.084% as a result of factor analysis. CONCLUSIONS: The Neck Bournemouth Questionnaire is a valid and reliable scale for patients with chronic neck pain in the Turkish population.

Acute effects of distal fibular taping technique on pain, balance and forward lunge activities in Chronic Ankle Instability.

BACKGROUND: Chronic Ankle Instability (CAI) is characterized by altered muscle activation, reduced range of motion (ROM) and balance deficits. OBJECTIVE: The aim of this study was to determine whether fibular taping technique influenced the pain intensity, dorsiflexion ROM and dynamic balance in participants with CAI. METHODS: Twenty-six participants (16 males and 10 females; age 28.8 ± 5.74 y) with unilateral CAI who scored 85 points or less on the Foot and Ankle Outcome Score (FAOS) were included in our study. Mulligan distal fibular taping technique was applied. Visual Analog Scale, Star Excursion Balance Test in anterior, posteromedial and posterolateral directions and a Weight Bearing Lunge Test were taken before, after, 1 hour after and 24 hours after taping. RESULTS: Distal fibular taping technique decreases pain intensity (at rest, during range of motion and weight bearing conditions), while it increases forward lunge distance and reach distance in anterior, posteromedial and posterolateral directions (p= 0.001). CONCLUSIONS: Our study showed that distal fibular taping reduces pain intensity, postural control and dorsiflexion range of motion in individuals with CAI. Further studies are needed with participants with a lower functional level and a higher pain intensity.

Prevalence of and risk factors for low back pain among healthcare workers in Denizli.

OBJECTIVES: The purpose of this study was to examine personal, occupational, and psychosocial risk factors affecting prevalence of low back pain in healthcare workers. METHODS: Study included total of 1682 participants (1010 female, 672 male) working at Denizli State Hospital. Low back pain section of Standardized Nordic Musculoskeletal Questionnaire (SNMA) was used to evaluate recent occurrence, pain experienced within previous year, and over lifetime. Perceived Stress Scale and Job Satisfaction Scale were also administered. RESULTS: Prevalence of lifetime low back pain in healthcare workers was determined to be 53% based on SNMA. It was observed that low back pain was most common among medical secretaries (56.9%). Advanced age, female gender, high body mass index (p=0.002), being married (p=0.0001), lack of regular exercise (p=0.009), working for more than 4 hours while standing (p=0.012) or sitting at desk (p=0.021), using computer for more than 4 hours (p=0.0001), greater number of years of service (p=0.001), and low job satisfaction (p=0.001) were found to be factors increasing low back pain risk. CONCLUSION: Our study demonstrated that healthcare workers are among group with high risk of low back pain.

Quality of life, depression and musculoskeletal pain experience among employed women: A controlled study.

OBJECTIVE: The musculoskeletal pain is one of the leading health problems among employed women. The aim of our study was to examine musculoskeletal pain, depression and quality of life (QOL) among employed women and find out the differences with unemployed women. METHODS: A hundred and fifty employed women and 151 housewives were included in our study. We used visual analog scale (VAS) for the assessment of pain, Beck Depression Inventory (BDI) for the depressive symptoms and Nottingham Health Profile (NHP) for the assessment of QOL. RESULTS: The ratio of musculoskeletal pain among employed women and unemployed women were found as 42.5% and 57.5% respectively. A mild level of depression was found among employed women whereas moderate and vigorous level of depression were found among unemployed women. There were significant differences in terms of depression and QOL parameters. When the correlations of pain, depression and QOL were analyzed, significant high positive relationships between spinal, lower extremity, upper extremity pain levels and BDI and NHP were found only in housewives. CONCLUSIONS: Lower levels of depression among employed women can give the idea that social ambience at work place, focusing at work and economic independence play a role in decreasing depression.

How does pain localization affect physical functioning, emotional status and independency in older adults with chronic musculoskeletal pain?

[Purpose] The aim of this study was to show the impact of chronic musculoskeletal pain of the spinal column and lower extremities on physical functioning, emotional status, and independency in older adults. [Subjects] In this cross-sectional study, 258 older adults (mean age, 71.98±5.86 years, 50.8% males, 49.2% females) living in their own residences were evaluated. [Methods] Pain intensity was analyzed using a visual analogue scale. Physical functioning was evaluated with the Timed Up and Go Test (TUG) and a Six-Minute Walk Test. The Geriatric Depression Scale was used to determine emotional status. The independency in daily living of the participants was evaluated using the Lawton Brody IADL Scale. All participants were divided into two groups in accordance with the pain localization: the (1) spinal pain and (2) lower extremity pain groups. [Results] When the pain scores were compared, no significant differences between the two groups were found. The same results were found in terms of TUG scores. The spinal pain group had higher scores in terms of aerobic capacity than the lower extremity pain group. [Conclusion] The results indicate that chronic musculoskeletal pain in the lower extremities decreased aerobic capacity much more than spinal pain in older adults.

Upper extremities and spinal musculoskeletal disorders and risk factors in students using computers.

OBJECTIVE: To examine the effects of computer usage on the musculoskeletal system discomforts (MSD) of Turkish university students, the possible risk factors and study implications (SI). METHODS: The study comprised a total of 871 students. Demographic information was recorded and the Student Specific Cornell Musculoskeletal Discomfort Questionnaire (SsCMDQ) was used to evaluate musculoskeletal system discomforts. RESULTS: The neck, lower back and upper back areas were determined to be the most affected areas and percentages for SI were 21.6%, 19.3% and 16.3% respectively. Significant differences were found to be daily computer usage time for the lower back, total usage time for the neck, being female and below the age of 21 years (p<0.05) had an increased risk. CONCLUSIONS: The neck, lower back and upper back areas were found to be the most affected areas due to computer usage in university students. Risk factors for MSD were seen to be daily and total computer usage time, female gender and age below 21 years and these were deemed to cause study interference.

The impact of chronic low back pain on physical performance, fear avoidance beliefs, and depressive symptoms: A comparative study on Turkish elderly population.

OBJECTIVES: The purposes of this study were: (1) to show the impact of chronic low back pain (CLBP) on physical performance, fear avoidance behavior and depressive symptoms in older adults; (2) to describe the relationships between outcome measurements obtained in this study. METHODOLOGY: Ninety-one participants with or without chronic low back pain were included in this study. Only four tests in the Back Performance Scale were used to assess the physical performance of the participants. A Fear Avoidance Beliefs Questionnaire related to physical activity and the Geriatric Depression Scale were also used to examine each subject. RESULTS: The level of performance shown by elderly adults with low back pain was worse than elders without low back pain in the sock test and the pick-up test (p < 0.05). Little correlation between the finger-to-floor test and fear avoidance behaviour related to physical activity was found (p < 0.05). There was little/poor correlation between all performance tests and depressive symptoms (p < 0.05). CONCLUSIONS: The findings indicate that CLBP decreases physical performance, but increases fear avoidance behavior and depressive symptoms in elderly adults. At the same time, it was determined that performance level of elderly adults with back pain was related especially with depressive symptoms.

Comparison of emotional status and physical activity between women with chronic widespread pain and fibromyalgia.

OBJECTIVES: This study was conducted to compare the emotional status and physical activity level in women with chronic widespread pain (CWP) and fibromyalgia (FM). METHODS: Thirty-three women with CWP above the waist, including the upper extremities, and 68 women with FM were evaluated. To determine physical and emotional status, the Fibromyalgia Impact Questionnaire (FIQ), the Experience of Physical Activity Instrument, the Leisure Time Physical Activity Instrument, the Physical Activity at Home and Work Instrument, and the Hospital Anxiety and Depression Scale (HADS) were used. RESULTS: The CWP group had higher physical impairment scores than the FM group (p<0.05); however, the women with FM reported that they felt worse during the previous week than the other group before the interview. They also had higher scores for pain, morning tiredness and depression (FIQ 5, 7 and 10). Emotional symptoms were significantly elevated in FM patients versus the CWP patients. Conversely, no significant differences were found between the groups concerning the health status (FIQ-total) and physical activity (p>0.05). The results indicate that increased pain intensity and spread of pain have negative effects on both physical functioning and emotional status. CONCLUSION: The women with FM reported much more severe clinical symptoms than those with CWP. Therefore, in addition to physical functioning, the emotional status of women with chronic pain should also be evaluated.

A new tool measuring health-related quality of life (HRQOL): the effects of musculoskeletal pain in a group of older Turkish people.

The aims of this study were (1) to show the effects of musculoskeletal pain on health-related quality of life (HRQOL) and (2) to look at gender differences in this field in elderly people living in Turkey. Subjects were 900 men and women (65 years of age or above), with a mean of 70.93+/-5.6 years. The centers for disease control (CDC) HRQOL-4 survey tool was used to measure HRQOL of the subjects. A visual analog scale (VAS) was used to determine pain intensity. The subjects were also asked to indicate sites where they experienced pain in their body. Of the subjects, 72.1% reported musculoskeletal pain. The prevalence of pain was higher among women (85.5%) than men (61.8%). Pain of lower extremities was the most common in both sexes. Whereas the majority of the subjects with musculoskeletal pain reported fair-poor self-rated health, those without pain reported excellent-very good-good health. Compared with subjects who did not report pain, those with pain had increased the number of physically and mentally unhealthy days in the previous 30 days (p=0.0001). The investigators concluded that musculoskeletal pain interfered negatively with HRQOL, increasing the number of unhealthy days and decreasing physical and mental performance in the elderly participants.

Balance performance, aging and falling: a comparative study based on a Turkish sample.

The effects of aging and gender on balance performance (BP) among ambulatory adults were investigated in the current work. If there was a relation between the BP and a history of falling, this was also detected. Two hundred and forty ambulatory subjects were divided into two groups depending on their age: (1) 125 middle-aged subjects (50-64 years); (2) 115 elderly subjects (65-75). The functional reach (FR) test, the timed up and go (TUG) test, the sit to stand (STS) test and the step test (ST) were used to evaluate the BP. The fall rate (1-2 in the last year) was 8% for the middle-aged group and was 13.9% for the elderly group. Middle-aged adults had better scores on all tests in comparison to the elderly people. There have been differences found between genders regarding the BP in both groups, except the FR scores in the middle-aged group. The FR distance of the faller subjects was rather low in comparison to non-faller elderly subjects. However, there were no significant differences between the faller and non-faller subjects in both groups regarding other tests' scores. The results of this study indicate that aging affects the BP year by year. The information in this paper can provide normative data to be used as a comparison to clinically obtained information.

Attitudes of physiotherapists and physiotherapy students toward euthanasia: a comparative study.

This interventional study was undertaken to assess the impact of physiotherapy education on the knowledge and attitudes of physiotherapists (PTs) and physiotherapy students (PSs) toward euthanasia. The study, which was conducted during the period between 2004 and 2005, included a total of 494 participants (311 PTs; 183 PSs) aged 18 to 52 y from the western and central portions of Turkey, who responded to a self-report questionnaire (response rate, 96.4%) that was based on data from the literature. Results indicated that PTs (48.9%) were more likely to approve of euthanasia than PSs (38.3%) (P<.05). The legalization of euthanasia was favored by 43.7% of PTs, compared with 29.5% of PSs (P<.05). On the other hand, PTs and PSs expressed similar views regarding euthanasia, including reasons for accepting or opposing euthanasia and acceptable conditions for its use (P>.05). Overall results showed that sex and age had no effect on whether euthanasia was accepted (P>.05) religiousness was found to have the greatest effect on attitudes toward euthanasia (P<.05). The findings of the current study suggest that (1) the attitudes of PTs are different from those of PSs, and (2) the Islamic point of view has a negative impact on the attitudes of PTs and PSs toward euthanasia.

Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults.

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52+/-8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p<0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67+/-7.16cm) than among women (18.77+/-6.59cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging.

Upper extremities function in patients undergoing hemodialysis treatment.

OBJECTIVE: To determine the effects of hemodialysis treatment on upper extremities functional ability. METHODS: This study was carried out from June 2003 to March 2004 at Pamukkale University School of Physical Therapy, Denizli, Turkey. One hundred patients with chronic renal failure (CRF) undergoing hemodialysis treatment for at least 2 months participated in the study, and were compared with a control group (N=40 healthy subjects). The 100 patients were divided into 4 groups according to the length of hemodialysis duration: 19 patients dialyzing for less than one year (Group 1); 42 patients dialyzing for 1-4 years (Group 2); 21 patients dialyzing for 4.1-8 years (Group 3); 18 patients dialyzing for 8.1 or more years (Group 4). All participants were evaluated for range of motion by goniometry, muscle strength by manual muscle testing, sensation disturbances by Semmes-Weinstein monofilaments, static grip strength by hand dynamometer, and functional status of upper limbs by the Disabilities Arm Shoulder Hand Questionnaire (DASH-T). RESULTS: The results showed that the patients with CRF had significantly more functional problems associated with CRF and hemodialysis treatment than the healthy controls. In addition to these results, the scores of the DASH-T also showed that the most independent group was the control group with a mean score of 0.72+/-0.86, whereas, the most dependent group was the 3rd group of the hemodialysis groups (mean score of 2.70+/-1.77). CONCLUSION: Musculoskeletal or functional problems decreasing functional ability of the upper limbs are a common complaint in hemodialysis patients.