Ubon Pirunsan

Validation of thai versions of the neck disability index and neck pain and disability scale in patients with neck pain

Study Design. Cross-cultural validation of the Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDS). Objective. To translate and test the psychometric properties of Thai versions of the NDI and NPDS questionnaires. Summary of Background Data. The NDI and NPDS are questionnaires commonly used to measure neck pain and disability. The original versions of the NDI and NPDS have been translated into many languages but there are no validated Thai versions. Methods. Translation and cross-cultural adaptation of the original English versions of the NDI and NPDS were performed according to published guidelines. A total of 185 patients with neck pain participated in the study and were asked to complete the Neck Disability Index-Thai version (NDI-TH), Neck Pain Disability Scale-Thai version (NPDS-TH), and a visual analogue scale (VAS; 0–10). Psychometric evaluation included factor analysis, internal consistency, test-retest reliability, agreement, and convergent validity. Test-retest reliability for the NDI-TH was examined in 20 patients and in 17 for the NPDS-TH. Patients completed the questionnaires twice with an interval of 48 hours. Results. Factor analysis revealed a single-factor solution for the NDI-TH and three factor solution for the NPDS-TH. Cronbach &agr; values for the NDI-TH and NPDS-TH were excellent (0.85 and 0.96, respectively). The three NPDS-TH subscales ranged from 0.90 to 0.94. Good to excellent test-retest reliability was demonstrated for all measurements (Intraclass Correlation Coefficient range = 0.74–0.91, P < 0.001). The NDI-TH, NPDS-TH, and NPDS-TH subscales were moderately correlated with the VAS (range, r = 0.61–0.76, P < 0.001). The minimal detectable change was 16.1 points for the NDI-TH (scale range = 0–100) and 21.8 points for NPDS-TH (scale range = 0–100). Conclusion. The NDI-TH and NPDS-TH seem to be reliable instruments to measure functional limitation and disability in Thai patients with neck pain. However, further research is still needed to determine responsiveness and validity of these questionnaires.

Reliability of muscle function and sensory perception measurements of the wrist extensors

This study determined the reliability of muscle function and sensory perception measures of the wrist extensors. The test-retest reliability of the measurements was determined by an intraclass correlation coefficient (ICC), coefficient of variation (CV), standard error of measurements (SEMs), and one-way repeated measures ANOVA using the values collected from 25 young (20.6 ± 1.3 years) healthy male volunteers on two occasions separated by 1 day. The measures consisted of grip strength, wrist extension strength (WES), range of motion in active and passive wrist flexion and extension, choice reaction time (CRT), vibration sense (VIB), joint position error sense (JPE), cold pain (CP) and heat pain threshold, and pressure pain threshold. An acceptable reliability was determined as the ICC values greater than 0.85, CV less than 15%, and SEMs less than 5%. ICC of all measures except for JPE were greater than 0.85, only CV of JPE, CP, and VIB exceeded 15%, SEMs were higher than 5% only for JPE and CP, and the ANOVA showed a significant time effect for CRT and WES. It is concluded that most of the measurements except JPE are reliable and can be used to investigate effects of a physiotherapy intervention on the wrist extensors.

Multifidus muscle size and symmetry among elite weightlifters

OBJECTIVES To examine muscle cross-sectional areas (CSA) and symmetry of lumbar multifidus (LM) muscles in elite weightlifters. DESIGN Cross-sectional observational study SETTING Neuromuscular and Pain Research Unit. PARTICIPANTS Thirty-one elite weightlifters (15 males) participated in the study, representing the population of Thai weightlifters eligible for national selection. MAIN OUTCOME MEASURES Resting CSA of the LM muscle were assessed bilaterally at 4 lumbar vertebral levels using ultrasound imaging. The between side differences (relative to the side of the preferred hand) were used to determine the asymmetry. RESULTS The between side differences (relative to the preferred hand) of the LM muscle CSA were less than 3% for all vertebral levels and suggested symmetry between sides (p > .05). No difference was found between weightlifters with unilateral or bilateral pain symptoms. CONCLUSION This study provides new information on resting CSA for the LM muscle in elite weightlifters. Future studies could investigate other aspects of neuromotor control of the LM muscle to determine if there are impairments which could be addressed in an attempt to decrease the high prevalence of LBP in this population.

Improvements in tissue blood flow and lumbopelvic stability after lumbopelvic core stabilization training in patients with chronic non-specific low back pain.

[Purpose] This study investigated the effects of lumbopelvic stabilization training on tissue blood flow changes in the lumbopelvic region and lumbopelvic stability compared to placebo treatment and controlled intervention among patients with chronic non-specific low back pain. [Subjects and Methods] A total of 25 participants (7 males, 18 females; mean age, 33.3 ± 14.4 years) participated in this within-subject, repeated-measures, double-blind, placebo-controlled comparison trial. The participants randomly underwent three types of interventions that included lumbopelvic stabilization training, placebo treatment, and controlled intervention with 48 hours between sessions. Lumbopelvic stability and tissue blood flow were measured using a pressure biofeedback device and a laser Doppler flow meter before and after the interventions. [Results] The repeated-measures analysis of variance results demonstrated a significant increase in tissue blood flow over the lumbopelvic region tissues for post- versus pre-lumbopelvic stabilization training and compared to placebo and control interventions. A significant increase in lumbopelvic stability before and after lumbopelvic stabilization training was noted, as well as upon comparison to placebo and control interventions. [Conclusion] The current study supports an increase in tissue blood flow in the lumbopelvic region and improved lumbopelvic stability after core training among patients with chronic non-specific low back pain.

Clinical evaluation of the anterior translation of glenohumeral joint using ultrasonography: an intra- and inter-rater reliability study.

OBJECTIVE The aim of this study was to investigate the intra- and inter-rater reliability of ultrasonography (US) to measure anterior translation of the humeral head (ATHH) among healthy subjects and patients with sacroiliac joint dysfunction. METHODS The study included a total of 22 shoulder joints from 11 subjects. Six subjects were healthy and 5 had sacroiliac joint dysfunction. Anterior translation of the humeral head was measured twice using US by two different investigators. Intraclass correlation coefficient (ICC3,1), standard error of measurements (SEMs), coefficient of variations (CVs) and Bland-Altman plot were used as analytical tests to investigate intra- and inter-rater reliability, amount of error and agreeability of the measurements between investigators. RESULTS Intraclass correlation coefficient was 0.94, showing a high level of intra-rater reliability of the first investigator with SEMs (0.01 cm) and CV (5.1%) in measuring ATHH. Intra-rater reliability of the second investigator was 0.84 with SEMs (0.03 cms) and CV (9.6%), indicating a high level of reliability. Inter-rater reliability was high, with an ICC value of 0.92 with SEMs (0.02 cms) and CV (5.9%). CONCLUSION The use of US as a measurement of ATHH has good levels of intra- and inter-rater reliability in clinical practice.

Prophylactic Effects of Sauna on Delayed-Onset Muscle Soreness of the Wrist Extensors.

Background: High-intensity of exercise or unaccustomed eccentric exercise can cause the phenomenon of Exercise-Induced Muscle Damage (EIMD) which usually results in cramps, muscle strain, impaired muscle function and delayed-onset muscle soreness. Objectives: This study investigated the prophylactic effects of sauna towards the symptoms associated with muscle damage from eccentric exercises of wrist extensor muscle group. Patients and Methods: A total of twenty-eight subjects (mean age 20.9 years old, SD = 1.6) were randomly divided into the sauna group (n = 14) and the control group (n = 14). In the sauna group, subjects received sauna before eccentric exercise of the wrist extensor. The eccentric exercises were conducted on the non-dominant arm by using an isokinetic dynamometer. Pain Intensity (PI), Pressure Pain Threshold (PPT) and passive range of motion of wrist flexion (PF-ROM) and extension (PE-ROM) were measured as pain variables. Grip Strength (GS) and Wrist Extension Strength (WES) were measured as variables of wrist extensor muscle function. All the measurements were performed at baseline, immediately after and from 1st to 8th days after the exercise-induced muscle damage. Results: The sauna group significantly demonstrated a lower deficit in ROM (passive flexion and passive extension), GS and WES following exercise than that of the control group (P < 0.05). Conclusions: Sauna application prior to the exercise-induced muscle damage demonstrated effectiveness in reduction of sensory impairment (PF-ROM and PE-ROM) and improvement of muscle functions (GS, and WES) in wrist extensor muscle group.

Sacroiliac joint and weight distribution to feet: An opinion towards clinical and research practice

We enjoyed reading the published manuscript entitled ‘Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint.’ by Grassi et al. (2011) .W e thought of sharing our views on the published article. The authors took a common clinical concept and related it eloquently to sacroiliac joint dysfunction and after effects of sacroiliac manipulation. We would like to comment on few aspects related to record the weight distribution to the feet. Although, use of baropodometry measures are still considered superior compared to using digital weighing scale, the method adopted in the present study creates much interest and queries. The authors collected baropodometry variables such as peak pressure at feet and contact area of feet in standing. We would like to question why the baropodometry measurement was taken in standing and not during walking. This is because the influence of mobility of the sacroiliac joint may be higher during walking rather than standing. Walking is more functional compared to standing. Furthermore, during walking, the sacroiliac joint may be exposed to single leg stance phase where the load might be more exposed to the involved sacroiliac joint as the other side sacroiliac joint remains in swing phase of gait. One may also question the clinical reasoning behind taking pressure difference between the feet as measurement. It is interesting to raise the query why the authors did not consider taking mean peak pressure of the foot concerned with the involved sacroiliac joint. Instead, the authors considered the difference between the feet before and after sacroiliac joint manipulation. As the authors compared the weight distribution to feet before and after sacroiliac joint manipulation, perhaps, it may be appropriate to compare the peak pressure at the foot of the manipulated sacroiliac joint rather than comparing the difference between the feet. We believe that the study will be more interesting if the mean peak pressure or contact area of foot of the involved and uninvolved sacroiliac joint are presented separately. This would provide some reference values for practitioners and enable other researchers to cite such a paper. The validity of the diagnostic criteria used to identify sacroiliac joint restriction and dysfunction patients is another questionable fact. As a battery of clinical tests are suggested to identify patients with sacroiliac dysfunction (Arab et al., 2009), one would query the rationale for choosing only long sitting test and other two complementary screening tests. The reason for choosing paired t test instead of one way repeated ANOVA is questionable as the measurement were taken at three different situations. Also, rationale for using a non-parametric test (Spearman test) and parametric test (paired t test) for analyzing the same variable raises queries. Absence of intervention effect size and no p value for correlation tests makes it difficult for readers to apply the study findings in clinical practice. We appreciate the meticulous work by the authors and thank the editor for publishing such informative articles.

Lumbopelvic Core Stabilization Exercise and Pain Modulation Among Individuals with Chronic Nonspecific Low Back Pain.

Lumbopelvic stabilization training (LPST) may provide therapeutic benefits on pain modulation in chronic nonspecific low back pain conditions. This study aimed to examine the effects of LPST on pain threshold and pain intensity in comparison with the passive automated cycling intervention and control intervention among patients with chronic nonspecific low back pain.

Prophylactic effect of hot pack on symptoms of eccentric exercise-induced muscle damage of the wrist extensors

Abstract This study investigated whether hot pack treatment could provide prophylactic effects on muscle damage induced by eccentric exercise of the wrist extensors. Twenty-eight healthy men (age 21±1 years, weight 65±16 kg, height 171±6 cm) were randomly placed into hot pack (n = 14) and control (n = 14) groups. All participants performed an exercise consisting of 300 maximal eccentric contractions of the wrist extensors of the non-dominant arm using an isokinetic dynamometer. A hot pack was applied for 20 min to the wrist extensors of the exercised arm before the exercise for the hot pack group. The control group received no treatment before the exercise. Measured variables included pain intensity assessed by a visual analogue scale and a modified Likerts scale, cold thermal pain threshold, pressure pain threshold (PPT), range of motion in active wrist flexion (ROM-AF) and extension (ROM-AE), range of motion in passive wrist flexion (ROM-PF) and extension (ROM-PE), grip strength, and wrist extension strength. Changes in these variables before, immediately after, and 1 to 8 days following the exercise were compared between groups by a two-way repeated measures ANOVA. All outcome measures from both groups (except for the cold thermal pain threshold of the hot pack group) demonstrated a significant change within the first 2–3 days following exercise. Significant differences between groups were only found at a single point in time for PPT, ROM-PF, ROM-PE and ROM-AE, and the changes were smaller for the hot pack group in comparison to the control group. These results suggest that the prophylactic effects of hot pack treatment on eccentric exercise-induced muscle damage of the wrist extensors are limited.

Immedicate Effects of Core Stabilization Exercise on β-Endorphin and Cortisol Levels Among Patients With Chronic Nonspecific Low Back Pain: A Randomized Crossover Design

Objective The main objective of the study was to measure the levels of plasma &bgr;‐endorphin (PB) and plasma cortisol (PC) under lumbar core stabilization exercise (LCSE), placebo and control conditions in patients with chronic nonspecific low back pain. Methods Twenty‐four participants with chronic nonspecific low back pain participated in a randomized, placebo‐controlled, crossover design study. There were 3 experimental exercise conditions: control condition (positioning in crook lying and rest), placebo condition (passive cycling in crook lying using automatic cycler), and LCSE on a Pilates device tested with a 48‐hour interval between sessions by concealed randomization. A blood sample was collected before and after the exercise conditions. Plasma &bgr;‐endorphin and PC were measured through enzyme‐linked immunosorbent assay and electrochemiluminescence in a Cobas E411 auto analyzer. Results A significant difference in PB level was identified before and after the LCSE condition (P < .05), whereas no significant differences were noted in control and placebo exercise conditions. Also, the trend of elevation of PB under the LCSE was significantly different compared with the placebo and control conditions (P < .01). In contrast, the PC level remained unchanged in all 3 conditions. Conclusion The findings of this study indicate that LCSE could possibly influence PB but not PC level among patients with chronic nonspecific low back pain. The mechanism of action of the pain‐relieving effect of LCSE might be related to an endogenous opioid mechanism as part of its effects and might not be involved with a stress‐induced analgesia mechanism.