The Calculation of Motion Angles of Human Body by Inertial Sensors and Their Application in Clinical Tests

Introduction: Low back pain, knee disorders and rheumatoid arthritis are the most common musculoskeletal diseases in Iran and throughout the world. The studies conducted in the developed countries have shown that this disease has considerable effect on the functional abilities and quality of life of patients. There are a few studies about this issue in Iran. Therefore, this study aims to evaluate the effect of knee and low back pain on the functional disability and quality of life of patients resident in Tehran. Materials and Methods: 220 musculoskeletal disorders (knee and low back pain and rheumatoid arthritis) from one hospital in Tehran, Iran participated in the study. Persian versions of Arthritis Impact Measurement Scale 2-short form (AIMS2-SF) and Short form health survey (SF-12) were used to measure the functional disability and quality of life. AIMS2-SF questionnaire that has been designed exclusively for rheumatoid arthritis patients measures the functional disability of patients in five dimensions: physical (upper and lower limbs), symptoms, feelings and social condition. Results: mean age and education of patients in this study was 53(low back pain), 45 (knee pain), and 58 (RA) years old, respectively. 59% of subjects were women. Mean of physical dimensions, upper limbs, lower limbs, symptoms, feelings, and social conditions were 1.46, 1.32, 2.12, 3.65, 3.40, and 3.78 (of 10), respectively. The mean of eight dimensions of quality of life based on the SF-12 questionnaire was 43 to 64 (of 100). Conclusion: The results of this study showed that the quality of life and functional abilities of musculoskeletal disorders are influenced significantly by diseases. Based on this, the increasing of physical activity and the intensive physiotherapy programs result in improvement of quality of life in these diseases

Comparison of lumbar range of movement and lumbar lordosis in back pain patients and matched controls

Inconclusive findings have been shown in previous studies comparing lumbar range of movement (LROM) and lumbar lordosis between back pain patients and healthy subjects. In these studies, confounding variables such as age, gender, height, obesity, and pain level were usually not well controlled. The present study aimed to compare LROM and lumbar lordosis between back pain patients and matched controls. Fifteen male back pain patients and 15 age-, height-, obesity-, and physical activity-matched male controls were investigated. To minimize the effect of pain on the measurements, only patients with minimal or no pain at the time of testing were included in the study. Inclinometer technique was used for the evaluation of LROM in flexion, extension and lateral flexion as well as lumbar lordosis. A lumbar rotameter was used for measuring axial rotation. Pelvic motion was limited by a pelvic restraint device during LROM measurements. Results showed that there were no significant differences between the back pain and control groups in flexion, extension, lateral flexion and axial rotation LROM and also in lumbar lordosis. This may indicate that when a back pain patient is not in pain, LROM and lumbar lordosis may not be the measures that distinguish between back pain patients and subjects without back pain

Abdominal hollowing and lateral abdominal wall muscles' activity in both healthy men & women: An ultrasonic assessment in supine and standing positions

The objective of this study was to investigate the effects of Abdominal Hollowing (AH) maneuver on External Oblique (EO), Internal Oblique (IO) and Transversus Abdominis (TrA) muscles in both healthy men and women during the two postures of supine and upright standing. The study was conducted on 43 asymptomatic volunteers (22 males and 21 females) aged 19-44 (27.8 ± 6.4) years. Rehabilitative Ultrasonic Imaging (RUSI) was simultaneously performed to measure muscle thickness in both rest and during AH maneuvers while activation of the TrA during AH was controlled by Pressure Biofeedback (PBF) device. Mixed-model ANOVA with repeated measures design, and Pearson correlation tests were used to analyze the data. Muscle thickness of all muscles was significantly higher for male subjects (F> 6.2, p< 0.017). The interaction effect of gender and muscle status was significant only for IO (F= 7.458, p= 0.009) indicating that AH maneuver increased the thickness of IO in men. Interaction effect of posture and muscle status on muscular thickness indicated that changing position only affects the resting thickness of TrA (F= 5.617, p= 0.023). Standing posture significantly affected the TrA contraction ratio (t= 3.122, p= 0.003) and TrA preferential activation ratio (t= 2.76, p= 0.008). There was no relationship between age and muscle thickness (r= 0.262, p= 0.09). The PBF has been introduced as a clinical and available device for monitoring TrA activity, while RUSI showed that both TrA and IO muscles had activated after AH maneuver. We recommend performing further investigations using electromyography and RUSI simultaneously at more functional postures such as upright standing. © 2009

The Correlation between Intersegmental Coordination Variability and Frontal Plane Hip Kinematics during Running in Persons with Patellofemoral Pain

Background: Despite the existing evidence indicating altered hip kinematics as well as the studies showing altered movement coordination variability in persons with patellofemoral pain (PFP), there is no study investigating the correlation between hip joint kinematic and movement coordination variability in persons with patellofemoral pain (PFP).Objective: This study aims to evaluate the correlation between peak hip adduction and variability of thigh frontal-shank transverse coordination during running in persons with PFP.Material and Methods: In this cross-sectional correlational study, kinematic data were collected from 34 females (17 with and 17 without PFP) aged 18-35 years during treadmill running at preferred and fixed speeds, each for 30 s. The continuous relative phase method was used to calculate the coordination of thigh frontal-shank transverse. To calculate the deviation phase as the variability of intersegmental coordination, the standard deviation of the ensemble continuous relative phase curve points was averaged. The parameters of interest were peak hip adduction and coordination variability of thigh frontal-shank transverse. The Pearson Correlation Coefficient (r) was used to calculate the correlation between the variables.Results: The Pearson correlation coefficient showed a significant negative correlation between the peak hip adduction angle and variability of thigh frontal– shank transverse during running at both fixed (r=-0.553, P0.05).  Conclusion: The results indicated that greater adduction of the hip joint in persons with PFP during running is contributed to lesser variability of thigh frontal-shank transverse

Reliability and validity of the Persian version of Foot and Ankle Ability Measure (FAAM) to measure functional limitations in patients with foot and ankle disorders

Objective: To translate the Foot and Ankle Ability Measure (FAAM) into Persian and to evaluate the psychometric properties of the Persian version of FAAM. Methods: 93 patients with a range of foot and ankle disorders, completed the Persian version of the FAAM and Short-Form 36 Health Survey (SF-36) in the test session. With an interval of 2-6 days, 60 patients filled out the FAAM in the retest session. The FAAM is composed of two subscales including activities of daily living (ADL) and SPORTS. Internal consistency was assessed using Cronbach's alpha, test-retest reliability using intraclass correlation coefficient (ICC) and standard error of measurement (s.e.m.), item internal consistency and discriminant validity using Spearman's correlation coefficient and construct validity using Spearman's correlation coefficient and Independent t-test. Results: Cronbach's alpha coefficient of 0.97 and 0.94 was obtained for ADL and SPORTS subscales, respectively. The ICC and s.e.m. were 0.98 and 3.13 for ADL and 0.98 and 3.53 for SPORTS subscale. Items were stronger measures of their hypothesized subscale than of other subscale. The ADL and SPORTS subscales had stronger correlation with SF-36 physical function (r=0.60, 0.53) and physical health summary measure (r=0.61, 0.48) than with SF-36 mental health (r=0.21, 0.10) and mental health summary measure (r=0.36, 0.27). A high correlation was found between FAAM scores and global scale of functional status for SPORTS (r=0.73) but not for ADL (r=0.42). FAAM scores were greater in individuals who rated their function as normal or nearly normal compared with those who rated as abnormal or severely abnormal for SPORTS (P=0.04) but not for ADL (P=0.15). Conclusion: The Persian version of FAAM is a reliable and valid measure to quantify physical functioning in patients with foot and ankle disorders. © 2010 Osteoarthritis Research Society International

Reliability of center of pressure measures of postural stability in patients with unilateral anterior cruciate ligament injury

The aim of this study was to estimate the test-retest reliability of some commonly used center of pressure measures in postural control investigations of sport injuries under the diverse stressful postural conditions. Twelve patients with anterior cruciate ligament injury were evaluated on two separate sessions. The center of pressure was recorded from force platform and the following measures were calculated (1) standard deviation of amplitude (2) mean velocity (3) standard deviation of velocity (4) phase plane parameters and (5) area (95 confidence ellipse). Relative and absolute reliability was assessed using intra-class correlation coefficient and coefficient of variation, respectively. Mean velocity and total phase plane parameters were the most reliable measures having high to very high correlation across all postural conditions. The mean and range of intra-class correlation coefficient for mean velocity and total phase plane parameters were 0.88 (range: 0.80 to 0.96) and 0.81 (range: 0.71 to 0.88), respectively. Interestingly, pattern of the coefficient of variation values was, to a great extent, consistent with the intra-class correlation coefficients. Therefore, mean velocity and total phase plane parameters may be sensitive center of pressure measures to differentiate balance between Anterior Cruciate Ligament (ACL) injured patients and to evaluate the effect of a rehabilitation program in this population. © 2008 Asian Network for Scientific Information

Translation and validation study of the Iranian versions of the neck disability index and the neck pain and disability scale

STUDY DESIGN. Cultural translation and psychometric testing. OBJECTIVE. To translate and validate the Iranian versions of the Neck Disability Index (NDI-IR) and the Neck Pain and Disability Scale (NPDS-IR). SUMMARY OF BACKGROUND DATA. The widely used the NDI and the NPDS scales have not been translated and validated for Persian-speaking patients with neck pain. This was to provide a validated instrument to measure functional status in patients with neck pain in Iran. METHODS. The translation and cultural adaptation of the original questionnaires were carried out in accordance with the published guidelines. One hundred and eighty-five patients with neck pain were participated in the study. Patients were asked to complete a questionnaire booklet including the NDI-IR, the NPDS-IR, the Iranian SF-36, and a visual analog scale (VAS) of pain. To carry out the test-retest reliability, 30 randomly selected patients with neck pain were asked to complete the questionnaire booklet 48 hours later for the second time. RESULTS. Cronbach α coefficient for the NDI-IR was 0.88 and for the 4 subscales of the NPDS-IR was found to be satisfactory (ranging from 0.74 to 0.94). The NDI-IR and the NPDS-IR subscales showed excellent test-retest reliability (intraclass correlation coefficient ranged from 0.90 to 0.97; P < 0.01). The correlation between the NDI-IR and the NPDS-IR subscales and functional scales of the SF-36 showed desirable results, indicating a good convergent validity (Pearson correlation coefficients ranged from -0.31 to -0.70). The correlation between the NDI-IR and the VAS was 0.71 and between the NPDS-IR subscales and the VAS ranged from 0.63 to 0.79 (P < 0.01). CONCLUSION. The Iranian versions of the NDI and NPDS are reliable and valid instruments to measure functional status in Persian-speaking patients with neck pain in Iran. They are simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian speaking communities. © 2007 Lippincott Williams & Wilkins, Inc

Distinction of non-specific low back pain patients with proprioceptive disorders from healthy individuals by linear discriminant analysis

The central nervous system (CNS) dynamically employs a sophisticated weighting strategy of sensory input, including vision, vestibular and proprioception signals, towards attaining optimal postural control during different conditions. Non-specific low back pain (NSLBP) patients frequently demonstrate postural control deficiencies which are generally attributed to challenges in proprioceptive reweighting, where they often rely on an ankle strategy regardless of postural conditions. Such impairment could lead to potential loss of balance, increased risk of falling, and Low back pain recurrence. In this study, linear and non-linear indicators were extracted from center-of-pressure (COP) and trunk sagittal angle data based on 4 conditions of vibration positioning (vibration on the back, ankle, none or both), 2 surface conditions (foam or rigid), and 2 different groups (healthy and non-specific low back pain patients). Linear discriminant analysis (LDA) was performed on linear and non-linear indicators to identify the best sensory condition towards accurate distinction of non-specific low back pain patients from healthy controls. Two indicators: Phase Plane Portrait ML and Entropy ML with foam surface condition and both ankle and back vibration on, were able to completely differentiate the non-specific low back pain groups. The proposed methodology can help clinicians quantitatively assess the sensory status of non-specific low back pain patients at the initial phase of diagnosis and throughout treatment. Although the results demonstrated the potential effectiveness of our approach in Low back pain patient distinction, a larger and more diverse population is required for comprehensive validation

Translation and validation study of the Persian version of the Arthritis Impact Measurement Scales 2 (AIMS2) in patients with osteoarthritis of the knee

Background: The Arthritis Impact Measurement Scales 2 (AIMS2) has not been translated and validated for Persian-speaking patients with osteoarthritis of the knee. This was to provide a validated instrument to measure functional disability and health-related quality of life in patients with osteoarthritis of the knee in Iran. The aim of this study was to culturally adapt and validate the AIMS2 for Persian-speaking patients with osteoarthritis of the knee in Iran. Methods: A consecutive sample of patients with knee osteoarthritis were asked to complete the AIMS2, the Short Form Health Survey (SF-36) and four visual analog scales for pain, joint stiffness, patient's and physician's global assessment. Internal consistency and convergent validity were applied to examine psychometric properties of the AIMS2. In addition, 30 randomly selected patients were asked to complete the questionnaire two days later for the second time for test-retest reliability. Finally factor structure of the Persian AIMS2 was performed using the principal component factor analysis. Results: In all 230 patients were entered into the study. The mean (SD) age of the participants was 56.9 (8.7) years and the mean (SD) duration of disease was 7.2 (3.5) years. Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) for the Persian AIMS2 scales ranged from 0.74 to 0.92 and 0.85 to 0.96, respectively. The correlation between most of the Persian AIMS2 scales and the physical and mental summary scores of the SF-36 and the visual analogue scales for pain, joint stiffness, patient's and physician's global assessment were statistically significant indicating a good convergent validity (p < 0.05). The results obtained from factor analysis indicated three latent factors that jointly accounted for 67.5% of the total variance. Conclusion: The results showed that the Persian AIMS2 had reasonably good internal consistency, test-retest reliability, and convergent validity in patients with osteoarthritis of the knee. It is simple and easy to use and now can be applied in the future studies in Iran. However, its sensitivity to change needs still to be studied.We wish to express our gratitude to physicians who co-operated in the selection of the patients and patients who gave their time to complete the questionnaires. This research was supported by Sport Medicine Research Center (SMRC), Tehran University of Medical Sciences; grant No 85-01-53-3579

Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Low back pain (LBP) is a recognized public health problem, impacting up to 80% of US adults at some point in their lives. Patients with LBP are utilizing integrative health care such as spinal manipulation (SM). SM is the therapeutic application of a load to specific body tissues or structures and can be divided into two broad categories: SM with a high-velocity low-amplitude load, or an impulse "thrust", (HVLA-SM) and SM with a low-velocity variable-amplitude load (LVVA-SM). There is evidence that sensorimotor function in people with LBP is altered. This study evaluates the sensorimotor function in the lumbopelvic region, as measured by postural sway, response to sudden load and repositioning accuracy, following SM to the lumbar and pelvic region when compared to a sham treatment.</p> <p>Methods/Design</p> <p>A total of 219 participants with acute, subacute or chronic low back pain are being recruited from the Quad Cities area located in Iowa and Illinois. They are allocated through a minimization algorithm in a 1:1:1 ratio to receive either 13 HVLA-SM treatments over 6 weeks, 13 LVVA-SM treatments over 6 weeks or 2 weeks of a sham treatment followed by 4 weeks of full spine "doctor's choice" SM. Sensorimotor function tests are performed before and immediately after treatment at baseline, week 2 and week 6. Self-report outcome assessments are also collected. The primary aims of this study are to 1) determine immediate pre to post changes in sensorimotor function as measured by postural sway following delivery of a single HVLA-SM or LVVA-SM treatment when compared to a sham treatment and 2) to determine changes from baseline to 2 weeks (4 treatments) of HVLA-SM or LVVA-SM compared to a sham treatment. Secondary aims include changes in response to sudden loads and lumbar repositioning accuracy at these endpoints, estimating sensorimotor function in the SM groups after 6 weeks of treatment, and exploring if changes in sensorimotor function are associated with changes in self-report outcome assessments.</p> <p>Discussion</p> <p>This study may provide clues to the sensorimotor mechanisms that explain observed functional deficits associated with LBP, as well as the mechanism of action of SM.</p> <p>Trial registration</p> <p>This trial is registered in ClinicalTrials.gov, with the ID number of <a href="http://www.clinicaltrials.gov/ct2/show/NCT00830596">NCT00830596</a>, registered on January 27, 2009. The first participant was allocated on 30 January 2009 and the final participant was allocated on 17 March 2011.</p