"Being in the digital box". Academic staff experiences in online practical teaching: A qualitative study from six universities and countries.

The COVID-19 pandemic has caused radical changes in education, as in everything else, bringing many challenges. Despite all the difficulties, the COVID-19 pandemic has enormous opportunities for online teaching and the use of digital technologies. A comprehensive understanding of this period is needed to investigate these opportunities. Thus, this study aims to explore the academic staff's experiences of online teaching and the use of digital technologies in practical skills-based courses in health care education. This study was conducted at six universities from six countries (Türkiye, Sweden, Finland, Portugal, Latvia, Lithuania). Data were collected between June 17, 2021 and November 30, 2021 via a focus group with an in-depth interview technique. 22 focus group interviews were conducted with a total of 117 participants. Colaizzi's method was used to evaluate the data to discover, comprehend, and define the experiences of academic staff. The analysis of the interview data resulted in 6 themes, 25 subthemes and 56 categories that captured participants' experiences regarding online teaching of practical skills and using digital technologies in health care education. The findings of the study provide crucial information that will help online teaching and digital technology for practical skills be successfully integrated.

Investigation of physical activity, fear of falling, and functionality in individuals with lower extremity lymphedema.

PURPOSE: To investigate the fear of falling, physical activity, and functionality in patients with lymphedema in the lower extremities. METHODS: Sixty-two patients who developed stage 2-3 lymphedema in the lower extremities due to primary or secondary causes (age: 56.03 ± 7.83 years) and 59 healthy controls (age: 54.61 ± 5.43 years) were included in the study. The sociodemographic and clinical characteristics of all individuals included in the study were recorded. In both groups, fear of falling was evaluated with the Tinetti Falls Efficacy Scale (TFES), lower extremity functionality with the Lower Extremity Functional Scale (LEFS), and physical activity with the International Physical Activity Questionnaire-Short Form (IPAQ-SF). RESULTS: There was no statistically significant difference between the demographic characteristics of the groups (p > 0.05). The primary and secondary lymphedema groups had similar LEFS (p = 0.207, d = 0.16), IPAQ (p = 0.782, d = 0.04), and TFES (p = 0.318, d = 0.92) scores. However, the TFES score of the lymphedema group was significantly higher than that of the control group (p < 0.01, d = 0.52), while the LEFS (p < 0.01, d = 0.77) and IPAQ scores (p = 0.001, d = 0.30) were significantly higher in the latter. There was a negative correlation between LEFS and TFES (r = -0.714, p < 0.001) and between TFES and IPAQ (r = -0.492, p < 0.001). LEFS and IPAQ were positively correlated (r = 0.619, p < 0.001). CONCLUSION: It was determined that individuals with lymphedema developed a fear of falling, and their functionality was negatively affected. This negative effect on functionality can be attributed to reduced physical activity and an increased fear of falling.

Acute effects of instrument assisted soft tissue mobilization technique on pain and joint position error in individuals with chronic neck pain: a double-blind, randomized controlled trial.

PURPOSE/AIM: The aim of this study was to determine the acute effects of IASTM on cervical joint position error and pain in individuals with chronic neck pain. METHODS: A total of 39 individuals with chronic neck pain were included in this study. Participants were randomized into three groups: Instrument-assisted soft-tissue mobilization(IASTM (n = 13), sham (n = 13), and control (n = 13). In the IASTM group, intervention was applied to the sternocleidomastoid and trapezius muscles with an application time of 45 s and a frequency of 60 beats/min. In the sham group, IASTM was applied at a 90° angle without pressure. The control group did not receive any intervention. The pain severity and joint position error(JPE) were evaluated before and after the intervention, by using the visual analogue scale and a cervical range of motion device. RESULTS: The effects of time and treatment group on visual analogue scale(VAS) score were statistically significant (p = .001). Instrument-assisted soft-tissue mobilization was more effective in VAS score than sham and control group (p < .001). Significant improvement was found in JPE in all range of motions of the cervical region in the instrument-assisted soft-tissue mobilization group (p < .05). In the sham group, significant improvements were observed in cervical extension, left rotation, and left lateral flexion movements in JPE during each cervical spine active movement (p < .05). Instrument-assisted soft-tissue mobilization group was more effective in JPE all directions than sham and control group. CONCLUSIONS: Instrument-assisted soft-tissue mobilization may be a useful technique in individuals with chronic neck pain. Instrument-assisted soft-tissue mobilization decreases VAS and improves JPE. CLINICAL TRIAL REGISTRATION NUMBER: NCT04882397 (05 August 2021).

Organ Donation Decisional Balance Survey: Reliability and Validity of the Turkish Version

OBJECTIVES: Despite the positive view about organ donation in our society, many people remain reluctant to donate. Identifying the perceived advantages and disadvantages and raising awareness about organ donation may help promote willingness for eligible people to become donors. Our aim was to determine the validity and reliability of the Organ Donation Decisional Balance Survey for the Turkish community in order to implement the transtheoretical model of behavior change and to emphasize the positive aspects of organ donation during the process of decision making. MATERIALS AND METHODS: A total of 420 adults, including 304 women and 116 men, voluntarily participated in the study. A personal information form, now known as the Organ Donation Decisional Balance Survey, and the Compassion of Others' Lives scale were used to evaluate the participants. Confirmatory factor analysis was used to examine the factor structure of the questionnaire. All data were analyzed with confirmatory factor analysis using the Amos 16 programs. RESULTS: Analysis results showed that the fit index values of the survey were acceptable (P < .01). Factor loads of the survey for the advantages subdimension were between 0.53 and 0.78, and the factor loads for the disadvantages subdimension were from 0.46 to 0.75. Internal consistency of these 2 components resulted in an acceptable Cronbach alpha value. We also identified a positive correlation between the advantages score and the Compassion of Others' Lives scale score. CONCLUSIONS: This survey can guide those who prepare training programs on organ donation by highlighting positive thoughts and reducing negative judgments. The Turkish version of the Organ Donation Decisional Balance Survey is acceptable, valid, and reliable.

Challenges and needs of informal caregivers in elderly care: Qualitative research in four European countries, the TRACE project.

BACKGROUND: Providing informal care may affects caregivers' life in different ways. Determining the needs of caregivers and supporting them can improve both the quality of life of the caregivers, as well as the elderly they take care of. OBJECTIVE: To explore the experiences and needs of the informal caregivers in four countries. DESIGN: Qualitative research method was used in the study. METHODS: The qualitative data was collected through focus groups and individual interviews between December 2016-May 2017. In all countries interviews were conducted in the mother language of the informants. Informants of the qualitative research were adult people who take primary care of an individual with chronic diseases, aged 65 years or older. Data were collected from 72 informal caregivers from four European countries. Inductive content analysis was performed. RESULTS: Informal caregivers identified 2 themes, 5 subthemes, 19 categories and 7 subtcategories. The themes highlighted two major issues: informal caregiver's challenges and needs related to the management of care of elderly and caregivers' personal needs. CONCLUSION: The important and charming results of the present study are, difficulties of managing caregiver's own life, and coping with emotions are common in four countries. Identifying challenges and needs of informal caregivers enable healthcare professionals to develop care strategies and plan interventions focused to support and help to reduce the burden of care for elderly with chronic diseases.

Reliability and Validity of the Turkish Version of Illness Cognition Questionnaire.

Background: This study aimed to determine the validity and reliability characteristics of the Illness Cognition Questionnaire (ICQ). Methods: A total of 205 patients who had pain related to chronic musculoskeletal diseases were referred to the study. In order to test the validity, Short Disease Perception Scale (SDPS), Hospital Anxiety and Depression Scale (HADS) were administered together with the ICQ. Confirmatory factor analysis was used to measure the construct validity of the ICQ, and convergent and divergent validities were evaluated using Pearson correlation analysis. In order to achieve the test-retest reliability of the questionnaire, 81 patients re-applied the questionnaire after two days. Cronbach's alpha internal consistency and test-retest reliability coefficients were calculated to determine the reliability level of the questionnaire. Results: The factor loadings of the ICQ helplessness subscale ranged from 0.784 to 0.853, the acceptance subscale ranged from 0.583 to 0.855, and the perceived benefits subscale ranged from 0.733 to 0.794. Internal consistency coefficients of the ICQ were found α = 0.929 for the helplessness subscale, α = 0.868 for the acceptance subscale, and α = 0.896 for perceived benefits subscale. The results of the analysis showed that there was a statistically significant positive correlation between the initial measurement of helplessness sub-scale and the retest helplessness subscale at 0.697 level (p < .05). A statistically significant positive correlation was determined between the test and the retest of acceptance sub-scale at 0.465 level (p < .05). A statistically significant positive correlation was found between the first test of the perceived benefits sub-scale and the retest test at the 0.661 level. Conclusion: The Turkish version of the ICQ was found to be valid and reliable. It is a measurement tool that could be used easily in clinics because of its short application time and easy to understand. We think that ICQ which provides a new awareness in the perception of disease in Turkish society should be examined in different diseases and age groups.

Is training for informal caregivers and their older persons helpful? A systematic review.

BACKGROUND: The steady increase in the number of people suffering from chronic diseases and increasing life expectancy raises new demands on health care. At the same time, the need for informal caregivers is increasing. This study aims to perform a systematic review of the methodologies used to identify effect of different types of training on informal caregivers and their older persons. METHODS: MEDLINE (PubMed), CINAHL and Ovid were searched from December 2016 and April 2017. The following keywords were used; "informal caregiver", "training" "elderly", older persons". Identified publications were screened by using the following inclusion criteria; systematic reviews, randomized controlled trials, prospective cohort and multicentre studies, English language full text journals, samples or interventions that included caregivers of older persons and published in last 10 years. RESULTS: Twenty four studies (12 randomised control trials, 8 intervention studies and 4 systematic reviews) were included. Most of the randomized controlled trials involved both caregivers and elderly. Pretests and post-tests were used in intervention studies (5 out of the 8 studies). ICT-based, psychosocial interventions on family caregivers' education program for caregivers were applied. Caregivers following a supportive educative learning had a significantly better quality of life. CONCLUSIONS: The findings of this systematic review suggest that support interventions for caregivers can be effective in reducing caregivers' stress, with a consequent improvement of the quality of care. However, results are based on relatively small studies, reporting somewhat controversial findings supporting the need to perform further research in this field.

Relationship Between Exercise Perception With Physical Activity Level, Body Awareness, and Illness Cognition in Renal Transplant Patients: A Pilot Study.

OBJECTIVES: Transplantation offers better quality of life and long-term survival benefits. Further knowledge is needed regarding exercise in daily life of transplant recipients. Here, we investigated the relationship between exercise perception and physical activity level, body awareness, and illness cognition in renal transplant patients. MATERIALS AND METHODS: Our study included 53 renal transplant recipients (Standardized Mini-Mental Test score = 26.35 ± 1.36; age = 41.11 ± 13.52 year, body mass index = 25.96 ± 5.26 kg/m², elapsed time after transplant = 3.68 ± 1.53 year). Perceived benefits and barriers to exercise, physical activity level, body awareness, and illness cognition were assessed with the Exercise Benefits/Barriers Scale, International Physical Activity Questionnaire, Body Awareness Questionnaire, and Patient Illness Perception Questionnaire, respectively. Correlations were established with Spearman test for nonparametric data, with regression analysis used to find determinants of physical activity levels. RESULTS: We observed correlations between physical activity level and perceived benefits and barriers to exercise. There was a positive relationship between body awareness and perceived benefits and barriers to exercise and also illness cognition, with significant correlation between perceived benefits and barriers to exercise and illness cognition (P < .05). Perceived benefits and barriers to exercise (P = .006, R = 0.373, R2 = 0.139, beta = 0.373, t = 2.867, F = 8.22) were determining factors for physical activity level. CONCLUSIONS: Psychologic and physical factors, including negative emotions and body dissatisfaction, are risk factors for poor quality of life. Although it is important to increase quality of life, tools to enhance body awareness and to develop strategies to alter motor behaviors in daily living activities are needed. Treatment and assessment strategies on body awareness and illness perception should be considered, with emphasis on the importance of physical activity posttransplant.

The effects of Clinical Pilates exercises on patients with shoulder pain: A randomised clinical trial.

AIM: The purpose of this study was to determine the effect of Clinical Pilates exercises on patients with shoulder pain. MATERIAL AND METHODS: Thirty-three patients, experiencing shoulder pain continuously for at least four weeks were selected as study subjects. The patients were randomly divided into two groups, namely Clinical Pilates exercise (n = 17) group and conventional exercise (n = 16) group. The patients were treated for five days a week, the total treatment being carried out for 10 days. The assessment of pain and disability amongst the patients were done at the baseline and at the end of the treatment sessions, using Visual Analogue Scale (VAS) and Shoulder Pain and Disability Index (SPADI). RESULTS: The clinical Pilates exercise group showed a significant improvement in all scores used for assessment (p < 0.05), while the conventional exercise group demonstrated a significant improvement only in the SPADI total score (p < 0.05). A comparison of scores for the VAS, SPADI-Pain and SPADI-Total between the two groups, revealed a significant improvement in the Clinical Pilates exercise group (p < 0.05). CONCLUSION: It was demonstrated by the study that Clinical Pilates exercise is an efficient technique for patients experiencing shoulder pain, as it helps reduce pain and disability among them.

Comparison of upper extremity function, pain, and tactile sense between the uneffected side of hemiparetic patients and healthy subjects.

[Purpose] The aim of this study was to compare the unaffected upper extremity of patients with hemiparesis with that of healthy subjects in terms of function, pain, and tactile sense. [Subjects and Methods] Upper extremity evaluation parameters of 20 patients with hemiparesis were compared with an age-matched control group of 20 healthy subjects. A shorter version of the Disability of Arm and Shoulder Questionnaire, Upper Extremity Functional Index, and Simple Shoulder Test were used to evaluate the upper extremity functionality. The Visual Analog Scale was used to measure pain severity at rest, at night, and during activity. Tactile sensation levels were assessed by Semmes-Weinstein monofilaments at four palmar areas. [Results] A statistically significant difference was found in the upper extremity functionality between the groups. Pain severity at rest was significantly higher in the hemiparetic group. There was no significant difference in night and activity pain severities or tactile sensation levels between the groups. [Conclusion] According to our results, the unaffected side of patients with hemiparesis differs in functionality and pain at rest compared with that of healthy persons. Studies with larger sample size and various evaluation tests are needed to further investigate the unaffected side of patients with hemiparesis.

The effects of scapular mobilization in patients with subacromial impingement syndrome: a randomized, double-blind, placebo-controlled clinical trial.

OBJECTIVE: To determine the effects of scapular mobilization on function, pain, range of motion, and satisfaction in patients with subacromial impingement syndrome (SAIS). DESIGN: Randomized, double-blind, placebo-controlled clinical trial. SETTING: University hospital clinics in Turkey. PARTICIPANTS: 66 participants (mean ± SD age 52.06 ± 3.71 y) with SAIS. INTERVENTIONS: Participants were randomized into 3 groups: scapular mobilization, sham scapular mobilization, and supervised exercise. Before the interventions transcutaneous electrical stimulation and hot pack were applied to all groups. Total intervention duration for all groups was 3 wk with a total of 9 treatment sessions. MAIN OUTCOME MEASURES: Shoulder function and pain intensity were primary outcome measures; range of motion and participant satisfaction were secondary outcome measures. Shoulder function was assessed with the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). A visual analog scale was used to evaluate pain severity. Active range of motion was measured with a universal goniometer. A 7-point Likert scale was used to evaluate satisfaction. Outcome measurements were performed at baseline, before visits 5 and 10, 4 wk after visit 9, and 8 wk after visit 9. RESULTS: There was no group difference for DASH score (P = .75), pain at rest (P = .41), pain with activity (P = .45), pain at night (P = .74), and shoulder flexion (P = .65), external rotation (P = .63), and internal rotation (P = .19). There was a significant increase in shoulder motion and function and a significant decrease in pain across time when all groups were combined (P < .001). The level of satisfaction was not significantly different for any of the questions about participant satisfaction between all groups (P > .05). CONCLUSION: There was not a significant advantage of scapular mobilization for shoulder function, pain, range of motion, and satisfaction compared with sham or supervised-exercise groups in patients with SAIS.

The Upper Extremity Functional Index (UEFI): cross-cultural adaptation, reliability, and validity of the Turkish version.

BACKGROUND: Turkish version of the Upper Extremity Functional Index (UEFI) may help to assess shoulder function in patients with shoulder impingement syndrome (SAIS). OBJECTIVE: To translate and cross-culturally adapted UEFI into Turkish and to assess its acceptability, reliability, validity in patients with SAIS. METHODS: This study conducted with 93 SAIS participants. UEFI, the short version of the Disability of the Arm, Shoulder and Hand scale (Quick DASH), the Shoulder Pain and Disability Index, and the Short Form-36 Health Survey (SF-36) were administered. Acceptability was assessed in terms of refusal rate, rates of missing responses, and administration time. Test-retest reliability was assessed with intra class correlation coefficient (ICC), internal consistency was assessed with Cronbach's alpha coefficient. Validity was assessed by floor and ceiling effects, skew of distributions and Pearson's correlation coefficients. RESULTS: Cronbach's alpha coefficients for the UEFI at Time 1 and Time 2 were as follows: α = 0.89 and α = 0.89. Average measure ICC was 0.80. The UEFI score demonstrated strong negative correlations with SPADI total score and Quick DASH score. There was not a significant correlation between the UEFI and mental health subscale score derived from SF-36. CONCLUSIONS: The Turkish version of UEFI is acceptable, valid, and reliable.

Scapular resting position, shoulder pain and function in disabled athletes.

BACKGROUND: Despite the fact that the number of disabled individuals participating in sports is increasing, there are only sparse reports in the literature concerning overuse injuries. OBJECTIVES: The purpose of this study was to compare scapular resting position, shoulder pain, and function in wheelchair basketball, amputee soccer, and disabled table tennis players. STUDY DESIGN: Descriptive study. METHODS: A total of 63 disabled players from amputee soccer, wheelchair basketball, and disabled table tennis participated in our study. Scapular resting position was taken as primary outcome; pain and function were taken as secondary outcome measurements. Scapular resting position was evaluated with Lateral Scapular Slide Test. Visual Analog Scale was used for evaluating shoulder pain intensity. Quick disabilities of the arm, shoulder, and hand questionnaire were used to assess upper extremity function. RESULTS: There was a significant difference in shoulder pain, function, and scapular resting position in all groups (p < 0.05). Paired comparisons between amputee soccer and wheelchair basketball players and also amputee soccer and disabled table tennis showed difference for all measurement parameters (p < 0.05). CONCLUSION: When the results are evaluated, it may be stated that amputee soccer players have better scapular resting position than other sports. Crutch usage may not negatively affect scapular resting position and perceived function as much as wheelchair usage. Exercise techniques for shoulder and resting position could be included in training programs of disabled athletes. CLINICAL RELEVANCE: Wheelchair/crutch usage is a risk, and special exercise techniques for shoulder and dyskinesis could be included in training programs to prevent injury. However, it may not just be important for wheelchair athletes, it may also be important for amputee soccer players. In particular, total upper extremity evaluations and exercises could be added within exercise programs.

Is there a relationship between core stability, balance and strength in amputee soccer players? A pilot study.

BACKGROUND: The body is a kinetic chain and all the systems and muscle groups play important roles in this chain. Core stability, strength and balance are important components of performance within many sports, and in particular soccer. However, the relationship between these components is not fully understood. OBJECTIVES: To investigate the relationship between core stability, balance and strength in amputee soccer players. STUDY DESIGN: Clinical pilot trial. METHODS: Eleven amputee soccer players (mean age = 24.63 ± 6.48 years) participated in our study. A Kinesthetic Ability Trainer device was used to assess balance. Trunk strength was evaluated by isokinetic dynamometer. Gillet test was used to evaluate the sacroiliac joint movement. Modified plank test was used to determined dynamic core stability. Disability was evaluated using the Oswestry Disability Index. RESULTS: The results showed that there was a correlation between flexor isokinetic trunk muscle strength at the velocity of 60°/sec and modified plank test (r = 0.630, p = 0.038). There was a negative correlation between flexor isokinetic trunk muscle strength at the velocity of 180°/sec and Oswestry Disability Index score (r = -0.649, p = 0.031). CONCLUSIONS: Amputee soccer is a sport which is generally performed with one limb balance with crutches. It is therefore perceived that a relationship between balance and sacroiliac mobility, and should be considered for evaluation process and performance analysis in amputee soccer. However, in future studies, we recommend that such evaluations on amputee soccer players should be carried out with increased numbers.

Descriptive analysis of pitch volume in southeastern conference baseball pitchers.

BACKGROUND: Representative data on typical pitch volume for collegiate pitchers functioning in their specific roles is sparse and is needed for training specificity. OBJECTIVE: To report pitch volumes in Division I collegiate pitchers. The authors hypothesize that pitcher role will result in different pitch volumes. METHODS: Pitchers from twelve Division I collegiate baseball teams pitch volume during the 2009 baseball season was retrospectively reviewed through each team's website. The number of pitches and innings pitched for each pitcher were recorded. Pitchers were categorized based on their role as "Starter-only" (n=15), "Reliever-only" (n=76), or "Combined Starter/Reliever" (n=94) and compared using ANOVA. RESULTS: "Starter-only" pitchers threw the most pitches (97±10) and pitched the most innings (6.0±1.0) per appearance (p=<.001). "Combined Starter/Reliever" functioning as a starter threw significantly more pitches (68±19) and pitched more innings (4.0±1.3) per appearance compared to "Combined Starter/Reliever" functioning as a reliever and "Reliever-only" pitchers (p=<.001). The cumulative volume during a 13 week regular season revealed that "Starter-only" pitchers threw significantly more total pitches (1204±387) compared to "Combined Starter/Reliever" pitchers (613±182) who threw significantly more than "Reliever-only" pitchers (254±77) (P<.001). DISCUSSION: Pitcher's specific roles and representative volumes should be used to design training and rehabilitation programs. Comparison of this data to reported adolescent pitch volumes reveal that adolescent pitch volume per appearance approaches collegiate levels. CONCLUSIONS: Collegiate pitcher roles dictate their throwing volume. Starter-only pitchers (8%) throw the greatest cumulative number of pitches and should be trained differently than the majority of college pitchers (92%) who function primarily as a reliever or in combination starter/reliever roles that on average only requires approximately 40 pitches per appearance.

Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial.

OBJECTIVE: The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function. DESIGN: Pretest-posttest for 3 groups (SM, sham, and control). SETTING: A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic. PARTICIPANTS: 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y). INTERVENTIONS: A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program. MAIN OUTCOME MEASURES: Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function. RESULTS: After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05). CONCLUSIONS: SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

Comparing hot pack, short-wave diathermy, ultrasound, and TENS on isokinetic strength, pain, and functional status of women with osteoarthritic knees: a single-blind, randomized, controlled trial.

OBJECTIVE: To investigate the therapeutic effects of physical agents administered before isokinetic exercise in women with knee osteoarthritis. DESIGN: One hundred patients with bilateral knee osteoarthritis were randomized into five groups of 20 patients each: group 1 received short-wave diathermy + hot packs and isokinetic exercise; group 2 received transcutaneous electrical nerve stimulation + hot packs and isokinetic exercise; group 3 received ultrasound + hot packs and isokinetic exercise; group 4 received hot packs and isokinetic exercise; and group 5 served as controls and received only isokinetic exercise. RESULTS: Pain and disability index scores were significantly reduced in each group. Patients in the study groups had significantly greater reductions in their visual analog scale scores and scores on the Lequesne index than did patients in the control group (group 5). They also showed greater increases than did controls in muscular strength at all angular velocities. In most parameters, improvements were greatest in groups 1 and 2 compared with groups 3 and 4. CONCLUSIONS: Using physical agents before isokinetic exercises in women with knee osteoarthritis leads to augmented exercise performance, reduced pain, and improved function. Hot pack with a transcutaneous electrical nerve stimulator or short-wave diathermy has the best outcome.

Effect of trunk-muscle fatigue and lactic acid accumulation on balance in healthy subjects.

OBJECTIVE: This study sought to determine the effects of trunk-muscle fatigue and blood lactic acid elevation on static and dynamic balance. INTERVENTION: Fatigue was induced by an isokinetic protocol, and static and dynamic balance were assessed during bilateral stance using a Kinesthetic Ability Trainer. Subjects participated in a fatigue protocol in which continuous concentric movements at 60 degrees/s were performed until the torque output for both trunk flexion and extension dropped below 25% of the calculated peak torque for 3 consecutive movements. MEASURES: Before and immediately after the fatigue protocol, blood lactic acid measurements and static- and dynamic-balance measurements were recorded. RESULTS: An increase in lactic acid levels was detected in all subjects. According to a dependent-samples t test, significant differences in balance and lactic acid values were found after the fatigue protocol. There was no correlation between lactic acid accumulation (change between prefatigue and postfatigue levels) and balance-score differences. CONCLUSION: Trunk-muscle fatigue has an adverse effect on static and dynamic balance.