Does Therapeutic Exercise Support Improvement in Cognitive Function and Instrumental Activities of Daily Living in Patients with Mild Alzheimer's Disease? A Randomized Controlled Trial

This randomized controlled trial aims to investigate the effect of 12 weeks of therapeutic exercise on cognitive function and daily activities in patients with mild Alzheimer's disease (AD). A total of 171 patients with mild AD from the Amarousion Day Care Center of the Alzheimer Society of Athens and the Athens General Hospital "G. Gennimatas" were randomly divided into three groups. Group A (aerobic and resistance exercise, n = 57), group B (resistance exercise, n = 57), and group C (control group, n = 57). Group A followed a weekly program consisting of 5 days with 30 min walking and 3 days with resistance exercises for about 45 min. Group B followed only a resistance exercise program, the same as group A. Group C did not participate in any exercise program. After the intervention, cognitive function was assessed with the Cognitive Examination-Revised (ACE-R), Trail Making Test A-B (TMT A-B), and Digit Span Test Forward and Backward (DST F-B) and daily activities with the instrumental activities of daily living scale (IADLs). A significant intervention effect was observed for all outcome measures (global cognitive function and instrumental activities of daily living). ANCOVA Bonferroni corrected post hoc tests revealed that the aerobic and resistance group improved compared to the control group on all measurement scales. The resistance group also showed an improvement compared to the control group. No significant effects were found between the aerobic and resistance group and the resistance group in any of the outcome measures.

Stair Climbing Ability and Identification of the Nine Stairs Ascent and Descent Test Cut-Off Points in Hip Osteoarthritis Patients: A Retrospective Study

Objectives As the prevalence and incidence of hip osteoarthritis (hip OA) continue to rise, measuring the impact of hip OA severity on a patient's functionality is essential. Stair walking is a particularly relevant task to assess hip OA patients, as difficulty with stair ascent is one of the driving factors in deciding to undergo a total hip arthroplasty. Although stairs tests often arise in post-arthroplasty measures, there is a lack of reported stairs performance time in hip OA patients. Therefore, this retrospective study aimed to report the stair performance time of hip OA patients categorized by disease severity and determine cut-off points that differentiate between severity grades. Materials and methods The patient selection was based on the review of de-identified data from our research laboratory database. 254 hip OA patients (aged ≥ 50 years) were divided according to the Kellgren-Lawrence classification system into three groups: Grade 2 (n=68), Grade 3 (n=109), and Grade 4 (n= 68). The stair-walking ability was evaluated using the 9S-A/D test. The time taken to ascend and descend the stairs was measured separately, and the total time (9S-A/D) was also recorded. The one-way ANOVA model, Welch test, Games-Howell posthoc test, Chi-Square tests, and Two-Way ANOVA model were used for the statistical analysis of the data. The cut-off points were obtained by receiver operating curve (ROC) analysis. The statistical significance was set at p<0.05. Results Homogeneity was found between the three groups regarding demographic and clinical characteristics, except age and gender (p<0.001). The comparison of the variables (9S-ascent, 9S-descent, and 9S-A/D) between groups, adjusted for gender and age, showed significant differences: Grade 2 individuals had shorter performance times compared to those in Grade 3 and Grade 4 (p<0.005). Simultaneously, patients with Grade 3 hip OA have a shorter performance time than those with Grade 4 hip OA (p<0.005). Regarding ROC analysis of Grade 2 versus Grade 3: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.742 (95%CI 0.67-0.81), 0.734 (95%CI 0.66-0.81), and 0.745 (95%CI 0.54-0.90), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 8.7 s (sensitivity 56%, specificity 88%), 7.1 s (sensitivity 58%, specificity 80%), and 16.25 s (sensitivity 54%, specificity 90%), respectively. Concerning ROC analysis of Grade 3 versus Grade 4: The AUCs of 9S-ascend, 9S-descent, and 9S-A/D were 0.702 (95%CI 0.62-0.78), 0.711 (95%CI 0.63-0.79), and 0.715 (95%CI 0.64-0.80), respectively (all p values <0.005). The cut-off points of 9S-ascend, 9S-descent, and 9S-A/D were 11.5 s (sensitivity 66%, specificity 65%), 8.3 s (sensitivity 71%, specificity 62%), and 19.05 s (sensitivity 71%, specificity 61%), respectively. Conclusions The study provides evidence that the progression of hip OA affected stair walking; the performance time of 9S-ascent, 9S-ascent, and 9S-A/D tests was significantly longer as the severity of hip OA worsened. ROC analysis results show tests' ability to distinguish the cut-off point between different hip OA grades. However, further research is required for the reporting and classification of stair performance time values in hip OA patients and to further investigate the ability of 9S-ascent, 9S-descent, and 9S-A/D tests to predict the grade of hip OA.

Clinical Significance of the Static and Dynamic Q-angle

Q-angle represents the resultant force vector of the quadriceps and patellar tendons acting on the patella. An increased Q-angle has been considered a risk factor for many disorders and injuries. This literature review challenges the clinical value of static Q-angle and recommends a more dynamic movement evaluation for making clinical decisions. Although there are many articles about static Q-angle, few have assessed the value of dynamic Q-angle. We searched Scopus and PubMed (until September 2021) to identify and summarize English-language articles evaluating static and dynamic Q-angle, including articles for dynamic knee valgus (DKV) and frontal plane projection angle. We also used textbooks and articles from references to related articles. Although static Q-angle measurement is used systematically in clinical practice for critical clinical decisions, its interpretation and clinical translation present fundamental and intractable limitations. To date, it is acceptable that mechanisms that cause patellofemoral pain and athletic injuries have a stronger correlation with dynamic loading conditions. Dynamic Q-angle has the following three dynamic elements: frontal plane (hip adduction, knee abduction), transverse plane (hip internal rotation and tibia external rotation), and patella behavior. Measuring one out of three elements (frontal plane) illustrates only one-third of this concept. Static Q-angle lacks biomechanical meaning and utility for dynamic activities. Although DKV is accompanied by hip and tibia rotation, it remains a frontal plane measurement, which provides no information about the transverse plane and patella movement. However, given the acceptable reliability and the better differentiation capability, DKV assessment is recommended in clinical practice.

Application of Wearable Sensors Technology for Lumbar Spine Kinematic Measurements during Daily Activities following Microdiscectomy Due to Severe Sciatica

Simple Summary

The recurrence rate after lumbar spine disc surgeries is estimated to be 5–15%. Lumbar spine flexion of more than 10° is mentioned in the literature as the most harmful load to the operated disc level that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify flexions during daily living following such surgeries, for six weeks postoperatively, using wearable sensors technology. These data determine the patients’ kinematic pattern, reflecting a high-risk factor for pathology recurrence. The operated patients were measured to have 30% normal lumbar motion after the first postoperative week, while they were restored to almost 75% at the end of the sixth, respectively. Further in vitro studies should be carried out using these data to identify if such kinematic patterns could lead to pathology recurrence.

Abstract

Background: The recurrence rate of lumbar spine microdiscectomies (rLSMs) is estimated to be 5–15%. Lumbar spine flexion (LSF) of more than 10° is mentioned as the most harmful load to the intervertebral disc that could lead to recurrence during the first six postoperative weeks. The purpose of this study is to quantify LSFs, following LSM, at the period of six weeks postoperatively. Methods: LSFs were recorded during the daily activities of 69 subjects for 24 h twice per week, using Inertial Measurement Units (IMU). Results: The mean number of more than 10 degrees of LSFs per hour were: 41.3/h during the 1st postoperative week (P.W.) (29.9% healthy subjects-H.S.), 2nd P.W. 60.1/h (43.5% H.S.), 3rd P.W. 74.2/h (53.7% H.S.), 4th P.W. 82.9/h (60% H.S.), 5th P.W. 97.3/h (70.4% H.S.) and 6th P.W. 105.5/h (76.4% H.S.). Conclusions: LSFs constitute important risk factors for rLDH. Our study records the lumbar spine kinematic pattern of such patients for the first time during their daily activities. Patients’ data report less sagittal plane movements than healthy subjects. In vitro studies should be carried out, replicating our results to identify if such a kinematic pattern could cause rLDH. Furthermore, IMU biofeedback capabilities could protect patients from such harmful movements.

Development of a clinical prediction model to inform clinical decision making for classification of patients with sciatica, based on their clinical characteristics, in the Greek health system: protocol for a prospective predictive exploratory study

INTRODUCTION

Sciatica is one of the most common reasons for seeking healthcare for musculoskeletal pain. Sciatica is primarily considered as neuropathic in nature when neural tissue in the low back is compromised, but sometimes other non-neural structures may be involved. Appropriate assessment and management are important for patients with sciatica. Therapists use several outcome measures to assess patients to inform selection of the most suitable treatment. There is limited evidence for the best treatment of sciatica, and this is likely contributed to by having no reliable algorithm to categorise patients based on their clinical characteristics to inform physiotherapy treatment. The purpose of this study is to develop a clinical prediction model to categorise patients with sciatica, in terms of early clinical outcome, based on their initial clinical characteristics.

METHODS AND ANALYSIS

A prospective observational multicentre design will recruit consecutive patients (n=467) with sciatica referred for physiotherapy. Each patient will be evaluated to determine whether or not they will be accepted into the study by answering some questions that will confirm the study's eligibility criteria. Patients' basic characteristics, patient-reported outcome measures and performance-based measures will be collected at baseline from multiple sites in the Greek territory using this same protocol, prior to commencement of treatment. The main researcher of this study will be responsible for data collection in all sites. On completion of the standard referred physiotherapy treatment after 3 weeks' time, participants will be asked by telephone to evaluate their outcome using the Global Perceived Effect Scale. For the descriptive statistical analysis, the continuous variables will be expressed in the form of 'mean' and 'SD'. In order to assess the prognostic value of each predictor, in terms of the level of improvement or worsening of the symptoms, multiple variable regression analysis will be used.

ETHICS AND DISSEMINATION

Τhis study is approved from the Ethics and Deontology Committee of the University of West Attica, Athens, Greece, protocol number: 38313-09/06/2020, 10226-10/02/2021. The study's findings will be published in a peer-reviewed journal and disseminated at national and international conferences and through social media.

PROSPERO REGISTRATION NUMBER

CRD42020168467.

LYMPHEDEMA DURATION AS A PREDICTIVE FACTOR OF EFFICACY OF COMPLETE DECONGESTIVE THERAPY

Lymphedema is a common condition with global impact and a multitude of complications, however, only a few professionals specialize in its management. A retrospective analysis of 105 subjects with unilateral lymphedema upper or lower limb was performed to investigate whether the duration of lymphedema constitutes an important factor associated with the efficacy of complete decongestive therapy (CDT). Subjects were classified into two groups according to the duration of lymphedema, prior to CDT: group A (≤1 year) and group B (>1 year). Both groups were treated daily according to the same CDT protocol for four weeks. The CDT efficacy was determined based on the percent reduction of excess volume (PREV) measurements. Lymphedema was significantly reduced in both groups of subjects, but significantly more in group A (p<0.001). In subjects with upper limb lymphedema, median value of PREV was 80.8% (interquartile range, 79.1-105.0%) in group A and 62.0% (interquartile range, 56.7-66.5%) in group B (p<0.001). In subjects with lower limb lymphedema PREV was 80.7% (interquartile range, 74.9-85.2%) and 64.5% (interquartile range, 56.0-68.1%) for groups A and B, respectively (p<0.001). Duration of lymphedema was found to be a strong predictive factor that may significantly impact CDT efficacy. Therapeutic effects were increased in subjects who were detected and treated earlier for lymphedema.

The Effect of Intensive Close-Kinetic-Chain Exercises on Functionality and Balance Confidence After Total Knee Arthroplasty

Objectives

The aim of this study was to evaluate the effects of an additional close-kinetic-chain exercise program (CKC-PT), in conjunction with the standard physiotherapy intervention (TKA-PT), on the general health status, functionality, balance confidence, and postoperative falls of knee osteoarthritic patients who had undergone total knee arthroplasty (TKA).

Patients and methods

Thirty community-dwellers, aged >65 years, were randomized into equal groups. The Greek versions of the SF-36 version1.0 (SF-36v1.0-Gr), WOMAC^® (WOMAC^®-Gr), Activities-specific Balance Confidence scale (ABC-Greek), Timed Up and Go (TUG) test, and Berg Balance Scale were assessed preoperatively and twice postoperatively (7^th week and 12^th month). Non-parametric (Mann-Whitney test) and parametric (two-way analysis of variance (ANOVA) model and student t-test) analyses were used to compare the percentage changes in all variables.

Results

The CKC-PT group reported better (%) functional improvement (WOMAC^®-Gr Physical­ Function subscale) and higher (%) balance confidence (ABS-Greek) at the seventh week and twelfth month as compared to TKA-PT (p<0.05). No other statistically significant differences were observed.

Conclusions

The implementation of a close-kinetic-chain exercise program, in addition to standard physiotherapy, may significantly increase both the functionality and balance confidence of patients who have undergone TKA. Further studies are needed to verify these findings.

Modified Harris Hip Score as patient-reported outcome measure in osteoarthritic patients: psychometric properties of the Greek version

INTRODUCTION

This study explored the psychometric properties of the modified Harris Hip Score-Greek version (mHHS-Gr) as a patient-reported outcome (PRO) measure in osteoarthritic hip patients.

METHODS

Internal consistency, test-retest reliability and reproducibility were evaluated in 90 patients aged >55 years. Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek) and WOMAC Index (WOMAC-Gr), and the Timed Up and Go (TUG) and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using TUG score (cut-off 13.5 s) as an estimate variable. Responsiveness was examined before and 4 weeks after direct anterior minimal invasive surgery.

RESULTS

Reliability: Internal consistency was moderate (Cronbach's a = 0.614, p < 0.001). Test-retest reliability was excellent (ICC = 0.881, 95% CI, 0.824-0.920). Reproducibility: Floor and ceiling effects were both 1.1%; measurement error was 3.54 (p < 0.05); minimal important change was lower than minimal detectable change.Validity: mHHS-Gr correlated strongly with both LEFS-Greek and WOMAC-Gr (Pearson's r 0.801 and -0.783, respectively; p < 0.001). The questionnaire's correlations with TUG and 9S-A/D were also significant but moderate (Spearman's ρ: -0.547 and -0.575, respectively; p < 0.001). Known-groups validity showed that mHHS-Gr scores were significantly higher in participants with TUG < 13.5 seconds than in those with TUG > 13.5 seconds (p < 0.001). In ROC analysis, the cut-off point of 52.5 yielded sensitivity 81% and specificity 71%.Responsiveness: Standardised response mean and Guyatt's responsiveness statistic were greater than 0.8.

DISCUSSION

mHHS-Gr showed significant moderate to excellent reliability, significant moderate to strong validity properties and excellent responsiveness. Overall, mHHS-Gr could be a reliable and valid PRO measure for assessing patients with osteoarthritis of the hip.

Lymphedema duration as a predictive factor of efficacy of complete decongestive therapy

Lymphedema is a common condition with global impact and a multitude of complications, however, only a few professionals specialize in its management. A retrospective analysis of 105 subjects with unilateral lymphedema upper or lower limb was performed to investigate whether the duration of lymphedema constitutes an important factor associated with the efficacy of complete decongestive therapy (CDT). Subjects were classified into two groups according to the duration of lymphedema, prior to CDT: group A (≤1 year) and group B (>1 year). Both groups were treated daily according to the same CDT protocol for four weeks. The CDT efficacy was determined based on the percent reduction of excess volume (PREV) measurements. Lymphedema was significantly reduced in both groups of subjects, but significantly more in group A (p<0.001). In subjects with upper limb lymphedema, median value of PREV was 80.8% (interquartile range, 79.1-105.0%) in group A and 62.0% (interquartile range, 56.7-66.5%) in group B (p<0.001). In subjects with lower limb lymphedema PREV was 80.7% (interquartile range, 74.9-85.2%) and 64.5% (interquartile range, 56.0-68.1%) for groups A and B, respectively (p<0.001). Duration of lymphedema was found to be a strong predictive factor that may significantly impact CDT efficacy. Therapeutic effects were increased in subjects who were detected and treated earlier for lymphedema.

Effectiveness and Safety of Complete Decongestive Therapy of Phase I: A Lymphedema Treatment Study in the Greek Population

Background

Lymphedema is a chronic condition caused by a failure in the lymphatic system that most commonly occurs in the limbs. Complete decongestive therapy (CDT) is the gold standard for lymphedema management.

Objective

To evaluate the effectiveness and safety of complete decongestive therapy (CDT) of phase I in the Greek population with lymphedema.

Methods

The patients’ demographic and clinical characteristics were recorded. CDT was implemented in all patients for 20 sessions in a four-week treatment period. The edema’s (excess volume (EV) and percent of excess volume (PEV)) measurements were carried out four times in the treatment period, whereas the percent reduction of excess volume (PREV) was calculated at the end of phase I. Moreover, we recorded every infection, trauma of skin, and pain of limb during the treatment.

Results

One-hundred five patients with lymphedema were enrolled in the present study, of whom 31.4% had upper limb lymphedema and 68.6% had lower limb lymphedema. All patients with upper limb lymphedema had a secondary type while the corresponding proportion of patients with lower limb lymphedema was 58.3%. A significant reduction (p<0.001) between the pre-treatment and post-treatment values of EV and PEV was found for both upper and lower limb lymphedema. For patients with upper limb lymphedema, the average PREV was 66.5% (interquartile range, 57.3%-80.6%), whereas for patients with lower limb lymphedema, a 71.5% (interquartile range, 64.5%-80.7%) median value was measured. No side effects from the treatment were recorded during CDT.

Conclusion

The proper treatment of the CDT phase I ensures safety and a great reduction in edema in patients with lymphedema that predispose the success of phase II of CDT.

International Hip Outcome Tool (12-items) as health-related quality-of-life measure in osteoarthritis: validation of Greek version

BACKGROUND

The 12-item International Hip Outcome Tool (iHOT12) is a patient-reported outcome (PRO) designed to evaluate quality of life. We assessed the psychometric properties of the Greek version (iHOT12-Gr) in hip osteoarthritic patients.

METHODS

Data from 124 patients aged > 50 years were used for factor analysis. Reliability evaluation included internal consistency, test-retest reliability, and interpretability. Content validity was examined by calculating the item-level content validity indices (I-CVI) and the scale-level content validity indices (S-CVI), using two methods: S-CVI Average (S-CVI/Ave), and the S-CVI Universal Agreement among experts (S-CVI/UA). Construct validity was tested against Greek versions of the Lower Extremity Functional Scale (LEFS-Greek), Modified Harris Hip Score (MHHS-Gr), and the 30 s chair-to-stand, Timed Up & Go (TUG), and 9-stairs-ascend/descend (9S-A/D) tests. Known-groups validity was examined using LEFS-Greek (cut-off = 53 points) as estimate variable. Responsiveness was examined pre and post total hip arthroplasty (4 and 8 weeks).

RESULTS

Factor analysis revealed a two-factor model. Factor-1 (items 1-9) reflects "Symptoms and functionality", while Factor-2 (items 10-12) reflects "Hip disorder-related concerns". Reliability: Internal consistency and test-retest reliability of iHOT12-Gr-total were excellent: Cronbach's alpha > 0.92 and ICC(95% CI) > 0.976(0.96-0.99)(p < 0.001). Interpretability: There was no floor or ceiling effect; measurement error: 3.72 (Factor-1), 3.64 (Factor-2), and 3.22 (iHOT12-Gr-total); minimal detectable change: 10.3 (Factor-1), 10.1 (Factor-2), and 8.92 (iHOT12-Gr-total).

VALIDITY

Content validity: The I-CVI value of the 12 items ranged from 1.00 to 0.83, the S-CVI/Ave was 0.97 and the S-CVI/UA was 0.83. Construct validity: iHOT12-Gr correlated strongly with both LEFS-Greek and MHHS-Gr, and weakly but significantly with 30s chair-to-stand, TUG and 9S-A/D (p < 0.001). Known-groups validity showed that iHOT12-Gr well discriminated subgroups of patients (p < 0.001). ROC analysis cut-off points were 51.9 (Factor-1), 25 (Factor-2) and 45.2 (iHOT12-Gr-total) (p < 0.001). Responsiveness: Four and 8 weeks postoperatively, standardized response means of Factor-1, Factor-2, and iHOT12-Gr-total were > 0.8.

CONCLUSION

iHOT12-Gr showed excellent reliability properties. The content validity was excellent and significant weak-to-strong correlations were found regarding construct validity. The known-group validity was also significant, while the responsiveness was excellent. iHOT12-Gr could be a reliable and valid PRO for assessing quality of life in patients with hip osteoarthritis.

All-Order Amplitudes at any Multiplicity in the Multi-Regge Limit

We propose an all-loop expression for scattering amplitudes in planar N=4 super Yang-Mills theory in multi-Regge kinematics valid for all multiplicities, all helicity configurations, and arbitrary logarithmic accuracy. Our expression is arrived at from comparing explicit perturbative results with general expectations from the integrable structure of a closely related collinear limit. A crucial ingredient of the analysis is an all-order extension for the central emission vertex that we recently computed at next-to-leading logarithmic accuracy. As an application, we use our all-order formula to prove that all amplitudes in this theory in multi-Regge kinematics are single-valued multiple polylogarithms of uniform transcendental weight.

The Effect of Intensive Abductor Strengthening on Postoperative Muscle Efficiency and Functional Ability of Hip-Fractured Patients: A Randomized Controlled Trial

BACKGROUND

Hip fractures are common in the elderly and many patients fail to regain prefracture hip abductor strength or functional status. The purpose of this clinical trial was to compare the effects of an intensive abductor muscle exercise program versus a standard physiotherapy intervention in hip-fractured patients.

MATERIALS AND METHODS

Ninety six femoral neck-fractured patients were randomized into equal-sized groups. A 12-week standard physiotherapy program was implemented in the control group(S-PT) whereas an intensive exercise program, emphasizing on abductors' strengthening, was implemented in the research group(I-PT). Abductors' isometric strength of the fractured hip, abductor ratio% in the fractured compared to contralateral hip, and functional level were assessed at the 3^rd (postintervention) and 6^th (followup) months.

RESULTS

Postintervention, abductors' isometric strength was 35.7% greater (P < 0.0005) and abductor ratio% was 2.5% higher (P < 0.0005) in I-PT group, compared to S-PT group. With regard to functional assessments, I-PT group was 29.1% faster during Timed Up and Go (TUG) test and achieved a 26.7% higher Lower Extremity Functional Scale Greek version's (LEFS-Greek) total score, compared to S-PT group (P < 0.0005). At followup, abductors' isometric strength was 37.0% greater (P < 0.0005) and abductor ratio% was 7.1% higher (P < 0.0005) in I-PT group, compared to S-PT group. In addition, I-PT group was 45.9% faster during TUG test (P < 0.0005) and achieved an 11.2% higher LEFS-Greek total score, compared to S-PT group (P = 0.013).

CONCLUSIONS

Compared to the standard physiotherapy intervention, the intensive abductor-strengthening program significantly increased both abductors' isometric strength of the fractured hip and abductor ratio% and resulted in patients' enhanced functional level.

CLINICAL TRIAL IDENTIFIER

ISRCTN30713542.

Association between abductor muscle strength and functional outcomes in hip-fractured patients: a cross-sectional study

OBJECTIVES

To explore associations between abductor strength and functionality in hip-fracture patients.

METHODS

Ninety-six participants (70-84 years) followed a 12-week physiotherapy programme emphasizing hip abductor strengthening. The abductor's isometric strength, the hip strength asymmetry (HSA), expressing the ratio of abductor strength in the fractured versus the contralateral hip, and the patients' functional level were recorded 3 months post-intervention. Functionality was assessed using the Timed Up & Go (TUG) test and the Lower Extremity Functional Scale (LEFS-Greek).

RESULTS

Abductor isometric strength and HSA were correlated negatively with TUG test (Pearson's r: -0.881 and -0.810, respectively; p⟨0.001) and positively with LEFS-Greek (Spearman's ρ: 0.668 and 0.404, respectively; p⟨0.001). Of all independent variables examined, abductor isometric strength was the main predictor of functional capacity, being strongly and directly associated with a faster TUG test time (p⟨0.001) and a better LEFS-Greek score (p⟨0.001). Abductor's isometric strength and age explained 79.0% and 49.5%, whereas HSA and age explained 69.7% and 41.9% of TUG and LEFS-Greek variance, respectively.

CONCLUSIONS

Abductor isometric strength was the main predictor of hip-fracture patients' functionality, strongly enhancing the measured functional outcomes. Hip abductor strengthening appears to be of major clinical importance and may contribute significantly to the functional rehabilitation of hip-fractured patients.

Evidence for association of STAT4 and IL12RB2 variants with Myasthenia gravis susceptibility: What is the effect on gene expression in thymus?

Myasthenia gravis (MG) is an autoimmune disease mediated by the presence of autoantibodies that bind mainly to the acetylcholine receptor (AChR) in the neuromuscular junction. In our case-control association study, we analyzed common variants located in genes of the IL12/STAT4 and IL10/STAT3 signaling pathways. A total of 175 sporadic MG patients of Greek descent, positively detected with anti-AChR autoantibodies and 84 ethnically-matched, healthy volunteers were enrolled in the study. Thymus samples were obtained from 16 non-MG individuals for relative gene expression analysis. The strongest signals of association were observed in the cases of rs6679356 between the late-onset MG patients and controls and rs7574865 between early-onset MG and controls. Our investigation of the correlation between the MG-associated variants and the expression levels of each gene in thymus did not result in significant differences.

Physiotherapeutic rehabilitation of lymphedema: state-of-the-art

Lymphatic diseases, especially lymphedema, represent a serious problem in the health community. We investigated strategies and methods for physiotherapeutic rehabilitation of lymphedema by carrying out a comprehensive search of the Medline and Embase databases from 1990 to 2016 to identify relevant published studies, articles, and reviews. Approaches for conservative management of lymphedema include the following: manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care, pneumatic compression, elevation of the extremities, thermal therapy, complete decongestive physiotherapy (CDT), taping, and aqua lymphatic therapy. Treatment of lymphedema with CDT, which is a combination of four methods (manual lymphatic drainage, lymphedema rehabilitation exercises, compression therapy, skin care), can achieve a 45-70% reduction in lymphedema volume. Prerequisites for successful physiotherapy are the availability of physicians, nurses and therapists who are specifically trained, educated, and experienced in each method. CDT is the most effective treatment as it reduces the symptoms of lymphedema and improves patients' functionality, mobility, and quality of life. Although other therapeutic techniques have demonstrated positive results, these surveys are limited and more studies are needed to confirm findings.

THE GREEK CATALOGUE OF ACTIVE FAULTS AND DATABASE OF SEISMOGENIC SOURCES

The new reasearch project to create the Greek Catalogue of Active Faults and Database of Seismogenic Sources has three major goals: (i) the systematic collection of all available information concerning neotectonic, active and capable faults as well as broader seismogenic volumes within the Aegean Region; the search will be mainly based on geological and geophysical data; (ii) the quantification of the principal seismotectonic parameters of the different sources and the associated degree of uncertainty; (iii) to supply an integrated view of potentially damaging seismogenic sources for a better assessment of the Seismic Hazard of Greece. The informatic framework of the database follows that used for the Italian Database of Individual Seismogenic Sources (DISS). In this paper we present the architecture of the new Database of Active faults of the broader Aegean Area relative to Greece, the progress made up to present and the following activities yet to be accomplished.

Association of high blood pressure with body mass index, smoking and physical activity in healthy young adults

Introduction:

The purpose of this study was to examine the associations between resting blood pressure (BP), smoking, physical activity (PA) and body mass index (BMI) in Greek young adults.

Materials and Methodology:

A standardised questionnaire and the Greek version of IPAQ-short were given to 1500 randomly selected health science students, in order to record smoking behaviour, PA status, BMI and resting BP. All healthy young adults aged 19-30 years old were eligible. The final size of the study cohort was 1249 students (522 men).

Results:

Males’ BP was 129.2/77.0 mmHg, significantly higher than the females’ values of 119.9/73.4 mmHg. Approximately 17% of the total population were classified as overweight and 3% as obese. In the overall population, smoking prevalence was 35.2%, with 15.3% being heavy smokers (≥21 cigs/d). Smoking prevalence did not differ significantly between sexes. The prevalence of health-enhancing PA (high PA_class) was only 14.0%, while 42.8% of the study population were classified as insufficiently active (low PA_class). Of the three lifestyle risk factors examined, only BMI was significantly and directly associated with systolic and diastolic BP levels. The prevalence of hypertension (≥140/90 mmHg) was significantly higher in men compared to women, and in obese and overweight participants compared to normal-weight subjects. Smoking and categorical PA (PA_class) were not correlated with BP. Continuous vigorous PA_score was significantly and directly associated with systolic BP, but only in males.

Conclusion:

BMI was significantly and directly associated with resting BP in both sexes. Smoking prevalence and PA status were not associated with BP in this sample of Greek young adults.

Clinimetric properties of WOMAC Index in Greek knee osteoarthritis patients: comparisons with both self-reported and physical performance measures

This observational study aimed to examine the clinimetric properties of the Greek for Greece translation of the Western Ontario and McMaster Osteoarthritis Index (WOMAC(®)). One hundred and twenty-three patients with knee osteoarthritis (mean age 69.5 years) participated in the study. An extensive reliability study was carried out to assess WOMAC's internal consistency and repeatability (8-day interval). In addition, we examined the construct (convergent, nomological and known-groups) and criterion-related (concurrent and predictive) validity of the index against both self-report [SF-36 and combined visual analog/faces pain scale-revised (VAS/FPS-R)] and physical performance measures [timed up and go test (TUG)]. The internal consistency of the WOMAC subscales ranged from high (0.804) to excellent (0.956). Intra-class correlation coefficients for test-retest reliability were excellent, ranging from 0.91 to 0.95. Partial correlation analysis, adjusted for age and use of an assistive device, showed that WOMAC scores were significantly associated with all validation criteria, presenting fair to strong (-0.33 to -0.86) correlation coefficients. WOMAC-function was strongly associated with SF36-function (-0.86) and TUG (0.71), WOMAC-pain to VAS/FPS-R (0.71) and SF36-pain (-0.67). Of all WOMAC outcomes, stiffness subscale had the lowest, though still significant, correlations with all validation criteria. Multiple linear regression analyses indicated that WOMAC-function was a significant factor for TUG, WOMAC-pain for VAS/FPS-R and both for SF36-function and SF36-pain. The WOMAC LK3.1 Greek for Greece Index is a reliable and valid assessment tool for the evaluation of individuals with knee osteoarthritis, showing excellent reliability and significant validity properties.

Effects of smoking on heart rate at rest and during exercise, and on heart rate recovery, in young adults

INTRODUCTION

There is an established link between smoking, abnormal heart rate (HR) values, and impaired cardiovascular health in middle-aged or older populations. The purpose of this study was to examine the effects of smoking on resting HR and on HR responses during and after exercise in young adults.

METHODS

A sample of 298 young adults (159 men), aged 20-29 years old, were selected from a large population of health-science students based on health status, body mass index, physical activity, and smoking habit. All subjects underwent a maximal Bruce treadmill test and their HR was recorded during, at peak, and after termination of exercise.

RESULTS

Smokers had significantly higher resting HR values than non-smokers. Both female and male smokers showed a significantly slower HR increase during exercise. Female smokers failed to reach their age-predicted maximum HR by 6.0 bpm and males by 3.6 bpm. The actual maximum HR achieved (HRmax) was significantly lower for both female smokers (191.0 bpm vs.198.0 bpm) and male smokers (193.2 bpm vs.199.3 bpm), compared to non-smokers. Heart rate reserve was also significantly lower in female (114.6 bpm vs. 128.1 bpm) and male smokers (120.4 bpm vs. 133.0 bpm). During recovery, the HR decline was significantly attenuated, but only in female smokers. Females had a higher resting HR and showed a higher HR response during sub-maximal exercise compared to males.

CONCLUSIONS

Smoking was found to affect young smokers' HR, increasing HR at rest, slowing HR increase during exercise and impairing their ability to reach the age-predicted HRmax. In addition, smoking was associated with an attenuated HR decline during recovery, but only in females.

Cross-exercise on quadriceps deficit after ACL reconstruction

A few studies concerning the improvement of quadriceps muscle strength deficit (QD) at an early stage following anterior cruciate ligament (ACL) reconstruction have been conducted whereas, ACL rehabilitation protocols based on contralateral quadriceps strength (QS) do not exist. Given these, the goals of our study were (1) to evaluate the effects of cross-eccentric exercise (CEE) on QD on ACL reconstructed knees, and (2) to explore any changes in QD following CEE provided at the frequencies of 3 or 5 times per week. For this study, 42 ACL-reconstructed patients were randomly assigned into 3 groups, two experimental and one control and followed an 8-week rehabilitation program. Additionally, the experimental groups received CEE for 3 and 5 days per week for 8 weeks in their uninjured knees. QS was evaluated with an isokinetic/isometric test, at 60 degrees of knee flexion of both limbs before and after completion of CEE. Two-factor ANOVA showed a significant improvement of QD between groups (F = 5.16, p = 0.01) after CEE completion on ACL reconstructed knees. Statistically significant results arose from the 3 days per week (D = 18.60, p = 0.01) and 5 days per week (D = 15.12, p = 0.04) experimental groups, whereas the control group did not yield any statistically significant differences. CEE used as an adjunct to the ACL traditional rehabilitation program at the weekly frequencies of 3 and 5 times at the early stage of reconstruction significantly improved QD.

Cognitive assessment of musculoskeletal pain with a newly validated Greek version of the Fear-Avoidance Beliefs Questionnaire (FABQ)

Fear of pain and avoidance are psychological factors of primary importance when assessing chronic musculoskeletal pain, which are often measured with the Fear-Avoidance Beliefs Questionnaire (FABQ). Both two- and three-subscale versions have been described. The aims of this study were: to assess the cognitive traits of musculoskeletal pain patients using a newly validated Greek version of the FABQ, and to further examine the construct validity and responsiveness of the measure. Factor analysis yielded three factors that accounted for 65% of the total variance. Physical activity explained 12.3% of the variance and was identical to the original version, unlike the work subscale which split into two: the FABQ work1 related to "work as cause" (15.2% of the variance) and the FABQ work2 related to "work as prognosis" (37.5% of the variance). Internal consistency was good (0.72-0.90). Test-retest reliability was satisfactory and close to the original version both for individual items and the subscales. Responsiveness of the 3-factor model was satisfactorily assessed as the ability to detect: (A) change in general - (paired t test, effect size); (B) clinically important change (paired t test, standardised effect size), and (C) real change in the concept being measured (ROC analysis). Construct validity of the FABQ was shown through the interaction with anxiety and depression, pain control and responsibility, psychological distress and pain intensity, and criterion-related validity through the association with another fear-avoidance measure (TSK). New aspects of responsiveness and construct validity were demonstrated for the FABQ, using a three-subscale validated Greek version.

Smoking and physical activity interrelations in health science students. Is smoking associated with physical inactivity in young adults?

BACKGROUND

Smoking and physical inactivity constitute a major public health concern for Greece. The purpose of this study was to examine smoking behaviour and physical activity (PA) in Greek health science students.

METHODS

A standardised questionnaire and the Greek version of IPAQ-short were given to 2000 health science students, randomly selected from five higher education institutions, in order to record smoking behaviour and PA status. All healthy young adults aged 19-30 years old were eligible. The final cohort size of the study was 1651 students (690 men).

RESULTS

In the overall population, smoking prevalence was 37.6%, with 23.1% being heavy smokers (=21 cig/day). Smoking prevalence did not differ significantly between sexes, but heavy smoking was more prevalent in males. Age at smoking initiation was negatively associated with the daily number of cigarettes smoked (smoking volume), but only in females. The prevalence of health-enhancing PA (high PAclass) was only 14.2%, while 45.4% of the study population was classified as insufficiently active (low PAclass). Males were more physically active than females. Logistic regression analysis showed a strong inverse association between smoking and PA that was more pronounced in males. Smoking was associated with significantly decreased odds of being either moderately or highly physically active. Smoking volume was also negatively related with PA, but this relation was more pronounced in females.

CONCLUSION

Smoking prevalence and rates of physical inactivity are considerably high in Greek health science students. Smoking was strongly and inversely associated with PA in this sample of Greek young adults.

Reliability measures of the short International Physical Activity Questionnaire (IPAQ) in Greek young adults

INTRODUCTION

The short International Physical Activity Questionnaire (IPAQ-short) has frequently been used for national and international comparable physical activity (PA) prevalence studies. The purpose of this paper is to describe a Greek version of IPAQ-short (IPAQ-Gr) and present its reliability properties in Greek young and healthy adults.

METHODS

Two hundred and eighteen health science students of the Athens Technological Educational Institute, aged 19-29 years, were randomly selected and participated in the study. An intra-examiner reliability study over time (8 and 30 days apart) was carried out to assess IPAQ-Gr repeatability. An inter-examiner reliability study was also performed to assess the consistency of IPAQ-Gr outcomes between examiners. At the same time, an intra-examiner reliability study using an independent sample of 175 medical students at the University of Ioannina was carried out in order to examine multi-centre IPAQ-Gr reliability. Intra-class correlation coefficients for IPAQ scores and kappa statistics and percent agreement for physical activity classification were used in the analysis.

RESULTS

Intra-class correlation coefficients (ICCs) between day-1 and day-9 assessments for IPAQ total and vigorous PA were high in all groups examined (0.84 to 0.93). ICCs for walking PA, moderate PA and sitting hours were lower, but still good (0.69 to 0.81). Repeatability of IPAQ-Gr outcomes after one-month re-administration was high for total and vigorous PA (0.87, 0.81) and good for moderate (0.66) and walking PA (0.75). Inter-examiner reliability data showed that all correlations between examiners were greater than 0.70, up to 0.87 (paired t-test, p=NS), with the exception of moderate PA, where correlations were weaker (0.58 to 0.64). Similar results were found when intra-examiner correlations were compared between educational institutes (multi-centre inter-examiner reliability of IPAQ).

CONCLUSIONS

IPAQ-Gr was found to present acceptable reliability properties in Greek young adults. IPAQ-Gr showed high repeatability values for total and vigorous PA, and good for moderate and walking PA.

Sex differences in the effects of two stress paradigms on dopaminergic neurotransmission

Sex differences in behavioral and neurobiological responses to stress are considered to modulate the prevalence of some psychiatric disorders, including major depression. In the present study, we compared dopaminergic neurotransmission and behavior in response to two different stress paradigms, the Forced Swim Test (FST) and the Chronic Mild Stress (CMS). Male and female rats were subjected to one session of swim stress for two consecutive days (FST) or to a variety of mild stressors alternating for six weeks (CMS). Subsequently, the tissue levels of dopamine (DA) and its metabolites (HVA and DOPAC) in the hippocampus, the hypothalamus, the prefrontal cortex and the striatum were measured using high-performance liquid chromatography (HPLC). The ratios HVA/DA and DOPAC/DA were also calculated as indices of the dopaminergic activity. Results from the FST determined that males exhibited lower immobility, higher climbing duration and increased dopaminergic activity in the prefrontal cortex and the hippocampus compared to females. CMS induced alterations in sucrose intake in both sexes, while it only decreased dopaminergic activity in the prefrontal cortex of females. These findings show that FST and CMS have different effects on the dopaminergic activity of discrete brain regions depending on the sex of the animal. These data support the growing evidence that females display a differential response and adaptation to stress than males.

Prevalence of low back pain in greek public office workers

BACKGROUND

Epidemiological studies have provided information on the prevalence and risk factors of low back pain (LBP) in white collar workers in industrialized countries. Little information has related individual, work ergonomic, and psychosocial factors to the incidence of LBP in low income countries.

OBJECTIVES

To assess the prevalence of LBP among Greek public office workers. To identify and relate the individual, work ergonomic, and psychosocial factors to the occurrence of LBP.

DESIGN

Cross-sectional study of Greek office workers in the public sector.

METHODS

A self-reported standardized questionnaire was constructed to record risk factors associated with the occurrence of LBP. Personal characteristics, work ergonomics, and psychosocial traits were collected and related to LBP prevalence.

RESULTS

Of the 771 office workers, 648 responded (84% return rate). The majority of the participants were women (75.8%). Among all responders, 33%, 37.8%, 41.8%, and 61.6% presented with point, one-year, two-year, and lifetime prevalence respectively. Sleep disturbances due to pain were reported in 37% of the office clerks with chronic low back pain. Multiple logistic regression models have revealed that significant determinants for predicting LBP occurrence are age, gender, body mass index, body distance from computer screen, adjustable back support, clerk body position while sitting, sitting time of greater than 6 hours, job satisfaction, repetitive work, and anger during last 30 days.

CONCLUSION

High proportions of Greek office workers suffer from LBP which might affect the Greek economy. The incidence of LBP status is significantly associated with some anthropometric, ergonomic, and psychosocial factors.

Individual responses to novelty predict qualitative differences in d-amphetamine-induced open field but not reward-related behaviors in rats

Differences in the locomotor response of rats to a novel environment (high responders [HR] versus low responders [LR]) have been associated with differences in vulnerability to psychostimulants. In the present study we profiled extensively the behavioral repertoire of HR and LR rats (differentiated on the basis of vertical activity) during exposure to a novel environment and in response to d-amphetamine (d-amp; 1.5 mg/kg, i.p.). Moreover, we ascertained whether HR and LR rats differ in the rewarding effects of medial forebrain bundle electrical self-stimulation and in the ability of d-amp to increase the reinforcing efficacy of self-stimulation. Apart from rearing, HR animals displayed increased moving, sniffing, but decreased standing and yawning compared with LR. Factor analysis revealed a more complex behavioral structure consisting of locomotion, exploration, vertical activity and self-directed behavior for HR compared with LR rats. Qualitative, but not quantitative differences, between the two groups of rats in their behavioral responses to d-amp were found. In particular, a more complex profile mainly characterized by self-directed behavior, locomotion and vertical activity was manifested for HR as compared with LR rats. Baseline brain stimulation reward thresholds did not differ between the two groups of rats. Additionally, brain stimulation reward thresholds for the two groups were not differentially affected by d-amp. The above results suggest that HR and LR can be further differentiated upon exposure to a novel environment and in response to d-amp. This differentiation is primarily based on qualitative cohorts of their behavioral structure, but not on deviations in the reward processes as assessed by intracranial self-stimulation.

Sex differences in behavioral, neurochemical and neuroendocrine effects induced by the forced swim test in rats

The forced swim test (FST) has been considered as a pharmacologically valid test of the depressive syndrome in rodents. However, few studies have focused on neurochemical and behavioral responses during FST in both male and female rats. Thus, we investigated certain behavioral and neuroendocrine responses as well as the serotonergic activity after the application of FST in both sexes. Our data show that the duration of immobility was increased in both male and female rats during the 2nd session of the FST. Sex differences are observed in some behavioral responses, such as head swinging that is mostly present in male rats. In female rats FST induced a decrease in serotonergic activity in hippocampus and hypothalamus while in male rats it induced an increase in serotonergic activity in hypothalamus. Corticosterone serum levels were elevated in both sexes. However, hippocampal GR mRNA levels tended to be increased in males and females respectively. Moreover, hypothalamic serotonin (5-HT)1A mRNA levels were decreased in female rats while in male rats hippocampal 5-HT1A mRNA levels were increased. These data have shown that FST induces "depressive like symptoms" in both sexes and provide evidence that sex differences characterize certain behavioral aspects in the FST. Notably, hippocampal and hypothalamic serotonergic activity has been differentially modified in male rats compared with female rats and these neurochemical findings could be relevant to the differentiated expression of 5-HT1A receptor. Hypothalamic-pituitary-adrenal axis activity was also affected by FST application in a sex specific manner. The present results support that FST induced behavioral, neurochemical and neurobiological alterations, which are sex dependent.