ß-Alanine supplementation improves fractional anisotropy scores in the hippocampus and amygdala in 60-80-year-old men and women.

Recently, ß-alanine (BA) supplementation was shown to improve cognitive function in older adults with decreased cognitive function. Mechanisms supporting these improvements have not been well defined. This study examined the effects of 10-weeks of BA supplementation on changes in circulating brain inflammatory markers, brain derived neurotrophic factor (BDNF), and brain morphology. Twenty participants were initially randomized into BA (2.4 g·d-1) or placebo (PL) groups. At each testing session, participants provided a resting blood sample and completed the Montreal cognitive assessment (MoCA) test and magnetic resonance imaging, which included diffusion tensor imaging to assess brain tissue integrity. Only participants that scored at or below normal for the MoCA assessment were analyzed (6 BA and 4 PL). The Mann-Whitney U test was used to examine Δ (POST-PRE) differences between the groups. No differences in Δ scores were noted in any blood marker (BDNF, CRP, TNF-α and GFAP). Changes in fractional anisotropy scores were significantly greater for BA than PL in the right hippocampus (p = 0.033) and the left amygdala (p = 0.05). No other differences were noted. The results provide a potential mechanism of how BA supplementation may improve cognitive function as reflected by improved tissue integrity within the hippocampus and amygdala.

Exercise combined with electrical stimulation for the treatment of chronic ankle instability - A randomized controlled trial.

PURPOSE: To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI). METHODS: Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport). RESULTS: Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI -8.1, -0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT. CONCLUSION: The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.

Peroneal muscle response to single-leg drop-jump and unexpected leg-drop in young and middle-aged adults before and after one session of neuromuscular training.

BACKGROUND: Changes in neuromuscular ability in middle age (MA) may lead to deterioration of postural control. The aim of this study was to investigate the anticipatory response of the peroneus longus muscle (PL) to landing after a single-leg drop-jump (SLDJ), and its postural response after an unexpected leg-drop in MA and young adults. A second aim was to investigate the influence of neuromuscular training on PL postural responses in both age groups. METHODS: Twenty-six healthy MA (55.3 ± 4 years) and 26 healthy young adults (26.3 ± 3.6 years) participated in the study. Assessments were performed before (T0) and after (T1) PL EMG biofeedback (BF) neuromuscular training. Subjects performed SLDJ, and PL EMG activity in preparation for landing (% of flight time) was calculated. To measure PL time to activation onset and time to peak activation in response to an unexpected leg-drop, subjects stood on a customized trapdoor device that produced a sudden 30° ankle inversion. RESULTS: Before training, the MA group showed significantly shorter PL activity in preparation for landing compared to the young adults (25.0% vs. 30.0%, p = 0.016), while after training there was no difference between the groups (28.0% vs. 29.0%, p = 0.387). There were no differences between groups in peroneal activity after the unexpected leg-drop before and after training. CONCLUSIONS: Our results suggest that automatic anticipatory peroneal postural responses are decreased at MA, whereas reflexive postural responses appear to be intact in this age group. A short PL EMG-BF neuromuscular training may have an immediate positive effect on PL muscle activity at MA. This should encourage the development of specific interventions to ensure better postural control in this group. TRIAL REGISTRATION: ClinicalTrials.gov NCT05006547.

Young, but not in the dark-The influence of reduced lighting on gait stability in middle-aged adults.

BACKGROUND: The aim of this study was to investigate the effects of walking in reduced lighting with or without performing a secondary cognitive task on gait dynamics in middle-aged adults and to compare them with young and old adults. METHODS: Twenty young (age 28.8±4.1), 20 middle-aged (age 50.2±4.4), and 19 elderly (age 70.7±4.2) subjects participated in the study. Subjects walked on an instrumented treadmill at a self-determined pace under four conditions in randomized order: (1) walking in usual lighting (1000 lumens); (2) walking in near-darkness (5 lumens); (3) walking in usual lighting with a serial-7 subtraction dual-task; and (4) walking in near-darkness with a serial-7 subtraction dual-task. Variability in stride time and variability in the trajectory of the center of pressure in the sagittal and frontal planes (anterior/posterior and lateral variability) were measured. Repeated measures ANOVA and planned comparisons were used to determine the effects of age, lighting conditions, and cognitive task on each gait outcome. RESULTS: Under usual lighting, stride time variability and anterior/posterior variability of the middle-aged subjects were similar to those of the young and lower than those of the old. The lateral variability of the middle-aged subjects was higher than that of young adults under both lighting conditions. Similar to the older adults, the middle-aged participants increased their stride time variability when walking in near-darkness, but they were the only ones to exhibit increased lateral variability and anterior/posterior variability in near-darkness. Young adult gait was not affected by lighting, and concurrent performance of a cognitive task while walking did not affect gait stability in all groups under any of the lighting conditions. CONCLUSIONS: Gait stability decreases in middle age when walking in the dark. Recognition of functional deficits in middle age could promote appropriate interventions to optimize aging and reduce fall risk.

Self-Reported Questionnaire to Evaluate Functional Abilities in Middle Age: A Call for Delphi Expert Panel.

Early detection of functional decline is important for promoting optimal aging. Self-reported questionnaires can efficiently assess functional abilities. Therefore, we aimed to highlight the lack of functional ability assessment questionnaires for the middle-aged population (MA, 45-65 years) and the need to develop such a questionnaire. An online search was performed to find questionnaires quantifying self-reported performance and functional abilities at MA. We also conducted an online survey of a group of the MA population and interviewed individuals who reported age-related functional decline. Eight potentially relevant questionnaires were found, and one hundred and twenty-three individuals responded to our survey, five of whom were interviewed. None of the questionnaires were specifically designed to assess functional capacity at MA, and most of the questionnaires are likely to have a ceiling effect in assessing the MA population. Furthermore, the questionnaires do not capture functions related to dynamic balance, flexibility, and maximum strength, which are reported as difficult by our respondents, making them less appropriate for assessing function at MA. There is a need to engage a Delphi expert panel of several relevant healthcare professionals to develop a functional capacity assessment questionnaire for MA.

Role of ß-Alanine Supplementation on Cognitive Function, Mood, and Physical Function in Older Adults; Double-Blind Randomized Controlled Study.

This study investigated 10 weeks of ß-alanine (BA) supplementation on changes in cognitive function, mood, and physical performance in 100 older adults (70.6 ± 8.7 y). Participants were randomized into a BA (2.4 g·d-1) or placebo (PL) group. Testing occurred prior to supplementation (PRE), at the midpoint (MID), and at week-10 (POST). Participants completed cognitive function assessments, including the Montreal cognitive assessment (MOCA) and the Stroop pattern recognition test, at each testing session. Behavioral questionnaires [i.e., the profile of mood states, geriatric depression scale (GDS), and geriatric anxiety scale (GAS)] and physical function assessments (grip strength and timed sit-to-stand) were also conducted. No difference between groups was noted in MoCA scores (p = 0.19). However, when examining participants whose MOCA scores at PRE were at or below normal (i.e., ≤26), participants in BA experienced significant improvements in MOCA scores at MID (13.6%, p = 0.009) and POST (11.8%, p = 0.016), compared to PL. No differences were noted in mood scores, GAS, or any of the physical performance measures. A significant decrease was observed in the GDS for participants consuming BA but not in PL. Results suggested that BA supplementation can improve cognitive function in older adults whose cognitive function at baseline was at or below normal and possibly reduce depression scores.

Dynamic postural control in individuals with and without chronic ankle instability-do the modified star-excursion balance test and jump-landing stabilization have the same control mechanism?

OBJECTIVE: To examine the relationship between two dynamic postural tasks in subjects with and without chronic ankle instability (CAI). DESIGN: Cross-sectional study. SETTING: Biomechanics lab. PARTICIPANTS: Thirty subjects with CAI and 30 healthy controls. MAIN OUTCOME MEASURE: Performance of two dynamic postural control tests: the modified Star-Excursion Balance Test (mSEBT) and an assessment of a single limb jump-landing on a force plate that yielded two outcomes: time to stabilization (TTS) and the absolute average force in the mediolateral plane during the first 0.4 s after landing (AAFML). RESULTS: In the CAI group, a significant correlation was found between the mSEBT score and the AAFML (ρ = -0.54, p < 0.01), but not between the mSEBT or TTS or between the AAFML and the TTS. However, in the control group, a significant correlation was found between AAFML and the TTS (ρ = 0.43, p < 0.05), but not between the mSEBT and TTS or between the mSEBT and AAFML. CONCLUSION: These results suggest that there is no association between the different dynamic balance tasks. The different pattern of association in individuals with CAI may indicate altered central neural control. Clinicians and researchers should therefore not use a single task to assess dynamic postural control.

A matter of choice: Should students self-select exercise for their nonspecific chronic low back pain? A controlled study.

OBJECTIVES: To explore the effect of autonomy to choose exercise-therapy (ET) for nonspecific chronic low back pain (NSCLBP) on treatment adherence and clinical outcomes. PARTICIPANTS: Forty-six students were recruited from Ariel University. METHODS: Every two gender-and-age-matched students were allocated to either self-selected exercise group (SSE) or pre-determined exercise group (PDE). Subjects completed 4-weeks exercise and filled a training-log. Oswestry disability-index (ODI) and numerical pain-rating scores (NPRS) were measured, as well as exercise quality-performance. RESULTS: ODI and NPRS improved in both groups, with no between-group differences. Exercise quality-performance was also similar between groups. A trend for better exercise-adherence was found in the SSE-group (75.3% vs 65.0% adherence, p = 0.08, effect size d = 0.59). Meaningful NPRS improvement was demonstrated in 54.5% of SSE-group participants compared with 33.3% in the PDE-group. CONCLUSIONS: Autonomy may serve as a factor to enhance treatment adherence and clinical outcomes of ET for NSCLBP among students.

Functional tests as predictors of ankle instability six months after an acute lateral ankle sprain.

BACKGROUND: This study investigated whether functional tests performed in the acute-subacute phase after a lateral ankle sprain and demographic data are predictive of ongoing ankle instability. METHODS: Thirty-three subjects (mean age 23.6±3.6 years, 63.6% males) were tested within three weeks of injury using the Balance Error Scoring System (BESS) modified with a dual cognitive task, the single-leg drop landing task (SLDL) and the drop vertical jump task (DVJ). The Cumberland Ankle Instability Tool (CAIT) at six months and the occurrence of a new sprain during follow-up were used to define potential ankle instability. Associations between functional tests and demographic variables to ankle instability outcomes were measured with χ2, Mann-Whitney U Test, and logistic regressions. RESULTS: Twenty-one participants (63.6%) met the ankle instability criteria at six months from injury. Each extra point in the Modified-BESS Foam-Tandem sub-task increased the likelihood of ankle instability (OR=1.55, P=0.037). Unwillingness to perform SLDL increased the likelihood of ankle instability (OR=10.0, 95% CI: 1.1-91.9, RR=1.8, 95% CI: 1.1-2.8), as did non-dominant ankle sprain (OR=6.0, 95% CI: 1.2-29.4, RR=1.88, 95% CI: 1.03-3.4). These three outcomes explained between 33.6% to 45.9% of the variance and correctly classified 75.8% of cases (sensitivity, 85.7%; specificity, 58.3%; P=0.004). CONCLUSIONS: The variables studied may help identify individuals who have an increased potential to develop ankle instability and may be used in decision-making. Further studies should validate these findings with a larger and broader sample.

Random walk: Random number generation during backward and forward walking- the role of aging.

Deficits in executive function, visuospatial abilities, and cognitive embodiment may impair gait performance. This study aimed to investigate the effect of age on random number generation (RNG) performance during forward and backward locomotion to assess cognitive flexibility and cognitive embodiment during walking. Another aim was to examine the effect of age on the associations of RNG performance during walking with stride time variability (STV), the percentage of double support (DS%), and visuospatial abilities as measured by a spatial orientation test (SOT). Twenty old (age 68.8 ± 5.3, 65% female) and 20 young (age 25.2 ± 2.2, 45% female) adults generated random numbers during backward walking (BW) and forward walking (FW) over-ground and over a treadmill with an internal focus of attention and visual-attentive distraction; six walking conditions in total. To assess cognitive flexibility, sample entropy was calculated for each RNG sequence. The average of the first 5 numbers in each RNG task was calculated to assess the relationship between small/large numbers and movement direction. STV and DS% were recorded using inertial measurement units, and spatial orientation was measured using a computerized test. The older subjects had less flexibility in generating random numbers in three of the six walking conditions. A negative correlation between RNG flexibility and STV was found in older adults during treadmill BW with visual-attentive distraction and forward over-ground walking, whereas no correlations were demonstrated in the young group. The spatial orientation score (a higher value means a worse outcome) correlated positively with RNG flexibility in the older group under all walking conditions, suggesting that older adults with better visuospatial orientation have lower cognitive flexibility, and vice versa. There was no correlation between small/large numbers and direction of motion in either group. The correlation between RNG flexibility and STV may indicate similar executive control of verbal and gait rhythmicity in old adults. Conversely, our results suggest that cognitive flexibility and visuospatial ability may decline differently.

Can stabilization analysis following a single leg drop jump be compared between young and middle-aged adults.

We aimed to verify whether the computational approaches previously proposed to analyze stability after a single-leg drop-jump (SLDJ) could be applied to a population of middle-aged adults. Fifteen middle-aged (56.4 ± 4.6 years) and 15 young adults (26.7 ± 3.9 years) performed five SLDJs. Stabilization measurements included (1) time to stabilization (TTS) based on vertical ground reaction force (GRF) (TTSv) and a fixed stabilization threshold; (2) TTS based on medio-lateral GRF (TTSml) using five different methods to preprocess the signal and stabilization threshold; (3) early medio-lateral stabilization- the averaged absolute values of the GRF in 0.2-1.4 s post-landing; (4) late medio-lateral stabilization - the averaged absolute values of the GRF at 1 s-5 s after landing. TTSv showed longer TTS values in middle-aged participants. In addition, middle-aged adults showed greater sway in late stabilization. However, TTSml values varied considerably between calculation methods, and early stabilization showed no significant differences between groups except in the first 0.2 s after landing. The results of the current study suggest that TTS calculations are sensitive to signal and threshold selection, and to the processing method. Calculations based on a fixed threshold are more appropriate for studying dynamic postural stability in middle age. With appropriate method selection, a decreased stabilizing performance can be demonstrated in middle-aged adults compared to young adults.

Reliability and Validity of Patient-Reported Outcome Measures for Ankle Instability in Hebrew.

BACKGROUND The International Ankle Consortium has recommended several instruments for assessing and diagnosing chronic ankle instability. These include the Ankle Instability Instrument (AII), Cumberland Ankle Instability Tool (CAIT), Identification of Functional Ankle Instability (IdFAI), and Foot and Ankle Ability Measure (FAAM). This study aimed to translate, culturally adapt, and assess the reliability, validity, discriminative power, and classification agreement of the Hebrew online versions of the AII, CAIT, IdFAI, and FAAM. MATERIAL AND METHODS After translation and cross-cultural adaptation of the questionnaires, we recruited 87 participants with self-reported ankle disorders to evaluate the psychometric properties of the questionnaires. To evaluate each questionnaire's discriminative power, we recruited 75 healthy participants. Reliability was assessed by calculating internal consistency (Cronbach's alphas) and test-retest intraclass correlation coefficients. Convergent and divergent validity were assessed by Spearman's correlation between each instrument and the Short-Form-12 (SF-12) score for physical and mental components, respectively. RESULTS All instruments had acceptable internal consistency (alpha>0.7) and good test-retest reliability (ICC2,1>0.8), except for the IdFAI (ICC2,1=0.73). All instruments had moderate convergent validity (ρ>0.4 with SF-12 physical component) except for AII (r=0.36). No instrument was correlated with the SF-12 mental component score (good divergent validity, ρ<0.3). All instruments had excellent discriminative power (area under the receiver operator characteristic curve >0.9). Strong correlations were found between all instruments. CONCLUSIONS The Hebrew online versions of the AII, CAIT, IdFAI, and FAAM are reliable and valid and can be used in research or clinical settings.

The Immediate Carryover Effects of Peroneal Functional Electrical Stimulation Differ between People with and without Chronic Ankle Instability.

Chronic ankle instability (CAI) is a common condition that may develop after an ankle sprain. Compared with healthy individuals, those with CAI demonstrate excessive ankle inversion and increased peroneal electromyography (EMG) activity throughout the stance phase of gait, which may put them at greater risk for re-injury. Functional electrical stimulation (FES) of targeted muscles may provide benefits as a treatment modality to stimulate immediate adaptation of the neuromuscular system. The present study investigated the effect of a single, 10 min peroneal FES session on ankle kinematics and peroneal EMG activity in individuals with (n = 24) or without (n = 24) CAI. There were no significant differences in ankle kinematics between the groups before the intervention. However, after the intervention, healthy controls demonstrated significantly less ankle inversion between 0-9% (p = 0.009) and 82-87% (p = 0.011) of the stance phase. Furthermore, a significant within-group difference was observed only in the control group, demonstrating increased ankle eversion between 0-7% (p = 0.011) and 67-81% (p = 0.006) of the stance phase after the intervention. Peroneal EMG activity did not differ between groups or measurements. These findings, which demonstrate that peroneal FES can induce ankle kinematics adaptations during gait, can help to develop future interventions for people with CAI.

Cross-Cultural Adaptation, Reliability, and Validity of a Hebrew Version of the Physiotherapist Self-Efficacy Questionnaire Adjusted to Low Back Pain Treatment.

BACKGROUND: Clinician self-efficacy may be an important factor in the success of treatment for low back pain (LBP), which has unique clinical features and a high prevalence rate. Therefore, it is important to assess clinicians' self-efficacy in this particular condition. The Physiotherapist Self-Efficacy (PSE) questionnaire was designed to measure self-efficacy of physiotherapy students. OBJECTIVES: To translate and trans-culturally adapt the PSE into Hebrew, to adjust the questionnaire to assess clinicians' self-efficacy in the treatment of LBP, and to assess the construct validity and reliability of the PSE in the Hebrew version. METHODS: After adjustment for LBP and cross-cultural adaptation, test-retest reliability was assessed with 140 physiotherapists. The analyses used included exploratory factor analysis for structural validity, Cronbach's alpha for internal consistency, and intraclass correlation coefficients (ICC) for test-retest reliability. RESULTS: Factor analysis revealed a unidimensional structure with an acceptable model fit. The PSE translated into Hebrew exhibited a very high internal consistency (α = 0.93) and excellent test-retest reliability (ICC = 0.94). The standard error of measurement (SEM) and minimal detectable change (MDC) were 1.75 and 4.85, respectively. CONCLUSIONS: The Hebrew-translated PSE showed adequate validity and excellent reliability, indicating its suitability to measure clinician self-efficacy in treating patients with LBP.

Backward Running on a Negative Slope as a Treatment for Achilles Tendinopathy in Runners: A Feasibility Pilot Study.

CONTEXT: Achilles tendinopathy (AT) is a common musculoskeletal injury among runners. Eccentric exercises are considered first-line treatment. However, during the early stages of rehabilitation, patients are usually instructed to stop running. Backward running (BR) on a negative slope provides a similar eccentric load while enabling ongoing physical activity; thus, it may be suggested as an alternative treatment. OBJECTIVES: To determine the feasibility of a BR program as a treatment option for AT in runners. DESIGN: Prospective, single-arm feasibility study. SETTING: Outpatient clinic. PATIENTS: Recreational runners diagnosed with AT and referred to the Meuhedet Health Services Physical Therapy Clinic in Jerusalem, Israel, from September 2019 to February 2020. INTERVENTION: The patients completed a 5-week (9 sessions) rehabilitation program of supervised BR on a negatively inclined treadmill. MAIN OUTCOME MEASURES: Compliance with the program was evaluated by calculating the percentage of patients who completed the full protocol with no adverse events. Personal running-related goals were set before the program and were assessed following rehabilitation using the goal attainment scaling method. Forward-running time until the onset of relevant Achilles tendon pain, and the Victorian Institute of Sports Assessment Scale-Achilles were measured at baseline (T0), before treatment session 6 (T1), and after the last session (T2). RESULTS: Among the 15 patients recruited, 14 (93%), average age 48.8 (10.4) years (86% males), completed the full protocol with no adverse events. Almost all participants (85.7%) achieved their running-related functional goals. Postintervention, the median forward-running time increased from 52.5 (92.5) to 900 (522.5) seconds (P = .008, effect size = .858), and the median Victorian Institute of Sports Assessment Scale-Achilles score improved by 28 points (P = .003, effect size = .881). CONCLUSIONS: BR on a negative slope may be a feasible treatment method for runners suffering from AT. Future randomized control trials are required to further validate the efficacy of this method.

Does Acute Exercise Stress Affect Postural Stability and Cognitive Function in Subjects with Chronic Ankle Instability?

Altered postural control in people with chronic ankle instability (CAI) may be attributed to deficits that are associated with neurocognitive function. Acute training is another factor that may negatively affect postural control and increase the risk of ankle sprain. The purpose of this investigation was to determine the effect of acute exercise on postural stability and cognitive function among patients with CAI. Fifteen patients with CAI (aged 21.5 ± 2.0 years) and 15 healthy controls (aged 20.3 ± 1.7 years) completed a single-limb stance postural control test and a battery of computer-based cognitive tests before and after acute exercise. The overall stability index (OSI) was used as a measure of postural stability. The cognitive domains tested were global cognitive score, executive function, attention, visual-spatial perception, information processing, and fine motor control. Subjects in both groups had similar OSI scores, with a trend for reduced stability in the CAI after the exercise protocol (p = 0.053). There were no differences between the groups in all cognitive domains before or after exercise. Following exercise, the domains of overall cognitive score, visual-spatial perception, and information processing speed improved in both groups (p = 0.003, p = 0.033, p = 0.001; respectively). These findings should be considered with caution due to the heterogeneity of the CAI population.

The Relationship Between Fear Avoidance Beliefs, Muscle Strength, and Short-Term Disability After Surgical Repair of Shoulder Instability.

CONTEXT: Arthroscopic surgical repair of the shoulder is recommended when conservative treatment for shoulder instability (SI) fails. However, many patients undergoing this procedure do not return to same level of activity. Psychological factors and muscle strength have been shown to be associated with postoperative outcomes in other musculoskeletal conditions. OBJECTIVE: To investigate the association between fear avoidance, muscle strength, and short-term function in patients after surgical SI repair. METHODS: Twenty-five male patients who underwent shoulder surgery following at least one event of SI were included in this study. Evaluations of fear avoidance related to physical activity and disability were performed at baseline (during the first encounter with the physical therapist) and 7 to 8 weeks postsurgery. Fear avoidance beliefs were assessed using the Fear Avoidance Beliefs Questionnaire. Disability was assessed using the Disabilities of Arm, Shoulder, and Hand questionnaire and the Western Ontario SI index. The follow-up evaluation (weeks 7-8) included measurement of maximal isometric strength of the internal and external rotators. Nonparametric Kendall tau was used to determine the correlations between baseline fear avoidance, muscle strength, and disability at follow-up. RESULTS: Disabilities of Arm, Shoulder, and Hand questionnaire at follow-up was significantly correlated with baseline Disabilities of Arm, Shoulder, and Hand questionnaire (τ = .520, P < .001), baseline fear avoidance (τ = .399, P = .008), and both internal rotator (τ = -.400, P = .005) and external rotator strength (τ = -.353, P = .014). Western Ontario SI index at follow-up was moderately correlated with baseline Western Ontario SI index (τ = .387, P = .007), internal rotator (τ = -.427, P = .003), and external rotator (τ = -.307, P = .032), but not with baseline Fear Avoidance Beliefs Questionnaire (τ = .22, P = .145). CONCLUSIONS: The results indicate a possible association between fear avoidance beliefs and short-term disability. Further studies are warranted to better explore and understand these relationships.

Agreement of Gait Events Detection during Treadmill Backward Walking by Kinematic Data and Inertial Motion Units.

Backward walking (BW) is being increasingly used in neurologic and orthopedic rehabilitation as well as in sports to promote balance control as it provides a unique challenge to the sensorimotor control system. The identification of initial foot contact (IC) and terminal foot contact (TC) events is crucial for gait analysis. Data of optical motion capture (OMC) kinematics and inertial motion units (IMUs) are commonly used to detect gait events during forward walking (FW). However, the agreement between such methods during BW has not been investigated. In this study, the OMC kinematics and inertial data of 10 healthy young adults were recorded during BW and FW on a treadmill at different speeds. Gait events were measured using both kinematics and inertial data and then evaluated for agreement. Excellent reliability (Interclass Correlation > 0.9) was achieved for the identification of both IC and TC. The absolute differences between methods during BW were 18.5 ± 18.3 and 20.4 ± 15.2 ms for IC and TC, respectively, compared to 9.1 ± 9.6 and 10.0 ± 14.9 for IC and TC, respectively, during FW. The high levels of agreement between methods indicate that both may be used for some applications of BW gait analysis.

Individuals with back and neck pain on medical forums: What do they mention? What do they fear?

BACKGROUND: The use of online medical forums is on the rise globally. Data scraping is a method of extracting website content using an automated computer program. We scraped users' questions regarding back and neck pain (BNP) from popular Israeli online medical forums. We aimed to identify the sort of questions being asked about BNP, and to analyse explicit themes that characterize their questions. METHODS: Six leading Israeli BNP forums were identified. In phase 1, Python scripts scraped 12,418 questions into a data set. In phase 2 - five themes were identified: Surgery (n = 2,957); health care professions (n = 2,361); Sports (n = 2,304); drugs (n = 1,419) and interpretation of imaging (n = 845). Phase 3 - included the categorization of explicit fear-related words by the authors. Phase 4 - analysis of explicit fear-related themes yielded 402 questions. RESULTS: Gender was identified for 394 users, and age was identified for 181 users. A total of 248 users (61.6%) were women and 146 men (36.3%). Mean age 36.3 ± 16.15 for women and 35.5 ± 16.1 for men. The most commonly expressed fears were related to: invasive procedures, 30.9% (131 questions); fear of serious condition or misdiagnosis, 17.0% (72 questions); General concerns, 13.7% (58 questions); fear of worsening or relapse, 12.3% (52 questions); adverse effects of oral drugs or radiation, 10.8% (46 questions) and concerns related to lifestyle, 9.7% (41 questions). CONCLUSIONS: Web scraping is a feasible strategy with which to explore medical forums and the above-mentioned themes, all of which are of potential clinical significance. SIGNIFICANCE: Using automated algorithms, a total of 12,369 questions from online back and neck medical forums were scraped and analysed. Secondary analysis categorized fear-related themes that were mentioned by users. Identifying and addressing patients' fear has potential to improve communication and therapeutic outcome. For example, questions regarding surgery were typically asked after the option was mentioned by a physician. This insight should encourage physicians to devote extra time explaining the possible implications of surgery, should they consider it as an option.

Spatiotemporal gait characteristics and ankle kinematics of backward walking in people with chronic ankle instability.

Backward walking offers a unique challenge to balance and ambulation. This study investigated the characteristics of spatiotemporal gait factors and ankle kinematics during backward walking in people with chronic ankle instability. Sixteen subjects with chronic ankle instability and 16 able-bodied controls walked on a treadmill at their self-selected speed under backward and forward walking conditions. Gait speed, cadence, double limb support percentage, stride time variability, and three-dimensional ankle kinematics were compared between groups and conditions. During backward walking, both groups had significantly slower gait speed, lower cadence, and greater stride time variability. In addition, under backward walking condition, subjects in both groups demonstrated significant sagittal and frontal kinematic alternations, such as greater dorsiflexion and inversion following initial contact (0-27.7%, 0-25.0% of gait cycle respectively, p < 0.001). However, there were no significant differences between groups in any of the measured outcomes. This indicates that subjects with chronic ankle instability adapt to self-selected speed backward walking similarly to healthy controls. Assessments with more challenging tasks, such as backward walking with dual task and backward walking at fast speed, may be more appropriate for testing gait impairments related to chronic ankle instability.