Additional effect of neuromuscular electrical stimulation in a conservative intervention on morphology and strength of abductor hallucis muscle and correction of hallux valgus deformity: a randomized controlled trial.

BACKGROUND: In hallux valgus, morphological changes and functional weakness of intrinsic foot muscles occur, especially in the abductor hallucis muscle. OBJECTIVES: This study aimed to investigate how a conservative treatment with the addition of neuromuscular electrical stimulation affects the volume and strength of the muscle, the correction of deformity, passive range of motion, pain, and disability. METHODS: Twenty-eight female participants (48 feet) were randomly assigned to two groups. The interventions included orthoses and exercise (Ortho) in both groups. One group received additional neuromuscular electrical stimulation of abductor hallucis muscle to activate it. Each group received the treatments for one month and was assessed two times, at baseline before starting and after one month of treatment. Mixed within-between ANOVA, analysis of covariance, and nonparametric tests were used for data analysis. RESULTS: The muscle volume, abduction strength, goniometric angle, and passive hallux dorsi/plantar flexion showed significant changes in both groups (p < .001). Subscales of the foot and ankle ability questionnaire, significantly changed (p ≤ .05). Pain decreased significantly in the two groups (p < .001 and p = .02). Intermetatarsal angle did not significantly differ between the two groups (p = .86, partial eta effect size = 0.001). But, the hallux valgus angle mean (on MRI) in the Ortho group was less than that of the orthoNMES group (p = .007, partial eta effect size = 0.15). CONCLUSION: Both groups showed nearly identical treatment effects in the primary volume and hallux valgus correction outcome measures. In this study, adding neuromuscular electrical stimulation did not have an additional effect compared to conservative in the treatment of hallux valgus. TRIAL REGISTRATION NUMBER: The RCT Code is IRCT20200915048725N1.

Does brain entrainment using binaural auditory beats affect pain perception in acute and chronic pain?: a systematic review.

BACKGROUND: Pain is a major clinical problem across all ages with serious social and economic consequences and a great negative impact on quality of life. Brain entrainment using binaural beats is a non-pharmaceutical intervention that is claimed to have analgesic effects in acute and chronic pain. We aimed to systematically review the available randomized clinical trials on the efficacy of binaural auditory beats in reducing adults' pain perception in acute and chronic pain. A systematic search in electronic databases including Medline (via PubMed), Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was performed. The search was completed through Google Scholar and a manual search of the reference lists of all included studies. Randomized clinical trials with full text available in English that investigated the effect of binaural auditory beats on pain perception in acute and chronic pain in adults were included. The risk of bias was assessed by the revised Cochrane risk-of-bias (RoB 2) tool. Furthermore, The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the quality of the evidence. Sixteen studies (three on chronic pain and thirteen on acute pain perception) fulfilled the eligibility criteria. Because of substantial heterogeneity of the studies, a meta-analysis was inappropriate and this review focused on the narrative interpretation of the results. The risk of bias in most studies was high and the quality of evidence was low to very low. Although the effects of binaural beats on pain perception seem to be influenced by the etiology of pain or medical procedures, our review identifies alpha or a combination of tones in the range of delta to alpha as a potential non-pharmacological intervention in reducing acute pain. However, drawing a conclusion regarding the efficacy of binaural beats for chronic pain requires more high-quality studies. REGISTRATION: The protocol of this review was registered in PROSPERO (No. CRD42023425091).

Effect of Knee Orthosis and Kinesio Taping on Clinical and Neuromuscular Outcomes in Patients with Knee Osteoarthritis: A Randomized Clinical Trial.

Objectives: Impaired proprioception and muscle weakness may not only be a consequence of knee osteoarthritis (OA) but also part of its pathogenesis. Thus, the enhancement of quadriceps strength and proprioceptive accuracy can play a pivotal role in the management of knee OA. This study aimed to investigate the effects of Kinesio tape and flexible knee orthosis in terms of clinical and neuromuscular outcomes in patients with knee OA. Methods: This clinical trial was conducted on 56 patients with knee OA, randomly allocated to two groups: knee orthosis or Kinesio tape. The knee orthosis group wore a neoprene knee support for 4 weeks. For participants in the Kinesio tape group, tape was applied once a week, for 4 weeks. The primary outcomes were pain intensity and physical function evaluated through the visual analog scale and the Western Ontario and McMaster OA index. The secondary outcomes were concentric and isometric quadriceps strength, Joint Position Sense (JPS), Threshold to Detect Passive Motion (TTDPM), and force sense (FS), all measured by isokinetic dynamometry. Results: All outcome measures were significantly improved in the orthosis group. The Kinesio tape group also demonstrated significant changes in all outcome measures except three proprioception components namely JPS (70° target), FS, and TTDPM. At the end of the fourth week, there were no significant between-group differences for measured parameters. Conclusion: Wearing a flexible knee orthosis and/or Kinesio tape for 4 weeks significantly improved knee pain, physical function, and quadriceps strength. Although knee orthosis showed significant beneficial effects on various components of proprioception, there were no significant differences between the two groups at the end of the 4-week intervention.

Effect of external lumbar supports on joint position sense, postural control, and postural adjustment: a systematic review.

PURPOSE: To review the effects of external lumbar supports on various aspects of sensorimotor function including joint position sense (JPS), postural control, anticipatory postural adjustments (APAs), and compensatory postural adjustments (CPAs). METHODS: A systematic literature search was performed in PubMed, EMBASE, Scopus, Ovid, Cochrane library, and Web of Science. Two reviewers selected studies which assessed the effect of lumbosacral orthosis or kinesio-tape on JPS, postural control or APAs/CPAs in subjects with and without low back pain (LBP). The methodological quality of included studies was assessed using a modified version of Downs and Black's checklist. RESULTS: Findings demonstrated moderate effects of lumbosacral orthosis on specific aspects of sensorimotor control including JPS and to a lesser extent standing stability. These domains were not or minimally affected by application of kinesio-tape. Both orthosis and kinesio-tape had negligible effects on APAs and CPAs. CONCLUSIONS: The positive effects of lumbar orthosis on JPS or postural control were mostly observed in conditions where sources of proprioceptive feedback are impaired (such as LBP) or absent (standing with eyes closed on an unstable surface). However, evidence does not prove significant positive effects for the application of kinesio-tape to improve sensorimotor control.IMPLICATIONS FOR REHABILITATIONWearing lumbar orthosis leads to an improvement in joint position sense.Postural stability seems to be affected to some extent by utilizing lumbar orthosis.Clinicians can administer orthosis to improve sensorimotor adaptation, especially in conditions with poor proprioception.Kinesio-tape had negligible effects on all domains of sensorimotor control.Improvement of sensorimotor function as a result of application of kinesio-tape is questionable.

Effect of a semi-rigid backpack type thoracolumbar orthosis on thoracic kyphosis angle and muscle performance in older adults with hyperkyphosis: a randomized controlled trial.

PURPOSE: To investigate the effect of a semi-rigid backpack type thoracolumbar orthosis (TLO) on thoracic kyphosis angle (TKA) and potentially contributing factors of hyperkyphosis, including position sense and back muscle strength and endurance. METHOD: This randomized, controlled trial was conducted on 48 older adults with hyperkyphosis, randomly allocated to an experimental or control group. The experimental group wore a semi-rigid TLO for 3 consecutive months. The control group received no external support or exercise. Thoracic kyphosis angle (TKA), joint position sense, back muscle strength and endurance were evaluated at the baseline and at the end of week 6 and week 12. RESULTS: The two-way (group × time) interactions were significant in terms of TKA (F = 37.88, p ≤ 0.001, ηp2 = 0.45), muscle strength (F = 26.005, p ≤ 0.001, ηp2 = 0.36), muscle endurance measured via load cell (F = 3.417, p = 0.039, ηp2 = 0.06), and endurance holding time of Ito test (F = 3.629, p = 0.045, ηp2 = 0.07). A further analysis using one-way repeated measures of ANOVA showed that TKA, muscle strength and endurance were significantly improved in the experimental group. Also, two-way interactions were significant for absolute error and variable error of trunk neutral repositioning test from a trunk flexed and/or extended position for global components and horizontal components trunk repositioning test. CONCLUSION: Wearing a semi-rigid backpack type TLO even from an unknown brand for short periods during the day (e.g., 2-4 h) over 3 months not only modifies kyphotic posture but also can enhance back muscle performance in older adults with hyperkyphosis. IMPLICATIONS FOR REHABILITATIONPrescription of a semi-rigid backpack type thoracolumbar orthosis for older adults has no adverse effects such as muscle weakness if it is applied for short periods during the day.A semi-rigid backpack thoracolumbar orthosis can prevent position sense degradation in older adults with hyperkyphosis.A semi-rigid backpack type thoracolumbar orthosis may counteract trunk flexion and kyphotic posture by applying the biomechanical principles of the three-point pressure system.Improvement in spinal alignment resulting from wearing thoracolumbar orthosis should not occur in exchange for muscle deconditioning.

Efficacy of a multiple-indication antiviral herbal drug (Saliravira®) for COVID-19 outpatients: A pre-clinical and randomized clinical trial study.

BACKGROUND: The scientific researches on COVID-19 pandemic topics are headed to an explosion of scientific literature. Despite these global efforts, the efficient treatment of patients is an in-progress challenge. Based on a meta-study of published shreds of evidence about compounds and their botanic sources in the last six decades, a novel multiple-indication herbal compound (Saliravira®) has been developed. Based on the antiviral, anti-inflammatory, and immune-enhancing properties of its ingredients, we hypothesized that Saliravira® has the potential to act as an antiviral agent, accelerate treatment, and reduce undesirable effects of COVID-19. METHODS: In this randomized, controlled, open-label clinical trial, COVID-19 outpatients were included by RT-PCR test or diagnosis of physicians according to the symptoms. Participants were randomly divided into intervention and control groups to receive Saliravira® package plus routine treatments of COVID-19 or routine treatments of COVID-19 alone, respectively. Saliravira® package includes tablets, nasal-sinuses spray, oral-pharynx spray, and inhaler drops. The treatment was for 10 days and followed up till 23 days after admission. RESULTS: On the 8th day, the "mean reduction rates" of viral load of the patients in the intervention group was 50% lower compared to the control group with a p-value < 0.05. The improvement of 10 out of 14 COVID-19 symptoms in the intervention group was significantly accelerated. The mean treatment duration of patients in the intervention group was 4.9 days less than the control group. In addition, no patients in the intervention group were hospitalized compared to 28% of the control group needed to be hospitalized.

Impairments in trunk muscles performance and proprioception in older adults with hyperkyphosis.

BACKGROUND AND OBJECTIVES: Thoracic hyperkyphosis is one of the most common postural deformities in the geriatric population. This study investigated whether trunk proprioception, muscle strength, and endurance differ between older adults with hyperkyphosis and the age-matched control group. This study also aimed to explore the association of kyphotic posture with muscle performance, position sense, and force sense. METHODS: Ninety-seven elderly volunteers (61 with hyperkyphosis and 36 normal controls) participated in this cross-sectional study. The kyphosis degree, trunk position sense, force sense, back muscle strength, and endurance were assessed in all participants. RESULTS: The results showed lower back extensor strength and endurance, also higher force and position sense error in the hyperkyphotic group than the control group. In addition, the findings revealed that back extensor strength and endurance, as well as trunk position sense, were associated with kyphotic posture in older adults. DISCUSSION AND IMPLICATIONS: This study suggests that back extensor strength and endurance and trunk position sense and force sense are potentially modifiable impairments associated with thoracic kyphosis in older adults with hyperkyphosis. It seems monitoring these potentially contributing factors would be helpful in the assessment and treatment of hyperkyphotic older individuals.

Translation, Cultural Adaptation, and Psychometric Evaluation of the Manchester Foot Pain and Disability Index in Persian-Speaking Iranians With Foot Disorders.

Foot pain has a significantly detrimental effect on mobility, function, and health status. Researchers have developed a number of measurement tools to assess foot health and its impact on quality of life. This study was conducted to translate the original English Manchester Foot Pain and Disability Index (MFPDI) into Persian and to examine the psychometric properties of the Persian version. A total of 206 patients with a range of foot disorders filled out the Persian version of the MFPDI and the Short-Form 36 Health Survey. The Persian version of the MFPDI was re-completed by the participants at an interval of 5 to 7 days. The analyses performed included internal consistency, test-retest reliability, construct validity, and floor and ceiling effect analysis. The Persian MFPDI had a good internal consistency (Cronbach's α ≥ 0.70) and test-retest reliability (intraclass correlation coefficient = 0.84). The construct validity of the Persian MFPDI was demonstrated to be acceptable as a result of its significantly strong negative correlations with the Short-Form 36 Health Survey. The results of this study showed that the Persian version of the MFPDI is a valid and reliable measure to assess foot-related disability.

Validity and test-retest reliability of photogrammetry in adolescents with hyperkyphosis.

BACKGROUND: A variety of noninvasive instruments have been introduced in the literature to assess thoracic curvature, although the psychometric properties of many of these instruments have not been satisfactory. Photogrammetry is a safe, accessible, and reliable technique. However, its validity in adolescents with hyperkyphosis has not yet been investigated. OBJECTIVES: To investigate the validity and test-retest reliability of photogrammetry in the measurement of thoracic kyphosis among adolescents with hyperkyphosis. METHODS: Fifty adolescents with hyperkyphosis participated in this study. The kyphosis angle was measured using radiography and photogrammetry. A two-way random model of the intraclass correlation coefficient (ICC2,3) was used to estimate relative reliability. Absolute reliability was assessed by calculating the standard error of the measurements (SEM) and the minimal detectable change (MDC). Pearson's correlation coefficient was calculated to evaluate the validity of the photogrammetry technique. Bland-Altman plots were plotted to determine the agreement between the angles measured by radiography and photogrammetry. RESULTS: There was a strong correlation between the values obtained from the photogrammetry technique and those from the radiography method (r = 0.94). The 95% limits of agreement indicated that the photogrammetric measurements of thoracic kyphosis angle might range from 2.4 degrees greater to 10.2 degrees lower than the Cobb radiographic angle. Photogrammetric measurements of thoracic kyphosis showed excellent test-retest reliability (ICC = 0.97; SEM = 1.67; MDC = 4.62). CONCLUSION: High reliability of photogrammetry technique and its strong correlation with radiographic Cobb angle support the application of this technique for the measurement of thoracic kyphosis in clinical practice.

Test-retest reliability of a load cell setup, Ito, and timed loaded standing tests for measuring muscle strength and endurance in older adults with and without hyperkyphosis.

BACKGROUND: The association of back muscle weakness with greater thoracic kyphosis has been widely documented. Reliable and easy-to-use techniques are needed to monitor changes in muscle function over time and assess the effectiveness of therapeutic interventions. Therefore, the present study aimed to evaluate the test-retest reliability of a designed load-cell setup and two clinical tests, namely Ito and Timed loaded standing (TLS) tests for measuring back muscle function (i.e., strength and endurance) in older adults with and without hyperkyphosis. METHOD: Fifty-three older people (28 with thoracic hyperkyphosis and 25 normal age-matched controls) completed the present test-retest reliability study. A two-way random model of the Intraclass Correlation Coefficient (ICC2,3) was used to estimate relative reliability. Absolute reliability was assessed by calculating Standard Error of the Measurements (SEM) and Minimal Detectable Change (MDC). RESULTS: The findings showed excellent test-retest reliability in all performed tests for this population (ICC = 0.95-0.99). In addition, the MDC values for measuring endurance time via load cell, Ito, and TLS tests in the hyperkyphosis group, were 16.5, 28.2, and 35.1 s, respectively. These values ranged from 36 to 39 s for the control group. CONCLUSION: The present study suggests high test-retest reliability of the designed load-cell setup, Ito, and TLS for assessing back extensor muscle strength and endurance in older adults with and or without hyperkyphosis.

The relationship between common foot problems with falls and quality of life in older people.

OBJECTIVES: To evaluate the relationship between a number of prevalent foot problems in older people and their history of falls and quality of life. To examine the relationship between timed up and go (TUG) test time and ankle muscles' strength. METHOD: In this cross-sectional observational study on a convenient sample of 350 people 65 years and older, direct logistic and hierarchical regressions were used to assess the relation of self-reported falls and quality of life with hallux valgus, oedema, sensory loss and callus. The correlation coefficients were calculated to measure the relationship between TUG test time and ankle muscle strength. RESULTS: Moderate negative correlations were measured between ankle muscles' strength and TUG time (rDorsiflexors  = -0.42 p = 0.000, rPlantar flexors  = -0.45 p = 0.000). The odds ratio extracted from logistic regression for foot pain was 3.05 (p = 0.000, 95% CI: 1.8-5.1). The results of the hierarchical regression showed that oedema had the highest contribution to depicting the quality of life (standardised B = -0.22, p = 0.001), followed by foot pain (beta = -0.178, p = 0.004) and plantar sensory loss (beta = -0.143, p = 0.019). CONCLUSION: The results of this study highlight the importance of foot problems in older people. Foot pain showed relationship with self-reported fall experience. Oedema and foot pain had negative impact on quality of life. Ankle muscles' strength may affect balance in older people. However, because of the small effects sizes and wide confidence intervals, the results should be interpreted cautiously.

The translation, cultural adaptation and psychometric evaluation of the Manchester Foot Pain and Disability Index in Persian-speaking Iranians with foot disorder.

BACKGROUND: Foot pain has a significantly detrimental effect on mobility, function and health status. Researchers have developed a number of measurement tools to assess foot health and its impact on the quality of life. This study was conducted to translate the original English Manchester Foot Pain and Disability Index (MFPDI) into Persian and to examine the psychometric properties of the Persian version. METHODS: A total of 206 patients with a range of foot disorders filled out the Persian version of the MFPDI and the Short-Form 36 Health Survey (SF-36). The Persian version of the MFPDI was re-completed by the participants at an interval of five to seven days. The analyses performed included internal consistency, test-retest reliability, construct validity, and floor and ceiling effect analysis. RESULTS: The Persian MFPDI had a good internal consistency (Cronbach's α≥0.70) and test-retest reliability (ICC=0.84). The construct validity of the Persian MFPDI was demonstrated to be acceptable as a result of its significantly strong negative correlations with the SF-36. CONCLUSION: The results of this study showed that the Persian version of the MFPDI is a valid and reliable measure to assess foot-related disability.

Smartphone Applications as a Suitable Alternative to CROM Device and Inclinometers in Assessing the Cervical Range of Motion in Patients With Nonspecific Neck Pain.

OBJECTIVE: The purpose of this study was to compare the reliabilities of the cervical range-of-motion (CROM) device and a dual digital inclinometer (as accepted clinical tools) and iPhone or Android smartphone applications (clinometer and compass; as new technologies) in measuring cervical range of motion in patients with neck pain. METHODS: Twenty participants (13 women, 7 men; age 19-33 years) with neck pain persisting for at least 4 weeks were enrolled. Neck movements were measured in each participant using 4 noninvasive devices in random order. RESULTS: The CROM device showed excellent intra- and interrater reliabilities in assessing cervical range of motion except in right rotation for which it showed moderate intrarater reliability. The dual digital inclinometer demonstrated moderate to excellent intra- and interrater reliabilities. Cervical range of motion measurements using iPhone applications showed good to excellent intra- and interrater reliabilities, whereas Android applications had poor to excellent intra- and interrater reliabilities. Based on the validity results, all assessment tools differed from the CROM device depending on the direction of movement, although the iPhone applications showed fewer differences than the other 2 devices. CONCLUSION: Generally, the CROM device showed the highest reproducibility, and iPhone applications showed more acceptable intra- and interrater reliabilities than the digital inclinometer and Android applications. The clinometer application of smartphones could be reliable in measuring frontal and sagittal cervical range of motion in patients with neck pain and in a sitting position. However, the compass application of the iPhone showed acceptable results, whereas that of the Android device could not be recommended for clinical use.

The functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus deformity: A systematic review.

BACKGROUND: The intrinsic foot muscles are vital for maintaining normal foot function. This study was conducted to systematically review the literature on the functional capacity and morphological characteristics of the intrinsic foot muscles in subjects with Hallux Valgus (HV) deformity. METHODS: A search was carried out in all available electronic databases, including Pub Med, Scopus, Embase and Web of Science, for identifying any relevant studies published from 1990 to October 2018. RESULTS: Three studies had investigated intrinsic foot muscle size using ultrasound imaging; two had reported electromyography parameters and four had measured the muscle force capacity. The results of the present review suggested that the functional capacity and morphological characteristics of intrinsic foot muscles are different in subjects with HV compared to those without this deformity. CONCLUSION: This review found scientific evidence on muscle performance impairment in the abductor hallucis and flexor hallucis brevis in subjects with HV deformity.

Effect of a Spinomed orthosis on balance performance, spinal alignment, joint position sense and back muscle endurance in elderly people with hyperkyphotic posture: A randomized controlled trial.

BACKGROUND: Hyperkyphosis may cause balance impairment in elderly people. Although the effectiveness of orthoses for improving balance in hyperkyphotic elderly people has received much attention, the mechanisms by which devices affect balance remain unknown. OBJECTIVES: The objective of this study was to evaluate changes in balance performance, thoracic kyphosis angle, craniovertebral angle, back muscle endurance and joint position sense after 3 months of wearing a Spinomed orthosis. The study also included a secondary exploratory analysis to determine whether changes in any of the above-mentioned outcome measures can predict balance performance improvement in elderly people with hyperkyphosis. STUDY DESIGN: Parallel group randomized controlled trial. METHODS: In total, 44 hyperkyphotic elderly people were randomly allocated to an experimental group, who wore a Spinomed orthosis and a control group, who did not. No other treatment or change in physical activity was permitted during the study. A blinded assessor evaluated thoracic kyphosis angle, joint position sense, craniovertebral angle, back muscle endurance, Timed Up and Go Test time and Berg Balance Scale score at baseline and after 5, 9 and 13 weeks. All dependent variables were measured without the orthosis and analyzed separately using a 2 × 4 (time × group) mixed model analysis of variance. Based on the results of correlation analysis, thoracic kyphosis angle, back muscle endurance and joint position sense were selected as independent variables in a stepwise multiple regression model. RESULTS: The two-way (group × time) interactions were significant in terms of Berg Balance Scale (F = 11.6, P ⩽ 0.001, ηp2=0.59), Timed Up and Go Test (F = 3.74, P = 0.013, ηp2=0.46), thoracic kyphosis angle (F = 43.39, P ⩽ 0.001, ηp2=0.96), craniovertebral angle (F = 5.245, P = 0.002, ηp2=0.59) and joint position sense (F = 4.44, P = 0.005, [Formula: see text]). The two-way interaction was not significant in terms of back muscle endurance; however, the main effect of group was significant for this variable (F = 3.85, P = 0.025). Stepwise multiple regression showed that thoracic kyphosis angle and joint position sense were significant determinants of Timed Up and Go Test time (R2 = 0.155, P = 0.037 and R2 = 0.292, P = 0.012, respectively). CONCLUSION: Wearing a Spinomed orthosis for 3 months improved the posture, position sense and muscle performance of hyperkyphotic elderly people. Orthoses may improve balance performance by correcting spinal alignment and increasing proprioceptive information.

The Amount and Temporal Structure of Center of Pressure Fluctuations During Quiet Standing in Patients With Chronic Low Back Pain.

The characteristics of postural sway were assessed in quiet standing under three different postural task conditions in 14 patients with nonspecific chronic low back pain and 12 healthy subjects using linear and nonlinear center of pressure parameters. The linear parameters consisted of area, the mean total velocity, sway amplitude, the SD of velocity, and the phase plane portrait. The nonlinear parameters included the Lyapunov exponent, sample entropy, and the correlation dimension. The results showed that the amount of postural sway was higher in the patients with low back pain compared with the healthy subjects. Assessing the nonlinear parameters of the center of pressure showed a lower sample entropy and a higher correlation dimension in the patients with low back pain compared with the healthy subjects. The results of this study demonstrate the greater regularity and higher dimensionality of the center of pressure fluctuations in patients with nonspecific chronic low back pain, which suggests that these patients adopt different postural control strategies to maintain an upright stance.

Effects of lumbosacral orthosis on dynamical structure of center of pressure fluctuations in patients with non-specific chronic low back pain: A randomized controlled trial.

BACKGROUND: A few clinical trials have examined the effect of treatment interventions on postural control in patients with chronic low back pain, all of which have exclusively evaluated postural stability using traditional linear measures of postural sway. However, postural control improvement cannot be determined by exclusively relying on linear measurements, because these parameters provide no information on underlying motor control mechanisms. OBJECTIVE: This study aimed to compare the effect of using lumbosacral orthoses (LSO) together with routine physical therapy, compared to routine physical therapy alone on postural control, using nonlinear analysis techniques. METHODS: Forty-four patients with low back pain were randomly allocated to the intervention and control groups. Both groups underwent 8 sessions of physical therapy twice weekly for 4 weeks. The intervention group received LSO in addition to routine physical therapy. Before and after the intervention, non-linear dynamical features of center of pressure fluctuations were assessed during quiet standing at 3 difficulty levels of postural tasks, including eyes open while standing on a rigid surface, eyes closed while standing on a rigid surface, and eyes closed while standing on a foam surface. RESULTS: The results of this study showed that a 4-week intervention consisting of LSO and routine physical therapy modalities did not affect the temporal structure of postural sways in patients with low back pain. CONCLUSION: Treatment strategies, such as routine physical therapy modalities or LSO, which exclusively focus on the correction of peripheral mechanics, fail to affect the behavior of the postural control system.

Immediate Effects of Lumbosacral Orthosis on Postural Stability in Patients with Low Back Pain: A Preliminary Study.

BACKGROUND: Lumbosacral orthosis (LSO) is commonly used for the treatment of back pain. The clinical and mechanical effectiveness of this device has been repeatedly investigated in several studies; however, its sensorimotor effectiveness has been rarely considered. Regarding this, the aim of the current study was to investigate the effect of a non-extensible LSO on postural stability (as a construct of sensorimotor function) in patients with nonspecific chronic low back pain (LBP). METHODS: This preliminary study was conducted on 17 patients with nonspecific chronic LBP using a single-group quasi-experimental design. Postural stability was measured while the participants were placed in a quiet standing position, under the combined conditions of base of support (rigid and foam surface), visual input (open eyes and closed eyes), and LSO (with and without orthosis). RESULTS: The findings demonstrated that wearing orthosis during the most challenging postural task (i.e., blindfolded while standing on a foam surface) significantly reduced postural sway parameters related to the position and displacement of the center of pressure (COP; the sway area and sway amplitude in the anteroposterior direction; P<0.001). However, the use of this device had no significant effect on COP velocity. CONCLUSION: As the findings of the present study indicated, the use of a non-extensible LSO decreased the COP displacement; however, it did not affect the COP velocity. Therefore, our data could not utterly support the effectiveness of non-extensible LSO on postural stability as a construct of sensorimotor function. Postural control is an appropriate indicator for assessing the global functioning of the sensorimotor system due to its dependence upon the interaction between the neural and musculoskeletal systems. Consequently, further studies are needed to elucidate the positive effects of LSO on the aspects of sensorimotor function.

Ergonomic Latex Pillows as a Part of a Multimodal Intervention or as an Adjunct to Rehabilitation Programs in Cervical Spondylosis: Are They Useful?: A Randomized Controlled Trial.

OBJECTIVE: This study evaluated the effectiveness of ergonomic latex pillows in terms of clinical and biomechanical (cervical range of motion) outcome measures in patients with cervical spondylosis. DESIGN: This parallel-group randomized controlled trial randomly assigned 42 patients with cervical spondylosis to the experimental and control groups. Both groups received 12 sessions of routine physical therapy for 4 wks. While the experimental group received an ergonomic latex pillow, the control group slept on their own usual pillow during the mentioned 4-wk period. Pain intensity, functional disability, medication use, and cervical range of motion were measured before and after 4 wks of intervention. RESULTS: After 4 wks of intervention, the experimental group showed pain relief, decreased disability, and significantly increased range of motion in all directions. The simultaneous use of an ergonomic latex pillow and physical therapy could more successfully decrease pain intensity compared with routine physical therapy alone. In addition, extension and right lateral flexion variables significantly increased in the experimental group compared with the control group. CONCLUSIONS: The administration of an ergonomic latex pillow can ameliorate treatment outcome in patients with cervical spondylosis.

The Effect of Lumbosacral Orthosis on the Thickness of Deep Trunk Muscles Using Ultrasound Imaging: A Randomized Controlled Trial in Patients With Chronic Low Back Pain.

OBJECTIVE: This study was conducted to evaluate the changes occurring in the thickness of deep trunk muscles, measured using ultrasound imaging, after 4 wks of lumbosacral orthosis use in conjunction with routine physical therapy. DESIGN: This parallel-group, randomized, controlled trial was conducted on 44 patients with nonspecific chronic low back pain, randomly allocated to the experimental and control groups. Both groups received eight sessions of physical therapy twice per week for 4 wks. The experimental group wore nonextensible lumbosacral orthosis, in addition to undergoing routine physical therapy. The thickness of the transversus abdominis, obliquus internus, and lumbar multifidus was measured by ultrasound before and after the 4-wk intervention. RESULTS: The deep trunk muscles differed in thickness in various test positions. Four weeks of intervention with lumbosacral orthosis and routine physical therapy, however, did not change the thickness of the obliquus internus, transversus abdominis, and lumbar multifidus. CONCLUSIONS: Wearing lumbosacral orthosis for an average of 7.21 hrs/d for 4 wks in conjunction with routine physical therapy did not affect the thickness of obliquus internus, transversus abdominis, and lumbar multifidus.