Cross-cultural adaptation, reliability and validity of the Greek version of the Spinal Appearance Questionnaire (SAQ) in patients with adolescent idiopathic scoliosis.

PURPOSE: The Spinal Appearance Questionnaire (SAQ) is a widely validated tool for assessing perceptions of spinal deformity in adolescent idiopathic scoliosis (AIS) patients. This study aimed to develop and validate a Greek version of the SAQ (GR-SAQ). METHODS: A cross-cultural adaptation of the SAQ following international guidelines was performed. Internal consistency and test-retest reliability were evaluated. Convergent validity was assessed by correlating the GR-SAQ with the Appearance domain of Scoliosis Research Society-22 (SRS-22) and the Cobb angle with the Trunk Shift domain of GR-SAQ. Divergent validity was examined through the relationship between GR-SAQ, patient characteristics, and clinical measures including Cobb angle, DIERS Formetric 4D angle, and scoliometer readings. RESULTS: The study included 61 AIS patients (52 females, 13.91 ± 2.57 years, 25.33 ± 10.14° Cobb angle). GR-SAQ exhibited good internal consistency (Cronbach's α = 0.794) and excellent test-retest reliability (ICC = 0.931, 95%CI: 0.880-0.960). Correlations between GR-SAQ and SRS-22 showed a low-to-moderate negative correlation (r = -0.351, p = 0.006). The Trunk Shift domain moderately correlated with the Cobb Angle (r = 0.393, p = 0.002). Divergent validity analyses did not demonstrate statistical significance (p > 0.05). CONCLUSION: The GR-SAQ is a valid and reliable tool for evaluating spinal deformity perception in Greek AIS patients.

Ηand dexterities assessment in stroke patients based on augmented reality and machine learning through a box and block test.

A popular and widely suggested measure for assessing unilateral hand motor skills in stroke patients is the box and block test (BBT). Our study aimed to create an augmented reality enhanced version of the BBT (AR-BBT) and evaluate its correlation to the original BBT for stroke patients. Following G-power analysis, clinical examination, and inclusion-exclusion criteria, 31 stroke patients were included in this study. AR-BBT was developed using the Open Source Computer Vision Library (OpenCV). The MediaPipe's hand tracking library uses a palm and a hand landmark machine learning model to detect and track hands. A computer and a depth camera were employed in the clinical evaluation of AR-BBT following the principles of traditional BBT. A strong correlation was achieved between the number of blocks moved in the BBT and the AR-BBT on the hemiplegic side (Pearson correlation = 0.918) and a positive statistically significant correlation (p = 0.000008). The conventional BBT is currently the preferred assessment method. However, our approach offers an advantage, as it suggests that an AR-BBT solution could remotely monitor the assessment of a home-based rehabilitation program and provide additional hand kinematic information for hand dexterities in AR environment conditions. Furthermore, it employs minimal hardware equipment.

Role of Microglia in Neuropathic Pain.

Microglial cells are specialized macrophage cells of the central nervous system responsible for the innate immunity of the spinal cord and the brain. They protect the brain and spinal cord from invaders, microbes, demyelination, trauma and remove defective cells and neurons. For immune protection, microglial cells possess a significant number of receptors and chemical mediators that allow them to communicate rapidly and specifically with all cells of the nervous tissue. The contribution of microglia in neuropathic pain challenges conventional concepts toward neurons being the only structure responsible for the pathophysiological changes that drive neuropathic pain. The present study is a narrative review focusing on the literature concerning the complex interaction between neurons and microglia in the development of neuropathic pain. Injury in the peripheral or central nervous system may result in maladaptive changes in neurons and microglial cells. In neuropathic pain, microglial cells have an important role in initiating and maintenance of pain and inflammation. The interaction between neural and microglial cells has been proven extremely crucial for chronic pain. The study of individual mechanisms at the level of the spinal cord and the brain is an interesting and groundbreaking research challenge. Elucidation of the mechanisms by which neurons and immune cells interact, could constitute microglial cells a new therapeutic target for the treatment of neuropathic pain.

Comparability of the Effectiveness of Different Types of Exercise in the Treatment of Achilles Tendinopathy: A Systematic Review.

Achilles tendinopathy (AT) is a common condition both in athletes and the general population. The purpose of this study is to highlight the most effective form of exercise in managing pain-related symptoms and functional capacity as well as in a return to life activities, ensuring the quality of life of patients with AT, and creating a protocol to be used in rehabilitation. We conducted a systematic review of the published literature in Pubmed, Scopus, Science Direct, and PEDro for Randomised Controlled Trials concerning interventions that were based exclusively on exercise and delivered in patients 18-65 years old, athletes and non-athletes. An amount of 5235 research articles generated from our search. Five met our inclusion criteria and were included in the review. Research evidence supports the effectiveness of a progressive loading eccentric exercise program based on Alfredson's protocol, which could be modified in intensity and pace to fit the needs of each patient with AT. Future research may focus on the optimal dosage and load of exercise in eccentric training and confirm the effectiveness of other type of exercise, such as a combination of eccentric-concentric training or heavy slow resistance exercise. Pilates could be applied as an alternative, useful, and friendly tool in the rehabilitation of AT.

The Modified Somatic Perception Questionnaire (MSPQ): Validation and Cultural Adaption in Greek.

Introduction: Somatic awareness as well as anxiety may be assessed with the Modified Somatic Awareness Questionnaire (MSPQ). The present study validates and adapts the Greek version of the MSPQ (MSPQ-GR) in individuals with chronic low-back pain. Methods:The MSPQ-GR along with the Greek versions of the Hospital Anxiety and Depression Scale (HADs-GR) and the Fear Avoidance Beliefs Questionnaire (FABQ-GR) were completed by 69 consecutive individuals suffering from chronic low-back pain. Test-retest reliability was tested 48 hours later. Construct validity was studied with the correlation of MSPQ- GR to the FABQ-GR as well as to the HADs-GR. Analysis included the Pearson's correlation coefficient (r), the Cronbach's alpha for internal consistency and the Intraclass Correlation Coefficient (ICC). Results:Most patients were females (82.6%), while the cohort's mean age was 40.2 years. Cronbach's alpha was 0.87 and ICC was found to be 0.92. MSPQ-GR and the HAD-GR anxiety correlation was r=0.36, p=0.002, while MSPQ-GR and HAD-GR depression correlation was r=0.42, p<0.001. Correlation of the MSPQ-GR and FABQ were non-significant (FABQ-work r= 0.19, NS, FABQ physical r= 0.2, NS), confirming the discriminant construct validity of the MSPQ-GR. Conclusions:The present study provided initial evidence for the validity and reliability of the MSPQ-GR and thus, it may be used in clinical practice in patients with chronic LBP.

Lumbar Kinematics Assessment of Patients with Chronic Low Back Pain in Three Bridge Tests Using Miniaturized Sensors.

Lumbar muscle atrophy, diminished strength, stamina, and increased fatigability have been associated with chronic nonspecific low back pain (LBP). When evaluating patients with LBP, trunk or core stability, provided by the performance and coordination of trunk muscles, appears to be essential. Several clinical tests have been developed to identify deficiencies in trunk performance, demonstrating high levels of validity and reproducibility. The most frequently prescribed tests for assessing the core body muscles are the prone plank bridge test (PBT), the side bridge test (SBT), and the supine bridge test (SUBT). However, quantitative assessments of the kinematics of the lumbar spine during their execution have not yet been conducted. The purpose of our study was to provide objective biomechanical data for the assessment of LBP patients. The lumbar spine ranges of motion of 22 healthy subjects (Group A) and 25 patients diagnosed with chronic LBP (Group B) were measured using two inertial measurement units during the execution of the PBT, SUBT, and SBT. Statistically significant differences between the two groups were found in all three tests' kinematic patterns. This quantitative assessment of lumbar spine motion transforms the three bridge tests into an objective biomechanical diagnostic tool for LPBs that may be used to assess the efficacy of applied rehabilitation programs.

Cognitive Assessment of Musculoskeletal Pain: Validity and Reliability of the Greek Version of the Tampa Scale of Kinesiophobia in Patients Suffering from Chronic Low Back Pain.

Objectives: The Tampa Scale of Kinesiophobia (TSK) evaluates pain associated fear, which is considered an important factor in the cognitive assessment of musculoskeletal pain according to the biopsychosocial model. The aim of this study was to validate the Greek version of the TSK (TSK-GR) in a population suffering from chronic low back pain. Methods:Following Institutional Review Board's approval (ref.: 6/16-2-2018), 70 consecutive patients with low back pain, lasting more than three months, completed the TSK-GR together with the Greek versions of the Hospital Anxiety & Depression Scale (HADs-GR), Fear Avoidance Beliefs Questionnaire (FABQ-GR), Pain Locus of Control (PLC-GR) and visual analogue scale for pain (VAS). A subgroup of 20 patients completed the TSK-GR (48 hours) twice (test-retest reliability). Construct validity was evaluated through the a priori hypothesis of correlation with the FABQ-GR, HADs-GR and VAS, while discriminant construct validity through the lack of correlation with the PLC-GR. The Cronbach's alpha (a), the Pearson's correlation coefficient (r) and the Intraclass Correlation Coefficient (ICC) statistics were used for analyses. Results:Internal consistency and test-retest reliability were satisfactory (Cronbach's a=0.74 and ICC=0.78). The construct validity of the TSK-GR was shown through its association with both FABQ subscales (FABQ-work: r=0.48, p<0.001, and FABQ-physical: r=0.51, p<0.001), with both HADs subscales (HADs-depression: r=0.45, p<0.001, and HADs-anxiety: r=0.34, p<0.005) and with the VAS (r=0.62, p<0.001). Discriminant construct validity was shown through the lack of association between TSK-GR and the PLC-GR. Conclusion:This study provided evidence for the validity and reliability of the Greek version of TSK in patients with chronic low back pain.

The impact of fascia iliaca compartment block on chronic postsurgical pain in patients undergoing hip fracture repair.

STUDY OBJECTIVE: Chronic postsurgical pain (CPSP), i.e. pain persisting >3 months, may appear after any type of surgery. There is a paucity of literature addressing CPSP development after hip fracture repair and the impact of any analgesic intervention on the development of CPSP in patients after hip fracture surgery. This study is the first aiming to examine the impact of ultrasound-guided fascia iliaca compartment block (USG FICB) on the development of CPSP after hip fracture repair. DESIGN: Prospective randomized study. SETTING: Operating room. PATIENTS: 182 patients scheduled for hip fracture surgery. INTERVENTIONS: Patients were randomized to receive a USG FICB (FICB group) or a sham saline injection (sham FICB group), twenty minutes before positioning for spinal anesthesia. MEASUREMENTS: The hip - related characteristic pain intensity (CPI) at 3- months post-surgery was the primary outcome measure. Presence and severity of hip-related pain at 3- and 6-months post-surgery, numeric rating pain scale (NRS) scores at 6, 24, 36, 48 postoperative hours, total 24-hour tramadol PCA administration and timing of the first tramadol dose, were documented as well. MAIN RESULTS: FICB group presented with lower CPI scores 3- months postoperatively (p < 0.01), as well as lower percentage of patients with high-grade CPSP, 3 and 6 months postoperatively (p < 0.001). FICB group also showed significantly lower NRS scores in all instances, lower total 24 - hour tramadol consumption and higher mean time to first tramadol dose (p < 0.05). The overall sample of 182 patients reported a considerably high incidence of hip -related CPSP (60% at 3 months, 45% at 6 months). CONCLUSIONS: USG FICB in the perioperative setting may reduce the incidence, intensity and severity of CPSP at 3 and 6 months after hip fracture surgery, providing safe and effective postoperative analgesia.

Cross-cultural Adaptation and Psychometric Properties of the Greek Version of the Central Sensitization Inventory.

OBJECTIVES: Recent studies support the opinion that central sensitization (CS) plays an important role in the pathophysiology of many chronic pain conditions. CS refers to hyperexcitability of the central nervous system, which can result in pain hypersensitivity and other somatosensory symptoms. Recognition of CS-related symptomology is crucial in chronic pain evaluation and rehabilitation. The Central Sensitization Inventory (CSI) was created to evaluate symptoms that have been found to be associated with CS. The aim of the current study was the cross-cultural adaptation of the CSI into Greek (CSI-Gr). METHODS: To evaluate discriminate validity, 200 patients with chronic pain and 50 healthy control subjects participated. The sample was divided into 4 diagnostic groups (fibromyalgia, single pain complaints, multiple pain complaints, and a control group) and into 5 CSI severity subgroups, from subclinical to extreme. Convergent validity was determined by evaluation of the relationship between the CSI-Gr and the Pain Catastrophizing Scale (PCS). Additionally, 30 patients completed the CSI a second time for the purpose of a test/retest analysis. RESULTS: The results showed high internal consistency (Cronbach's alpha = 0.994) and test-retest reliability (intraclass correlation coefficient = 0.993). The standard error of measurement was 2.1. The CSI-Gr correlated moderately with the PCS (r = 0.68). Statistically significant differences were found among the 3 comparison groups, with patients who had fibromyalgia reporting the highest CSI severity and healthy control subjects reporting the lowest severity. CONCLUSIONS: As determined in the present study, the CSI-Gr was found to be a reliable and valid tool for recognition of CS-related symptomology.

Similar 2-point discrimination and stereognosia but better locognosia at long term with an independent home-based sensory reeducation program vs no reeducation after low-median nerve transection and repair.

STUDY DESIGN: Prospective controlled study. INTRODUCTION: Previous studies evaluated the effectiveness of sensory reeducation (SR) after peripheral nerve injury and repair. However, evidence for long-term clinical usefulness of SR is inconclusive. PURPOSE OF THE STUDY: The purpose of this study is to compare the sensory results of patients with low-median nerve complete transection and microsurgical repair, with and without SR at long term. METHODS: We prospectively studied 52 consecutive patients (mean age, 36 years; range, 20-47 years) with low-median nerve complete transection and microsurgical repair. When reinnervation was considered complete with perception of vibration with a 256-cycles per second tuning fork (mean, 3.5 months after nerve injury and repair), the patients were sequentially allocated (into 2 groups [group SR, 26 patients, SR; group R, 26 patients, reassured on recovery without SR). SR was conducted in a standardized fashion, in 2 stages, as an independent home-based program: the first stage was initiated when reinnervation was considered complete, and included instruction in home exercises to identify familiar objects and papers of different roughness, and localization of light touch (eyes open and closed); the second stage was initiated when the patients experienced normal static and moving 2-point discrimination (2PD) at the index fingertip of injured hand, and included instruction in home exercises for stereognosia, supplementary exercises for localization of light touch, and identification of small objects (eyes open and closed). Exercises were prescribed for 5-10 minutes, 4 times per day. At 1.5, 3, and 6 years after nerve injury and repair, we evaluated the static and moving 2PD, stereognosia with the Moberg's pick-up test, and locognosia with the modified Marsh test. Comparison between groups and time points was done with the nonparametric analysis of variance (Kruskal-Wallis analysis of variance). RESULTS: Static and moving 2PD and stereognosia were not significantly different between groups at any study period. Locognosia was significantly better at 1.5 and 3 years in group SR; locognosia was excellent in 17 patients of group SR vs 5 patients of group R at 1.5-year follow-up and in 14 patients of group SR vs 5 patients of group R at 3-year follow-up. Locognosia was not different between the study groups at 6-year follow-up. CONCLUSION: A 2-stage home program of SR improved locognosia at 1.5 and 3 years after low-median nerve complete transection and repair without significant differences in other modalities or the 6-year follow-up of a small subsample.

The effect of physiotherapy and acupuncture on psychocognitive, somatic, quality of life, and disability characteristics in TTH patients.

INTRODUCTION: Nonpharmacological therapies have been widely used to treat tension-type headache (TTH); however, limited evidence exists with regards to their effectiveness. Therefore, the aim of the present study was to examine the combined effect of acupuncture, stretching, and physiotherapy (myofascial release techniques and microwave diathermy) on psychocognitive, somatic, quality of life, and disability characteristics in such patients. SUBJECTS AND METHODS: Patients with TTH (n=44) performed either acupuncture or stretching (control group, n=20) or acupuncture, stretching, and physiotherapy (experimental group, n=24) during a 4-week intervention period including 10 treatment sessions. They were tested for the Greek version of the Short-Form McGill Pain Questionnaire, the Greek version of the Migraine Disability Assessment Questionnaire, the Greek version of the Hospital Anxiety and Depression Scale, Short Form Health Survey 12 9 (SF-12), and Pain Catastrophizing Scale at baseline after the fifth and tenth sessions. RESULTS: All measures were improved throughout the first to tenth session (P<0.05), though no significant differences were observed between the two groups (P>0.05). CONCLUSION: In summary, a significant beneficial role of acupuncture, stretching, and physiotherapy on cognitive, psychosomatic pain measures, disability index, quality of life, and catastrophizing in patients with TTH was observed.

Fall Risk Assessment Metrics for Elderly Patients With Hip Fractures.

The most common surgery performed by orthopedic surgeons likely involves that for hip fractures. The incidence of hip fractures is anticipated to rise in the coming decades. Hip fractures most commonly occur in elderly women with osteoporosis after a fall from standing position. In an effort to reduce the incidence, improve the postoperative care, and accelerate the rehabilitation of hip fractures, it is important to evaluate the fall risk of these patients, as it is an objective indication of their level of physical activity. Metrics currently available for the evaluation of fall risk in the elderly vary widely, with each having been designed to assess a specific patient population. However, their applicability has often proved to be much broader than expected. This review summarizes the metrics available for fall risk assessment of elderly patients with hip fractures, describes their individual features and efficacy, and highlights those that seem to be more reliable for the assessment of rehabilitation of these patients after hip fracture surgery. [Orthopedics. 2018; 41(3):142-156.].

The effect of myofascial release and microwave diathermy combined with acupuncture versus acupuncture therapy in tension-type headache patients: A pragmatic randomized controlled trial.

BACKGROUND AND PURPOSE: Nonpharmacological therapies for tension-type headache (TTH) and cervicogenic cephalalgia are often a treatment choice, despite the weak to moderate evidence. The aim of this study was to compare the effectiveness of an acupuncture/stretching protocol versus acupuncture/stretching plus physiotherapy techniques, in patients with TTH cephalalgia. METHODS: A single-blind, prospective, multicentre, randomized controlled trial was designed considering the pragmatic situation of administering such protocols and treating the 44 headache patients participating in this study. The patients were randomly assigned in 2 treatment groups (control group, n = 20, acupuncture/stretching; experimental group, n = 24, acupuncture/stretching plus physiotherapy) and completed 10 treatment sessions within 4 weeks with measurements taking place before treatment, after the fifth treatment and after the 10th treatment. The mechanical pressure pain threshold (PPT) was considered as the main outcome measure, using a mechanical algometer to measure 7 bilateral somatic points. Acupuncture in both groups included 17-20 acupuncture points, whereas stretching was initially taught and subsequently self-administered (self-stretches), following a standardized set of movements of the cervical spine. Physiotherapy consisted of microwave diathermy and myofascial release with hands-on techniques. RESULTS/FINDINGS: An improvement was noted in both groups/treatments regarding the main outcome measure PPT, all the way from the first to fifth and the 10th treatment, at all measuring sites and at all measurements in both groups (p < .001). When comparing the 2 groups, differences were noted after the 10th treatment (p < .05). DISCUSSION: In conclusion, patients with TTH headache were benefited from acupuncture and stretching but further PPT improvements were evidenced when physiotherapy hands-on techniques were added. In clinical terms, the combination of physiotherapy in the form of myofascial release and microwave diathermy with acupuncture and stretching in order to improve the analgesic effect (PPT) is strongly recommended.

Smoking cessation can improve quality of life among COPD patients: validation of the clinical COPD questionnaire into Greek.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) remains a major public health problem that affects the quality of life of patients, however smoking cessation may emeliorate the functional effects of COPD and alter patient quality of life. OBJECTIVE-DESIGN: The aim of this study was to validate the Clinical COPD Questionnaire (CCQ) into Greek and with such to evaluate the quality of life in patients with different stages of COPD, as also assess their quality of life before and after smoking cessation. RESULTS: The internal validity of questionnaire was high (Cronbach's a = 0.92). The reliability of equivalent types in 16 stabilized patients also was high (ICC = 0.99). In general the domains within the CCQ were strongly correlated with each other, while each domain in separate was strongly correlated with the overall CCQ score (r2 = 0.953, r2 = 0.915 and r2 = 0.842 in regards to the functional, symptomatic and mental domain, respectively). The CCQ scores were also correlated with FEV1, (r2 = -0.252, p < 0.001), FEV1/FVC, (r2 = -0.135, p < 0.001) as also with the quality of life questionnaire SF-12 (r2 = -0.384, p < 0.001). Smoking cessation also lead to a significant reduction in CCQ score and increase in the SF-12 score. CONCLUSIONS: The self administered CCQ indicates satisfactory validity, reliability and responsiveness and may be used in clinical practice to assess patient quality of life. Moreover the CCQ indicated the health related quality of life gains attributable to smoking cessation among COPD patients, projecting smoking cessation as a key target in COPD patient management.

Criterion-related validity of the short International Physical Activity Questionnaire against exercise capacity in young adults.

BACKGROUND: Self-reported physical activity (PA) is well associated with cardiorespiratory fitness and exercise capacity. The short International Physical Activity Questionnaire (IPAQ-short) is a frequently used instrument for cross-national assessments of PA in adults. The purpose of this study was to validate IPAQ-short against exercise capacity in Greek young adults. DESIGN AND METHODS: One hundred and thirteen men and 105 women, aged 20-29 years, were randomly selected from a larger population of young health-science students. A Greek version of IPAQ-short (IPAQ-Gr) was administered to all participants before their exercise capacity evaluation with a maximal Bruce treadmill test. Multiple regression and correlation analyses were used to examine the associations between all IPAQ-Gr outcomes with exercise capacity based on maximal treadmill time. RESULTS: Spearman's correlations for total and vigorous PA against maximal treadmill time were significant in all groups examined, ranging from 0.35 to 0.43. Moderate and walking PA correlations were poor and nonsignificant, ranging from near-zero values to 0.19. In multiple linear regression analysis, only sex, smoking, and vigorous PA from all personal and log-transformed IPAQ-Gr data were significantly associated with maximal treadmill time. Partial correlation analysis for the overall population, adjusted for sex and smoking, showed that total PA (r=0.37) and vigorous PA (r=0.47) were significantly associated with exercise capacity. CONCLUSION: IPAQ-Gr was tested against exercise capacity and showed acceptable validity properties in Greek young adults. Total and vigorous weekly PA expenditure were well associated with exercise capacity, presenting significant validity correlations against maximal treadmill time.

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

INTRODUCTION: The short International Physical Activity Questionnaire (IPAQ-short) has frequently been used for national and international comparable physical activity (PA) prevalence studies. The purpose of this paper is to describe a Greek version of IPAQ-short (IPAQ-Gr) and present its reliability properties in Greek young and healthy adults. METHODS: Two hundred and eighteen health science students of the Athens Technological Educational Institute, aged 19-29 years, were randomly selected and participated in the study. An intra-examiner reliability study over time (8 and 30 days apart) was carried out to assess IPAQ-Gr repeatability. An inter-examiner reliability study was also performed to assess the consistency of IPAQ-Gr outcomes between examiners. At the same time, an intra-examiner reliability study using an independent sample of 175 medical students at the University of Ioannina was carried out in order to examine multi-centre IPAQ-Gr reliability. Intra-class correlation coefficients for IPAQ scores and kappa statistics and percent agreement for physical activity classification were used in the analysis. RESULTS: Intra-class correlation coefficients (ICCs) between day-1 and day-9 assessments for IPAQ total and vigorous PA were high in all groups examined (0.84 to 0.93). ICCs for walking PA, moderate PA and sitting hours were lower, but still good (0.69 to 0.81). Repeatability of IPAQ-Gr outcomes after one-month re-administration was high for total and vigorous PA (0.87, 0.81) and good for moderate (0.66) and walking PA (0.75). Inter-examiner reliability data showed that all correlations between examiners were greater than 0.70, up to 0.87 (paired t-test, p=NS), with the exception of moderate PA, where correlations were weaker (0.58 to 0.64). Similar results were found when intra-examiner correlations were compared between educational institutes (multi-centre inter-examiner reliability of IPAQ). CONCLUSIONS: IPAQ-Gr was found to present acceptable reliability properties in Greek young adults. IPAQ-Gr showed high repeatability values for total and vigorous PA, and good for moderate and walking PA.

Effects of chronic smoking on exercise tolerance and on heart rate-systolic blood pressure product in young healthy adults.

BACKGROUND: Smoking is a major cause of cardiovascular disease and mortality. Smoking-related deaths in Greece account for 23%, whereas 41% of young Greeks are smokers, the highest percentage in Europe. The purpose of this study was to examine the effects of chronic smoking on the rate-pressure product and exercise tolerance in young, healthy male smokers. DESIGN AND METHODS: Forty-two smokers and 51 nonsmokers were selected from a population of 543 students based on their age, sex, body mass index, physical fitness, smoking habit and health status. All participants were tested with the standard Bruce treadmill protocol. The rate-pressure product was obtained at rest and during exercise at a given submaximal workload. The evaluation of exercise tolerance was based on peak workload achieved and maximal exercise test duration. RESULTS: The smokers had a higher rate-pressure product at rest (P<0.001) due to their higher resting heart rate (P<0.001). Resting values of blood pressure did not differ significantly between the two groups. During exercise, smokers had a greater rate-pressure product (P<0.001), mainly due to their significantly higher systolic blood pressure (P=0.008). The smokers had a higher submaximal heart rate (P=0.005), but the differences in heart rate between groups were reduced for smokers during exercise when compared to rest. The smokers' exercise tolerance was impaired and their maximal exercise test duration time was significantly shorter (P<0.001). CONCLUSIONS: Chronic smoking was found to affect young male smokers' cardiovascular fitness, impairing the economy and decreasing the capacity of their circulatory system.

Prevalence of low back pain in greek public office workers.

BACKGROUND: Epidemiological studies have provided information on the prevalence and risk factors of low back pain (LBP) in white collar workers in industrialized countries. Little information has related individual, work ergonomic, and psychosocial factors to the incidence of LBP in low income countries. OBJECTIVES: To assess the prevalence of LBP among Greek public office workers. To identify and relate the individual, work ergonomic, and psychosocial factors to the occurrence of LBP. DESIGN: Cross-sectional study of Greek office workers in the public sector. METHODS: A self-reported standardized questionnaire was constructed to record risk factors associated with the occurrence of LBP. Personal characteristics, work ergonomics, and psychosocial traits were collected and related to LBP prevalence. RESULTS: Of the 771 office workers, 648 responded (84% return rate). The majority of the participants were women (75.8%). Among all responders, 33%, 37.8%, 41.8%, and 61.6% presented with point, one-year, two-year, and lifetime prevalence respectively. Sleep disturbances due to pain were reported in 37% of the office clerks with chronic low back pain. Multiple logistic regression models have revealed that significant determinants for predicting LBP occurrence are age, gender, body mass index, body distance from computer screen, adjustable back support, clerk body position while sitting, sitting time of greater than 6 hours, job satisfaction, repetitive work, and anger during last 30 days. CONCLUSION: High proportions of Greek office workers suffer from LBP which might affect the Greek economy. The incidence of LBP status is significantly associated with some anthropometric, ergonomic, and psychosocial factors.

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

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