Reliability of diaphragmatic mobility assessment using a real time ultrasound among non-specific low back pain

Background and Objective: Ultrasound measurement of Diaphragmatic Mobility (DM) has been shown to be a reliable measurement tool among healthy subjects. However, the measures of reliability are needed prior to clinical use of this device among Non-Specific Low Back Pain (NS-LBP). Therefore, the aim of the study was to investigate the relative and absolute reliability of DM using Real Time Ultrasound (RTUS) among subjects with NS-LBP. Materials and Methods: Nine subjects with NS-LBP (23.33 ± 1.58) years old were recruited. A qualified examiner performed measurement of DM using RTUS by placing transducer on the right subcostal region in semi-fowler’s position with 30 degree elevation of the trunk. The test-retest measures were re-assessed with 24 hour interval between sessions. Results: There was no systematic errors between the test-retest measures (p>0.05). Intra rater reliability showed ICC value of 0.92, which indicates an excellent reliability. The SEMs of the measurement was 2.56 mm and the MDC of 7.09mm. Conclusion:The RTUS for assessing DM provides an excellent intra-rater reliability which may be used as an assessment technique for clinical evaluation of DM in adults with NS-LBP. The SEMs and MDC reported may also allow for accurate interpretation of DM assessments in NS-LBP

Feldenkrais method on neck and low back pain to the type of exercises and outcome measurement tools: A systematic review

Introduction Feldenkrais method (FM) has been applied on a large number of people as an educational method to create awareness of themselves and of their own body postures. Despite several existing FM studies, there has not yet been a review of FM in the context of musculoskeletal disorders. Aim This review aimed at determining the effect, type of exercises, duration and the outcome measure utilized in assessing the FM among individuals with neck and low back pain (LBP). Material and methods Four databases were searched for eligible studies, which were published in the years 1999–2015. Two authors individually assessed selected studies. From a total of 165 articles, 3 articles were selected and another 1 article from other resources with a total of 4 articles. Results and discussion The number of participants in all of the four included studies were 65.5 ± 30.1 (mean ± SD). The quality of the studies that was assessed using Physiotherapy Evidence Databases (PEDro) scale revealed the score of at least 5/10. Evidence exists that FM may be used for treating musculoskeletal disorders. However, the studies were not enough to make a decision because of different selections of FM lessons, duration and outcome measures. The review also determined type of exercises and outcome utilized in assessing the benefit of FM. Conclusions Overall, judging from the increasing number of articles in recent years related to FM, this review reports sufficient evidence that FM is increasingly being used in the management of neck pain and LBP

Reliability of diaphragmatic mobility assessment: A systematic review

Introduction: Diaphragm Mobility (DM) assessment is gaining interest in the field of medicine and in the healthcare sector. Despite its clinical usage, the measure of reliability in assessing DM is not clearly known. Aim: To critically appraise the evidence describing the reliability measures of DM assessment using any of the diagnostic modalities. Material and methods: A systematic search across five databases was carried out from January 1990 to September 2016. Quality Appraisal of Reliability Studies (QUAREL) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were used to assess the risk of bias and for rating the quality of the evidence. In addition, levels of evidence grading which synthesize all the included articles for grading were also used. Results and discussion: Four papers were included for assessing both intra-rater and inter-rater reliability using ultrasound and radiography. Three papers reported ICC measures of reliability, with one paper reporting CV% of reliability. The results demonstrate that, overall, lower levels of evidence exist among the selected articles between moderate and good for intra-rater reliability and good for inter-rater reliability measures. The synthesis of all the included articles demonstrated that, overall, moderate evidence exists. Conclusions: There were moderate-to-good reliability measures with a low risk of bias in both the forms of reliability for assessing diaphragmatic mobility

Intra-rater and inter-rater reliability of total faulty breathing scale using visual observation and videogrammetry methods.

Faulty breathing is an aspect of alteration in the normal fundamental pattern of breathing. The available existence of scales in assessing faulty breathing has not frequently been used. Measurement errors in assessing and quantifying breathing patterns may originate from unclear directions and variation between observers. This study determined the measure reliability of the Total Faulty Breathing Scale (TFBS) for quantifying breathing patterns. Twenty seven participants were recruited comprising healthy and unhealthy subjects. Two examiners assessed their breathing patterns using the TFBS on two different occasions with visual observation and a videogrammetry method. Evaluation of the observational breathing pattern method for intra-rater and inter-rater showed agreement of 96.30% and a kappa score of greater than 0.78, which indicated substantial agreements. The videogrammetry method showed a percent agreement of (100%) with a kappa score of (1.00). This study indicates that the TFBS is a considerably reliable tool for evaluating breathing patterns with both visual observation and a videogrammetry method

Validity and reliability of outcome measures to assess dysfunctional breathing: a systematic review.

OBJECTIVE: This study aimed to systematically review the psychometric properties of outcome measures that assess dysfunctional breathing (DB) in adults. METHODS: Studies on developing and evaluating measurement properties to assess DB were included. The study investigated the empirical research published between 1990 and February 2022, with an updated search in May 2023 in the Cochrane Library database of systematic reviews and the Cochrane Central Register of Controlled Trials, the Ovid Medline (full), the Ovid Excerta Medica Database, the Ovid allied and complementary medicines database, the Ebscohost Cumulative Index to Nursing and Allied Health Literature and the Physiotherapy Evidence Database. The included studies' methodological quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Data analysis and synthesis followed the COSMIN methodology for reviews of outcome measurement instruments. RESULTS: Sixteen studies met the inclusion criteria, and 10 outcome measures were identified. The psychometric properties of these outcome measures were evaluated using COSMIN. The Nijmegen Questionnaire (NQ) is the only outcome measure with 'sufficient' ratings for content validity, internal consistency, reliability and construct validity. All other outcome measures did not report characteristics of content validity in the patients' group. DISCUSSION: The NQ showed high-quality evidence for validity and reliability in assessing DB. Our review suggests that using NQ to evaluate DB in people with bronchial asthma and hyperventilation syndrome is helpful. Further evaluation of the psychometric properties is needed for the remaining outcome measures before considering them for clinical use. PROSPERO REGISTRATION NUMBER: CRD42021274960

Improved respiratory characteristics in non-specific low back pain: Comparison of Feldenkrais method versus routine physiotherapy

© 2020 - IOS Press. All rights reserved. PURPOSE: Abnormal breathing patterns, decrease in respiratory muscle strength and endurance are some of the alterations, which are observed in non-specific low back pain (NS-LBP). The purpose of this study was to determine the efficacy of the Feldenkrais method (FM) on respiratory muscle strength, Maximum Voluntary Ventilation (MVV), Total Faulty Breathing Scale (TFBS), Cloth Tape Measure (CTM) and core stability among NS-LBP participants. METHODS: Participants were recruited from a rehabilitation clinic and randomized either to experimental group (EG) or the control group (CG). For the EG (FM and routine physiotherapy), and for the CG routine physiotherapy alone were carried out three days per week over a period of 8 weeks. Outcome measures including Respiratory Muscle Strength, MVV, TFBS, Numeric Rating Scale (NRS), CTM, and Pressure biofeedback device (PBU) were evaluated at baseline and 8 weeks. RESULTS: Forty participants were assigned to an EG (n = 20) and CG (n = 20) based on the study criteria. There was a significant increase in inspiratory muscle strength (MIP) (p = 0.004) for the EG, but no significant change in the CG (p = 0.455). There was also a significant increase in the expiratory muscle strength (MEP) for the EG (p = 0.001), but no changes in the CG (p = 0.574). In addition, decrease in pain, increase in xiphoid process chest expansion and improvement in core stability were observed in EG and improvement in MVV was observed in CG. CONCLUSIONS: FM is a potential training program that can improve respiratory variables among NS-LBP

The Effect of Core Stability Training with Ball and Balloon Exercise on Respiratory Variables in Chronic Non-Specific Low Back Pain: An Experimental Study.

Background Studies have shown the involvement of respiratory characteristics and their relationship with impairments in non-specific low back pain (NS-LBP). The effects of core stability with a combined ball and balloon exercise (CBB) on respiratory variables had not been investigated. Objective To evaluate the effectiveness of CBB on respiratory variables among NS-LBP patients. Study Design pre- and post-experimental study. Participants Forty participants were assigned to an experimental group (EG) [n=20] and control group (CG) [n=20] based on the study criteria. Interventions The EG received CBB together with routine physiotherapy and the CG received routine physiotherapy over a period of 8 weeks. Participants were instructed to carry out the exercises for 3 days per week. The training was evaluated once a week and the exercises progressed based on the level of pain. Outcome measures: Primary outcomes were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) and maximum voluntary ventilation (MVV). The secondary outcomes were measured in the numeric rating scale (NRS), total faulty breathing scale (TFBS), cloth tape measure (CTM) and lumbo-pelvic stability. Results: The MIP increased significantly among the EG when compared with that in the CG (p>0.05).The EG showed a significant increase in MVV (p=0.04) when compared to the CG (p=0.0001). There was a significant reduction in pain for both groups. The MEP, TFBS, chest expansion and core stability showed no changes in either group. Conclusion: CBB was effective in improving respiratory variables among NS-LBP patients

The influence of expectation on spinal manipulation induced hypoalgesia: An experimental study in normal subjects

<p>Abstract</p> <p>Background</p> <p>The mechanisms thorough which spinal manipulative therapy (SMT) exerts clinical effects are not established. A prior study has suggested a dorsal horn modulated effect; however, the role of subject expectation was not considered. The purpose of the current study was to determine the effect of subject expectation on hypoalgesia associated with SMT.</p> <p>Methods</p> <p>Sixty healthy subjects agreed to participate and underwent quantitative sensory testing (QST) to their leg and low back. Next, participants were randomly assigned to receive a positive, negative, or neutral expectation instructional set regarding the effects of a specific SMT technique on pain perception. Following the instructional set, all subjects received SMT and underwent repeat QST.</p> <p>Results</p> <p>No interaction (p = 0.38) between group assignment and pain response was present in the lower extremity following SMT; however, a main effect (p < 0.01) for hypoalgesia was present. A significant interaction was present between change in pain perception and group assignment in the low back (p = 0.01) with participants receiving a negative expectation instructional set demonstrating significant hyperalgesia (p < 0.01).</p> <p>Conclusion</p> <p>The current study replicates prior findings of c- fiber mediated hypoalgesia in the lower extremity following SMT and this occurred regardless of expectation. A significant increase in pain perception occurred following SMT in the low back of participants receiving negative expectation suggesting a potential influence of expectation on SMT induced hypoalgesia in the body area to which the expectation is directed.</p