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Abstract Introduction: Adolescent idiopathic scoliosis (AIS) is the most common and severe spinal deformity, which affects children and adolescents in the stage of neuromotor development and skeletal maturity of the sagittal curvatures of the spine. The literature presents several radiation-free instruments to assess and monitor the progression of scoliotic curvature angles in the AIS. However, the reliability and validity of the inclinometer at different stages of growth in relation to X-ray parameters has not been understood to date. Objective: To evaluate the reliability of the inclinometer and its validity with the X-ray exam on the sagittal parameters of the spine in the early and late growth stages of adolescents with AIS. Methods: A cross-sectional study was conducted with 39 adolescents with AIS who were divided into two groups: the initial growth phase (10-13 years) and the late growth phase (14-18 years). The evaluated sagittal parameters of the spine were the angle of the thoracic kyphosis and the angle of the lumbar lordosis, both measured by the X-ray image examination and the inclinometer. Results: The inclinometer showed excellent inter- and intra-examiner reliability for the different growth phases, early and late, with a strong association with the X-ray (gold standard; r = 0.84; p = 0.308 and r = 0.75; p = 0.517). The angle of lumbar lordosis was different between the inclinometer and X-ray instruments in the early and late stages of growth (p < 0.001), with moderate reliability and a less significant correlation with the gold standard of radiography (r = 0.38; p = 0.001 and r = 0.49; p = 0.024). Conclusion: The inclinometer showed excellent reliability and validity for the sagittal parameter of thoracic kyphosis in the early and late stages of growth. The angle of lumbar lordosis measured by inclinometer proved to be of moderate reliability and weak validity when considering the phases of skeletal growth, showing it to be an inefficient instrument for monitoring the lumbar scoliotic curvature for AIS.
Resumen Introducción: La escoliosis idiopática del adolescente (EIA) es la deformidad espinal más común y severa, que afecta a niños y adolescentes en la etapa de desarrollo neuromotor y madurez esquelética de las curvaturas sagitales de la columna. La literatura presenta varios instrumentos libres de radiación para evaluar y monitorear la progresión de los ángulos de curvatura escolióticos en el AIS. Sin embargo, hasta la fecha no se ha entendido la fiabilidad y validez del inclinómetro en diferentes etapas de crecimiento en relación con los parámetros de rayos X. Objectivo: Evaluar la confiabilidad del inclinómetro y su validez con el examen de rayos X sobre los parámetros sagitales de la columna vertebral en las etapas de crecimiento temprano y tardío de adolescentes con EIA. Materiales y métodos: Se realizó un estudio transversal con 39 adolescentes con EIA que se dividieron en dos grupos: la fase de crecimiento inicial (10-13 años) y la fase de crecimiento tardío (14-18 años). Los parámetros sagitales de la columna evaluados fueron el ángulo de la cifosis torácica y el ángulo de la lordosis lumbar, ambos medidos por el examen de imagen de rayos X y el inclinómetro. Resultados: El inclinómetro mostró una excelente confiabilidad inter e intraexaminador para las diferentes fases de crecimiento, temprana y tardía, con una fuerte asociación con la radiografía (estándar de oro; r = 0.84; p = 0.308 y r = 0.75; p = 0,517). El ángulo de lordosis lumbar fue diferente entre el inclinómetro y los instrumentos de rayos X en las etapas tempranas y tardías del crecimiento (p < 0,001), con confiabilidad moderada y una correlación menos significativa con el estándar de oro de la radiografía (r = 0,38; p = 0,001 y r = 0,49; p = 0,024). Conclusión: El inclinómetro mostró excelente confiabilidad y validez para el parámetro sagital de cifosis torácica en etapas tempranas y tardías de crecimiento. El ángulo de lordosis lumbar medido por inclinómetro demostró ser de confiabilidad moderada y validez débil al considerar las fases de crecimiento esquelético, mostrándose como un instrumento ineficiente para monitorear la curvatura escoliótica lumbar para EIA.
Subject(s)
Humans , Adolescent , Adult , Scoliosis/diagnosis , X-Rays , Growth and DevelopmentABSTRACT
Background: Mechanical neck pain is most prevalent in middle age and a common condition affecting 22 % to 70% of the general population. While the exact aetiology of the pain is unknown, most of the mechanical pain is due to mechanical factors such as sprains and strains of the neck muscles or ligaments. Methods: 60 subjects (male 33, female 27) with mechanical neck pain who fulfilled the inclusion criteria were chosen. After baseline evaluation of history, NPRS, cervical range of motion and Deep Cervical Flexor Endurance (DCF), the subjects were allocated into three groups which received DCF training by modifying the use of pressure biofeedback. Group 1 received DCF Training with Visual Pressure Biofeedback 10 repetition for three sets. Group 2 received DCF training without Visual Pressure Biofeedback 10 repetition three sets. And Group 3 received DCF training with Pressure Biofeedback (without visual input) 3 set of 10 repetitions. After 15 days of intervention, post-intervention measures of the variables were obtained. Results: Data were analyzed using SPSS 1 version. Between-group analyses showed that subjects in Group 1 have a statistically and clinically significant improvement (p-value< .005), pain (NPRS), cervical ROM, DCF endurance and Neck Disability Index when compared to the Group 2 and 3. The pre and post values for all the three groups within the group analysis showed a statistical and clinically significant difference. Conclusion: Deep Cervical Flexor Training with Visual Pressure Biofeedback provides better clinical improvement in terms of pain reduction, cervical flexion and extension ROM, DCF endurance, and Neck Disability Index score.
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Aims: The precise changes in postures of each part of the spine of primigravid women are still ambiguous. This study aimed to find out the spinal curvature and pelvic tilt changes during the first pregnancy. Study Design: Observational longitudinal study (Cohort study). Place and Duration of Study: The study was conducted at a hospital clinic in Iran, between April 2014 and December 2014. Methodology: Thirty primigravid women at the first, second and third trimesters of pregnancy were recruited in this cohort study and their lumbar and thoracic curves changes and pelvic inclination angles were studied and compared with 18 age-BMI matched non-pregnant women. The curves were measured by use of a flexible ruler and the pelvic inclination angle was measured by a pelvic inclinometer device. Before starting the main study, the reliability and repeatability of the measuring tools were confirmed in this study (ICC>0.87). A one-way ANOVA and independent t-test were used for statistical analysis. Results: Marked increased curvature and inclination angles were revealed as pregnancy advanced (P<0.05). The lumbar lordosis significantly increased when the first trimester was compared with the second and third ones. The thoracic curvature showed significantly increased curvature between the first and third and between the second and third trimesters. None of the lumbar or thoracic curve showed significantly difference between the control group and pregnant women during the first trimester of pregnancy. Although ten weeks pregnancy increased lumbar lordosis and thoracic kyphosis (4.2%, 8%, respectively), but it was not significant when compared with no pregnant women. The pelvic inclination angle showed to be more sensitive than spinal curvatures as it showed significant increase within all trimesters and when compared to the control group. Interestingly, it increased nearly 2.5 times more at the end of pregnancy (236%). Conclusion: The present study showed a significant increase in most variables that became higher as the months of pregnancy increased. The results might help clinicians for prescribing suitable exercises or spinal orthoses during pregnancy. More research is recommended in this area in women intending to get pregnant.
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Purpose: To validate a locally fabricated phantom of Imatrixx-2D Array by comparing its results with ArcCheck phantom and comparing portal dosimetry measurements with the two phantom studies. Materials and Methods: Electronic Portal Imaging Devices and Epiqa software were used for portal dosimetry. An Imatrixx-2D array with a locally fabricated phantom and ArcCheck cylindrical phantom were used for phantom studies. Eclipse-TPS with RapidArc treatment planning and portal dose prediction software was used for planar dose calculations. Three verification plans were created for each of the 15 patient plans of various sites, making a total of 45 plans to be delivered on 3 QA systems as above. Fifteen plans each with 2 arcs were delivered on the EPIDs of the Linacs, on Imatrixx-2D array phantom and on ArcCheck cylindrical phantom respectively. The planar dose matrices were analysed using global Gamma Index criteria of 3mm DTA and 3% dose difference. Results: The maximum deviations of percentage in dose points, in which γ>1, are 1.94, 1.89 and 1.5 in Imatrixx phantom, ArcCheck phantom and Portal dosimetry, respectively. Similarly, the mean deviations and SD values are less in portal dosimetry than that of phantom studies. The smaller deviations in portal dosimetry are attributed to closely embedded chambers in the EPID compared to the distance between the detectors placed in the phantom measurements. Conclusion: After carrying out the comparison of results, the locally fabricated phantom has been validated and accepted for the dosimetric studies. The conclusion is that all the three dosimetric QA systems are suitable for the patient-specific QA of RapidArc treatments.
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Thirty-one outpatients with acute low back pain were all educated about activities of daily living. They also received spinal manipulation and SSP (TENS), and took NSAID for a certain period of time. Half of them were additionally exposed an electric field using HEAL THTRON, an electric field therapeutic decice, in order to analyze its efficacy.<br>The patients were randomly divided (non-blind test) into two groups. Those who received ordinary treatment were called the Non-HEALTHTRON group (NH-group); those who received HEALTHTRON treatment in addition to ordinary treatment were called the HEALTHTRON Treatment group (H-group). During the 15-day study period, the patients were subjected to a total of four electric field exposures using HEALTHTRON. Efficacy of the treatment was measured as an objective evaluation by measuring range of motion (ROM) using an inclinometer, and Peak torque and Total work using a dynamometer. A subjective evaluation was performed using the Oswestry Low Back Pain Disability Questionnaire, ADL pain questionnaire, Visual analog scale for Patient global assessment, VAS (Patient) and Visual analog scale for Physician global assessment, VAS (Physician). After ordinary treatment, significant improvement was found in all 31 patients with acute low back pain. The VAS (Physician), ADL pain questionnaire and ROM were more significantly improved in the H-group than in the NH-group.
ABSTRACT
Measurement of spinal range of motion(ROM) can be effectively used in guiding the direction of therapy, determining the patient's response to rehabilitation treatment and functional assessment. However for a method of measurement to be commonly used in clinical and research settings, it must be easy to perform, rapid and highly reliable. The purpose of this study was to determine the possibility of clinical application of 2-dimensional motion analysis system to measure spinal ROM in patients with low back pain(LBP). Subjects included 10 healthy males and 10 patients with LBP. Using Electronic Digital Inclinometer (EDI 320) and 2-dimensional motion analysis system, thoracic, lumbar and pelvic ROMs were measured for trunkal flexion, extension, lateral flexion and rotation. Also proportions of decreased ROMs in LBP patients relative to healthy subjects and movement patterns of each spinal segment according to time sequence were investigated. LBP patients compared to normal subjects showed significantly low spinal ROM(P<0.05) except thoracic and pelvic ROM for extension. When looking at the change of each spinal ROM in respect to time with motion analysis system, normal subjects showed synchronized and sigmoid motion curve time from the initiation to the end of motion in all areas of spine during 4 motions. LBP patients took longer time from the initiation to the end of each motion, and showed smaller initial change and fluctuation in spinal ROM during each motion compared to normal subjects. The results of this preliminary study suggest that 2-dimensional motion analysis system can be effectively used for measuring spinal ROM in patients with LBP.