Investigation of Joint Position Sense and Balance in Individuals With Chronic Idiopathic Neck Pain: A Cross-Sectional Study.

OBJECTIVE: The aim of this study was to determine the relationship between joint position sense and static and dynamic balance in female patients with chronic neck pain compared with healthy controls. METHODS: The study sample comprised 25 female patients with chronic neck pain and 25 healthy (asymptomatic) female controls. Pain severity with the visual analog scale, joint position sense with the laser pointer method, static balance with the Single-Leg Balance Test, and dynamic balance with the Y Balance Test were assessed. RESULTS: The deviation in cervical joint position sense was greater in extension (P < .001), right rotation (P < .001), and left lateral rotation (P < .05) in the patients with chronic neck pain compared with the healthy controls. The results of the patients with chronic neck pain were worse than the healthy controls in the Single-Leg Balance Test with both eyes open (P < .05) and eyes closed (P < .05). The patients with chronic neck pain had worse dynamic balance only in the anterior direction reach of the left leg (P < .05). CONCLUSION: Cervical joint position sense and static balance were worse in female patients with chronic idiopathic neck pain when compared with asymptomatic controls. Dynamic balance in all other directions except for the anterior direction was not negatively affected in individuals with chronic idiopathic neck pain.

Body awareness and chronic low back pain: validity and reliability study of Turkish version of body awareness rating scale

Background/aim: Previous studies reported that patients with chronic low back pain (CLBP) had trouble describing senses or body functions. A questionnaire, the body awareness rating questionnaire (BARQ), was recently developed for assessing body awareness. The aim of the study was to develop a Turkish version of the BARQ and investigate the validity and reliability in patients with CLBP. Materials and methods: BARQ translated to Turkish with forward-backward method. Ninety-nine patients with CLBP and 101 healthy controls (HC) completed the BARQ-T. Fifty-one of patients with CLBP and HC repeated BARQ-T 3 days later. In addition to BARQ-T, Oswestry disability index (ODI), pain severity, short form 36 (SF-36) and Toronto alexithymia scale (TAS) were administered. Results: The current study found good-excellent Cronbach's alpha values for patients with CLBP (α: between 0.883­0.967) and acceptable-good Cronbach's alpha values for HC (α: between 0.649­0.825) in factors of BARQ-T. ICC values for test-retest validity were found to be good-excellent for patients with CLBP in all factors. BARQ-T was positively correlated with SF-36 and negatively correlated with ODI and TAS (P < 0.05). Conclusion: The study confirmed that the BARQ-T has acceptable validation and reliability in terms of pain perception and pain assessment in the Turkish CLBP community.

The effect of single-limb exercises on functional exercise capacity, pulmonary function and dyspnea in patients with COPD.

BACKGROUND: Aeorobic exercise is an essential component of the pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). Single-limb exercises are a type of aeorobic exercise that aims to increase patient tolerance by reducing the workload of the respiratory system. OBJEKTIVES: The aim of our systematic review was to determine the effects of single-limb exercises on pulmonary function, dyspnea, fatigue, and muscle dysfunction in patients with COPD. METHODS: Searches were performed using PubMed, Pedro, Google Scholar, MEDLINE, EMBASE, Scopus, Cochrane Library, Web of Science databases. Publications from the beginning to 2023 searched. Studies were selected by two authors by scanning the title, Mesh terms abstract in Rayyan QCRI software. Selected studies were subjected to full-text screening by applying selection criteria. Randomized controlled, case-control, cohort studies were included. RESULTS: In the first screening according to mesh terms, 1011 articles were identified. After the screening criteria and duplicate articles were evaluated, 10 articles were included. This systematic review includes seven case-control, one randomized control trial (RCT), one cross-sectional, and one non-randomized study. A total of 157 patients with COPD received treatment in these studies. According to the Bakker scale, single-limb exercises have been shown to improve pulmonary function with strong evidence. There is strong evidence that single-limb exercises have no effect on dyspnea and fatigue in COPD patients. There is limited evidence that single-limb exercises have an effect on functional exercise capacity. CONCLUSION: Single-limb exercise can advised in terms of improving pulmonary function in patients with COPD. Current systematic review has found single limb exercise has no effect on dyspnea and fatigue perception. No side effects were reported in the studies and these exercises can be considered safe.

Determination of cognitive status and influencing variables in patients with chronic neck pain: A cross-sectional study.

OBJECTIVES: This study aimed to evaluate cognitive function in individuals with chronic neck pain (CNP) and investigate the effects of different variables on cognition. METHODS: The sociodemographic characteristics of the individuals who participated in this study were recorded. Pain intensity of the individuals was evaluated using the Visual Analog Scale, pain-related disability was evaluated with the Neck Disability Index and cognitive function was evaluated using Montreal Cognitive Assessment (MoCA). RESULTS: For this study, 95 patients with CNP were recruited. The mean age was 45.61 ± 11.14, and the median MoCA score was 24 (20-26), and 64.2% of the patients scored below the original cutoff (<26/30 points). The regression analysis showed that higher age and lower education levels were associated with lower MoCA scores. Education appeared to be the most influential variable. Younger participants (18-45) performed systematically better on naming, attention and language domains than their older counterparts (over 45). CONCLUSIONS: The findings suggest that age and education play an important role in MoCA total and domain scores in these patients. While treating these patients, assessment of cognitive function can be useful for effective pain management.

Education level is a strong determinant of cognitive function as measured by MoCA in people with chronic low back pain.

BACKGROUND: Over recent years there has been increasing clinical interest in the relationship between chronic pain and cognitive function. There are very few studies on individuals with low back pain (LBP) in the literature, which has remained under-researched. OBJECTIVES: This study aimed to evaluate cognitive function in individuals with chronic back pain and investigate the effects of different variables on cognition. DESIGN: Cross-sectional study. METHODS: In this study, 115 individuals with chronic low back pain (CLBP) participated. The sociodemographic characteristics of the individuals who participated were recorded, including age, sex, weight, height, education and pain duration. Pain intensity of the individuals was evaluated using the Visual Analog Scale, functional status was evaluated with the Oswestry Disability Index, and cognitive function was evaluated using Montreal Cognitive Assessment (MoCA). RESULTS: One hundred fifteen individuals with CLBP were recruited. The mean age was 48.4±11.8, and the mean MoCA score was 22.9±4.4. MoCA scores were associated with education, age, gender and pain intensity. CONCLUSIONS: The findings obtained in the current study showed that individuals with CLBP had low MoCA scores and cognitive function was affected. In individuals with CLBP, cognitive function was affected depending on education level, age and intensity of pain. Assessment of the cognitive function in pain management can be useful for clinicians interested in LBP.

Limited Association between the Total Healthy Eating Index-2015 Score and Cardiovascular Risk Factors in Individuals with Long-Standing Spinal Cord Injury: An Exploratory Study: An Exploratory Study.

BACKGROUND: The healthy eating index-2015 (HEI-2015) reflects diet quality in reference to the 2015-2020 Dietary Guidelines for Americans (DGA). Little is known regarding its application in individuals with chronic spinal cord injury (SCI). OBJECTIVE: To explore the relationship between diet quality as assessed by the HEI-2015 and cardiovascular risk factors among individuals with chronic SCI. DESIGN: This is a cross-sectional analysis of baseline data collected from August 2017 through November 2019 for an interventional study that evaluates the effects of a high-protein/low-carbohydrate diet on cardiovascular risk factors in individuals with chronic SCI at the University of Alabama at Birmingham. PARTICIPANTS/SETTING: Twenty-four free-living adults with SCI (mean age, 45 ± 12 y; 8F/16M, level of injury: nine cervical, 15 thoracic; mean duration of injury: 20 ± 13 y) were included. MAIN OUTCOME MEASURES: Participants underwent a 2-hour oral glucose tolerance test (OGTT) and a dual-energy x-ray absorptiometry scan. Dietary intake was assessed by three, 24-hour multiple-pass dietary recalls to calculate the HEI-2015 using the simple HEI scoring algorithm method. DATA ANALYSIS: Multiple linear regression analyses were performed to predict indices of lipid metabolism and glucose homeostasis and C-reactive protein (CRP) from the HEI-2015. Principal component analysis was used to reduce the number of covariates (level of injury, sex, and body fat percentage). RESULTS: On average, participants' diets were of low quality (HEI-2015, 47.2 ± 10.8). The regression models for fasting glucose (FG), cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and CRP had moderate to large effect sizes (adjusted R2 ≥ 13%), suggesting good explanatory abilities of the predictors. Small or limited effect sizes were observed for glucose tolerance, fasting insulin, triglycerides, and Matsuda index (adjusted R2 < 13%). The HEI-2015 accounted for a moderate amount of variation in FG (partial omega-squared, ωP2 = 13%). Each 10-point HEI-2015 score increase was associated with a 3.3-mg/dL decrease in FG concentrations. The HEI-2015 accounted for a limited amount of variation in other indices (ωP2 < 5%). CONCLUSIONS: Among participants with SCI, higher conformance to the 2015-2020 DGA was 1) moderately associated with better FG homeostasis; and 2) trivially associated with other cardiovascular risk factors. Because of the small sample size, these conclusions cannot be extrapolated beyond the study sample. Future larger studies are warranted to better understand the relationship between diet quality and cardiovascular disease risks in this population.

Evaluation of a ketogenic diet for improvement of neurological recovery in individuals with acute spinal cord injury: study protocol for a randomized controlled trial.

BACKGROUND: Therapies that significantly improve the neurological and functional recovery of individuals with spinal cord injury (SCI) are still urgently needed. The ketogenic diet (KD) has been shown to improve forelimb motor function in an SCI rat model, likely by reducing inflammation and cell death in the spinal cord. Furthermore, our recent pilot study in patients with SCI showed that, compared with a standard hospital diet (SD), 5 weeks of KD started during acute care improved upper extremity motor function and reduced serum levels of a neuroinflammatory blood protein. The primary goals of the current study are to: 1) show the safety and feasibility of administering a KD during acute care for SCI; 2) determine if consuming 5 weeks of a KD significantly improves motor and sensory functions, functional independence and glycemic control; and 3) quantify serum biomarkers that are linked to improvements in neurological recovery and functional independence via targeted proteomics. METHODS/DESIGN: In a single-masked, longitudinal, randomized, parallel-controlled study, a total of 60 eligible, acutely traumatic spinal cord injured (cervical 5 to thoracic 12) participants ranging in age from 18 to 60 years with American Spinal Injury Association impairment scale (AIS) grades A-C (AIS-A, sensorimotor complete; AIS-B, sensory incomplete/motor complete; and AIS-C, nonfunctional motor incomplete) are being enrolled. Neurological and functional examinations, resting energy expenditure, blood, urine, and stool collections, and protein analyses related to neurological recovery will be performed within 72 h of injury (baseline measure) and repeated after 5 weeks of KD or SD (discharge measure). We anticipate a completion rate of 80% with a total of 48 participants. DISCUSSION: Intervention with a more neuroprotective diet during acute care of SCI can be implemented anywhere in the world at low cost and without major regulatory hurdles. Better functional recovery will lead to a better quality of life and long-term health outcomes in individuals with SCI. While this study targets SCI, if successful it has the potential to improve neurological outcomes for individuals with various traumatic injuries. TRIAL REGISTRATION: NCT03509571 Registered on April 28, 2018.

The effect of minimal invasive techniques and physiotherapy on pain and disability in elderly: A retrospective study.

BACKGROUND: Low back pain is one of the major musculoskeletal problems seen in elderly, and it's the fifth common cause for hospitalization. OBJECTIVE: This retrospective study has determined whether minimal invasive techniques or physiotherapy methods are effective for decreasing pain and improving functions in the geriatric population. METHODS: A retrospective design was used in this study. Sixty-one patients aged ⩾ 65, who were referred to physiotherapy enrolled in the study. The patients were divided into 2 groups; Group 1 received minimal invasive techniques, whereas Group 2 had no surgery or no minimal invasive application. Pressure Pain Threshold (PPT) was used for perceived pain intensity, Semmes Weinstein Monofilaments (SWM) was used to assess tactile sensitivity, and Oswestry Disability Index (ODI) was used to determine perceived functional disability. Physiotherapy methods including soft tissue mobilizations, muscle-energy techniques and spinal stabilization exercises were used in the treatment of all patients. The outcomes were evaluated pre- and post-physiotherapy applications. RESULTS: Significant improvements in PPT were shown in both groups after physiotherapy treatment as to baseline (p< 0.05). Despite the significant improvements in PPT values of all muscles in Group 1, Group 2 had significant improvements in PPT except Hamstring muscles (p< 0.05). Functional disability levels of both groups reduced acc. to ODI, improvement in disability scores was only significant in Group 1 (p< 0.05). CONCLUSION: Although both treatments showed pain relief, functional restoration and improvement in hypoesthesia existence; there was no superiority of physiotherapy alone over physiotherapy added minimal invasive treatments in terms of parameters.

Effectiveness of physiotherapy and minimal invasive technics on functional status and quality of life in geriatric patients with low back pain.

The aim of the study was to determine the effect of physiotherapy and minimal invasive technics (MIT) on pain, quality of life and functional disability in geriatric patients with chronic low back pain. According to previous files, 61 geriatric patients who received MIT and physiotherapy allocated to group 1, the patient who received physiotherapy alone allocated to group 2. All patients received soft tissue mobilizations, muscle-energy technics and spinal stabilization exercises. Pain severity, functional disability, life quality, and fear avoidance were assessed with visual analogue scale, Oswestry Disability Index (ODI), Nottingham Health Profile (NHP) and Fear Avoidance Beliefs Questionnaire, respectively. Improvements in ODI and NHP were seen in favor of group 2 after treatment as to baseline (P<0.05). Although both treatments showed pain relief, functional restoration, and improvement in quality of life; there was no additional improvement in patients received MIT different from the patients received physiotherapy alone.

Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial.

BACKGROUND AND OBJECTIVES: The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy (NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP). METHODS: A total of twenty patients diagnosed as LHNP and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly. Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. SG received additionally NSDT different from CG. Numeric Anolog Scale, Straight leg raise test, Oswestry Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy. RESULTS: Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in SG than CG, no significant differences were found between groups and any superiority to each other (p> 0.05). CONCLUSIONS: This study showed that patients with LHNP received physiotherapy had improvement based on clinical and radiologic evidence. NSDT can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.

The effect of manual therapy and exercise in patients with chronic low back pain: Double blind randomized controlled trial.

BACKGROUND AND OBJECTIVES: To determine the effects of spinal stabilization exercises (SSE) and manual therapy methods on pain, function and quality of life (QoL) levels in individuals with chronic low back pain (CLBP). METHODS: A total of one-hundred thirteen patients diagnosed as CLBP were enrolled to the study. The patients allocated into Spinal Stabilization group (SG) and manual therapy group (MG), randomly. While SSE performed in SG, soft tissue mobilizations, muscle-energy techniques, joint mobilizations and manipulations were performed in MG. While the severity of pain was assessed with Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form 36 (SF-36) assessments were performed to evaluate the functional status and QoL, respectively. All assessments were repeated before and after the treatment. RESULTS: Intragroup analyses both treatments were effective in terms of sub parameters of pain, function and life quality (p< 0.05). Inter group analyses, there was more reduction in pain and improvement in functional status in favor of MG (p< 0.05). CONCLUSIONS: This study showed that SSE and manual therapy methods have the same effects on QoL, while the manual treatment is more effective on the pain and functional parameters in particular.