Surgical Outcomes after Full Thickness Chest Wall Resection Followed by Immediate Reconstruction: A 7-Year Observational Study of 42 Cases.

Introduction: Reconstruction of full thickness chest wall defects is challenging and is associated with a considerable risk of complications. Therefore, the aim of this study was to investigate the surgical outcomes and their associations with patient and treatment characteristics following full thickness chest wall reconstruction. Patients and methods: A retrospective observational study was performed by including patients who underwent reconstruction of full thickness chest wall defect at the Erasmus MC between January 2014 and December 2020. The type of reconstruction was categorized into skeletal and soft tissue reconstructions. For skeletal reconstruction, only non-rigid prosthetic materials were used. Patient and surgical characteristics were retrieved and analyzed for associations with postoperative complications. Results: Thirty-two women and 10 men with a mean age of 60 years were included. In 26 patients (61.9%), the reconstruction was performed using prosthetic material and a soft tissue flap, in nine cases (21.4%) only a soft tissue flap was used, and in seven other patients (16.7%) only the prosthetic material was used. Pedicled musculocutaneous latissimus dorsi flaps were used most often (n=17), followed by pectoralis major flaps (n=8) and free flaps (n=8). Twenty-two patients (52.4%) developed at least one postoperative complication. Wounds (21.4%) and pulmonary (19.0%) complications occurred most frequently. Five (11.9%) patients required reoperation. There were no associations between patient and treatment characteristics and the occurrence of major complications. There was no mortality. Conclusions: Reconstruction of full thickness chest wall defects using only non-rigid prosthetic material for skeletal reconstruction appears safe with an acceptable reoperation rate and low mortality, questioning the need for rigid fixation techniques.

Clinical efficacy and patients' perception of virtual reality during wound care in adults: A systematic review with meta-analysis of randomised clinical trials.

This study was aimed to review Virtual Reality's (VR) impact on pain, anxiety, opioid usage, physiological and behavioural responses, and patients' experience during wound care (WC) in adults. We searched multiple databases (Embase, Medline ALL, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, CINAHL, Scopus and Google Scholar) from inception until January 27th, 2023. Included studies compared VR alone or as an adjunct to standard WC with standard WC or other distraction methods, in adults with burn or non-burn-related wounds. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomised parallel-group and crossover trials. The review followed PRISMA guidelines for reporting. Fourteen studies were eligible for inclusion. The meta-analysis was limited to studies comprising solely of adult participants. VR reduced pain intensity compared to standard WC in all study designs. Despite not being included in the meta-analysis due to reasons such as mixed population or lack of sufficient statistical data, other studies showed significant pain reduction using VR. Additionally, VR improved patients' experience of WC. No clear effect was found on other outcomes including anxiety, opioid usage and physiological and behavioural responses. VR shows promise in reducing acute pain and enhancing patients' experience of WC. The observed variations in the effects of VR at group and individual levels indicate the need for a personalised treatment plan by selecting the right VR for the right patient given at the right time.

Is movement variability altered in people with chronic non-specific low back pain? A systematic review.

BACKGROUND: Variability in spine kinematics is a common motor adaptation to pain, which has been measured in various ways. However, it remains unclear whether low back pain (LBP) is typically characterised by increased, decreased or unchanged kinematic variability. Therefore, the aim of this review was to synthesise the evidence on whether the amount and structure of spine kinematic variability is altered in people with chronic non-specific LBP (CNSLBP). METHODS: Electronic databases, grey literature, and key journals were searched from inception up to August 2022, following a published and registered protocol. Eligible studies must investigated kinematic variability in CNSLBP people (adults ≥18 years) while preforming repetitive functional tasks. Two reviewers conducted screening, data extraction, and quality assessment independently. Data synthesis was conducted per task type and individual results were presented quantitatively to provide a narrative synthesis. The overall strength of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation guidelines. FINDINGS: Fourteen observational studies were included in this review. To facilitate the interpretation of the results, the included studies were grouped into four categories according to the task preformed (i.e., repeated flexion and extension, lifting, gait, and sit to stand to sit task). The overall quality of evidence was rated as a very low, primarily due to the inclusion criteria that limited the review to observational studies. In addition, the use of heterogeneous metrics for analysis and varying effect sizes contributed to the downgrade of evidence to a very low level. INTERPRETATION: Individuals with chronic non-specific LBP exhibited altered motor adaptability, as evidenced by differences in kinematic movement variability during the performance of various repetitive functional tasks. However, the direction of the changes in movement variability was not consistent across studies.

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.

Are Measures of Physical Function of the Neck Region Associated With Poor Prognosis Following a Whiplash Trauma?: A Systematic Review.

OBJECTIVE: The objective of this study was to synthesize the current evidence regarding the predictive ability of measures of physical function (PF) of the neck region and perceived PF on prognosis following a whiplash injury. MATERIALS AND METHODS: Electronic databases were searched by 2 independent reviewers up to July 2020, including MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science as well as gray literature. Eligible studies were selected by 2 reviewers who then extracted and assessed the quality of evidence. Observational cohort studies were included if they involved participants with acute whiplash-associated disorders (WAD), followed for at least 3 months postinjury, and included objective measures of neck PF or self-reported measures of PF as prognostic factors. Data could not be pooled and therefore were synthesized qualitatively. RESULTS: Fourteen studies (13 cohorts) were included in this review. Low to very low quality of evidence indicated that initial higher pain-related disability and higher WAD grade were associated with poor outcome, while there was inconclusive evidence that neck range of motion, joint position error, activity of the superficial neck muscles, muscle strength/endurance, and perceived functional capacity are not predictive of outcome. The predictive ability of more contemporary measures of neck PF such as the smoothness of neck movement, variability of neck motion, and coactivation of neck muscles have not been assessed. DISCUSSION: Although initial higher pain-related disability and higher WAD grade are associated with poor outcome, there is little evidence available investigating the role of neck PF on prognosis following a whiplash injury.

Is movement variability altered in people with chronic non-specific low back pain: a protocol for a systematic review.

INTRODUCTION: Motor variability is an important feature when performing repetitive movement, and in asymptomatic people functional tasks are typically performed with variable motor patterns. However, in the presence of chronic non-specific low back pain (LBP), people often present with different motor control strategies than those without pain. Movement variability has been assessed using a wide range of variables, including kinetic and kinematic components of motion. This has resulted in a wide range of findings reported in the literature and some contradicting results. Therefore, the aim of this systematic review is to investigate whether the amount and structure of motor variability are altered in people with chronic non-specific LBP, during both repetitive non-functional and functional tasks. METHODS AND ANALYSIS: This protocol for a systematic review is informed by Cochrane guidelines and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. MEDLINE, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Scopus will be searched from their inception to December 2020 along with a comprehensive search of grey literature and key journals. Two independent reviewers will conduct the search, extract the data, assess risk of bias (using the Downs and Black Scale) for the included studies and assess overall quality of evidence based on Grading of Recommendations, Assessment, Development and Evaluation guidelines. Meta-analysis will be conducted if deemed appropriate. Alternatively, a narrative synthesis will be conducted and evidence summarised as an increase, decrease or no change in the motor variability of people with LBP compared with healthy controls. ETHICS AND DISSEMINATION: This study raises no ethical issues. Results will be submitted for publication in a peer review journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42020211580.

A meta-analysis and systematic review of changes in joint position sense and static standing balance in patients with whiplash-associated disorder.

OBJECTIVE: To synthesise and analyse the current evidence regarding changes in joint position sense (JPS) and standing balance in people with whiplash-associated disorder (WAD) taking the presence or absence of dizziness into account. DATA SOURCES: PubMed, CINAHL Plus, Web of Science, Embase, MEDLINE and APA PsycINFO were searched by two independent reviewers from inception until August 2020 and reference lists of all included studies were also reviewed. STUDY SELECTION: Only cross-sectional studies that measured JPS and/or standing balance between people with WAD vs. healthy controls (HC) or people with WAD complaining of dizziness (WADD) vs. those not complaining of dizziness (WADND) were selected. DATA EXTRACTION: Relevant data were extracted using specific checklists and quality assessment was performed using Downs and Black Scale (modified version). DATA SYNTHESIS: Twenty-six studies were included. For JPS, data were synthesized for absolute error in the primary plane of movement for separate movement directions. For standing balance, data were synthesized for traditional time- and frequency domain sway parameters considering the conditions of eyes open (EO) and eyes closed (EC) separately. For meta-analysis, reduced JPS was observed in people with WAD compared to HC when the head was repositioned to a neutral head position (NHP) from rotation (standardised mean difference [SMD] = 0.43 [95%: 0.24-0.62]) and extension (0.33 [95%CI: 0.08-0.58]) or when the head was moved toward 50° rotation from a NHP (0.50 [0.05-0.96]). Similarly, people with WADD had reduced JPS compared to people with WADND when the head was repositioned to a NHP from rotation (0.52 [0.22-0.82]). Larger sway velocity and amplitude was found in people with WAD compared to HC for both EO (0.62 [0.37-0.88] and 0.78 [0.56-0.99], respectively) and EC (0.69 [0.46-0.91] and 0.80 [0.58-1.02]) conditions. CONCLUSION: The observed changes of JPS and standing balance confirms deficits in sensorimotor control in people with WAD and especially in those with dizziness.

Sex and freezing of gait in Parkinson's disease: a systematic review and meta-analysis.

OBJECTIVE: It is unknown how sex affects the prevalence of freezing of gait (FOG). We conducted a systematic review and meta-analysis to establish the sex-specific prevalence of FOG in persons with Parkinson's disease (PD). In addition, we investigated whether men and women were represented accurately in intervention trials targeting FOG. METHODS: We queried the EMBASE and PubMed databases and identified 2637 articles. Of these, 16 epidemiological studies were included in the meta-analysis, and 51 intervention studies were included in the comparative analysis. RESULTS: In total, 5702 persons were included in the final meta-analysis of epidemiological studies. The pooled estimate of overall FOG prevalence was 43% [95% CI 33-53%]. We found no difference in FOG prevalence between men [44% (34-54%)] and women [42% (31-52%)] with PD. However, women were markedly underrepresented in intervention trials targeting FOG, with an average proportion of only 29.6% of women in trial populations. The percentage of women included in trials was similar across intervention types but differed greatly across geographical regions. CONCLUSION: Sex is not a predictor of FOG. This could aid clinicians in counseling persons with PD about FOG. Importantly, a global effort is needed to include more women into clinical trials. Given the skewed distribution of men and women included in intervention trials targeting FOG, caution might be warranted when extrapolating results from FOG trials to women.

Magnitude, symmetry and attenuation of upper body accelerations during walking in women: The role of age, fall history and walking surface.

OBJECTIVES: The present experiment examined the role of age and fall history in upper body accelerations when walking on an even and on an uneven surface. STUDY DESIGN: An observational cross-sectional study. MAIN OUTCOME MEASURES: The magnitude (root mean square [RMS]), symmetry (harmonic ratio) and attenuation (attenuation coefficient) of upper body accelerations were quantified as primary outcomes; gait spatiotemporal parameters were measured as secondary outcomes. METHODS: Twenty young adults (mean ± SD age: 29.00 ± 4.51 yrs), 20 older non-fallers (66.60 ± 5.43 yrs) and 20 older fallers (68.55 ± 4.86 yrs) walked on an even and on an uneven surface, while wearing four accelerometers attached to the forehead, pelvis, right and left shanks. RESULTS: Older fallers exhibited increased RMS acceleration in the mediolateral direction at the pelvis level compared with young adults when walking on the even surface (0.18 ± 0.04 vs. 0.14 ± 0.02, respectively), whereas walking on an uneven surface was associated with reduced magnitude of acceleration in older fallers (0.19 ± 0.04) compared with non-fallers (0.23 ± 0.04) and young adults (0.22 ± 0.03). Among other changes, walking on the uneven surface diminished pelvis-to-head attenuation in the mediolateral direction in older fallers (38.07 ± 14.51) compared with non-fallers (50.96 ± 11.03) and young adults (62.62 ± 8.21; all ps<0.05). CONCLUSIONS: Reduced mediolateral accelerations in older fallers when walking on the uneven surface can be interpreted as a compensatory mechanism to preserve stability through increased body stiffness. Reduced postural flexibility in the frontal plane compromises the central role of the trunk in minimizing the impact of gait-related oscillations to the head, as evidenced by reduced mediolateral attenuation in older fallers.

The effects of cryotherapy versus cryostretching on clinical and functional outcomes in athletes with acute hamstring strain.

PURPOSE: Hamstring strain is a common sport injury that results in pain and functional limitation. Despite its high frequency in active populations, there is no agreement regarding the best method used for early intervention of hamstring strain. The aim of the present study was to compare the effects of cryotherapy and cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. MATERIALS AND METHODS: Thirty seven elite athletes with an acute grade I or II hamstring strain were randomly assigned to either cryotherapy (n = 19) or cryostretching (n = 18) group, receiving 5 sessions of supervised treatment plus home-based intervention monitored by the therapist. Pre-treatment to post-treatment changes in pain, active and passive knee extension range of motion and functional status were compared between the two groups. RESULTS: Compared to cryotherapy, cryostretching resulted in larger improvement of function and passive knee extension range of motion. Changes in active knee extension range of motion and pain severity were not significantly different between the two groups. CONCLUSION: A rehabilitation protocol involving gentle stretching following cryotherapy is more effective than cryotherapy alone in the improvement of function and passive knee range of motion in patients with grade I and II hamstring strain.

A Persian-version of the stuttering severity instrument-version four (SSI-4): How the new additions to SSI-4 complement its stuttering severity score?

PURPOSE: The fourth version of the Stuttering Severity Instrument (SSI-4) has been available since 2009. It has some modifications and new features which make it more appropriate at least for clinical practice, although further documentation is needed. The objective of the current research was to translate SSI-4 into Persian language and to discuss its relative and absolute reliability as well as its criterion validity for Persian adults who stutter (PWS). We also aimed to study how the new subjective self-reports of the SSI-4 complement the stuttering severity score obtained from the SSI-3 or the SSI-4. METHOD: The cross-cultural guideline recommended by the International Quality of Life Assessment project was used to translate the SSI-4 into Persian language. Thirty five PWS from ages 17 to 42 were recruited and 10 speech and language pathologists assessed their stuttering severity using either the SSI-4 or stuttering severity ratings (SR) to test validity and reliability of the Persian translated version. RESULTS: A very high inter-judge relative reliability along with a poor absolute inter-judge reliability was found for the SSI-4 scores. The results were more promising for the intra-judge absolute reliability. Test-retest reliability of the complementary questions to the SSI-4 was also found acceptable. However, no strong relationship was found between the SSI-4 scores and its complementary questions. CONCLUSION: The Persian version of the SSI-4 can be used reliably by trained SLPs for research and clinical purposes, but not to document small changes in stuttering severity. We argue that the response of participants to the complementary self-report questions should also be considered in calculating their stuttering severity score.

Effects of narrow-base walking and dual tasking on gait spatiotemporal characteristics in anterior cruciate ligament-injured adults compared to healthy adults.

PURPOSE: The present experiment was conducted to examine the hypothesis that challenging control through narrow-base walking and/or dual tasking affects ACL-injured adults more than healthy control adults. METHODS: Twenty male ACL-injured adults and twenty healthy male adults walked on a treadmill at a comfortable speed under two base-of-support conditions, normal-base versus narrow-base, with and without a cognitive task. Gait patterns were assessed using mean and variability of step length and mean and variability of step velocity. Cognitive performance was assessed using the number of correct counts in a backward counting task. RESULTS: Narrow-base walking resulted in a larger decrease in step length and a more pronounced increase in variability of step length and of step velocity in ACL-injured adults than in healthy adults. For most of the gait parameters and for backward counting performance, the dual-tasking effect was similar between the two groups. CONCLUSIONS: ACL-injured adults adopt a more conservative and more unstable gait pattern during narrow-base walking. This can be largely explained by deficits of postural control in ACL-injured adults, which impairs gait under more balance-demanding conditions. The observation that the dual-tasking effect did not differ between the groups may be explained by the fact that walking is an automatic process that involves minimal use of attentional resources, even after ACL injury. Clinicians should consider the need to include aspects of terrain complexity, such as walking on a narrow walkway, in gait assessment and training of patients with ACL injury. LEVEL OF EVIDENCE: III.

Dual-Tasking Effects on Dynamic Postural Stability in Athletes With and Without Anterior Cruciate Ligament Reconstruction.

PURPOSE: To compare the effect of dual tasking on postural stability between patients with anterior cruciate ligament reconstruction (ACL-R) and healthy controls. METHODS: Single-limb postural stability was assessed in 17 athletes with ACL-R and 17 healthy matched athletes while standing on a Biodex Balance System platform in 4 conditions: stability level of 8 (ie, more-stable support surface) with eyes open, stability level of 8 with eyes closed, stability level of 6 (ie, less-stable support surface) with eyes open, and stability level of 6 with eyes closed. Postural-stability tasks were performed with and without auditory Stroop task. The anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI) as measures of postural performance, as well as reaction time and error ratio as measures of cognitive performance, were recorded. RESULTS: Dual-tasking effect on postural stability was not significantly different between the groups in 3 postural conditions. Only in level 6 with eyes open, for APSI and OSI, patients with ACL-R showed lower postural stability under the dual-task condition. However, patients showed poorer performance on both reaction time and error ratio in all postural conditions. CONCLUSIONS: The patients with ACL-R appeared to sacrifice their cognitive performance to optimize their performance on postural stability. This posture-first strategy was reflected by a more pronounced effect of dual tasking on the auditory Stroop task than the postural-stability task. In situations where maintenance of posture is challenging, giving priority to the postural task at the expense of cognitive performance can ensure safety from balance loss.

Attentional costs of walking are not affected by variations in lateral balance demands in young and older adults.

Increased attentional costs of walking in older adults have been attributed to age-related changes in visuomotor and/or balance control of walking. The present experiment was conducted to examine the hypothesis that attentional costs of walking vary with lateral balance demands during walking in young and older adults. Twenty young and twenty older adults walked on a treadmill at their preferred walking speed under five conditions: unconstrained normal walking, walking on projected visual lines corresponding to either the participant's preferred step width or 50% thereof (i.e. increased balance demand), and walking within low- and high-stiffness lateral stabilization frames (i.e. lower balance demands). Attentional costs were assessed using a probe reaction-time task during these five walking conditions, normalized to baseline performance as obtained during sitting. Both imposed step-width conditions were more attentionally demanding than the three other conditions, in the absence of any other significant differences between conditions. These effects were similar in the two groups. The results indicate that the attentional costs of walking were, in contrast to what has been postulated previously, not influenced by lateral balance demands. The observed difference in attentional costs between normal walking and both visual lines conditions suggests that visuomotor control processes, rather than balance control, strongly affect the attentional costs of walking. A tentative explanation of these results may be that visuomotor control processes are mainly governed by attention-demanding cortical processes, whereas balance is regulated predominantly subcortically.

Effects of narrow base gait on mediolateral balance control in young and older adults.

The aim of this study was to examine the effect of narrowing step width on mediolateral (ML) center of mass (COM) kinematics and margin of stability (MOS) in young and older adults. Fourteen young and 18 healthy older adults were asked to walk on a treadmill at preferred speed, stepping on projected lines at their predetermined preferred step width (PSW) and at a 50% narrowed step width (NSW). Linear trunk accelerations were recorded by an inertial sensor, attached at the level of the lumbar spine and foot placement was determined from force sensors in the treadmill. Mediolateral peak-to-peak COM displacement, COM velocity and MOS within strides were estimated. Mean ML-COM displacement and velocity, which were significantly higher in older compared to young adults, were significantly reduced in the NSW condition while the variability of ML-COM velocity was increased in the NSW condition. A significant interaction effect of step width and age was found for ML-COM velocity, showing larger decreases in older adults in the NSW condition. Walking with NSW reduced the ML-MOS significantly in both groups while it was smaller in the older group. Although reductions of ML-COM displacement and velocity may occur as direct mechanical effects of reduced step width, the larger variability of ML COM velocity in the older adults suggests active control of ML COM movements in response to the reduced base of support. Given the effects on MOS, narrowing step width might challenge ML-balance control and lead to less robust gait especially in older adults.

Effects of aging and dual tasking on step adjustments to perturbations in visually cued walking.

Making step adjustments is an essential component of walking. However, the ability to make step adjustments may be compromised when the walker's attentional capacity is limited. This study compared the effects of aging and dual tasking on step adjustments in response to stepping-target perturbations during visually cued treadmill walking. Fifteen older adults (69.4 ± 5.0 years; mean ± SD) and fifteen young adults (25.4 ± 3.0 years) walked at a speed of 3 km/h on a treadmill. Both groups performed visually cued step adjustments in response to unpredictable shifts of projected stepping targets in forward (FW), backward (BW) or sideward (SW) directions, at different levels of task difficulty [which increased as the available response distance (ARD) decreased], and with and without dual tasking (auditory Stroop task). In both groups, step adjustments were smaller than required. For FW and BW shifts, older adults undershot more under dual-task conditions. For these shifts, ARD affected the age groups differentially. For SW shifts, larger errors were found for older adults, dual tasking and the most difficult ARD. Stroop task performance did not differ between groups in all conditions. Older adults have more difficulty than young adults to make corrective step adjustments while walking, especially under dual-tasking conditions. Furthermore, they seemed to prioritize the cognitive task over the step adjustment task, a strategy that may pose aging populations at a greater fall risk. For comparable task difficulty, the older adults performed considerably worse than the young adults, indicating a decreased ability to adjust steps under time pressure.

Reliability, validity, and responsiveness of the Persian version of the rheumatoid and arthritis outcome score (RAOS) in patients with rheumatoid arthritis.

The aims of this study were to cross-culturally translate the original rheumatoid and arthritis outcome score (RAOS) into Persian and evaluate its reliability, validity, and responsiveness in a group of patients with rheumatoid arthritis (RA). The questionnaire was translated through a standard forward-backward translation. A sample of 103 patients was asked to complete the Persian RAOS, the Short Form-36 (SF-36), and the arthritis impact measurement scale-short form (AIMS2-SF). To determine test-retest reliability, the Persian RAOS was readministered to a sample of 50 patients, 3-6 days after the first visit. To evaluate responsiveness, 50 patients completed the Persian RAOS at baseline and at the end of a pharmacological intervention. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Construct validity was assessed by comparing the results of the RAOS with the Persian SF-36 and AIMS2-SF using Spearman's correlation coefficient. Responsiveness was assessed by the calculation of effect size (ES) and standardized response means (SRM). The acceptable level of ICC > 0.70 and Cronbach's alpha > 0.70 were obtained for the most RAOS subscales. As expected, moderate to strong correlations were observed between subscales of the RAOS and the SF-36/AIMS2-SF intended to measure similar constructs. The ES range of 0.18 to 0.51 and the SRM range of 0.25 to 0.91 were obtained for the RAOS subscales. In conclusion, the Persian RAOS is a reliable, valid, and responsive outcome measure for patients with RA suffering from arthritis in the lower limb joints.

Competing effects of pain and fear of pain on postural control in low back pain?

STUDY DESIGN: A cross-sectional, observational study. OBJECTIVE: To determine whether pain and fear of pain have competing effects on postural sway in patients with low back pain (LBP). SUMMARY OF BACKGROUND DATA: Competing effects of pain and pain-related fear on postural control can be proposed as the likely explanation for inconsistent results regarding postural sway in the LBP literature. We hypothesized that although pain might increase postural sway, fear of pain might reduce sway through an increased cognitive effort or increased cocontraction to restrict body movement. The cognitive strategy would be less effective under dual-task conditions and the cocontraction strategy was expected to be less effective when standing on a narrow base of support surface. METHODS: Postural sway was measured in combined conditions of base of support (full and narrow) and cognitive loading (single and dual tasks) in 3 experimental groups with current LBP, recent LBP, and no LBP. Sway amplitude, path length, mean power frequency, and sample entropy were extracted from center-of-pressure data. RESULTS: The current-LBP group and recent-LBP group reported significantly different levels of pain, but similar levels of pain catastrophizing and kinesiophobia. The current-LBP group tended to display larger sway amplitudes in the anteroposterior direction compared with the other 2 groups. Mean power frequency values in mediolateral direction were lower in patients with the current LBP compared with recent LBP. Smaller sample entropy was found in the current-LBP group than the other groups in most experimental conditions, particularly when standing on a narrow base of support. CONCLUSION: Alterations of postural sway are mostly mediated by pain but not pain-related fear. LBP tends to increase sway amplitude, which seems to be counteracted by increased effort invested in postural control leading to decreased frequency and increased regularity of sway particularly under increased task demands. LEVEL OF EVIDENCE: Cross-sectional study.

Attentional costs of visually guided walking: effects of age, executive function and stepping-task demands.

During walking, attention needs to be flexibly allocated to deal with varying environmental constraints. This ability may be affected by aging and lower overall executive function. The present study examined the influence of aging and executive function on the attentional costs of visually guided walking under different task demands. Three groups, young adults (n=15) and elderly adults with higher (n=16) and lower (n=10) executive function, walked on a treadmill in three conditions: uncued walking and walking with regular and irregular patterns of visual stepping targets projected onto the belt. Attentional costs were assessed using a secondary probe reaction time task and corrected by subtracting baseline single-task reaction time, yielding an estimate of the additional attentional costs of each walking condition. We found that uncued walking was more attentionally demanding for elderly than for young participants. In young participants, the attentional costs increased significantly from uncued to regularly cued to irregularly cued walking, whereas for the higher executive function group, attentional costs only increased significantly from regularly cued to irregularly cued walking. For the group with lower executive function, no significant differences were observed. The observed decreased flexibility of elderly, especially those with lower executive function, to allocate additional attentional resources to more challenging walking conditions may be attributed to the already increased attentional costs of uncued walking, presumably required for visuomotor and/or balance control of walking.

Effect of dual-tasking on dynamic postural control in individuals with and without nonspecific low back pain.

OBJECTIVE: The purpose of this study was to compare the effect of dual tasking on postural and cognitive performance between participants with and without nonspecific chronic low back pain. METHODS: In this 3-factor mixed-design study, dynamic postural stability was assessed in 15 patients with chronic nonspecific low back pain and 15 age-, sex-, and size-matched asymptomatic participants. Bilateral stance on a Biodex Balance System was investigated at 3 levels of postural task difficulty (different platform stabilities levels with eyes open and closed) and 2 levels of cognitive task difficulty (with or without auditory Stroop test). We measured anterior-posterior, medial-lateral, and overall indices for postural performance. Average reaction time and error ratio of a modified auditory Stroop test were calculated as measures of the cognitive task performance. RESULTS: Mixed-design 3-way analyses of variance revealed significant interactions. Post hoc 2-way analyses of variance showed significant group by cognitive task difficulty for anterior-posterior (P < .001), medial-lateral (P = .003), and overall stability indices (P < .001) on a stiffness level of 5 with eyes closed. At this level, there were significant differences between single- and dual-task conditions for anterior-posterior (P < .001), medial-lateral (P = .02), and overall stability indices (P < .001) only in the chronic low back pain group. Also, at the most difficult postural conditions, participants with chronic low back pain increased their error ratio (P = .002), whereas matched asymptomatic individuals increased their reaction time (P < .01) of the auditory Stroop test. CONCLUSION: Postural task performance is attenuated by cognitive loading at a moderate level of postural task difficulty. Therefore, to observe the effect of attentional demands of postural control, task difficulty should be considered.