Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice

INTRODUCTION AND HYPOTHESIS

Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research.

METHODS

For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification.

RESULTS

Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design.

CONCLUSIONS

Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.

Quality of life in sarcopenia measured with the SarQoL questionnaire: A meta-analysis of individual patient data

Age-related sarcopenia, resulting from a gradual loss in skeletal muscle mass and strength, is pivotal to the increased prevalence of functional limitation among the older adult community. The purpose of this meta-analysis of individual patient data is to investigate the difference in health-related quality of life between sarcopenic individuals and those without the condition using the Sarcopenia Quality of Life (SarQoL) questionnaire. A protocol was published on PROSPERO. Multiple databases and the grey literature were searched until March 2023 for studies reporting quality of life assessed with the SarQoL for patients with and without sarcopenia. Two researchers conducted the systematic review independently. A two-stage meta-analysis was performed. First, crude (mean difference) and adjusted (beta coefficient) effect sizes were calculated within each database; then, a random effect meta-analysis was applied to pool them. Heterogeneity was measured using the Q-test and I2 value. Subgroup analyses were performed to investigate the source of potential heterogeneity. The strength of evidence of this association was assessed using GRADE. From the 413 studies identified, 32 were eventually included, of which 10 were unpublished data studies. Sarcopenic participants displayed significantly reduced health-related quality of life compared with non-sarcopenic individuals (mean difference = -12.32; 95 % CI = [-15.27; -9.37]). The model revealed significant heterogeneity. Subgroup analyses revealed a substantial impact of regions, clinical settings, and diagnostic criteria on the difference in health-related quality of life between sarcopenic and non-sarcopenic individuals. The level of evidence was moderate. This meta-analysis of individual patient data suggested that sarcopenia is associated with lower health-related quality of life measured with SarQoL.

Inter-Rater and Test-Retest Reliability of an Innovative Evaluation Tool: CrossFit Functional Assessment Battery of Tests for the Shoulder Joint

Background and objectives This study aims to introduce an innovative functional assessment tool designed for CrossFit athletes, to identify a high risk of injury at the shoulder joint. Additionally, the study seeks to examine both inter-rater reliability, which was tested in 40 CrossFit participants, and test-retest reliability, which was assessed in twenty subjects. Methodology CrossFit Functional Assessment Battery for the Shoulder Joint (CrossFit FABS) is a newly created instrument presented for the first time. The evaluation of the performance of its six items aimed to reveal deficits that could contribute to incidents of shoulder injuries. For this purpose, 40 healthy CrossFit participants were concurrently but independently examined by two raters, and twenty healthy adults active in sports were assessed by the main investigator at two different time points. Cohen's kappa coefficient was used to analyze categorical data with an ordinal structure. Results Inter-rater reliability ranged from 0.824 to 1 (P = 0.000) and test-retest reliability was 0.661 to 0.906 (P < 0.001) for each test of CrossFit FABS. A strong to almost perfect correlation was demonstrated for all the variables between the two examiners. Moderate to almost perfect correlation was shown through test-retest procedures. Conclusions The proposed test battery was established as a reliable tool for evaluating performance routines that represent high injury-risk elements for the shoulder joint in CrossFit athletes.

Reliability and clinical applicability of lower limp strength using an enhanced paper grip strength

The enhanced paper grip test (EGPT) quantitatively assesses lower limb strength. EGPT assesses the hallux grip force by reacting a pulling force derived from a card, being positioned underneath the participant's hallux. This study aimed to investigate the repeatability and clinical applicability of the EPGT for assessing foot muscle strength. EPGT force was measured using a dynamometer. The reliability of the measurement of EPGT force was assessed by having two examiners performing the test on the same group of healthy adults. Clinical applicability was assessed in community-dwelling adults of both genders. EPGT force was recorded for both feet using the same standardised protocol for all participants. Regarding reliability, 20 healthy adults aged 23.04±5.5 years participated in the present study. The EGPT demonstrated good to excellent test-retest (ICC1,2 0.8 to 0.86) and interrater reliability (ICC1,2 0.82 to 0.88). A convenience sample of 15 community-dwelling adults (71.6±7.8 years, 68.5% women) was recruited for clinical applicability testing. All participants performed the test with mean score 15±5.7 N. EPGT is a reliable measurement of the hallux grip force strength and can be used for clinical and research purposes.

Frailty: future prospectives in rehabilitation medicine

Modern rehabilitation is based on the International Classification of Functioning, Disability and Health (ICF). We will discuss this Classification process in frailty. Frailty is defined as a condition of reduced functional reserve, a state of vulnerability that involves poor recovery of homeostasis and increased susceptibility to stressor mechanisms, with consequent difficulty in returning to the previous condition of balance. Rehabilitation of frailty is reported in the ICF, although, its consensus is not sufficiently addressed due to its recent identification and the limited available information regarding how it should be formulated. Thus, the aim of the present article is to present the current evidence-based rehabilitation strategies applied in management of frailty.

Cross-cultural adaptation of the Greek version of post-COVID-19 Functional Status Scale: assessment of non-hospitalised post-COVID-19 survivors

The objective of the study was to translate and validate into the Greek language and setting the Post-COVID-19 Functional Status (PCFS) scale. Greeks aged ≥18 years who recovered form COVID-19 (≥ 14 days since diagnosis), were invited to participate. This cross-sectional study followed international guidelines regarding the translation process (forward and backward) and the evaluation of the PCFS. Reliability was assessed by test-retest analyses using the intraclass correlation coefficient (ICC) and 95%CI. For the validation, all participants completed the European Quality of Life-5 (EQ-5D-5L), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. 82 adults (49 females, aged 40.2 ± 6.1) participated in the study. The Greek version of the PCFS demonstrated excellent test-retest reliability, with an ICC of 0.9 (95% CI 0.90- 0.95). The Cronbach's alpha value was 0.9, indicating good internal consistency. The PCFS score was strongly correlated with the EQ-5D-5L (r=0.6, p≤0.001) and weakly correlated with the HADS (r=0.41;p≤0.001). The Greek version of the PCFS was successfully adapted into Greek and is recommended to be used across clinical settings and research.

The effectiveness of blood flow restriction training in cardiovascular disease patients: A scoping review

Therapeutic exercise is integral to the comprehensive rehabilitation of patients with cardiovascular disease and, as such, is recommended by the American Heart Association as a valuable and effective treatment method for such patients. The type of exercise applied to these patients is aerobic and resistance exercise with mild intensities and loads to avoid overloading the cardiovascular system. Blood flow restriction exercise is a novel exercise modality in clinical settings that has in many studies a similar effect on muscle hypertrophy, strength, and cardiovascular response to training at a 70% strength level without blood flow restriction. Since this exercise mode does not require high-intensity loads, it can be a safe method for improving muscle strength, cardiovascular endurance, and functionality in cardiovascular patients. Given that, the objective of this review is to assess and summarize existing evidence for the use of blood flow restriction in cardiovascular patients. A scoping review of existing clinical trials was conducted. Eleven studies were examined that suggested the use of blood flow restrictions in cardiovascular patients to achieve improvements in muscle strength, functionality, and cardiovascular parameters such as blood pressure decrease.

Perampanel as precision therapy in rare genetic epilepsies

OBJECTIVE

Perampanel, an antiseizure drug with α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antagonist properties, may have a targeted effect in genetic epilepsies with overwhelming glutamate receptor activation. Epilepsies with loss of γ-aminobutyric acid inhibition (e.g., SCN1A), overactive excitatory neurons (e.g., SCN2A, SCN8A), and variants in glutamate receptors (e.g., GRIN2A) hold special interest. We aimed to collect data from a large rare genetic epilepsy cohort treated with perampanel, to detect possible subgroups with high efficacy.

METHODS

This multicenter project was based on the framework of NETRE (Network for Therapy in Rare Epilepsies), a web of pediatric neurologists treating rare epilepsies. Retrospective data from patients with genetic epilepsies treated with perampanel were collected. Outcome measures were responder rate (50% seizure reduction), and percentage of seizure reduction after 3 months of treatment. Subgroups of etiologies with high efficacy were identified.

RESULTS

A total of 137 patients with 79 different etiologies, aged 2 months to 61 years (mean = 15.48 ± 9.9 years), were enrolled. The mean dosage was 6.45 ± 2.47 mg, and treatment period was 2.0 ± 1.78 years (1.5 months-8 years). Sixty-two patients (44.9%) were treated for >2 years. Ninety-eight patients (71%) were responders, and 93 (67.4%) chose to continue therapy. The mean reduction in seizure frequency was 56.61% ± 34.36%. Sixty patients (43.5%) sustained >75% reduction in seizure frequency, including 38 (27.5%) with >90% reduction in seizure frequency. The following genes showed high treatment efficacy: SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, POLG1, POLG2, and NEU1. Eleven of 17 (64.7%) patients with Dravet syndrome due to an SCN1A pathogenic variant were responders to perampanel treatment; 35.3% of them had >90% seizure reduction. Other etiologies remarkable for >90% reduction in seizures were GNAO1 and PIGA. Fourteen patients had a continuous spike and wave during sleep electroencephalographic pattern, and in six subjects perampanel reduced epileptiform activity.

SIGNIFICANCE

Perampanel demonstrated high safety and efficacy in patients with rare genetic epilepsies, especially in SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, CDKL5, NEU1, and POLG, suggesting a targeted effect related to glutamate transmission.

Risk of sarcopenia, fear of COVID-19, anxiety, depression and physical activity levels: Associations across patients on hemodialysis within Greece

Objectives

The purpose of this multicenter cross-sectional study was to investigate the association between SARC-F, fear of COVID 19, anxiety, depression and physical activity in patients undergoing hemodialysis.

Methods

This study was conducted in 3 hemodialysis centers in Greece during the period of the COVID-19 pandemic. Sarcopenia risk was assessed using the Greek version of SARC-F (≥4). Demographic and medical history were collected from the patient's medical charts. The participants were also asked to fill the Fear of COVID-19 Scale (FCV-19S), the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ) questionnaire.

Results

A hundred and thirty-two (132) patients on hemodialysis (92 men, 70.75±13.14 years) were enrolled. Sarcopenia risk (utilizing the SARC-F) was found in 41.7% of patients on hemodialysis. The average duration of hemodialysis was 3.94±4.58 years. The mean score values for SARC-F, FCV-19S and HADS were 3.9±2.57, 21.08±5.32, and 15.02±6.69, respectively. The majority of patients were physically inactive. The SARC-F scores were strongly associated with age (r=56; p<0.001), HADS (r=0.55; p<0.001), levels of physical activity (r=0.5; p<0.001), but not with FCV-19S (r=0.27; p<0.001).

Conclusion

A statistically significant relationship was recorded between sarcopenia risk and age, anxiety/depression and levels of physical inactivity in patients on hemodialysis. Future studies are necessary in order to evaluate the association of specific characteristics of patients.

Greek Adaptation and Validation of the Bad Sobernheim Stress Questionnaire-Brace and the Bad Sobernheim Stress Questionnaire-Deformity

Adolescent idiopathic scoliosis (AIS) is a progressive condition responsible for spinal deformity in all three planes. Spinal deformity and how the rib hump affects the aesthetics, and the functionality of the trunk can be a cause of psychological distress as well. Bracing as a treatment can have a negative impact on QoL, cause pain, affect participation levels in physical activities, and cause isolation and depression. Brace-induced stress may affect the patient's compliance with the treatment which may lead to scoliosis progression. The purpose of this study was to adapt and validate in the Greek language two instruments that can evaluate stress levels induced by bracing treatment and by deformity. The process of cross-cultural adaptation and validation of the Bad Sobernheim Stress Questionnaire-Brace (ΒSSQ-Brace) and the Bad Sobernheim Stress Questionnaire-Deformity (BSSQ-Deformity) followed the International Quality of Life Assessment Project (IQOLA) guidelines. Forty-seven AIS patients with a mean age of 14.4 ± 1.51 years, mean Cobb angle of 30.08 ± 9.25, and mean duration of the bracing treatment at 20.5 ± 12.2 months participated. The mean score for GR-BSSQ Brace was 14.04 ± 6.42, which is interpreted as medium stress, whereas the mean score for GR-BSSQ Deformity was 20.34 ± 3.78, which is interpreted as low stress. GR-BSSQ Brace demonstrated good internal consistency with Cronbach's α = 0.87. GR-BSSQ Deformity demonstrated acceptable internal consistency with Cronbach's α = 0.73. Both GR-BSSQ Brace and GR-BSSQ Deformity exhibited excellent test-retest reliability with ICC values of 0.94 (95% CI 0.89-0.97) and 0.92 (95% CI 0.86-0.95), respectively. BSSQ Brace and BSSQ Deformity questionnaires have been cross-culturally adapted into the Greek language and have been proven to be valid and reliable instruments measuring brace and deformity-induced stress. Both questionnaires can be used for clinical and research purposes in Greek-speaking population.

The Effects of Exercise in Older Adults with Hyperkyphotic Posture

The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.

Investigation of Physical Activity Levels and Associated Factors of Greek Older Adults During COVID-19 Pandemic: A Community-Based Cross-Sectional Study

The purpose of this cross-sectional study was to investigate the self-reported impact of the COVID-19 pandemic on physical activity (PA), anxiety, and depression amongst Greek older adults. Participants were older adults (>60 years) recruited from community centers of Achaia (Open Care Centers for Older Adults), in Western Greek mainland during the period of December 2020-March 2021. The information was gathered through telephone interviews. Questions on social demographics, health history, diagnosis, quarantine, and hospitalization were asked, as well as impact of the pandemic health status and physical activity behavior. The level of PA was assessed via the International Physical Activity Questionnaire (IPAQ) questionnaire, while anxiety and depression via the Hospital and Anxiety and Depression Scale (HADS). The study protocol was approved by the Ethical Committee of the University of Patras. Four-hundred eleven (411) older adults (306 women, 105 men; mean age of 72.47 ± 6.89 years years) completed the survey. About half of the sample (n = 179; 43.5%) reported a decrease in physical activity due to the pandemic and social isolation restrictions. From the total sample, 211 older adults (51.3%) recorded fear of COVID-19 infection and 9 participants (2.1%) reported to have been diagnosed with the COVID-19 infection. The findings of this study demonstrated that PA was associated with place of living (r = 0.55; p ≤ 0.001), incidence of falls (r = 0.45; p ≤ 0.001), COVID-19 infection (r = 0.6; p ≤ 0.001), fear of COVID-19 infection (r = 0.45; p ≤ 0.05), and anxiety (r = 0.5; p ≤ 0.001). In summary, a decline in PA due to COVID-19 pandemic was reported by the majority of Greek older adults. Results of the present study show that the COVID-19 pandemic may have induced PA behavior changes in many older adults, which may accelerate their risk of developing frailty, sarcopenia, and disability. Interventions to improve PA in older adults should take into account social and community factors and should be key components of current and future pandemic plans, particularly for vulnerable groups.

The Effect of Schroth Method on Postural Control and Balance in Patients with Adolescent Idiopathic Scoliosis: A Literature Review

The objective of this review was to offer new information on the effectiveness of Schroth method on postural control and balance in patients with adolescent idiopathic scoliosis (AIS). PubMed, EBSCO, and Google Scholar databases were searched from June 2022 to August 2022 for prospective controlled trials and randomized controlled trials related to effects of Schroth exercises on postural control and balance in patients with AIS. The key words AIS, Schroth, balance, postural control, and proprioception were used. Studies written in English language, in the last decade were included. Seven studies were included in the review, with a total of 244 study subjects. Three studies investigated the effectiveness of Schroth exercises on balance and postural control. Two studies included investigated the effectiveness of Schroth method in combination with additional treatments of bracing and hippotherapy, while two other studies investigated effectiveness of Schroth when compared with Pilates and proprioceptive neuromuscular facilitation (PNF). The treatment duration varied from a week to 6 months. From the findings of this review, it is supported that Schroth method can have positive effects on balance and postural control in AIS patients. Further investigation is necessary.

Telerehabilitation and Fall Prevention in Older Adults

The objective of this review is to summarize the evidence regarding the use of telerehabilitation in the fall prevention of older adult patients. Medline and Google Scholar databases were searched from July to August 2022 for studies related to telerehabilitation interventions in older adults above 60 years of age. The study included all trials related to the telerehabilitation programs and fall prevention in older adults. The search items included "telerehabilitation," "falls," and "older adults." Five studies were included involving 694 older adults. The interventions included online exercise classes and exercise sessions via digital video disks (DVDs) and phone calls. The results of the present review showed that telerehabilitation offers positive clinical results for fall prevention.

Relationship of Ηand Grip Strength, Physical Activity, and Anthropometric Characteristics in a Sample of Male and Female Physiotherapy Students

The present study aimed to determine gender differences in the hand grip strength (HGS) and to examine the relations between HGS, anthropometric characteristics, and physical activity (PA) in Greek young adults. A cross-sectional observational study of 276 students (21.5 ± 4.1 years, 122 men, 154 women) was conducted at the University of Patras, Greece. HGS was assessed via a hand-held grip strength dynamometer; body composition was determined by bioelectrical impedance analysis; and calf, mid-arm, and waist circumferences with inelastic tape. PA was assessed with the modified Baecke Questionnaire for Habitual Physical Activity (mBQHPA). The mean of HGS was 37.15 ± 11.2 kg. Men had significantly (p < 0.001) greater HGS than women. Statistically large correlation was detected between HGS and muscle mass (r = 0.73; p ≤ 0.001), gender (r = 0.6; p ≤ 0.001), mid-arm (r = 0.74; p ≤ 0.001), and calf circumference (r = 0.69; p ≤ 0.001). Results show that fat mass was a risk factor associated with HGS, found using regression analyses in both genders. However, PA was a significant associated factor only for women participants (ΟR = 0.77; 95% confidence interval [CI]: 0.17-1.38; p ≤ 0.05). In summary, the HGS of Greek physiotherapy students was associated with muscle mass, gender, mid-arm, and calf circumference.

Cold-Water Immersion and Sports Massage Can Improve Pain Sensation but Not Functionality in Athletes with Delayed Onset Muscle Soreness

This study aimed to investigate the effects of cold-water immersion (CWI) and sports massage on delayed-onset muscle soreness (DOMS) in amateur athletes. Sixty male amateur athletes were randomised into four equal groups (n = 15) receiving either CWI, sports massage, their combination, or served as controls after applying plyometric training to their lower extremities. The main outcomes measures were pain, exertion, rectus femoris perimeter, knee flexion range of motion, knee extensors isometric strength and serum creatine phosphokinase (CPK) levels examined before the plyometric training, immediately after the treatment, and 24, 48 and 72 h post exercise. We observed no significant differences between study groups in the most tested variables. CWI improved pain compared to the combined application of CWI and sports massage, and the control group both on the second and third day post exercise. Sports massage combined with CWI also led to a significant reduction in pain sensation compared to the control group. In conclusion the treatment interventions used were effective in reducing pain but were unable to affect other important adaptations of DOMS. Based on the above, sports scientists should reconsider the wide use of these interventions as a recovery strategy for athletes with DOMS.

Reliability and Validity of Non-radiographic Methods of Forward Head Posture Measurement: A Systematic Review

Forward head posture measurement can be conducted using various methods and instruments. The selection of the appropriate method requires the factors of validity and reliability to be considered. This systematic review reports on the reliability and validity of the non-radiographic methods examined for measuring forward head posture. The review identified relevant studies following a systematic search of electronic databases. The studies were assessed for quality by two independent reviewers using a critical appraisal tool. The studies’ data were extracted and assessed, and the results were synthesized qualitatively using a level of evidence approach. Twenty-one studies met the eligibility criteria and were included in the review. Both reliability and validity were investigated for five studies, whereas reliability only was investigated for 17 studies. In total, 11 methods of forward head posture measurement were evaluated in the retrieved studies. The validity of the methods ranged from low to very high. The reliability of the methods ranged from moderate to excellent. The strongest levels of evidence for reliability support the use of classic photogrammetry. For validity, the evidence is not conclusive. Further studies are required to strengthen the level of evidence on the reliability and validity of the remaining methods. It is recommended that this point be addressed in future research.

The Effects of Exercise in Patients with Sarcopenia

The aim of this study was to assess the effects of different types of exercise interventions for treating sarcopenia compared to no specific treatment, a minimal intervention (e.g., education), or another active treatment (nutritional supplements). A review was conducted of the recent English literature searching PubMed and ScienceDirect databases. Ten randomized controlled trials (RCTs) were included in this review, presenting the results of 671 sarcopenic patients. The exercise interventions were resistance training (four studies), a multimodal program (five studies, encompassing resistance training and additional exercises such as aerobic exercises, flexibility, balance and strength training), and a whole body vibration program (one study). Results show that exercise interventions could have beneficial effects in improving muscle mass, muscle strength, and physical performance in 3 months of intervention. Resistance training, added to an adequate nutrition and aerobic exercise, appeared to deliver the most positive outcome after 3 months of intervention. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to the significant heterogeneity in clinical trials, the current evidence provides limited guidance. Well-designed studies evaluating exercise interventions are needed before treatment guidelines can be developed.

Neuromuscular control of the lower extremities can be better enhanced by applying ankle taping and kinesiological taping rather than elastic bandaging: a randomized control study in amateur soccer players

[Purpose] This study evaluated the effects of ankle elastic bandaging, taping, and kinesiology taping on the neuromuscular control of the lower extremities before and after their application and after exercise in soccer athletes. [Participants and Methods] Fifty-five amateur soccer players were randomly divided into four research sub-groups either receiving bandaging (n=15), taping (n=15), and kinesiology taping (n=15) on their ankle or serving as controls (n=10). The dynamic stability of the non-dominant limb was assessed through the star excursion balance test (SEBT) in three research conditions: a) before sports taping application, b) after the application, and c) after a 15 min laboratory simulation of soccer activities. [Results] Taping and kinesiology taping improved the dynamic stabilization of the lower limb more statistically significantly than bandaging. The addition of exercise significantly improved the SEBT results in the taping and kinesiology taping more than the bandaging and control groups. [Conclusion] Exercise activates the proprioceptive mechanisms of the lower limb and improves its neuromuscular control. This functional improvement of the lower limb appears to be enhanced after ankle taping and kinesiology taping compared with elastic bandaging and controls.

Prevalence of probable sarcopenia in community-dwelling older Greek people

Objectives:

The objective of this study was to assess the prevalence rate of probable sarcopenia and to determine the factors associated with it in older people living in Western Greece.

Methods:

Probable sarcopenia was estimated based on cut-off values for handgrip strength (HGS) as recommended by EWGSOP2. Information about socio-demographic, chronic diseases, fear of falls and lifestyle of the participants were also collected. HGS was assessed using a SAEHAN dynamometer. Calf circumference was assessed with inelastic tape. A logistic regression analysis was performed in order to determine associated risk factors.

Results:

The sample comprised 402 participants (292 women;110 men), with a mean age of 71.51±7.63 years. Overall, 25.4% of the elderly participants were diagnosed with probable sarcopenia (men:36.4%; women:21.2%). The findings of this study demonstrated that probable sarcopenia was positively associated with age (OR=0.14, 95% CI=0.008 to 0.200), gender (OR=-0.6, 95% CI=-0.700 to -0.530), Body mass Index (OR=0.01, 95% CI=-0.030 to -0.005), Skeletal muscle mass index (OR=0.05, 95% CI=0.030 to 0.080), calf circumference (OR=0.02, 95% CI=0.007 to 0.040), and comorbidities (OR=0.04, 95% CI=0.030 to 0.080).

Conclusion:

There was a 25.4% prevalence of probable sarcopenia in Greek elderly. The results highlight the importance of the detection of HGS and probable sarcopenia in older people in order to develop effective strategies of prevention and intervention of sarcopenia.

Cross cultural adaptation, reliability and validity of the Greek version of Identification of Functional Ankle Instability (IdFAI) questionnaire

BACKGROUND

The objectives of our study were to develop the Greek version of the Identification of Functional Ankle Instability (IdFAI) questionnaire and to evaluate its psychometric properties.

METHODS

The IdFAI was translated and adapted into Greek according to the guidelines for cross-cultural adaptation of self report measures. It was tested for test-retest reliability, validity, internal consistency and floor-ceiling effects in 141 participants (54 males, 87 females; 23.5 ± 7.2 years). All participants were asked to fill the Greek IdFAI (IdFAI-GR), the Cumberland Ankle Instability Tool (CAIT), and the Lower Extremity Functional Scale (LEFS), in order to determine construct validity. To determine the test-retest reliability, fifty randomly selected individuals re-filled IdFAI seven days after the first session.

RESULTS

The IdFAI-GR had high internal consistency (Cronbach alpha = 0.94) and excellent test-retest reliability (ICC_2,1 = 0.97; SEM = 0.7). The IdFAI-GR had strong correlation with the CAIT (r = 0.7; p < 0.001) and moderate correlation with the LEFS (r = 0.5; p < 0.001). No ceiling or floor effects were observed.

CONCLUSION

The Greek IdFAI questionnaire has proven to be a valid and reliable instrument to identify functional ankle instability. It can therefore, be used for both clinical and research purposes in Greek-speaking individuals.

The Effects of a Home-Based Combined Motor Control and Ergonomic Program on Functional Ability and Fear of Falling: A Randomized Controlled Trial

Objectives

Physical exercise is a key intervention for improving functional ability and preventing falls in older people. However, the implemented interventions targeted balance, gait, and muscle strength, while little is known regarding motor control exercises in this population. Therefore, this study aimed to investigate the effects of a 12-week home-based motor control exercise program combined with an ergonomic home modification (the McHeELP program).

Patients and methods

Fifty-two older people (aged ≥65 years), who had experienced at least one fall incident in the past 12 months, were randomly assigned into two groups; the McHeELP group (McHeELP-G) (n=26) that received the McHeELP program and the control group (CG) (n=26). Physical performance measures (PPMs) and patient-reported outcomes (PROs) were used to evaluate participants. At baseline, 3rd month (post-intervention), and again at 6th month (follow up), balance control was assessed using the Tandem stance test (Tandem) and the Functional Reach Test (FRT). Functionality was assessed by the 4 meters walking test (4MWT), Timed Up and Go (TUG) test, 30 seconds-Sit to stand test and the Greek version of Lower Extremity Functional Scale (LEFS-Greek). The Greek version of the Falls Self-efficacy International scale (FES-I_GREEK) was used for the evaluation of "fear-of-falling" (FOF). The home falls and accidents screening tool (HOMEFAST) is used to identify home hazards. Two-way mixed ANOVA model, independent samples t-test, One-factor Repeated Measures ANOVA model and ANCOVA model were used for the statistical analysis of the data.

Results

Homogeneity was found between McHeELP-G and CG regarding the demographic and clinical characteristics, and no statistically significant difference was found at baseline measurements of PROs and PPMs, except HOMEFAST (p=0.031). Post-intervention (3rd month), the comparison of the absolute values between groups revealed that the McHeELP-G achieved statistically significant better balance control (longer Tandem stance test and higher values of FRT), better functionality [faster gait speed (4MWT), shorter TUG performance time, and a higher number of repetitions at 30 seconds-Sit to stand] (all p-values <0.05), while no difference was found for LEFS-Greek score (p=0.095), compared to CG. In addition, McHeELP-G reported lesser FOF than CG [lower FES-I_GREEK score (p=0.041)], and fewer home-hazards [lower HOMEFAST score (p=0.041)]. At follow up measurement (6th month), all PPMs scores of McHeELP-G, regarding balance control and functionality, were remained statistically significant (all p-values <0.005), and the FES-I_GREEK score (p=0.034), while no difference was found between groups for LEFS-Greek score (p=0.146) and HOMEFAST score (p=0.185). Sensitivity analysis (from baseline to 3rd and 6th month) revealed similar findings to the "comparison of the absolute values between groups" analysis. The within-group changes from baseline to 3rd month of McHeELP-G were statistically significant improved for all PPMs and PROs (all p-values <0.05), while in CG, statistical significant difference was found for TUG, FRT-right, and HOMEFAST (p<0.05). Those within-group changes were also preserved until 6th month.

Conclusions

The study's findings provide encouraging evidence that McHeELP program may increase functional ability and decrease FOF of older people. However, further research is required for a thorough understanding of the effect of McHeELP program. 

Methodology of a home-based motor control exercise and ergonomic intervention programme for community-dwelling older people: The McHeELP study

The aim of this research (Motor control Home ergonomics Elderlies' Prevention of falls; McHeELP study) was to develop a novel intervention combining motor control home-based exercises and a home ergonomic safety-improvement strategy in order to reduce falls in frail ambulatory older adults. A randomized controlled trial of a novel intervention is proposed including motor control exercises and home ergonomic assessment and modification in older adults who have at least one fall experience. Participants are randomized to control or intervention group in a 1:1 ratio. Participants will be assessed three times: at baseline, at 3rd month (end of intervention period) and again at 6th month (follow-up measurement). The primary outcome is of the effect on functional mobility using the Timed Up and Go test. Secondary outcomes include assessments of functionality, fear of falling and quality of life. This will be the first study to develop an exercise intervention approach that combines home-based motor control exercise intervention with home assessment and modification. This study is expected to explore a low-cost, easy-to-popularize, and effective exercise intervention approach for improving functional mobility and prevent falls among older adults.

The Efficacy of Manual Therapy in Patients with Knee Osteoarthritis: A Systematic Review

Background and objectives: Osteoarthritis (OA) is among the most common degenerative diseases that induce pain, stiffness and reduced functionality. Various physiotherapy techniques and methods have been used for the treatment of OA, including soft tissue techniques, therapeutic exercises, and manual techniques. The primary aim of this systemic review was to evaluate the short-and long-term efficacy of manual therapy (MT) in patients with knee OA in terms of decreasing pain and improving knee range of motion (ROM) and functionality. Materials and Methods: A computerised search on the PubMed, PEDro and CENTRAL databases was performed to identify controlled randomised clinical trials (RCTs) that focused on MT applications in patients with knee OA. The keywords used were 'knee OA', 'knee arthritis', 'MT', 'mobilisation', 'ROM' and 'WOMAC'. Results: Six RCTs and randomised crossover studies met the inclusion criteria and were included in the final analysis. The available studies indicated that MT can induce a short-term reduction in pain and an increase in knee ROM and functionality in patients with knee OA. Conclusions: MT techniques can contribute positively to the treatment of patients with knee OA by reducing pain and increasing functionality. Further research is needed to strengthen these findings by comparing the efficacy of MT with those of other therapeutic techniques and methods, both in the short and long terms.

Cross-cultural validation of the start back screening tool in a Greek low back pain sample

BACKGROUND

Keele STarT Back Screening Tool (SBST) is a popular 9-item prognostic recovery questionnaire for low back pain (LBP) with validation studies in several cultural settings, but not Greek.

OBJECTIVES

The cross-cultural adaptation and validation of the SBST into Greek among LBP and LBP-associated leg pain patients.

METHODS

A five-stage forward-backward translation procedure developed the Greek SBST. LBP and sciatica patients completed SBST, Roland-Morris Disability Questionnaire (RMDQ), Hospital Anxiety and Depression Scale (HADS), Short-form Health Survey (SF-12), Sciatica Bothersomeness Index (SBI), numeric pain rating scale (NPRS) and body chart pain location sites. Measurement properties (internal consistency, content, construct and discriminatory validity) were explored. Test-retest reliability was explored by re-administering SBST after 7-10 days across patients whose symptoms remained unchanged.

RESULTS

124 LBP patients (75 females, 49.1 ± 14.2 years-old) 43.5% of whom had sciatica completed Greek SBST. No floor/ceiling effects were detected. Mean score distributions were statistically different across SBST groups. Moderate to strong correlations were found for SBST (total and psychosocial scores) with RMDQ, SBI, HADS and SF-12 (Spearman's ρ = 0.42-0.60). Most associations between individual SBST items and reference standards were moderately correlated (ρ = 0.32-0.49). Greek SBST yielded acceptable discriminant validity with RMDQ (AUC of 0.80). Items 1, 3, 4, and 9 yielded acceptable discrimination against reference standards. Test-retest reliability was satisfactory for total score (ICC_2,2 = 0.93) and individual items (kappa = 0.59-0.88). Cronbach's α was 0.70 (total score) and 0.76 (psychosocial subscale).

CONCLUSIONS

The Greek SBST was comprehensible, valid and reliable and may thus, be used across Greek cross-cultural rehabilitation research and practice.

Motor Control and Ergonomic Intervention Home-Based Program: A Pilot Trial Performed in the Framework of the Motor Control Home Ergonomics Elderlies' Prevention of Falls (McHeELP) Project

Objectives Falls are a serious problem that can reduce living autonomy and health-related quality of life of older adults. A decrease in the muscular strength of the lower limbs and the deterioration of balance or motor performance deficits may lead to falls. "Motor Control Home Ergonomics Elderlies' Prevention of Falls" (McHeELP) is a novel motor control exercise program combined with ergonomic arrangements of the home environment. This pilot trial is conducted in order to examine the feasibility and acceptability of the McHeELP program, the selection of the most appropriate outcome measures, and the exact sample size calculation that should be used for the randomized controlled trial (RCT) with Clinical Trial Identifier: ISRCTN15936467. Patients and methods Twenty older adults (aged ≥65 years) who had experienced at least one fall-incident in the past 12 months have participated in the trial; they were randomized in a 1:1 ratio to the McHeELP group (McHeELP-G) and the Control group (CG). The McHeELP-G received a personalized therapeutic motor control and learning exercise program performed three times per week for 12 weeks. Regarding McHeELP - home modification, a booklet that contained basic advice and tips on the modification for their inside and outside home environment was provided to the participants. Objective and self-reported outcome measures, collected at baseline and post-intervention (end of the third month), included functional, fear of falling, and quality of life measurements. Results The McHeELP intervention was very feasible and acceptable to the participants, and the adherence was excellent (100%). The majority of outcome measures seemed appropriate and significant differences were also revealed between the two groups. Specifically, post-intervention statistically significant improvement was found in the 4 meters walking test, Timed Up and Go test, Sit to Stand test, Tandem Stance test, Functional Reach test, Foot tapping test, EuroQoL-5D-5L - visual analog scale (VAS), Lower Extremity Functional Scale, Falls Self-Efficacy International Scale, and Home Falls and Accidents Screening Tool (HOMEFAST) questionnaire of McHeELP-G (all p-values ≤0.002). No statistically significant difference was observed in the mobility, self-care, usual activities, pain/discomfort subscales of Euro QoL-5D-5L (all p-values >0.05), except the anxiety/depression subscale of McHeELP-G (p=0.008). Moreover, no statistically significant improvement was found regarding McHeELP participants' knee flexion/extension restriction and ankle dorsiflexion/plantar-flexion restrictions. Regarding CG, no statistically significant difference was found (p>0.05), except the Tandem Stance test (p=0.003) and HOMEFAST (p<0.001). Referring to the future McHeELP RCT, it was estimated that a sample size of 25 evaluable patients per group is required. Conclusions This pilot trial's findings suggest that it is feasible to deliver an RCT of the McHeLP program to this population. Exercise programs that are easy to administer need to be developed and implemented to reduce the burden of falls in older adults.

Cross-cultural adaptation and validation of the Greek Version of the SARC-F for evaluating sarcopenia in Greek older adults

OBJECTIVE

To translate and validate into Greek, the SARC-F questionnaire, a screening tool for sarcopenia.

METHODS

Questionnaire was back-translated and culturally adapted into Greek according to guidelines proposed by the World Health Organization. A convenience sample of 197 Greek elderly people (71.6±7.8 years, 68.5% women) was recruited, 64 of which were classified as persons at risk of sarcopenia according to the SARC-F. Internal consistency, test-retest and inter-rater reliability were evaluated. Validity (sensitivity, specificity, predictive positive value and predictive negative value) was assessed against the definition from the European Working Group of Sarcopenia in Older People (EWGSOP2), which is considered gold standard. Receiver-operating characteristic analysis was also performed to calculate the area under the curve.

RESULTS

SARC-F demonstrated high internal consistency (Cronbach's alpha of 0.93) and excellent inter-rater and test-retest reliability, with intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.79-0.96), and 0.93 (95% CI 0.91-0.95), respectively. According to the definition of sarcopenia from the EWGSOP2, 53 (26.85) participants were identified as probable sarcopenic and 23 (11.6%) as sarcopenic. Sensitivity of the tool for sarcopenia was 34.4 and specificity was 93.2. Positive predictive values were 26.4 and negative predictive values were 66.6%.

CONCLUSION

Τhe SARC-F was successfully adapted into Greek language. The Greek SARC-F revealed low sensitivity but high specificity with EWGSOP2 sarcopenia definitions, indicating that it can detect with precision the absence of sarcopenia.

What is most appropriate number of repetitions of the sit-to-stand test in older adults: a reliability study

The most frequently employed versions of the sit-to-stand test (STST) are the 5 times STSΤ and the 30 seconds STST. However, it is not known whether a variation with different number of repetitions or time could be more appropriate for older adults. The objective of this study was to investigate the reliability of STST at different time points and number of repetitions. The test was performed in 33 older adults (73±6.1 years) for 40 seconds. The participants performed the procedure twice with a day interval between the sessions. The test was video-taped and the data were processed by two examiners. The highest test-retest reliability was found for the 4th (ICC=0.73, SEM=1.48, SDD=1.68), 5th (ICC=0.76, SEM=1.73, SDD=1.97) and 6th repetition (ICC=0.78, SEM=1.78, SDD=2.03). The inter-rater reliability was excellent independently of the number of trials (ICC>0.9). The correlation of the time at the 4th and 6th repetition with the time at the traditionally selected 5th repetition was excellent (r>0.9). The termination of the STST at the 4th repetition seems to provide equally reliable and valid estimations with the termination at the 5th repetition. Future studies should examine a 4 times STST since the reduction of the number of repetitions may be less tiring and safer for older adults.

Sarcopenia in patients with chronic obstructive pulmonary disease: A study of prevalence and associated factors in Western Greek population

Background:

Chronic obstructive pulmonary disease (COPD) is associated with a progressive loss of muscle mass and function and a systemic inflammatory process that can cause sarcopenia.

Objective:

The objective of this study is to estimate the prevalence rate of sarcopenia in COPD patients and to determine the factors associated with sarcopenic patients living in Western Greece.

Methods:

European Working Group on Sarcopenia in Older People criteria were applied to 69 outpatients with stable COPD. Body composition, exercise capacity, functional performance, physical activity, and health status were also assessed. COPD disease severity (COPD stage) was evaluated with the Global Initiative for chronic obstructive lung disease. The study protocol was approved by the Ethical Committee of the Technological Educational Institute of Western Greece.

Results:

The sample comprised 69 patients (59 women and 10 men), with a mean age of 71.33 ± 7.48 years. The prevalence of sarcopenia was 24.6% (n = 17). A high percentage (82.6%; n = 57) of the 69 Greek participants did not perform any regular exercise. The findings of this study demonstrated that sarcopenia was positively associated with COPD, age, body mass index, skeletal muscle mass, hand grip strength, and 4 m test.

Conclusions:

In conclusion, there is a 24.6% prevalence of sarcopenia in patients with COPD. Further research with larger samples would be indicated to clarify the precise association of specific characteristics of patients with sarcopenia and COPD.

Effects of the Ergon® instrument-assisted soft tissue mobilization technique (IASTM), foam rolling, and static stretching application to different parts of the myofascial lateral line on hip joint flexibility

[Purpose] This study was aimed to compare the effects of three soft tissue treatments in different parts of the myofascial lateral line (LL) on the hip adduction range of motion (ROM). [Participants and Methods] Thirty university students received Ergon^® instrument-assisted soft tissue mobilization (IASTM) treatment, foam rolling, and static stretching on the upper or lower part of the LL on the side of their non-dominant lower limb, while the other body side served as control. The participants received one treatment per week for six weeks with a simultaneous pre-and post-therapy assessment of their hip adduction ROM. [Results] The hip adduction ROM was improved on the intervention side in all experimental groups. The gains were more significant in groups that received the Ergon treatment. All Ergon interventions, as well as foam rolling on the upper part of the LL, led to the greatest hip adduction ROM improvement compared to the control side. No differences were observed between the Ergon groups. [Conclusion] The findings suggest that the implementation of Ergon IASTM, foam rolling, and stretching can produce positive effects on the hip ROM. The Ergon Technique is more effective compared to foam rolling and stretching, irrespective of the application site.

Posterior thigh thermal skin adaptations to radiofrequency treatment at 448 kHz applied with or without Indiba® fascia treatment tools

[Purpose] This study aimed to evaluate the posterior thigh’s skin thermal responses to 448-kHz radiofrequency-based therapy applied either in the form of standard application (Indiba^®Activ) or combined soft tissue treatment (Indiba^®Fascia treatment). [Participants and Methods] Ten healthy males (22 ± 3 years of age, weight 75.2 ± 4.9 kg, height 178.5 ± 4.7) received four different treatments which included a) Indiba^®Activ (IA) radiofrequency treatment, b) Indiba^®Fascia (IF), c) Indiba^®Activ placebo (IAP) and d) Indiba^®Fascia Placebo (IFP) in the posterior thigh of their dominant lower limb, while the non-dominant served as the control. Skin temperature was recorded pre- and post-treatment and every minute until the surface temperature reached pre-treatment levels using a wireless infrared thermometer. [Results] Both radiofrequency-based therapy groups IA and IF led to a significant increase in skin temperature compared to placebo applications. The IF intervention led to an average retention of elevated temperature for 164.2 minutes compared to 54.8 minutes of IA, 23.17 of IFP and 17.6 minutes of IAP. [Conclusion] These findings indicate that radiofrequency treatment at 448 kHz can induce and sustain significant thermal skin adaptations reflecting an increased blood circulation and metabolism of underlying tissues.

Cross cultural adaptation, reliability, and validity of the Greek version of the Cumberland Ankle Instability Tool

Objectives: This study's objective was to translate and cross-culturally adapt the Cumberland Ankle Instability Tool (CAIT) into the Greek language and to evaluate its psychometric properties.Methods: CAIT was translated and adapted into Greek according to official cross-cultural adaptation guidelines of self-reported measures. The Greek version of the CAIT (CAIT-GR) was tested for reliability (internal consistency, test-retest reliability), validity (discriminative and convergent validity) and floor-ceiling effects. Additionally, a cut-off value discriminating between stable and unstable ankles across healthy participants and participants with ankle complaints was calculated. A convenience sample of 123 Greek individuals was recruited, 43 of which had a history of at least one ankle sprain. All participants completed the final version of the CAIT-GR twice within 7-10 days. Participants with a history of ankle sprain also completed the Greek version of the Lower Extremity Functional Scale (LEFS) and the Visual Analogue Scale (VAS).Results: CAIT-GR mean scores were 26.9 ± 3.16 for participants without a history of ankle sprain and 20.6 ± 4.62 for the instability group. The cut-off value was at 24.5 points of the total CAIT score (range 0-30). CAIT-GR had a moderate correlation with VAS (0.54) and a high correlation with LEFS (0.735). Results indicated good discriminative validity, high internal consistency (Cronbach's alpha of 0.97) and excellent test-retest reliability (ICC_2,1 = 0.97, 95%CI = 0.97-0.98). Neither a floor nor a ceiling effect was observed.Conclusions: The CAIT-GR questionnaire was found to be a reliable and valid measure for chronic ankle instability. It is therefore, available for use in future clinical research and practice.

Standard error of measurement and smallest detectable change of the Sarcopenia Quality of Life (SarQoL) questionnaire: An analysis of subjects from 9 validation studies

Objectives

The Sarcopenia Quality of Life (SarQoL) questionnaire, a sarcopenia-specific patient-reported outcome measure, evaluates quality of life with 55 items. It produces 7 domain scores and 1 overall quality of life score, all between 0 and 100 points. This study aims to contribute to the interpretation of the SarQoL scores by calculating the standard error of measurement (SEM) and smallest detectable change (SDC) in a sample of subjects from 9 studies.

Methods

Subjects from 9 studies (conducted in Belgium, Brazil, Czech Republic, England, Greece, Lithuania, Poland and Spain) were included. The SEM, a measure of the error in the scores that is not due to true changes, was calculated by dividing the standard deviation of the difference between test and retest scores (SDdiff) by √2. The SDC, defined as change beyond measurement error, was calculated by multiplying SDdiff by 1.96. Bland-Altman plots were assessed for the presence of systematic errors.

Results

A total of 278 sarcopenic subjects, aged 77.67 ± 7.64 years and 61.5% women, were included. The SEM for the overall SarQoL score ranged from 0.18 to 4.20 points for the individual studies, and was 2.65 points when all subjects were analyzed together. The SDC for the overall score ranged from 0.49 to 11.65 points for the individual studies, and was 7.35 points for all subjects. The Bland-Altman plots revealed no systematic errors in the questionnaire.

Conclusion

This study shows that, for individual subjects, a change in overall quality of life of at least 7.35 points (on a scale from 0 to 100) would have to be observed to confirm that a true change, beyond measurement error, has occurred. It also demonstrated that the SarQoL questionnaire is a precise instrument, with the observed scores within less than 3 points of the theoretical “true score”.

The Effects of Group and Home-Based Exercise Programs in Elderly with Sarcopenia: A Randomized Controlled Trial

Physical exercise is effective for sarcopenic elderly but evidence for the most effective mode of exercise is conflicting. The objective of this study was to investigate the effects of a three-month group-based versus home-based exercise program on muscular, functional/physical performance and quality of life (QoL) across elderly with sarcopenia. 54 elderly (47 women, 7 men aged 72.87 ± 7 years) were randomly assigned to one of three interventions: supervised group (n = 18), individualized home-based exercise (n = 18) and control group (n = 18). Body composition was determined by bioelectrical impedance analysis, calf measurement with inelastic tape and strength assessments (grip and knee muscle strength) via hand-held and isokinetic dynamometers. Functional assessments included four-meter (4 m), Τimed-Up and Go (TUG) and chair stand (CS) tests. QoL was assessed with Greek Sarcopenia Quality of Life (SarQol_GR) questionnaire. Outcomes were assessed at baseline, immediately post-intervention (week 12), and 3 months post-intervention (week 24). Significant group x time interactions (p < 0.001) were observed in QoL, calf circumference, TUG, CS, and 4 m tests, grip and knee muscle strength. Group-based compared to home-based exercise yielded significant improvements (p < 0.05) in muscle mass index, CS and 4 m tests, calf circumference, muscle strength at 12 weeks. Most improvements at 24 weeks were reported with grouped exercise. No changes were found across the control group. Results suggest group-based exercise was more effective than home-based for improving functional performance.

Cross cultural adaptation of the Greek sarcopenia quality of life (SarQoL) questionnaire

Purpose: To translate and validate into the Greek language and setting the Sarcopenia Quality of Life (SarQoL^®) questionnaire.Methods: A convenience sample of 176 Greek elderly people (136 females, 40 males; aged 71.19 ± 7.95 years) was recruited, 50 of which (36 females, 14 males) were diagnosed sarcopenic. Questionnaire was back-translated and culturally adapted into Greek according to international guidelines. To validate the Greek SarQoL^®, we assessed its validity (discriminative power, construct validity), reliability (internal consistency, test-retest reliability) and floor/ceiling effects. Participants were divided into sarcopenic and non-sarcopenic. Sarcopenic subjects apart from the Greek SarQoL (SarQoL^GR) filled out the Greek versions of two generic questionnaires; Short Form-36 and EuroQoL 5-dimension.Results: The Greek SarQoL questionnaire was translated without major difficulties. SarQoL^GR mean scores were 52.12 ± 11.04 (range: 24.74-71.81) for sarcopenic subjects and 68.23 ± 14.1 (range: 24.83-94.81) for non-sarcopenic ones. Results indicated good discriminative power across sarcopenic and non-sarcopenic subjects (p = 0.01), high internal consistency (Cronbach's alpha of 0.96) and excellent test-retest reliability (ICC = 0.96, 95% CI = 0.95-0.97). Neither a floor nor a ceiling effect was observed.Conclusions: The Greek SarQoL was found to be a reliable and valid measure of quality of life for sarcopenic patients. It is therefore, available for use in future clinical research and practice.Implications for rehabilitationThe Greek version of the SarQoL^® questionnaire is a valid and reliable outcome measure for assessing patients with sarcopenia.The Greek SarQoL is recommended to be use in clinical settings and research.The Greek SarQoL^® questionnaire is available online www.sarqol.org.

Restless legs syndrome/Willis-Ekbom disease prevalence in beta thalassemia patients

PURPOSE

Both beta thalassemia and restless legs syndrome (RLS) patients share some common pathophysiological characteristics related to iron handling. In the present study, the aim was to explore the prevalence of RLS as well as to explore potential association between the syndrome and various quality of life-related parameters in a sample of beta thalassemia patients.

METHODS

One hundred fourteen (age 40 ± 11 yr, 59 M/55F) beta thalassemia patients participated in this cross-sectional descriptive study. Patients were screened for RLS based on the international RLS study group diagnostic criteria as well as a battery of validated questionnaires.

RESULTS

The prevalence of RLS in this sample of beta thalassemia patients was zero. The quality of life score was low (78 ± 18). Iron levels were within normal range (191 ± 66 mcg/dL) while ferritin levels were high as expected (1836 ± 225 ng/dL).

CONCLUSIONS

Our sample of patients comes from central Greece where the prevalence of RLS in the general population is 4% while in renal failure patients is 27%. To our surprise, there was no presence of RLS among this sample of beta thalassemia patients. The adequate levels of iron and ferritin often seen in these patients could be the reason of the absence of RLS symptoms.

Debates on youth participation: from citizens in preparation to active social agents

Abstract This article presents current debates regarding the presence of young people in the public domain. There is a wealth of discussion and perplexity regarding how young people choose to get active in the public domain that originates from the distinct use of the term political in academic and policy debates. This article will proceed in the following way: it will summarise the main tenets of the Decline discourse, it will present how the Personalisation discourse draw our attention to alternative ways of involvement, it will discuss how Context focused discourses highlight how participatory decision making relates to the ways young people conceptualise their daily lived experience, and concludes arguing that youth participation can be better understood when it is contextualised within everyday lived experience.

The effect of short-term calcitonin administration on biochemical bone markers in patients with acute immobilization following hip fracture

The effect of salmon calcitonin on changes in mineral metabolism was studied in 40 elderly patients with recent hip fracture. All patients underwent surgery (internal fixation) 1 week after admission and were randomly divided into two equal groups: group A, which received no treatment, and group B, which received 100 IU/day salmon calcitonin intramuscularly for 2 weeks starting on admission. Blood and 24-h urine parameters of mineral metabolism were measured on admission and at the end of weeks 1 and 2. No intra- or intergroup changes in serum calcium, phosphorus or alkaline phosphatase were observed. At the end of week 2 biochemical markers of bone resorption (urinary calcium and hydroxyproline) had significantly increased in group A and significantly decreased in group B, indicating a reduction in bone resorption in group B. Urinary phosphorus had also increased in group B, possibly due to the phosphaturic effect of calcitonin. It is concluded that immobilization resulting from a hip fracture, and possibly surgery itself, causes significant changes in biochemical markers of bone resorption. Calcitonin successfully reverses these changes and may also be effective in preventing subsequent bone loss, particularly in patients who cannot be remobilized immediately.

A 12- to 18-year radiographic follow-up study of Charnley low-friction arthroplasty. The role of the center of rotation

In a 12- to 18-year radiographic follow-up study of 95 Charnley low-friction total hip arthroplasties (THA), there was a statistically significant correlation between location of the center of rotation of the total hip prosthesis (notably the element horizontal distance cup to tear-drop) and long-term, unfavorable, radiographic signs, such as acetabular and stem demarcation, cup wear, cup migration, subsidence of the stem, and calcar resorption. Small differences, as little as 2 mm, in the placement of the cup in relation to anatomic landmarks were responsible for these findings. A logistical regression analysis showed that the horizontal distance cup to teardrop was the most significant parameter influencing long-term unfavorable radiographic signs of a THA in comparison with the parameters of age, gender, diagnosis, and body-weight.

Analgesic effect of salmon calcitonin in osteoporotic vertebral fractures: a double-blind placebo-controlled clinical study

Back pain due to vertebral collapse is the main symptom of postmenopausal osteoporosis. The clinical picture in these crush fractures varies, depending on the type and the location of fracture, but in general, a new vertebral crush fracture gives rise to severe pain that immobilizes the patient and necessitates bedrest. In this double-blind controlled clinical trial, 56 patients who had recently (within the last 3 days) suffered an osteoporotic vertebral fracture were hospitalized for a period of 14 days. Salmon calcitonin (100 IU) or placebo injections were given daily. Pain was rated daily on a 10-point scale by the same observers. Blood and urinary parameters were also evaluated. The results showed a significant (P less than 0.001) difference in pain intensity between the calcitonin group and the placebo group. This beneficial effect was generally apparent from the second day of treatment onward, and over the following 2 weeks, the patients were able to sit and stand, and gradually started to walk again. A significant decrease in urinary hydroxyproline and urinary calcium was also noted in the calcitonin group. It is concluded that calcitonin exerts a beneficial effect on back pain following a vertebral crush fracture.

The natural history of the osteoporotic vertebral fracture

The clinical picture of the osteoporotic fractures of the spine presents an heterogeneity in their intensity and duration. In 210 cases of osteoporotics with acute pain and radiological evidence of spinal fracture we separate their clinical picture in two groups. In Type I (121 cases) pain is acute and severe, improving gradually; the vertebral wedging is obvious from the beginning and remain unchanged. The duration of this event exceeds 4-8 weeks. In Type II (89 cases) pain is less and of shorter duration, but after 6-16 weeks a new attack of acute pain presents. This picture can be repeated for 6-18 months. Radiologically the fracture is not clear during the first attack but wedging gradually developed during the next months. Bone density of the lumbar spine (DPA) was measured in all cases. Type I had a significantly lower BMC than Type II. We suggest that patients with unclear vertebral fractures, minor symptoms and relatively high bone mass must classified in Group II and deterioration can occur during the next months. Long term treatment and additional orthopaedic prevention is needed. In Group I a short term calcitonin treatment helps early relief and mobilization.