Reliability and validity of an iPhone® application for the measurement of lumbar spine flexion and extension range of motion

Background: Measurement of lumbar spine range of motion (ROM) is often considered to be an essential component of lumbar spine physiotherapy and orthopedic assessment. The measurement can be carried out through various instruments such as inclinometers, goniometers, and etc. Recent smartphones have been equipped with accelerometers and magnetometers, which, through specific software applications (apps) can be used for inclinometric functions. Purpose: The main purpose was to investigate the reliability and validity of an iPhone® app (TiltMeter© -advanced level and inclinometer) for measuring standing lumbar spine flexion-extension ROM in asymptomatic subjects. Design: A cross-sectional study was carried out. Setting: This study was conducted in a physiotherapy clinic located at School of Rehabilitation Sciences, Iran University of Medical Science and Health Services, Tehran, Iran. Subjects: A convenience sample of 30 asymptomatic adults (15 males; 15 females; age range = 18-55 years) was recruited between August 2015 and December 2015. Methods: Following a 2-minute warm-up, the subjects were asked to stand in a relaxed position and their skin was marked at the T12-L1 and S1-S2 spinal levels. From this position, they were asked to perform maximum lumbar flexion followed by maximum lumbar extension with their knees straight. Two blinded raters each used an inclinometer and the iPhone® app to measure lumbar spine flexion-extension ROM. A third rater read the measured angles. To calculate total lumbar spine flexion-extension ROM, the measurement from S1-S2 was subtracted from T12-L1. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. All of the measurements were conducted 3 times and the mean value of 3 repetitions for each measurement was used for analysis. Intraclass correlation coefficient (ICC) models (3, k) and (2, k) were used to determine the intra-rater and inter-rater reliability, respectively. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone® app. Furthermore, minimum detectable change at the 95 confidence level (MDC95) was computed as 1.96 � standard error of measurement � �2. Results: Good to excellent intra-rater and inter-rater reliability were demonstrated for both the gravity-based inclinometer with ICC values of �0.84 and �0.77 and the iPhone® app with ICC values of �0.85 and �0.85, respectively. The MDC95 ranged from 5.82°to 8.18°for the intra-rater analysis and from 7.38°to 8.66° for the inter-rater analysis. The concurrent validity for flexion and extension between the 2 instruments was 0.85 and 0.91, respectively. Conclusions: The iPhone®app possesses good to excellent intra-rater and inter-rater reliability and concurrent validity. It seems that the iPhone® app can be used for the measurement of lumbar spine flexion-extension ROM. © 2016 Pourahmadi et al

The effectiveness of classification-specific physical therapy for people with low back pain within dominant movement-based schemes: A systematic review

Background: Identification of homogenous subgroups of patients with low back pain (LBP) and classification-based treatment have been recommended by some researchers and primary care clinicians. However, evidence regarding the effectiveness of this approach is not conclusive; one reason for this controversy appears to be the heterogeneity of trials in this context. Methods: The aim of this study was to determine the effectiveness of classification-specific physical therapy in patients with LBP. The included trials were investigated in more homogeneous categories with respect to their classification scheme. Electronic databases including Medline, Cochrane, Ovid, Scopus, and PEDro were searched systematically for English-language randomized controlled trials (RCTs), published from 1980 to October 3, 2015. We included studies on LBP cases, which aimed to compare classification-specific physical therapies with non-specific treatments lacking patient classification. PEDro scoring was used to check the quality of the included trials, and the GRADE approach was used to evaluate the overall quality of evidence. Data on participants� characteristics, sample size, and inclusion/exclusion criteria were extracted to obtain an overview of the included RCTs. Results: A total of 12 RCTs were identified and categorized into four classification schemes. Some evidence supporting classification-specific treatment was found in each of the schemes. However, the reported evidence was conflicting predominantly due to differences in the study design. Also, GRADE quality assessment indicated the low quality of evidence for both approaches. Conclusions: Categorization of trials based on their classification scheme to investigate the efficacy of classification-based physical therapy could reduce the heterogeneity of trials and allow researchers to understand the contradictory results in this context. © 2016, Iranian Red Crescent Medical Journal

MR defecography: A diagnostic test for the evaluation of pelvic floor motion in patients with dyssynergic defecation after biofeedback therapy

Background: Dyssynergic defecation is a major cause of chronic functional constipation as a common digestive complaint. We clinically evaluated the effects of biofeedback therapy on the pelvic floor motion indices through magnetic resonance (MR) defecography, quality of life and depression in patients with dyssynergic defecation. Methods: In this clinical trial study, among patients referring to the Colorectal Clinic of Hazrat Rasoul Hospital, 22 subjects were randomly assigned into two equal groups (n= 11) to receive either standard only or biofeedback and standard therapy. Dynamic changes of the pelvic floor were measured by MR defecography. During the simulated defecation, two MR defecography dynamic indices including abnormal anorectal angle change and perineal descent were measured before and after treatment. The effects of biofeedback therapy on patients' symptoms, quality of life and severity of depression were assessed and compared with the standard therapy. Statistical analysis was carried out using independent t-test and Mann-Whitney test. Results: Paradox index (p< 0.001), perineal descent index (p< 0.001), depression (p< 0.1), physical function (p< 0.001), vitality (p< 0.001) and role emotion (p< 0.001) significantly improved in the biofeedback therapy group in contrast to the standard therapy SDT group. Conclusion: Biofeedback therapy appears to be effective in improving symptoms of functional constipation and dysfunction of pelvic floor motion as well as patient's quality of life and depression state. MR defecography is able to show the changes in dynamic indices of the pelvic floor through biofeedback therapy

Comparison of postural balance between subgroups of nonspecific low-back pain patients based on O'Sullivan classification system and normal subjects during lifting

Background: Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there is insufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present study was to compare postural control between subgroups of chronic nonspecific LBP and healthy subjects during lifting. Methods: A total of 35 men with chronic LBP (19 active extension pattern AEP and 16 flexion pattern FP) and 15 healthy controls were enrolled in this cross-sectional study. Pooled LBP was subdivided based on the O'Sullivan's classification system (OCS). The participants were asked to lift a box from the ground to the waist level and hold it for 20 seconds. The load was 10% of the subject's weight. Force plate system was used to record balance parameters, including standard deviations (SDs) of center of pressure (COP) amplitude and COP velocity in anterior-posterior and medial-lateral directions and mean total velocity. The test was divided into two static and dynamic phases. Data were analyzed using one-way analysis of variance and independent t-test. Results: There were no significant differences between pooled LBP and control groups in any of the variables, except for the SD of the anterior-posterior direction velocity in the X-plane in the static phase (P=0.017). After classifying LBP, the results showed that the healthy and AEP groups were significantly different in SD of COP velocity in the frontal plane (P=0.021), mean total velocity (P=0.010), and SD of COP velocity in the sagittal plane (P=0.039). Conclusion: The present study showed that postural control was not different between the pooled LBP and normal groups. After classifying pooled LBP based on OCS, we found that the AEP showed different postural control as compared to healthy controls in the dynamic phase. The FP and AEP exhibited different postural control relative to the healthy controls in the static phase, and COP velocity was lower in those groups compared to the control group. The results of this study support the concept of LBP classification. © 2019 BY THE ARCHIVES OF BONE AND JOINT SURGERY

Gender-related differences in reliability of thorax, lumbar, and pelvis kinematics during gait in patients with non-specific chronic low back pain

Objective To evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system. Methods A convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated. Results Intraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally �4.8°) and females (generally �5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements. Conclusion Although ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study. © 2018 by Korean Academy of Rehabilitation Medicine

Gender-related differences in reliability of thorax, lumbar, and pelvis kinematics during gait in patients with non-specific chronic low back pain

Objective To evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system. Methods A convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated. Results Intraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally �4.8°) and females (generally �5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements. Conclusion Although ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study. © 2018 by Korean Academy of Rehabilitation Medicine

The influence of temperature alterations on eccentric contraction-induced isometric force and desmin loss in ratmedial gastrocnemius muscle

In this study isolated perfused rat muscle was used to examine the direct effect of temperature changes on the eccentric contraction-induced force and desmin loss. The left medial gastrocnemius muscle was separated and the entire lower limb was transferred into a prewarmed (35°C) organ bath. Temperature was adjusted to 31 or 39°C before and during eccentric contractions. Maximal isometric force and desmin loss were measured after 15 isometric or eccentric contractions. According to our data, organ bath temperature changes before or during eccentric contractions had no significant effect on force loss. However, a strong correlation between desmin loss and temperature changes before (r = 0.93, p<0.05) and during (r = 0.87, p<0.05) eccentric contractions was observed. Present results suggest that cooling before or during eccentric contractions may decrease desmin loss

The effect of upper trapezius muscle dry needling treatment on sleep quality: A case report

Myofascial pain syndrome is characterized by trigger points in muscles, resulting in pain, limitation of motion, muscle weakness and also referral pain. Upper part of trapezius muscle is one the most common sites in upper quadrant affected by this condition. Among various manual and non-manual techniques, dry needling is one of the most effective treatment methods, and is widely used recently by physiotherapists. A 34 year old, female hairstylist with chronic shoulder pain was admitted to a physiotherapy clinic and was treated with dry needling approach, after which she found improvement of shoulder symptoms and sleep quality. Results from this case report can create an interesting and clear precedent for considering dry needling treatment in future clinical trials. © 2017 Elsevier Lt

The effect of upper trapezius muscle dry needling treatment on sleep quality: A case report

Myofascial pain syndrome is characterized by trigger points in muscles, resulting in pain, limitation of motion, muscle weakness and also referral pain. Upper part of trapezius muscle is one the most common sites in upper quadrant affected by this condition. Among various manual and non-manual techniques, dry needling is one of the most effective treatment methods, and is widely used recently by physiotherapists. A 34 year old, female hairstylist with chronic shoulder pain was admitted to a physiotherapy clinic and was treated with dry needling approach, after which she found improvement of shoulder symptoms and sleep quality. Results from this case report can create an interesting and clear precedent for considering dry needling treatment in future clinical trials. © 2017 Elsevier Lt

Effect of gastrocnemius Kinesio taping on countermovement jump performance and vertical stiffness following muscle fatigue

Context: Kinesio tape (KT) is a widely used intervention in the fields of sports and rehabilitation. However, its effects on lowerextremity behavior during functional activities are not entirely known. Objective: To test the hypothesis that application of KT can change performance and vertical stiffness (VS) during the countermovement jump (CMJ) before and after a fatigue protocol. Design: A predesign and postdesign to study the effect of KT in 2 situations, prefatigue and postfatigue. In each fatiguing condition, there were 2 conditions with and without KT application on the gastrocnemius muscle. Setting: Biomechanics laboratory. Participants: Fifty healthy, nonathlete participants (26 females and 24 males). Interventions: KT application on the gastrocnemius muscle and a fatigue protocol to induce fatigue in plantar flexor muscles. Main Outcome Measures: Various jumping parameters, including jump height, maximum force, maximum power, rate of force development, eccentric lower-limb stiffness, and VS, were calculated using the vertical ground reaction force data. Eccentric lower-limb stiffness and VS were calculated using a mass-spring model. The studied variables can present lower-extremity elastic behavior and performance during CMJ. Results: The results of a 2-way repeated-measures analysis of variance showed no significant effect for KT application. Fatigue resulted in lower values of jump height, maximum power, and VS. Moreover, male subjects showed greater values of jump height, maximum force, and maximum power than did females. Conclusions: The main finding of this study was that gastrocnemius KT has no effect on performance or elastic behavior of the lower-extremity during CMJ. Moreover, KT cannot reduce the adverse effect of fatigue in a functional activity such as CMJ. It seems that gastrocnemius KT is not effective for demanding activities. © 2018 Human Kinetics, Inc