Evaluation of lumbopelvic stabilization in patellofemoral pain syndrome

BACKGROUND

Patellofemoral pain syndrome (PFPS) is a prevalent knee condition in physically active individuals, with a multifactorial etiology. This study aimed to assess the effectiveness of lumbopelvic stabilization in treating patients with PFPS.

METHOD

The study involved 28 PFPS patients and 28 healthy controls, all aged between 18 and 45 years. Sociodemographic data were collected, and measurements were taken using ultrasonography (USG) to assess muscle thickness of the transverse abdominis (TrA) and multifidus lumborum (ML), as well as static and dynamic endurance of the trunk muscles in both groups. Pain levels were evaluated using the Visual Analog Scale (VAS), and knee function was assessed using the Kujala Patellofemoral Rating Questionnaire (KPSQ).

RESULTS

The TrA and ML muscle thicknesses were symmetrical and statistically similar in both the PFPS and control groups at rest and during contraction (p > 0.05). However, significant differences were found between the muscle thicknesses of the PFPS and control groups for both the right (p < 0.01) and left sides (p < 0.01), both at rest and during contraction. Additionally, significant differences were observed in the dynamic and static trunk endurance tests between the PFPS and control groups (p < 0.001). Pain levels and knee functionality also differed significantly between the two groups (p < 0.001).

CONCLUSION

The findings of this study indicate that individuals with PFPS exhibited differences in the thickness of the TrA and ML muscles compared to asymptomatic controls, suggesting potential lumbopelvic involvement in PFPS pathology.

Cross-cultural adaptation and validation of a revised Italian Anterior Knee Pain Scale version

BACKGROUND

The study aimed to validate a revised Italian version of the Anterior Knee Pain Scale (AKPS) by addressing shortcomings in previous adaptations and following the COSMIN guidelines to ensure robust psychometric evaluation.

METHODS

One hundred thirty patients with anterior knee pain symptoms were recruited, with 65 undergoing a retest after 7 days to assess the scale's reliability. Structural validity was assessed through confirmatory factor analysis (CFA) to evaluate the scale's dimensionality. Internal consistency was measured using Cronbach's alpha, while test-retest reliability was assessed using the intraclass correlation coefficient (ICC). Measurement error was evaluated using the standard error of measurement (SEM) and the smallest detectable change (SDC). Construct validity was examined by correlating the AKPS with other established scales, including the Knee Injury and Osteoarthritis Outcome Score, Internal Knee Documentation Committee, Victorian Institute of Sport Assessment - Patella, Short-Form 36 Health Survey, and the Visual Analogue Scale.

RESULTS

The CFA supported a three-factor model encompassing pain intensity and interference, functional limitations in daily activities, and knee structural and functional issues. The scale demonstrated good internal consistency (Cronbach's α=0.79) and excellent test-retest reliability (ICC=0.91), with low measurement error (SEM<5%). Construct validity was confirmed through moderate-to-strong correlations with related scales, particularly in domains related to pain intensity, symptoms, and daily functioning.

CONCLUSIONS

The newly validated scale, demonstrating strong psychometric properties, meets international standards for clinical assessment tools, making it a reliable and effective instrument for assessing anterior knee pain in the Italian context.

The Physical and Psychological Effects of Kinesiotaping in Patients With Chronic Low Back Pain

As no other investigators have holistically addressed kinesiotaping (KT) effects on physical and psychological measures in patients with chronic low back pain (CLBP). Our aim in the present study was to investigate the effects of KT application on pain, flexibility, function, back awareness, fear-avoidance, anxiety, and depression in patients with CLBP. We conducted a single-blind, randomized controlled trial with 52 patients with CLBP who were randomized to either or an electrotherapy (ET) group (n = 26) or a KT + ET group (n = 26). The ET group received only conventional electrophysical interventions for two weeks, while the KT + ET group received kinesiotaping plus the electro-physical interventions. At baseline, after the second week (post-treatment), and at an eighth-week follow-up, participants were given the Visual Analogue Scale (VAS) for self-reported pain, the Fremantle Low Back Awareness Questionnaire (FreBAQ), the Five Times Sit-to-Stand Test (FTST), the Timed Up and Go Test (TUG), the Roland Morris Disability Questionnaire (RMDQ), the Modified Schober Test (mST), the Hospital Anxiety and Depression Scale (HADS), and the Fear Avoidance Beliefs Questionnaire (FABQ). The KT + ET group showed greater improvement than the ET group on the VAS, TUG, FTST, FreBAQ, and FABQ and was significantly improved at both the second and eighth weeks (p < .05). The subjective function (RMDQ) score of the KT group was better at the eighth week (p < .05). There was no significant difference between the groups on the mST, HADS-D, and HADS-A (p > .05). However, both the KT + ET and ET groups showed significant improvement on the HADS-D and HAD-S-A (p < .05). These results show that the KT application provided additional benefits relative to ET alone in participants' perceived pain, and their objective and subjective functioning, low back awareness, and fear avoidance.

Hidden Asymmetries: Leg Length Discrepancy and Breast Asymmetry in Adolescent Scoliosis and Postural Disorders-A Cross-Sectional Study

Background/Objectives: Morphological spinal alterations in adolescents, including idiopathic scoliosis (IS) and postural scoliotic attitudes (paramorphisms), may be associated with leg length discrepancy (LLD) and breast asymmetry (BA). This study aimed to assess the prevalence and characteristics of LLD and BA in adolescents with spinal paramorphisms and dysmorphisms (IS), and to explore associations between these asymmetries and spinal curve features. Methods: A cross-sectional observational study was conducted. Adolescents aged 10-18 years were included. LLD was measured clinically via direct tape measurement and, when necessary, ultrasound. BA was assessed via visual inspection. Spinal deformities were characterized via clinical and radiological examination. Results: Among the 44 participants, 26 (60%) had IS and 18 (40%) had postural scoliotic attitudes. LLD was present in 79.5% (mean 0.7 ± 0.6 cm; all mild). BA was observed in 14% of the sample. LLD was more frequent in IS (87%) than in postural scoliotic attitudes (72%). In lumbar postural curves, the shorter limb was consistently ipsilateral to the curve convexity. In IS, no consistent association was found between LLD and curve characteristics. BA was slightly more prevalent in IS (19%) than postural scoliotic attitudes (17%), with no consistent pattern relative to curve convexity. Conclusions: Mild LLD is common in adolescents with spinal asymmetries and reflects general population norms. While LLD may influence compensatory postural curves, it does not appear to affect IS curve patterns or severity. BA is more frequent in IS, but shows variable association with curve features. Considering LLD and BA prevalence in adolescents with spinal asymmetries routine assessment is warranted, though their impact on IS progression is limited.

The effectiveness of graded motor imagery training on pain and functionality in patients with subacromial pain syndrome: A prospective, single-blind, randomized controlled trial

Background

Pain from subacromial pain syndrome (SAPS) can limit individuals' daily activities and reduce physical performance. The effectiveness of graded motor imagery (GMI) training for this condition remains unexplored. This prospective, randomized controlled trial aimed to determine the effects of GMI training in patients with chronic painful SAPS.

Methods

Forty-two patients with SAPS were randomly assigned to the GMI (n = 21) and the control (n = 21) groups. Primary measures were the visual analogue scale (VAS), and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. Secondary measures were Active Range of Motion (AROM), muscle strength, lateralization performance and Kinesthetic and Visual Imagery Questionnaire (KVIQ). Evaluations occurred at baseline, postintervention (6 weeks), and after a 6-week follow up.

Results

The GMI group showed significantly greater improvements in both primary and secondary outcomes compared to the control group (p < 0.001). Significantly larger effect sizes were found in favor of the GMI group for VAS, DASH, abduction, external rotation AROM, muscle strength, lateralization performance, and KVIQ (ηp2 < 0.14, p < 0.05, for all).

Conclusions

The integration of GMI training into conventional physiotherapy for SAPS rehabilitation provides more effective clinical results in improving pain intensity and increasing functionality.

Mid-term Radiologic and Clinical Results of Pediatric-adolescent Lisfranc Injuries

INTRODUCTION

The incidence of Lisfranc injury in pediatric-adolescent children is lower compared with adults. There is limited research on adolescent patients in this age group, with only a few case reports of pediatric patients. Furthermore, studies with adequate follow-up are lacking in the literature. This study aims to provide insights into the causes and types of fractures and evaluate mid-term clinical and radiologic outcomes.

METHODS

A retrospective analysis was conducted on pediatric-adolescent patients diagnosed with a Lisfranc injury who underwent surgical treatment between June 2015 and January 2022. Patients underwent open reduction and internal fixation using Kirschner wires and/or screws, had satisfactory imaging, and were followed up for at least 2 years. Radiologic measurements included intermetatarsal distance, meary angle, and calcaneal height angle, done while the patient was standing. Assessments were made using the AOFAS midfoot score, the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), Visual Analog Scale (VAS) scores, and physical activities.

RESULTS

The study included 14 surgically treated patients with a minimum 2-year follow-up. The average patient age was 12.6 years, with a mean follow-up of 52.4 months. In pediatric cases, crush injury was the predominant trauma type ( P = 0.009). There were no significant differences in calcaneal pitch angle or meary angle between healthy and injured feet ( P = 0.2 and 0.1), but a greater intermetatarsal distance was observed on the injured side ( P = 0.02). The mean Visual Analog Scale (VAS) score was 1.5, the AOFAS midfoot score averaged 91.5, and the OxAFQ-C score averaged 86.3%.

CONCLUSIONS

The mid-term outcomes for this age group were promising compared with adults. The use of Kirschner wires for fixation is more common in younger patients. Crush injuries and complications like compartment syndrome are more prevalent in the pediatric age group.

Surface topography demonstrates gradual improvement in spinal range of motion in all three planes following posterior spinal fusion in adolescent idiopathic scoliosis

INTRODUCTION

After posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), there is alteration in trunk range of motion (ROM) in the coronal, sagittal and axial planes. Previous studies have shown that ROM decreases with increased number of levels fused, which may affect the ROM between patients who undergo non-selective thoracic fusion (NSF) and selective thoracic fusion (STF) patient groups. This study sought to longitudinally evaluate the ROM of the trunk in patients with AIS who underwent posterior spinal fusion, using surface topography, comparing STF and NSF patient motion at multiple time points postoperatively.

METHODS

A retrospective review of data from a single-center prospective registry was conducted. Inclusion criteria required subjects to span 11-21 years of age at surgery, a diagnosis of AIS, and valid ROM measurements obtained via ST scanning. Axial, sagittal and coronal ROM was performed at six timepoints: preoperative, 6 weeks, 3, 6, 12, and 24 months postoperative. All patients had an upper instrumented vertebra (UIV) of T2, T3 or T4, and a lower instrumented vertebra (LIV) of T12, L1, L2 or L3. STF was defined as an LIV of T12 or L1, and NSF as LIV as L2 or L3. SRS22r was collected at all time points. Generalized estimation equation modeling across timepoints were conducted.

RESULTS

54 patients were evaluated: 40 patients in the NSF group (average preoperative Cobb angle of 56.4 ± 12.3°) and 14 in the STF group (average preoperative Cobb angle of 57.4° ± 6.7°). In the NSF group, ROM in the coronal and axial planes decreased significantly postoperatively and remained significantly decreased at 24 months postoperatively (25% decrease in the axial plane, 20% in the coronal plane). Sagittal ROM had significant decrease in ROM at all time points, but at 2 years postoperatively was no longer significant, although still 17% decreased. In the STF group, all three planes had significantly decreased initially but axial and coronal planes returned to baseline (no significant difference from preoperative values) at 24 months, while sagittal plane motion remained significantly diminished, although only by 4%. STF demonstrated no difference in SRS22r total, pain or self-image scores between preoperative and 2 years, while NSF had worse SRS22r total, pain, and self image scores at 2 years vs. preoperative values. When comparing NSF to STF, there was diminished axial, sagittal and coronal plane range of motion at 24 months postoperatively, but no differences in SRS22r total.

CONCLUSION

The coronal, sagittal, and axial ROM as measured by ST demonstrated significant decreases from preoperative to postoperative following PSF; however, this deficit trends towards improvement over time. Our data demonstrates that at two years, NSF has poorer motion than STF patients in all three planes.

Impact of backpack load during walking: an EMG and biomechanical analysis

This study aims to understand the impact of backpack carriage, a regular activity for many, on back muscles and joint mobility during walking so that clinicians can develop strategies or products to ensure individuals' safety and well-being. Surface electromyography (EMG) and XSENS Awinda motion capture systems were used to analyze the effects of carrying a backpack (12% of body weight) on erector spinae and multifidus muscles, as well as spinal, hip, knee, and ankle joints. Subjects walked at 4 km/h on flat and inclined surfaces. Paired t-tests compared backpack loads to baseline measurements. Carrying a backpack reduced activation levels in erector spinae and multifidus muscles and restricted spinal joint range of motion (axial and lateral bending, p < 0.05 ). Hip joint rotation increased ( p < 0.05 ). Moderate to strong correlations were observed between muscle activity and spinal joint ROM, notably with left erector spinae and L5-S1 lateral bending (r = 0.723 , p < 0.001 ). Backpack carriage decreases back muscle activation and alters the joint range of motion. Asymmetric correlations show that the subjects adapt muscle activity and gait patterns asymmetrically to manage external loads.

Foot pressure in patients with chronic lumbar radicular pain (sciatica) caused by lumbar disc herniation: a case-control observational study

OBJECTIVE

This study aimed to determine whether there are differences in plantar pressures during gait between patients with lumbar disc herniation -induced sciatica and healthy individuals.

METHODS

This observational case-control study included 41 patients with sciatica due to lumbar disc herniation and 30 healthy controls. Plantar pressures were evaluated using the FootScan® platform in 10-foot zones during 3 gait phases, defined as rockers. After walking, body advancement with the supporting foot depends on stance-limb mobility, with the supporting foot acting as a pivot system. In a serial fashion, the heel, ankle, and forefoot serve as rockers that allow the body to advance smoothly. Data were also collected on quality of life, low back pain, lower limb pain, foot pain, foot pain-related disability, foot joint range of motion, and foot posture index. All variables were compared between the two groups.

RESULTS

Patients with sciatica had a longer contact time and higher mean and peak pressures in all foot zones, except for the first metatarsal and toes. Pressures were higher in the third to fifth metatarsals, especially during push-off. Patients with sciatic arthritis experience not only low back pain, but also lower limb and foot pain, as well as higher foot pain-related disability. There were no significant differences in foot posture or joint ranges, except for decreased subtalar pronation in patients with sciatica.

CONCLUSION

Altered plantar pressure distribution in patients with sciatica may be associated with neuromuscular compensation mechanisms.

The Influence of an Eight-Week Home Exercise Program on Spatiotemporal and Kinetic Characteristics of Gait and Knee Function in Women with Severe Knee Osteoarthritis Scheduled for Arthroplasty

Background and Objectives: The increased prevalence of knee osteoarthritis (OA) and need for total knee arthroplasty (TKA) indicate a growing need for effective prehabilitation. The effect of preoperative home exercise programs (HEPs) on gait in patients with severe knee OA is under-investigated. This study aimed to evaluate the influence of an 8-week preoperative HEP on gait characteristics, leg extensor muscle strength, knee function, and health status in women with severe knee OA scheduled for TKA and to compare them with healthy control data. Material and Methods: Eighteen women with severe knee OA (KOA, aged 61.8 ± 1.6 years) and ten age-matched healthy women (CON) participated in this study. The KOA group performed an HEP with 15 exercises aimed at improving lower limb muscle strength, motion, balance, and coordination. Gait spatiotemporal and kinetic characteristics during the loading response, isometric leg extensor strength, knee active range of motion (AROM), and The Western Ontario and McMaster Universities Arthritis Index (WOMAC) were investigated. Associations between characteristics were analyzed. Results: Improvements in ground reaction force (GRF) during the loading response of gait, leg extensor muscle strength, the knee AROM, and the WOMAC index were found post-HEP. The KOA group demonstrated lower (p < 0.05) spatiotemporal and GRF characteristics than the CON group. Knee extension moment (KEM) was lower pre-HEP (p < 0.05) but did not differ significantly from the CON group post-HEP. Gait characteristics and WOMAC were associated with leg extensor muscle strength and knee AROM and pain in the KOA group. Conclusions: An eight-week preoperative HEP improved GRF and KEM during the loading response of gait, muscle strength, knee function, and self-reported knee OA-related health status in women with severe knee OA. Preoperative HEP before TKA, focusing on leg extensor muscle strength, range of motion, and pain relief, is an effective alternative to supervised exercise therapy in women with severe knee OA.

Efficacy on pain and knee function of Kinesio taping among patients with patellofemoral pain syndrome: a systematic review and meta-analysis

OBJECTIVE

Kinesio taping (KT) has been widely used in patients with Patellofemoral pain syndrome (PFPS) because of its convenience and positive effects. However, there exists conflicting evidence regarding its efficacy. To systematically evaluate the effect of KT on pain and knee function in patients with PFPS.

METHODS

This study was registered in PROSPERO (registration number CRD 42023442333) and completed following the PRISMA checklist. This study did not receive any funding. PubMed, Embase, The Cochrane Library, Web of Science, and EBSCO databases were comprehensively searched by two independent reviewers following PRISMA guidelines for the inclusion of randomized controlled trials (RCTs) exploring the effects of KT on pain and knee function in patients with PFPS. Quality assessment was evaluated using the Cochrane Risk Assessment Scale. Statistical analysis was performed using Review Manager 5.3.

RESULTS

Ten RCTs published from 2011 to 2022 were included in this review. A total of 364 PFPS patients were analyzed, with 184 in the KT group and 180 in the control group. The KT group primarily received KT plus routine rehabilitation, while the control group received routine rehabilitation alone. The overall quality of the included studies was relatively low. Meta-analysis showed that KT significantly reduced visual analog scale pain scores (MD=-0.58, 95% CI: -1.10 to -0.07, P = 0.03) and increased the Kujala anterior knee pain scale score (MD = 2.28, 95% CI: 0.00 to 4.56, P = 0.05) in patients with PFPS compared with controls. While knee extension peak torque (SMD = 0.06, 95% CI: -0.39 to 0.52, P = 0.79), knee flexion peak torque (SMD = 0.36, 95% CI: -0.28 to 0.99, P = 0.27), knee flexion range of motion (MD=-0.93, 95% CI: -4.54 to 2.68, P = 0.61), and knee joint position error (MD=-0.48, 95% CI: -1.91 to 0.96, P = 0.51) were not significantly different among KT and control groups.

CONCLUSION

Current evidence suggests that Kinesio taping reduces pain in patients with patellofemoral pain syndrome, but its effects on knee muscle strength, knee flexion range of motion, and knee proprioception need further investigation. Given its low cost and accessibility, Kinesio taping can be used for pain management in patellofemoral pain syndrome.

Biomechanical preservation of lumbar spine stability and motion with an intraosseous implant following vertebral body osteotomy

PURPOSE

When nonsurgical treatments for low back pain with radiculopathy fail to relieve symptoms from nerve root compression, lumbar spine fusion is the standard treatment. A potential new option is using a vertebral body osteotomy (VBO) with the Vertiwedge Intraosseous System™, a novel spinal implant designed to restore foraminal height, spinal alignment, and preserve motion. The purpose was to demonstrate that VBO with the Vertiwedge implant can stabilize and correct collapsed segments while maintaining the spine's native stability and motion under various loading conditions.

METHODS

The Vertiwedge was biomechanically assessed in a novel spine simulator via non-destructive articulations that included randomized compression loads (0-500 N) and planar motions in flexion/extension (20°/18°), lateral flexion (19°), and axial rotation (9°). Simulations were conducted on 8 cadaveric specimens (5 M:3 F, spinal segments L1-S1, ages 35-75 years). A cubic fit model compared equivalence and linear mixed model compared stiffness with covariates of condition, motion, and compression. Change in foraminal height was not addressed as cadaveric specimens were non-pathological.

RESULTS

After surgical implantation, the cubic fit model demonstrated an overall equivalence (60-80%) to the Native condition. The mixed model demonstrated no differences in maximum moments between any conditions (p ≥ 0.067) or condition*motion (p ≥ 0.196). The full interaction (condition*motion*compression) demonstrated no differences of biomechanical stiffness (p ≥ 0.991).

CONCLUSION

The Vertiwedge, after surgical implantation, demonstrated a return of biomechanical stiffness (stability) compared to the native state of the lumbar spine specimen with all three planes of motion across various physiologic compression loads. The Vertiwedge accomplished nearly native stiffness while preserving lumbar spine motion.

Comparative Efficacy of Supervised, Web-Based, and Self-Guided Exercise Interventions in Women with Patellofemoral Pain Syndrome

Background/Objectives: Patellofemoral pain syndrome (PFPS) is a common musculoskeletal condition that causes anterior knee pain, often linked to increased joint stress. Rehabilitation typically includes education, strength training, and functional exercises. Recently, telerehabilitation has become a promising alternative, particularly useful in improving access to care in rural areas. This study compares the effects of supervised (SE), web-based (WBE), and self-guided (SGE) exercise programs on pain, functionality, and fear of movement (kinesiophobia) in individuals with PFPS. Materials and Methods: Sixty female patients with PFPS participated in this randomized controlled trial. They were randomly assigned to one of three groups: SE, WBE, or SGE. Each program lasted six weeks, with exercises adjusted based on individual tolerance. Outcomes were assessed using the Kujala Anterior Knee Pain Scale, the visual analog scale (VAS) for pain, the Timed Up and Go Test (TUG) for mobility, and the Tampa Kinesiophobia Scale. Results: All groups showed significant improvements in pain, functionality, and kinesiophobia (p < 0.05). The SE group achieved the greatest improvements across all measures, reducing pain and kinesiophobia while enhancing functionality (p < 0.017). The WBE group also showed significant improvements, outperforming the SGE group in all outcomes (p < 0.017). The SGE group demonstrated the least improvement but still achieved positive changes. Conclusions: Supervised exercise programs were the most effective in managing PFPS symptoms. However, the web-based programs also provided substantial benefits, making them a viable option when in-person supervision is not feasible. Future research should aim to enhance digital interventions for broader accessibility and engagement. Trial Registration: The study protocol was also registered on ClinicalTrials.gov (NCT06625086).

Specific modes of exercise to improve rotator cuff-related shoulder pain: systematic review and meta-analysis

Objective

To investigate the effect of specific modes of exercise on rotator cuff-related shoulder pain (RCRSP) patients, aiming to provide a theoretical reference for conservative treatment and exercise prescription.

Methods

Data sources included PubMed/MEDLINE, Web of Science, ScienceDirect, and CNKI, covering studies from database inception to June 2024. Study selection followed pre-set inclusion/exclusion criteria. Cochrane methods guided quality assessment and data extraction. Outcome measures included VAS, CMS, and DASH scores. Publication bias assessed via funnel plots; forest plots created using RevMan 5.4.

Results

13 studies (n = 690) met inclusion criteria for RCRSP exercise interventions. It is indicated that: (1) specific exercises led to modest improvements in performance of pain (SMD = -0.31, 95% CI: 0.46 to -0.16, P < 0.0001) and function, with enhancements in CMS (SMD = 0.59, 95% CI: 0.44 to 0.74, P < 0.00001) and DASH (SMD = -0.60, 95% CI: 0.80 to -0.39, P < 0.00001). (2) Interventions lasting less than 2 months were slightly more effective than those lasting 2 months or longer, observed in VAS (SMD = -0.35, 95% CI: 0.56 to -0.15, P = 0.0007), CMS (SMD = 0.71, 95% CI: 0.47 to 0.96, P < 0.00001), and DASH (SMD = -0.71, 95% CI: 0.99 to -0.43, P < 0.00001). (3) Subgroup analyses revealed that handgrip strength exercises enhanced shoulder pain relief, shoulder mobilization/stretching improved both function and pain levels over 2 months, scapular stabilization exercise improved pain and DASH performance over 2 months, eccentric exercises boosted CMS and DASH performance over 2 months, while proprioceptive exercises showed no significant improvement in pain or CMS performance.

Conclusion

Compared to non-specific exercises, specific exercise programs moderately alleviate RCRSP symptoms, with shorter interventions (<2 months) demonstrating marginally superior outcomes. Efficacy varies by exercise type, emphasizing the need for individualized prescriptions.

Systematic Review Registration

PROSPERO (CRD42024550602).

Naviculectomy With Limited Soft-Tissue Releases as a Third Way Beyond Manipulative Treatment and Extensive Soft-Tissue Releases for Ambulatory Children With Complex Congenital Vertical Talus: A Technical Note

We investigated the radioclinical outcomes of naviculectomy and limited/tailored soft-tissue releases in a short series of ambulatory children with complex/intractable congenital vertical talus subsets namely neglected, multiple operated, and recurrent patients. We postulated that this technique will yield satisfactory radioclinical outcomes and minimal complications because it avoids extensive surgical release/trauma that is otherwise classically recommended for complex congenital vertical talus. The cohort consisted of 5-4 boys and 1 girl-complex congenital vertical talus children with neglected, multiple operated, and/or recurrent subsets. Patients were included if manipulative casting techniques were deemed unlikely to produce a plantigrade foot. Patients underwent naviculectomy with variable on-demand limited soft-tissue releases. Two patients had bilateral affection and 2 had a nonidiopathic cause. The mean age was 5.2 years (4-6.25) and mean follow-up was 2.3 years (1-3). We reported satisfactory outcomes as per foot posture, function, overall parent satisfaction including pain and radiography per lateral views of talar-axis-first metatarsal base angle on the short/intermediate term. Whereas manipulative casting is unlikely to yield lasting outcomes in ambulatory children with complex subsets of congenital vertical talus, extensive surgical soft-tissue releases have unfavorable long-term complications. As a substitute, naviculectomy as a form of resection arthroplasty created a practical and affordable third way between manipulative casting with or without minimally invasive surgery and the extensive surgical soft-tissue releases on the short-to-intermediate term.Level of Evidence:Level IV case series.

Correction of L5 Tilt in 2-Row Vertebral Body Tethering Versus Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

STUDY DESIGN

Single-center retrospective cohort study.

OBJECTIVE

To compare the correction of fractional curve and L5 tilt in 2RVBT versus PSF with LIV in the lumbar spine.

SUMMARY OF BACKGROUND DATA

Vertebral body tethering, an AIS fusion-alternative, avoids rigid constructs, allowing for lower instrumented vertebra (LIV) selection. Single-tether constructs break, but mini-open thoracoscopic assistant double-row vertebral body tethering (2RVBT) reduces this. Limited comparative studies exist with posterior spinal fusion (PSF).

METHODS

Retrospective analysis of AIS correction surgeries with lumbar LIV using preoperative and minimum 2-year postoperative imaging. Patients were divided into 2RVBT or PSF groups. Data included age, Riser, UIV, LIV, instrumented levels, and revision rates. Radiographic analyses included preoperative and postoperative main curve Cobb (MCC), secondary curve Cobb (SCC), fractional curve Cobb (FCC), and L5 tilt.

RESULTS

Ninety-nine patients participated (49 in 2RVBT, 50 in PSF). Preoperatively, secondary CC differed significantly (2RVBT: 44.6±10.4 degrees vs. PSF: 39.5±11.8 degrees, P =0.026), but not L5 tilt, MCC, or FCC. Postoperatively, MCC (2RVBT: 25.7±12.3 degrees vs. PSF: 19.5±7.4 degrees, P =0.003) and SCC (2RVBT: 18.0±8.4 degrees vs. PSF: 14.5±6.6 degrees, P =0.012) varied. Preoperative to postoperative changes in MCC (2RVBT: -32.0±11.3 degrees vs. PSF: -37.2±13.3 degrees, P =0.044) and L5 tilt (-13.8±9.0 degrees vs. PSF: -8.1±6.8 degrees, P =0.001) differed. Revision rates were similar (2RVBT: 2.0%, PSF: 4.0%, P =0.57). In 2RVBT, 3 tethers broke, 1 revision occurred for a broken tether, and 1 pleural effusion needed thoracocentesis. In PSF, 1 superficial infection needed surgery, and 1 revision was for add-on phenomenon. After PSM for Lenke classification, 54 patients remained (27 in each group). At 2 years, 2RVBT showed less MCC correction (-30.8±11.8 degrees vs. -38.9±11.9 degrees, P =0.017), but greater L5 tilt correction (-14.6±10.0 degrees vs. -7.5±6.0 degrees, P =0.003).

CONCLUSIONS

This study with a minimum 2-year radiographic follow-up demonstrates that 2RVBT results in greater L5 tilt correction when compared with posterior spinal fusion after PSM for Lenke classification and similar rates of revision surgery.

LEVEL OF EVIDENCE

Level III.

2D and 3D Classification Systems for Adolescent Idiopathic Scoliosis: Clinical Implications and Technological Advances

Classification systems for Adolescent Idiopathic Scoliosis (AIS) play an important role in guiding both surgical planning and conservative treatments. Traditional 2D classification systems, such as the Lenke, King and Lehnert-Schroth classifications, have been widely used for the clinical diagnosis and treatment of scoliosis. However, with the growing understanding of the three-dimensional nature of scoliosis and advancements in 3D reconstruction technologies, 3D classification systems are gaining increasing attention. This paper reviews the current applications, advantages, and limitations of different 2D and 3D classification systems, focusing on their clinical significance in treatment planning. While 3D classification systems offer clear advantages in capturing the complexity of spinal deformities, their clinical implementation faces challenges such as high costs and technical complexity. Additionally, studies show that computer-assisted technologies, artificial intelligence can significantly improve the accuracy and consistency of classification systems, reducing human errors. The paper also explores the future directions of classification system development, emphasizing the potential of combining 2D and 3D technologies and the impact of these advancements on personalized scoliosis treatment.

Postural asymmetry in low back pain - a systematic review and meta-analysis of observational studies

PURPOSE

Systematic review and meta-analysis to examine common static postural parameters between participants with and without low back pain (LBP).

METHODS

Systematic search on the PubMed, CINAHL, Embase and SCOPUS databases using keywords 'posture' and 'low back pain'. Observational studies comparing static postural outcomes (e.g. lumbar lordosis) between participants with and without LBP were included. Two independent reviewers conducted screening, data extraction and quality assessment. Methodological quality was assessed using Joanna Briggs Institute's critical appraisal tools.

RESULTS

Studies included in review = 46 (5,097 LBP; 6,974 controls); meta-analysis = 36 (3,617 LBP; 4,323 controls). Quality of included studies was mixed. Pelvic tilt was statistically significantly higher in participants with LBP compared to controls (n = 23; 2,540 LBP; 3,090 controls; SMD:0.23, 95%CI:0.10,0.35, p < 0.01, I2=72%). Lumbar lordosis and sacral slope may be lower in participants with LBP; pelvic incidence may be higher in this group; both were not statistically significant and the between study heterogeneity was high. Thoracic kyphosis and leg length discrepancy showed no difference between groups.

CONCLUSIONS

Lumbopelvic mechanisms may be altered in people with LBP, but no firm conclusions could be made. Pelvic tilt appeared to be increased in participants with LBP. Postural variable measurement needs standardisation. Better reporting of study characteristics is warranted.

Association among clinical severity indicators, psychological health status and elastic properties of neck muscles in patients with chronic mechanical neck pain

BACKGROUND

Since objective stifness measures are not consistent with the patients' perception and its correlation with the clinical severity of neck pain is not clear, novel studies assessing the clinical relevance of muscle stiffness are needed.

OBJECTIVES

To analyze the correlation among psychological factors, clinical severity indicators, and muscle stiffness in neck muscles in patients with chronic mechanical neck pain, and compare these factors with asymptomatic controls.

METHODS

A cross-sectional observational study was conducted. Participants included cases with chronic neck pain and asymptomatic controls, assessed for muscle stiffness using shear wave elastography, psychological health (anxiety and kinesiophobia), and clinical severity. Data analysis involved correlation matrices and comparison between groups.

RESULTS

Although no significant differences in levator scapulae stiffness were observed between groups (p > 0.05), patients exhibited significantly increased stiffness in the anterior scalene and cervical multifidus muscles (p = 0.009 and p = 0.040, respectively). STAI scores were significantly higher in patients for both subscales (STAI-S p = 0.002 and STAI-T p < 0.001), but no kinesiophobic behaviors differences were found (p > 0.05). Significant correlations between pain chronicity, intensity, disability, and psychological factors were confirmed. Notably, the levator scapulae stiffness was positively associated with disability, anxiety, and kinesiophobia (all p < 0.01). However, the anterior scalene and cervical multifidus stiffness, even if significantly associated with demographic factors (p < 0.05), were not associated with clinical or psychological outcomes.

CONCLUSION

The findings underscore the intertwined nature of psychological factors and muscle stiffness in chronic neck pain, suggesting the need for integrated approaches in treatment that consider both physical and psychological dimensions.

Upper limb muscle strength and neuromuscular coordination and other factors as determinants of kinesiophobia in people with cervical and cervicothoracic spine dysfunction

The aim of this study was to analyze the incidence of neuromuscular coordination disorders and upper limb muscle strength in people with functional disorders of the cervical and cervicothoracic spine. A total of 407 participants took part in the study. The level of kinesiophobia was assessed using the Tampa scale. For cervical spine dysfunction, the pain was measured using the visual analogue scale (VAS) and the cervical disability index (NDI). Neuromuscular control was tested using the Deep Cervical Neck Flexor test with the Stabilizer device. Upper limb muscle strength was measured using a dynamometer test. The data obtained revealed a correlation between higher Tampa scale scores and most of the variables assessed. A positive correlation between age (rho = 0.27; p < 0.001), pain (rho = 0.43; p < 0.001), and NDI (rho = 0.43; p < 0.001) was registered. A negative relationship was found between neuromuscular coordination (rho = 0.41; p < 0.001) and muscle strength of most muscles(rho - 0.14 to -0.28, p < 0.01). Higher Tampa scale values correlate with poorer neuromuscular coordination, older age, pain, weaker NDI score, and strength of some upper limb muscles in the cervical and cervicothoracic spine functional impairment group. There is no correlation between kinesiophobia presence and gender.

Effectiveness of bracing combined with exercise-based treatment of adolescent idiopathic scoliosis: Assessing the synergistic benefits: A systematic review

The purpose of this study was to evaluate evidence on the effectiveness of combined bracing and exercise on adolescent idiopathic scoliosis (AIS). From inception to April 28, 2022, PubMed and Web of Science searched for randomized clinical and nonrandomized prospective studies reporting Cobb angle (CA), angle of trunk rotation (ATR), quality of life (QoL), and pulmonary function (PF) in AIS patients treated with exercise and braces (10 years-skeletal maturity). Two authors analyzed and extracted data for this review. The PEDro scale was used to assess the risk of bias (RoB). Therapy protocols and basic data have been collected. Each CA, ATR, QoL, and PF study's evidence and strength were also included. A total of 12 studies with 714 patients with AIS were included. Five studies used a control group with exercises and 7 with braces. The results showed that exercise-brace can decrease CA and ATR and increase QoL and PF with AIS; however, the strength of conclusion for all outcomes was moderate. In this review, 4 studies were categorized as low RoB, 3 as moderate RoB, and 5 as high RoB. Level of evidence analysis revealed that 12 studies were classified as level of evidence B. The current studies do not sufficiently support the effects of exercise and brace therapy on CA, ATR, QoL, and PF in patients with AIS.

Are some people more susceptible to placebos? A systematic review and meta-analysis of inter-individual variability in musculoskeletal pain

Existing data suggest placebo responses to treatments are small, but some people may be more likely to respond. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) on interindividual variability in response to placebo interventions MEDLINE, EMBASE, CINAHL, Web of Science Core Collection, CENTRAL, and SPORTDiscus were searched from inception to September 2023. Trial registry searches, citation tracking, and searches for prior systematic reviews were completed. The PEDro scale assessed study quality. Random effects robust variance estimation estimated the log variability ratio (VR), identifying subgroups with varying responses. Twenty-six studies were included, comprising various musculoskeletal pain conditions. Analysis of pain intensity (VR: 1.06, 95%-confidence interval (CI):[0.97; 1.16], 95%-prediction interval (PI):[0.75; 1.51], p = 0.17, k = 26 studies, N = 52 outcomes, GRADE: low), physical function (VR: 1.14, 95%-CI:[0.97; 1.34], 95%-PI:[0.62; 2.11], p = 0.11, k = 19, N = 40, GRADE: low), and health-related quality of life (VR: 1.14, 95%-CI:[0.91; 1.41], 95%-PI:[0.72; 1.80], p = 0.19, k = 7, N = 13, GRADE: low) outcomes revealed minimal, non-statistically significant variability in placebo response compared to control. However, wide prediction intervals suggest uncertainty regarding individual response patterns. There are likely no distinct subgroups of people who are more likely to respond to placebo interventions in musculoskeletal pain; although the available data limits the certainty of this assessment. Future work should consider individual participant data meta-analyses to better elucidate potential responder subgroups and optimize treatment strategies for musculoskeletal pain. PERSPECTIVE: This study systematically reviewed and analyzed RCTs to assess interindividual variability in placebo responses for musculoskeletal pain. Findings suggest minimal variability in placebo response, with no distinct subgroups more likely to respond. Wide prediction intervals indicate uncertainty, highlighting the need for future individual participant data meta-analyses to better elucidate potential responder subgroups.

VR Head Tracking as a Useful Tool for the Qualitative Assessment of Cervical Spine Movement

Virtual reality (VR), among other technologies, is establishing the direction of development in the rehabilitation field. Diagnostic tools in cervical spine movement assessments have been described in many studies. The aim of this study was to present the potential of using VR for diagnosing movement quality disorders in the cervical spine. Additional objectives of the research include determining whether Virtual Reality conditions are reliable and objective for measuring the range of motion of the cervical spine when using the proprietary VR Head Tracking application, as well as assessing the level of satisfaction and tolerance of this type of diagnostic method among the subjects. We reached the following conclusions: the measurements of the cervical spine range of motion conducted using the proprietary VR Head Tracking application are reliable and objective, the level of satisfaction with the diagnostic method, as well as the tolerance of the VR examination, is consistently favorable in adults, the results obtained from the VR application allow for a deeper analysis of the data, beyond just the angles of the range of motion. The use of diagnostic methods in a Virtual Reality environment for assessing the biomechanics of the musculoskeletal system in the cervical spine is valid and can be efficiently and non-invasively carried out.

The clinical efficacy of proprioceptive neuromuscular facilitation technique in the treatment of scapulohumeral periarthritis: a systematic review and meta-analysis

BACKGROUND

Scapulohumeral periarthritis (SP) is a disease caused by chronic inflammation of the shoulder soft tissue area, which is characterized by shoulder pain and limited mobility. Due to the long course of disease, it often has a great impact on the life and work of patients.

OBJECTIVES

The purpose of this study was to systematically evaluate the effect of proprioceptive neuromuscular facilitation (PNF) stretching technique in the treatment of SP.

METHODS

A systematic search of 10 databases such as China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database, Weipu, Wanfang, PubMed, Embase, Web of Science, Cochrane Library, Clinical Trials, and China Clinical Trial Registry Platform was performed. The retrieval time was from inception to January 2024. Two researchers screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated the quality.Revman5.3 software was used for meta-analysis, and only descriptive analysis was performed on the outcome indicators of the number of literature ≤ 2.

RESULTS

A total of 12 articles were included, including 968 patients. The results of Meta-analysis showed that PNF technique could reduce pain intensity ((Visual analog scale (VAS) score (SMD = -0.67, 95% CI [-1.18, -0.15], P = 0.03), Japanese Orthopaedic Association (JOA) score (subjective pain score standard) (SMD = 0.79, 95% CI [0.23,1.35], P < 0.01)), improve the shoulder function of patients (SMD = 1.13, 95% CI [0.96,1.31], P < 0.01), and improve the patient's daily living ability (SMD = 1.06, 95% CI [0.77,1.34], P < 0.01). The results of descriptive analysis showed that the PNF technique could improve the psychological state of patients with scapulohumeral periarthritis to a certain extent.

CONCLUSION

The PNF technique can help patients with scapulohumeral periarthritis to relieve pain, improve shoulder function, and strengthen daily living ability. In addition, a good psychological state is conducive to better recovery of patients ' health. In clinical work, medical staff should pay attention to the psychological state of patients with SP.

CLINICAL TRIAL NUMBER

Not applicable.

Test-retest reliability and concurrent validity of the unilateral seated shot-put test in patients with subacromial pain syndrome

The aim of this cross-sectional study was to assess the test-retest reliability and concurrent validity of the Unilateral Seated Shot-Put Test (USSPT) in patients with subacromial pain syndrome (SAPS). Twenty three patients were included in the study. The participants were assessed using the USSPT for functional power; Visual analog scale (VAS) for pain at activity; Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) and Shoulder Pain and Disability Index (SPADI) for disability, hand-held dynamometer for shoulder flexion and shoulder abduction muscle strength, and grip strength. Test-retest reliability of the USSPT was found excellent with an intraclass correlation coefficient (ICC2,1) score of 0.976, a standard error of measurement (SEM) of 12.47, and a minimum detectable change (MDC95) score of 34.54. There was high to excellent correlations between the USSPT and the SPADI (r = -0.756, p = <0.001), shoulder flexion muscle strength (r = 0.834, p = <0.001), and shoulder abduction muscle strength (r = 0.711, p = <0.001). SPADI score and shoulder flexion muscle strength were the most important factors influencing USSPT performance, accounting for 73.3% of the variance. The USSPT is a reliable and valid test for assessing upper extremity functional power.

Predictors for Poor Outcomes at Six Months on Pain, Disability, Psychological and Health Status in Greek Patients with Chronic Low Back Pain After Receiving Physiotherapy: A Prospective Cohort Study

Background: Although previous studies have suggested a variety of sociodemographic and psychological factors as predictors of poor outcomes in patients with chronic low back pain (CLBP), longitudinal studies remain rare. Objectives: To examine the prognostic indicators for poor outcome at 6 months on pain, disability, quality of life, anxiety, depression and somatic symptom disorders (SSDs) in Greek backache patients and to evaluate the medium-term effects of a conservative physiotherapeutic approach (massage, ultrasound, transcutaneous electrical nerve stimulation, low-level laser and exercise program). Methods: A prospective cohort study of 145 volunteers receiving treatment for CLBP in a physiotherapy unit was conducted using random systematic sampling. The intervention was assessed by comparing pre-treatment, post-treatment and six-month measurements with Friedman's test and the Bonferroni correction, using the pain numerical rating scale (PNRS), Roland-Morris disability questionnaire (RMDQ), EuroQol-5-dimension-5-level (EQ-5D-5L), Hospital Anxiety and Depression Scale (HADS) and Somatic Symptom Scale-8 (SSS-8). Multiple linear regression analysis was carried out to determine the impact of demographics and pre-treatment scores with scores at six months. Results: The mean age was 60.6 years (±14.7). Post-treatment, statistically significant improvements were observed across all outcome measures, including PNRS, RMDQ, EQ-5D-5L and SSS-8 (all p ≤ 0.001), with anxiety showing a notable reduction (p = 0.002). After examining the multiple regression analysis, pre-treatment SSS-8 emerged as a predictor of elevated levels of pain, disability, anxiety and depression at 6 months. Conclusions: The findings yielded not only somatic symptom burden, greater age and pain intensity as prognostic indicators for poor outcomes at six months, but also reported favorable medium-term effects for a conventional physiotherapy regimen in CLBP management, as well.

Evaluation of Primary Correction and Its Influencing Factors in Adolescent Idiopathic Scoliosis After Treatment with the Charleston Bending Brace as the Sole Intervention

BACKGROUND

All-day braces are predominantly used for the conservative treatment of adolescent idiopathic scoliosis (AIS). The Charleston Bending Brace is a pure nighttime brace. The aim of this study was to investigate the primary in-brace correction of the main curve of AIS when treated with the Charleston Bending Brace. Specifically, the factors influencing major curve correction were examined.

METHODS

The retrospective analysis included 97 patients with AIS who were treated between October 2010 and September 2020. Patients with secondary scoliosis or orthotic pretreatment were excluded. Standardized radiographs were used to determine the Cobb angle of the major and minor curves. Curve correction in relation to Lenke's classification, the Risser stage, and rotation were assessed at four different time points (t0: before treatment, t1: 6-12 months, t2: 13-24 months, and t3: 25-36 months during treatment).

RESULTS

The average Cobb of the main curve at the beginning of the study was 25.7°. The night brace achieved excellent in-brace correction at t1, with nearly half of the patients (43%) showing a correction exceeding 80%. Curve localization, the Lenke type, and the Nash-Moe rotation significantly influenced initial in-brace curve correction at t1. At t2, there was also a significant in-brace correction of the initial Cobb by 93.0%. Similar improvements were observed at t3 for in-brace correction as well as without the brace (p < 0.031).

CONCLUSIONS

The results of the study revealed good primary in-brace correction of the main curve of the AIS with the nighttime brace, which was at least equivalent when compared to values from the literature for the Chêneau brace. Also, while restricted to medium-term results due to our study limitations, the percentage of correction in out-of-brace data of our patients was similar to weaned 24 h brace patients.

Re-evaluation of Incorrect Posture as a Diagnostic Criterion for Scoliosis in School Screenings: A Cross-Sectional Study in Vietnam

A cross-sectional study was performed to determine the prevalence of idiopathic scoliosis through school screening and to evaluate the correlation between incorrect posture identified during screening and the confirmed diagnosis of scoliosis, utilizing the gold standard criterion in 3,527 children aged 10 to 17 years from March 2023 to December 2023 in Ho Chi Minh City, Vietnam. The evaluation method included Adam's forward bending test with the angle of trunk rotation, and a cut-off point greater than or equal to 5°. Based on clinical examination, the research results show that 312 (8.7%) children were suspected of having scoliosis. Still, the prevalence of idiopathic scoliosis confirmed by X-rays was 130 (3.6%) children, with the standard being Cobb angle ≥10°. Most people with idiopathic scoliosis had moderate curves, including 119 (91.5%) and 130 (100%) demonstrated positive vertebral body rotation, with a female-to-male ratio of 2.11:1. The study identified a correlation between suspected scoliosis and incorrect posture seen during screening, including "shoulder-height difference", "any curve in the spine", and "humps on one side" (p < 0.001). However, no correlation was determined between these listed incorrect postures and a definitive diagnosis of idiopathic scoliosis by X-rays (p > 0.05). The results of the research suggest that incorrect posture found by clinical assessment shouldn't be used as the main criterion for scoliosis diagnosis during screening. The use of the angle of trunk rotation, combined with Adam's forward bending test and a suitable cut-off angle, is required to be considered for scoliosis screening in schools.

Research trends of biomechanics in scoliosis from 1999 to 2023: a bibliometric analysis

OBJECTIVE

Despite the abundance of research on the biomechanics of scoliosis, there is a lack of a comprehensive bibliometric analysis. This study utilizes bibliometric methods to elucidate the research trends and hotspots within this domain.

METHODS

The data for this study were obtained from the Web of Science Core Collection and then analyzed using the open-source Bibliometrix R package and Citespace.

RESULTS

The analysis encompassed 410 publications published from 1999 to 2023. There is a sustained increase in the number of publications within the field. Utilizing citation analysis and keyword analysis, the study identified key research focuses. Burst keyword analysis identified 19 keywords.

CONCLUSIONS

The period from 1999 to 2023 has witnessed significant research attention on the biomechanics of scoliosis. The demographic shift towards an aging population has recently increased interest in ASD. Proximal biomechanical changes and transitional zones in PJK and PJF are hotspots in research, offering emerging scholars in this discipline valuable opportunities for exploration.

Effect of Self-reported Physical Activity on Glycaemia and Blood Pressure in Healthy Participants from Bissau: A Cross-sectional Study

BACKGROUND

Recent data show a dramatic increase in non-communicable diseases in developing countries, including cardiovascular disease, obesity and diabetes. Most of these diseases may be preventable and to some extent treatable by alterations in physical activity. We investigated the correlations of physical activity levels, according to energy expenditure [measured in metabolic equivalent minutes per week (METs x min/week)] with fasting glycaemia levels, blood pressure, body compositions and anthropometric variables in participants from Bissau, Guinea-Bissau.

METHOD

The International Physical Activity Questionnaire was used to assess levels of physical activity, by calculating METs x min/week. These were subsequently divided into low, moderate or high physical activity categories in a healthy group of participants. Fasting glucose, arterial blood pressure, body mass index and body fat were also assessed. Data was analyzed using the SPSS statistical software.

RESULTS

429 participants were included from sports and health facilities around the country. Of these, 187 were highly active (> 3000 MET × min/ week or at least 1500 METs × min/week) and had a mean age of 26.8 ± 7.5 years. 76% (327/429) were male and 24% were female (102/429). The mean energy expenditure was 4866.7 ± 1241.2 METs × min/week and the mean fasting glucose was 94.0 ± 14.1 mg/dl. 4.1% (18/429) of the participants had diabetes and 12.8% (55/429) had hypertension. A significant negative correlation was found between blood glucose and total physical activity (rs = - 0.117, p = 0.015). Sedentary participants had the highest proportion (5.1%) of diabetes and higher rates of hypertension (15.8%). These participants had the highest obesity (10.1%) and overweight prevalence (23.7%). In addition, they also presented the highest percentage (5.1%) of body fat, with 55% of them showing high or very high visceral fat% content. In the sedentary group, a significant positive correlation, was found, indicating a low moderate association, between systolic blood pressure and weekly sitting time, rs(175) = 0.205, p = 0.006.

CONCLUSION

While high levels of physical activity had a significant impact on glycaemia control, physical activity had no significant impact on blood pressure. However, weekly sitting time may increase blood pressure.

Exploring the Relationship Between Brain Neurochemistry, Cervical Impairments and Pain Sensitivity in People with Migraine, Whiplash-Headache, Low Back Pain and Healthy Controls: A Secondary Analysis of a Cross-Sectional Case-Control Study

Background/Objectives: Gamma-Aminobutyric Acid (GABA) and glutamate are the main inhibitory and excitatory neurochemicals of the central nervous system. Recently, increased GABA+ (GABA+ macromolecules) and Glx (glutamate and glutamine) levels have been reported in migraine. Conversely, decreased GABA+ and Glx levels have been reported in conditions such as chronic musculoskeletal pain and other chronic widespread pain conditions. This has led to the hypothesis that unique neurochemical profiles may underpin different headache and pain conditions. What is currently unknown is how neurochemical levels correlate with different clinical presentations of local and widespread pain sensitivity. The aims of this study were therefore to (i) explore the relationship between brain neurochemicals and clinical presentations of different headache and pain conditions and (ii) use a novel approach to explore how participants cluster based on their neurochemical profiles and explore the clinical characteristics of the participants in these neurochemical clusters. Methods: In this exploratory secondary analysis of a cross-sectional study, participants with migraine (n = 20), whiplash-headache (n = 20), and low back pain (n = 20), and healthy controls (n = 21) completed pain, disability and psychological distress questionnaires, received Magnetic Resonance Spectroscopy (MEGAPRESS), and underwent cervical musculoskeletal and quantitative sensory testing. Participants were classified based on cervical musculoskeletal impairment, increased cervical pain sensitivity, and central sensitization. Correlations between neurochemical levels and clinical classifications were explored. Cluster analysis was used to determine how participants grouped based on their neurochemical profiles. Pain, disability and psychological distress scores and clinical classifications were then compared between the resultant clusters. Post hoc testing explored increased cervical pain sensitivity within the clusters. Results: GABA+ levels moderately correlated with increased cervical pain sensitivity (r2 = 0.31, p = 0.006), with no other significant correlations. Cluster analysis revealed three neurochemical profiles, Cluster 1 (Low GABA+ levels) had moderate disability, Cluster 2 (highest Glx levels) had the lowest pain and disability, and Cluster 3 (highest GABA+ levels) had the highest pain and disability. Post hoc testing demonstrated that the cluster with the highest GABA+ levels (Cluster 3) had the most cervical pain sensitivity. Conclusions: This study suggests that considering the pain condition or presence of central sensitization alone is not sufficient to explain GABA+ and Glx levels. Our findings suggest that increased cervical pain sensitivity might be more reflective of GABA+ levels than pain condition or central sensitization and would benefit from further investigation to further elucidate the relationship between brain neurochemicals and clinical characteristics of pain sensitivity.

Effect of an 11-Week Repeated Maximal Lumbar Movement with Controlled Breathing on Lumbar Sagittal Range of Motion in Elite Swimmers: A Randomized Clinical Trial

Lumbar range of motion (ROM) is essential to develop effective movements during the underwater undulatory swimming technique. Core exercises are used to improve the strength of the muscles that participate in that technique, and variations in sensory input and attentional focus may modulate neuromuscular responses and impact training outcomes. The aim of this study was to investigate the impact of an 11-week program of repeated maximal lumbar movements with closed eyes and without focused attention on lumbar sagittal ROM in elite swimmers versus executing them solely with proper exercise technique with controlled breathing.

METHODS

A sample of 57 professional swimmers, including 34 males (20.2 ± 4.2 years) and 23 females (20.7 ± 3.3 yrs), volunteered to complete this study. They were randomly divided into two experimental groups (EG1 and EG2) and one control group (CG). All subjects underwent the same type of training program in parallel with the EG intervention. EG1 and EG2 performed three sets of ten repetitions of lumbar flexion and extension exercises at breathing pace, 6 days a week for 11 weeks. EG1 performed the core workout with closed eyes and focused attention on the lumbar movement, while EG2 only followed the technique of the exercises at a controlled breathing pace. Lumbar flexion (F), extension (E), and total ROM (TROM) were assessed by an electrogoniometer in a seated, relaxed position over a Swiss ball.

RESULTS

Repeated measures ANOVA showed significant differences in the multivariate profiles across groups and over time. F (8, 48) = 3.495, p = 0.002. EG1 had non-significant increases in lumbar ROM, EG2 had significant increases in TROM and extension ROM, and CG had no changes.

CONCLUSIONS

The results suggest that repeating maximal lumbar movement at a controlled breathing pace, with opened eyes and non-focusing attention on the movement, increases lumbar ROM in the sagittal plane.

Effects of neural mobilization on respiratory parameters, pain, range of motion, and neck awareness in patients with chronic neck pain: A randomized controlled trial

BACKGROUND

Chronic neck pain (CNP) does not have a direct effect on breathing, but movements are restricted due to pain, and kyphotic posture may make movement of the diaphragm difficult.

OBJECTIVE

This study aimed to determine the effects of neural mobilization (NM) on respiratory functionss in patients with chronic neck pain.

METHODS

Overall, 26 patients with CNP were randomly assigned to two groups: NM (10 sessions) or control. In these participants, pain intensity was first assessed using a Visual Analog Scale (VAS). Next, the active range of motion (ROM) of the cervical joint was measured. Following this, respiratory function was evaluated using spirometry, which included parameters such as Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), and the FEV1/FVC ratio. Finally, neck awareness was assessed using the Fremantle Neck Awareness Questionnaire (FreNAQ).

RESULTS

There was a significant difference in terms of pain intensity (p < 0.05) and range of motion of the neck joint in both groups after treatment (p < 0.05). In addition, there was a significant difference between the two groups in terms of respiratory function tests (p = 0.001) and neck awareness (p = 0.001).

CONCLUSION

The results of our study suggest that the use of NM treatment in addition to conventional physiotherapy in patients with chronic neck pain has beneficial effects on respiratory functions, joint range of motion, pain, and neck awareness.

Systematic Review of Clinical Outcome Parameters of Conservative Treatment of Adolescent Idiopathic Scoliosis Patients

Background: The purpose of this systematic review was to investigate the clinical outcome measures, either in separation or in conjunction with the Cobb angle, that were employed in randomized controlled trials to evaluate posture and spinal deformity. Methods: The PubMed, PEDro, OVID, and Scopus electronic databases were used to search for published articles from January 2004 to May 2024. All the searches included English language studies. Keywords were determined as "scoliosis, exercise, physical activity, brace, bracing, conservative treatment, rehabilitation, physiotherapy and physical therapy". Results: The most commonly used clinical evaluation parameters other than the Cobb angle in the studies were the ATR and surface topography measurements. The most commonly used assessment methods were POTSI asymmetry assessment performed with measurements made on photographs, the WRVAS, a deformity perception assessment evaluated with different photographs, and the SRS-22 scale, a disease-specific quality of life assessment. Conclusions: New developments in the treatment of scoliosis have brought about alternative measurement techniques that offer a more comprehensive view of patient outcomes. As a result of the review of the literature, it has emerged that radiation-free, valid, and reliable multidimensional evaluations should be performed in follow-up and treatment efficacy evaluations after initial diagnosis in adolescent idiopathic scoliosis.

Effects of a smartphone game to facilitate active neck movements on the incidence of neck pain among office workers: A 6-month cluster-randomized controlled trial

OBJECTIVES

To evaluate the effects of a smartphone game for active neck movement exercise on perceived neck discomfort, new onset neck pain, and active cervical range of motion among high-risk office workers.

METHODS

A 6-month prospective cluster-randomized controlled trial was conducted. Workers were randomly assigned at the cluster level into either the intervention group (n = 50), who received a smartphone game to play twice a day, or the control group (n = 50), who received a placebo seat pad to use while sitting. Both groups were followed up for 6 months and outcome measures included the incidence of neck pain, perceived neck discomfort, assessed by the Borg CR-10, and active cervical range of motion. Analyses were performed using Cox proportional hazard models.

RESULTS

The 6-month incidence of neck pain was 20% and 44% in the intervention and control groups, respectively. Hazard ratios, after adjusting for biopsychosocial factors, showed a protective effect of the smartphone game for new onset neck pain (HRadj = 0.43, 95% CI 0.20 to 0.91). The between group differences in perceived neck discomfort during the follow up did not reach the minimally clinically important difference level. Mean active cervical range of motion in the intervention group were significantly greater than the control group in all directions (p < 0.05).

CONCLUSION

The smartphone game for active neck movement exercise is an effective intervention to prevent neck pain among high-risk office workers.

Can surface topography reliably determine the Rigo classification system?

PURPOSE

No studies have explored the reliability of the Rigo classification system using surface topography (ST), which would allow optimization without radiation exposure. This study aims to measure and compare the intra- and inter-observer reliability (Kappa values) and accuracy of the Rigo system between ST and X-ray for overall types and subtypes.

METHODS

X-ray and ST images of 31 adolescent idiopathic scoliosis patients were selected. Three investigators were blinded to assess images using the Rigo system, twice for each patient on different weeks, with 372 overall image readings. Afterwards, all investigators agreed upon the correct Rigo scores for finalized classifications.

RESULTS

For Rigo types, the average intra-observer Kappa value was slightly better for ST (0.77, p<0.001) than X-ray (0.75, p<0.001). For Rigo subtypes, the average intra-observer Kappa value was again slightly better for ST (0.74, p<0.001) than X-ray (0.65, p<0.001). The inter-observer reliability was expectedly lower than intra-observer, with ST (0.53, p<0.001) comparable to X-ray (0.54, p<0.001) for the type. For subtype inter-observer reliability, ST (0.43, p<0.001) was slightly better than X-ray (0.36, p<0.001). For the type, the overall accuracy of the observers was slightly lower for ST (77.96%) than X-ray (79.57%). For the subtype, the accuracy of observers was slightly higher for ST (70.97%) than X-ray (65.05%).

CONCLUSION

ST-based Rigo system demonstrates very good intra-rater reproducibility and moderately good inter-rater reproducibility. Surface topography is comparable to X-ray for the Rigo system, and therefore can be considered a reliable alternative in clinical application.

Supervised or Home-Based? Exploring the Best Exercise Approach for Knee Osteoarthritis Management: A Systematic Review and Meta-Analysis

Background/Objective: Knee osteoarthritis (OA) is a common and debilitating condition affecting older adults, often progressing to advanced stages and requiring total joint replacement. Exercise therapy is widely recognized as the first-line approach for the prevention and initial management of OA. This systematic review assessed the effectiveness of home-based exercises (HBEs) compared to supervised exercises in alleviating pain and reducing disability among patients with knee OA. Methods: A systematic search of PubMed, Cochrane Library, and ScienceDirect identified randomized controlled trials (RCTs) published between January 2001 and October 2024. Methodological quality was evaluated using the Physiotherapy Evidence Database (PEDro) scale, and a meta-analysis was conducted to quantify the efficacy of these interventions. Results: Ten RCTs involving 917 patients were included, ranging in moderate to high methodological quality (PEDro score: 6.3 ± 1.2). Intervention durations ranged from 4 to 12 weeks. Both supervised and HBEs were found to be effective, but supervised exercises demonstrated statistically significant improvements in pain (SMD = -0.45 [95% CI -0.79; -0.11], p = 0.015) and disability (SMD = -0.28 [95% CI -0.42; -0.14], p < 0.001) compared to HBEs. Conclusions: Despite the superiority of supervised exercises over HBEs, considering the cost-effectiveness and ease of implementation of HBEs, we developed recommendations to create a hybrid rehabilitation program that combines both approaches to maximize clinical outcomes.

Effectiveness of movement representation techniques in non-specific shoulder pain: a systematic review and meta-analysis

This systematic review and meta-analysis aims to assess the effects of movement representation techniques (MRT) on pain, range of motion, functional outcomes, and pain-related fear in patients with non-specific shoulder pain (NSSP). A literature search conducted in PubMed, PEDro, EBSCO, Scopus, Cochrane Library, ScienceDirect, and gray literature on April 31, 2023. We selected seven randomized controlled trials based on the PICOS framework. Incomplete data or non-NSSP excluded. Study quality was assessed using the PEDro scale (mean score = 6.43), and certainty of evidence was evaluated with the GRADE approach. MRT demonstrated a large effect size for pain reduction (high heterogeneity, I2 = 85.2%, Hedges'g = 1.324, 95% CI = 0.388-2.260, P = 0.006), functional improvement (moderate heterogeneity, I2 = 70.82%, Hedges'g = 1.263, 95% CI = 0.622-1.904, P < 0.001), and reduction of pain-related fear (moderate heterogeneity, I2 = 70.86%, Hedges'g = 0.968, 95% CI = 0.221-1.716, P < 0.001). MRT also showed significant benefits for range of motion, particularly in flexion (low heterogeneity, I2 = 26.38%, Hedges'g = 0.683), abduction (low heterogeneity, I2 = 33.27%, Hedges'g = 0.756), and external rotation (low heterogeneity, I2 = 48.33%, Hedges'g = 0.542) (P < 0.001 for all), while no significant effect was found for internal rotation (P > 0.05). No publication bias was detected. While limited evidence and methodological concerns necessitate further research, MRT appears to positively impact pain, range of motion, functional outcomes, and pain-related fear in NSSP patients.

Efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions: A systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis is to assess the efficacy of mirror neuron system-based therapy for managing pain and improving motor and upper limb function in patients with upper limb orthopedic conditions.

LITERATURE SURVEY

Systematic bibliographical searches of the PubMed, SCOPUS, and CENTRAL registries and databases up to September 2023 were conducted to find randomized controlled trials (RCTs) assessing the efficacy of mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions.

METHODOLOGY

Two reviewers assessed the RCTs using a Cochrane risk-of-bias tool and extracted data from studies with similar outcome measures in the domains of pain, motor function, or functional score, which were pooled into meta-analyses.

SYNTHESIS

The review included 13 studies to compare the efficacy of mirror neuron system-based therapy with that of conventional rehabilitation programs. The therapy reduced pain intensity (mean difference [MD] 2.04, 95% confidence interval [CI] 1.46-2.63) and kinesiophobia (MD 8.43, 95% CI 6.98 to 9.88), and increased grip strength (MD 1.86, 95% CI 0.28-3.45). The therapy also improved upper limb functional outcomes as assessed by the 30-item Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score (MD 13.52, 95% CI 10.63-16.41). However, the outcomes as assessed by the 11-item QuickDASH questionnaire and the Shoulder Pain and Disability Index (SPADI) were not superior to conventional rehabilitation.

CONCLUSIONS

Mirror neuron system-based therapy for rehabilitation of upper limb orthopedic conditions may reduce pain intensity and kinesophobia, and improve grip strength and DASH scores compared with conventional rehabilitation programs. However, this interpretation is limited by the heterogeneity and various quality of the RCTs included in our meta-analysis.

Herbal prescription Siryeongtang and acupuncture treatment for gait disturbance due to idiopathic normal pressure hydrocephalus: A case report

BACKGROUND

Idiopathic normal-pressure hydrocephalus (iNPH), characterized by unexplained normal-pressure hydrocephalus, primarily presents with symptoms such as gait disturbances, cognitive impairment, and urinary incontinence. Currently, cerebrospinal fluid (CSF) drainage via shunting is the only effective treatment for iNPH.

CASE PRESENTATION

A 56-year-old Asian woman visited our hospital with a worsening gait disturbance and a history of recurrent falls over the past 2 years. She was diagnosed with iNPH using brain computed tomography. Notably, her gait disturbances continued to worsen despite undergoing a ventriculoperitoneal (VP) shunt. The patient was prescribed the herbal medicine Siryeongtang along with acupuncture and electroacupuncture. Subsequently, the changes in gait balance and speed were objectively assessed during the treatment period using the WIN-TRACK evaluation tool. The symmetry index for step length improved after 42 days of treatment, reaching 111 %, 71 %, and 37 % on days 15, 24, and 42, respectively. The symmetry index for step speed also decreased from 77 % on day 15 to 5 % on day 42. In addition, the time required to walk 5 m was reduced to 13, 10, and 9 s on days 15, 24, and 42, respectively.

CONCLUSIONS

Treatment with Korean medicine improved gait balance and speed in a patient with iINPH whose symptoms did not improve following shunt surgery.

Ultrasound measurement of abdominal and low back muscle symmetry in adult degenerative lumbar scoliosis: A case-control study

BACKGROUND

Individuals with adult degenerative lumbar scoliosis (ADLS) have underlying biomechanical alterations along the trunk muscles. However, few studies have evaluated trunk muscles in ADLS.

OBJECTIVE

To quantify and evaluate the symmetry, thickness, and stiffness (shear modulus) of the abdominal and back muscles in ADLS participants.

METHODS

This was a case-control study with participants aged 60-79 years with ADLS (n = 37) and without ADLS (n = 37). Radiographic examination data were collected from the participants. Ultrasound thickness and shear modulus measurements were performed to compare differences in the rectus abdominis, external oblique, internal oblique, transversus abdominis (TrA), multifidus, erector spinae, and quadratus lumborum muscles in the supine, prone and standing positions in the ADLS (n = 37) and control groups (n = 37). Thicknesses and shear modulus were compared.

RESULTS

The absolute thickness of the TrA in ADLS group was significantly greater on the convex side than on the concave side in both the supine (2.978 ± 0.552 vs. 2.556 ± 0.513, p = 0.041) and standing positions (2.671 ± 0.475 vs. 2.054 ± 0.401, p = 0.034). The percentage changes in both sides of the shear modulus of the TrA were significantly greater in the ADLS group than in the control group for the supine position (p = 0.019), and standing position (p = 0.039).

CONCLUSIONS

Compared with those in the control group, only the absolute muscle thicknesses and percent change in the shear modulus of the TrA in the ADLS participants were more asymmetric.

Prolonged Taping with Exercise Therapy for Patellofemoral Pain in Adults: A Systematic Review and Single-Arm Meta-Analysis

Purpose: To investigate the effects of prolonged taping on patellofemoral pain (PFP). Methods: A literature search of PubMed, EMBASE (Elsevier), CiNAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus, and Web of Science was conducted from database inception to 28 June 2024. Eligible studies reported PFP patients over 18 years of age undergoing an exercise protocol with additional taping that was maintained outside of exercise sessions (PROSPERO ID: CRD42023422792). Results: Seventeen studies met the eligibility criteria with 348 patients (n = 221 Kinesio taping, McConnell taping n = 127). For pain, the Kinesio baseline scores were 5.73 (95% CI: 4.73-6.73, I2= 97%), and the McConnell scores were 5.05 (95% CI: 3.82-6.28, I2 = 95%). At the combined recent follow-up, the Kinesio scores were 2.14 (95% CI: 1.11-3.18, I2 = 98%), and the McConnell scores were 2.58 (95% CI: 0.79-4.37, I2 = 98%). For functionality, the Kinesio baseline scores were 64.19 (95% CI: 53.70-74.68, I2 = 98%), and the McConnell scores were 68.02 (95% CI: 65.76-70.28, I2 = 0%). At the combined recent follow-up, the Kinesio scores were 84.23 (95% CI: 79.44-89.01, I2 = 95%), and the McConnell scores were 86.00 (95% CI: 83.82-88.17, I2 = 0%). The minimum clinically important difference (MCID) was achieved for both modalities at 6 weeks and beyond. Conclusions: Prolonged taping that remains on PFP patients outside of isolated exercise sessions appears beneficial in reducing pain and increasing functionality.

Trend of effects of various kinesiotaping methods on muscle contraction performance during fatigue: A randomized, crossover study

Objectives

This study aims to investigate the effects of different kinesiotaping methods on muscle contraction of fatigued biceps.

Patients and methods

Between April 01, 2019 to September 30, 2019, a total of 24 adults (11 males, 13 females; mean age: 31.8±6.1 years; range, 24 to 47 years) were recruited in the study. Each participant needed to receive all four types of tape attachment, including facilitation attachment (from origin to insertion), relaxation attachment (from insertion to origin), cross attachment, and control attachment after fatigue procedure. The order of taping approaches was randomly assigned. The outcome parameters were maximal isometric contraction strength, peak contraction speed, maximal 10-s power, and isokinetic contraction work.

Results

The results revealed no significant differences among the four tape attachment methods for any of the parameters. However, the facilitation attachment exhibited the highest trend of improvement in all muscle contraction performance during fatigue, and the cross attachment exhibited the lowest trend of improvement in maximal isometric contraction and speed.

Conclusion

None of the kinesiotape attachment methods significantly enhanced the contraction of fatigued muscles regardless of the attachment direction, including origin to insertion, insertion to origin and cross. Facilitation attachment exhibited the most effective trend of improvement and is, therefore, recommended for clinical applications. Cross attachment was not suggested to use due to the least effective trend.

Investigation of new application technique named star taping in patellofemoral pain: a randomized, single-blind, and placebo-controlled study

PURPOSE

Patellofemoral pain (PFP) is characterized by pain around the patella during functional actıvıty. The purpose of this study was to determine the effects of the new method of applying the patellar Kinesio taping (KT).

MATERIALS AND METHODS

Participants with PFP were randomly assigned to a Kinesio star taping (n = 14), placebo taping (n = 12), or control group (n = 13). Knee pain intensity during activity, resting, at night-time and during buckling were measured using the visual analogue scale under both KT, placebo taping, and home exercising before and after six weeks. Oedema, performance, knee function, and muscle strength were assessed with circumferential measurement, the Kujala questionnaire, vertical jumps, a 10-step down test, squat test, triple jump test, respectively, in all groups before and after taping.

RESULTS

Decreases were detected in pain in each group (p < 0.05) but there were no differences in pain during activity, and buckling in the three groups before and after taping (p > 0.05). Performances and knee functions showed similar results in all groups before and after taping (p > 0.05). The outcomes of all tapings showed that there were no differences between the groups in terms of oedema (p > 0.05), the knee functions (p > 0.05), and muscles strength on the affected and unaffected sides, there were no significant differences between inter and intra groups (p > 0.05).

CONCLUSIONS

A 6-week new technique star taping together with home-based exercises have similar effects with placebo taping and home exercise groups on oedema, pain, performance, function in PFP. The effects of star taping technique may be determined in future studies as long- and short-term in different types of injuries.

Reliability and validity of the Turkish version of the patellofemoral pain and osteoarthritis subscale of the KOOS

BACKGROUND

Patellofemoral pain and patellofemoral osteoarthritis are highly prevalent knee disorders associated with pain and functional limitations. The subscale of the Knee Injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF) was developed to evaluate patients with patellofemoral pain and osteoarthritis.

PURPOSE

This study aims to translate the KOOS-PF into Turkish and assess its measurement properties.

METHODS

The Turkish version of the KOOS-PF was tested for reliability and validity in a convenience sample of 55 patients with patellofemoral pain and/or osteoarthritis. Reliability analyses were conducted through a retest 7-14 days later with a subgroup of 35 patients. The KOOS-PF was compared with Kujala's Anterior Pain Scale (AKPS) and the Short Form-36 health survey (SF-36) to assess construct validity. Additionally, responsiveness analyses were performed on 29 patients who were followed up with a home-based exercise program three months later.

RESULTS

The Turkish version of KOOS-PF has high test-retest reliability (ICC2,1 = 0.96) and internal consistency (Cronbach's α = 0.91). It has a very good correlation with the AKPS (r = 0.77) and the SF-36 physical component summary (r = 0.64) with no floor or ceiling effects. Responsiveness is confirmed by a good correlation with the global rating of change score (r = 0.51). The minimal clinically important change is 16.5 points, and the minimal important difference is 10.2.

CONCLUSION

The Turkish version of the KOOS-PF is valid, reliable, and responsive for evaluating patients with patellofemoral pain and/or osteoarthritis.

The Effect of the Cheneau Brace on Respiratory Function in Girls with Adolescent Idiopathic Scoliosis Participating in a Schroth Exercise Program

Objectives: The aim of this study was to evaluate the effect of brace use application and the Schroth intervention on lung ventilation and respiratory muscle strength in patients treated long-term with a Chaneau brace and the Schroth method. Methods: A total of 26 post-menarche females aged 15.7 ± 1.5 years, with a Cobb angle of 18-48° and a diagnosis of AIS in inpatient rehabilitation were examined. All participants received brace treatment for a minimum of 3 months with a dosage of 20-22 h/day. This study protocol was performed three times: 1-brace intervention-first day of the present study; 2-without the brace-second day of the present study; and 3-Schroth intervention on the same day. Results: During the period of brace use, girls treated with a long-term therapy showed significantly reduced values for VC, FVC, and FEV1 and significantly higher values for inspiratory muscle strength PImax compared to values obtained in studies without the brace and after single exercises. Expiratory muscle strength did not differ significantly. Conclusions: The majority showed restrictive lung ventilation disorders and decreased respiratory muscle strength in relation to norms. There was a significant correlation of PImax with the duration of wearing the brace and the duration of therapy.

Validation of the Scoliosis Japanese Questionnaire-27 in Korean patients with adolescent idiopathic scoliosis

We sought to evaluate the reliability and validity of the Korean adaptation of the Scoliosis Japanese Questionnaire-27 (SJ-27). This involved translating the English SJ-27 into Korean and back-translating it, followed by completing all stages of the cross-cultural adaptation process. Subsequently, the Korean SJ-27, along with the validated Scoliosis Research Society-22 (SRS-22) questionnaire, was administered to 140 consecutive idiopathic scoliosis patients wearing a brace. Reliability was determined using kappa statistics to assess agreement for each item, the intraclass correlation coefficient (ICC), and Cronbach's α. Construct validity was established by comparing responses on the SJ-27 with those on the SRS-22 using Pearson's correlation coefficient. All items showed kappa statistics indicating agreement above 0.6. The SJ-27 demonstrated excellent test-retest reliability (ICC=0.91). Internal consistency measured by Cronbach's α was very good (α = 0.898). The Korean version of the SJ-27 exhibited significant correlations with both the total score and individual domain scores of the SRS-22. The adapted Korean SJ-27 was effectively translated and showed acceptable measurement properties, making it suitable for assessing outcomes in Korean-speaking patients with idiopathic scoliosis.