Association between Chronic Pain and Sarcopenia in Greek Community-Dwelling Older Adults: A Cross-Sectional Study.

(1) Background: Sarcopenia and chronic pain are prevalent syndromes among older adults that negatively affect their quality of life. The present study aimed to investigate the relationship between chronic pain and sarcopenia among Greek community-dwelling older adults. (2) Methods: Older adults >60 years of age were enrolled in this descriptive, cross-sectional study. Sarcopenia status was assessed according to the EWGSOP2 2019 algorithm. This assessment included the evaluation of muscle strength, body composition and gait speed. Pain location and pain characteristics were assessed using a self-reported questionnaire. Pain severity was assessed via the visual analog scale. The participants were also asked to fill out the SARC-F, the Hospital Anxiety and Depression Scale (HADS) and the Falls Efficacy Scale-International (FES-I) questionnaire. (3) Results: This study included 314 participants with a mean age of 71.3 ± 7.4 years. The prevalence of sarcopenia was 19.4 (n = 61), and 44.26% of the sarcopenic participants recorded chronic pain. Chronic pain was associated with sarcopenia, comorbidities, the number of drugs and HADS. (4) Conclusions: The results demonstrated a high percentage of chronic pain in the sarcopenic population. The results also highlight the importance of the detection of chronic pain in older patients with sarcopenia in order to develop effective preventive and therapeutic strategies.

The Feasibilty of the Motor Control Home Ergonomics Elderlies' Prevention of Falls (McHeELP) Programme in Patients with Sarcopenia: A Pilot Study.

Objectives: The objective of this pilot study was to investigate the feasibility of a three month 'Motor control Home ergonomics Elderlies' Prevention of falls' (McHeELP) programme on muscle mass, muscle strength, functionality, balance and fear of falling among older adults with sarcopenia. Methods: A feasibility study of the McHeELP programme was performed in patients with sarcopenia. Primary outcome measures included number of participants; number of participants that showed engagement with the programme; adherence rates; data loss in questionnaires and secondary outcome measures; any adverse events, related or not to the intervention programme. All participants received a home-based motor control exercise programme combined with an ergonomic home modification for 12 weeks. Secondary outcome measures included Hand Grip Strength, Bioimpendance Analysis, Muscle Mass, Functionality and Fear of Falling. Results: Twelve participants, (74.9±5 years), completed the pilot study. Significant differences were recorded before and after the programme on participants' functionality (p < 0.001), balance (p < 0.05) and fear of falling (p < 0.001). Conclusions: The present study revealed that the McHeELP programme is fesasible and that it is possible to implement the programme in clinical practice. The McHeELP programme positively affects functionality, balance and fear of falling. Thus, it seems feasible to conduct a full-scale randomised controlled trial.

Corrigendum: Quality of life and quality of education among physiotherapy students in Europe.

[This corrects the article DOI: 10.3389/fmed.2024.1344028.].

Validity and Reliability of the Greek Version of Pittsburgh Sleep Quality Index in Chronic Non-Specific Low Back Pain Patients.

The purpose of this study was to investigate psychometric properties of the Greek translation of Pittsburgh Sleep Quality Index (GR-PSQI) in a Greek chronic non-specific low back pain (CNSLBP) sample, thus, providing insight on its clarity and acceptability as a widely used sleep assessment tool in clinical practice. Asymptomatic volunteers (n = 73) and CNSLBP volunteers (n = 47), participated in the study. For the assessment of construct validity, the known-groups method was used. Thus, all the participants (asymptomatic and CNSLBP) completed the GR-PSQI. For the assessment of concurrent validity, the CNSLBP participants additionally completed the following validated questionnaires for depression, insomnia and sleep quality: Beck Depression Inventory Questionnaire (BDI), Insomnia Severity Index (ISI), and Sleep Quality Numeric Rating Scale (SQNRS). For the assessment of test-retest reliability, the CNSLBP participants completed the GR-PSQI a second time, one week after the first time. The results showed excellent test-retest reliability (ICC = 0.969, SEM = 0.90, SDD = 2.49%) and internal consistency (Cronbach α = 0.985), moderate to good concurrent validity (from r = 0.556 to r = 0.860) among PSQI, BDI, SQNRS, and ISI, as well as excellent construct validity (p = 0.000) between the two groups. The Greek translation of PSQI could be a valuable tool for Greek healthcare professionals in both clinical and research environments.

Quality of life and quality of education among physiotherapy students in Europe.

Background: The study of physiotherapy is challenging and can affect the students' well-being and quality of life. The aim of this study was to describe and compare factors that could affect well-being among students across Europe. Methods: In this descriptive cross-sectional study using an online questionnaire survey, students of bachelor's physiotherapy programs from 23 European faculties, from 8 countries, were interviewed on mental health and stress burden, sleep quality, dietary habits, and physical activity. Results: Although 75% of students rated their quality of life positively and 47% were satisfied with their mental health, 65% showed higher levels of stress and 51% described impaired sleep quality. The minimum physical activity of 150 min weekly was described by 79% of students, within which 67% engaged in strengthening twice a week. Students with a higher stress load/worse psychological health also showed worse sleep quality and lower amount of physical activity, women were significantly worse off. In terms of physical activity and sleep quality, students from Finland and Kosovo achieved the best results, while students from Italy, Greece, and Portugal achieved the worst. Students from Italy indicated the greatest dissatisfaction with the organisation of the study system and communication with teachers, while in Kosovo students rated the communication and study organisation the highest. All students had a problem with adhering to nutritional habits. Students from Italy and Spain, with the lowest body mass indexes and weight averages, were closest to the nutrition recommendations. Conclusion: We demonstrated that physiotherapy students are burdened with stress, suffer from sleep disorders, and do not follow the recommendations regarding nutrition nor physical activity. There are significant differences between universities and countries in some aspects.

Diastasis Recti Abdominis Rehabilitation in the Postpartum Period: A Scoping Review of Current Clinical Practice.

INTRODUCTION AND HYPOTHESIS: Despite exercise being the standard approach to diastasis recti abdominis (DRA) rehabilitation, there is no consensus on the most effective exercise routine and adjunct modalities for reducing DRA and improving functional parameters. The present study is aimed at investigating evidence for DRA rehabilitation in postpartum women, as well as knowledge gaps and areas for future research. METHODS: For this scoping review a systematic search was conducted in MEDLINE, AMED, CINAHL, Embase, ScienceDirect, Scopus, and PEDro up to November 2022. Selection criteria included studies investigating exercise therapy interventions both with and without adjunct modalities for postpartum DRA. Sample characteristics, diagnostic criteria, program design, and outcome measures were recorded. Critical appraisal of clinical trials was performed using PEDro classification. RESULTS: Twenty-eight studies were included: 14 clinical trials, 3 case series, and 11 observational studies. DRA exercises that focused on deep and superficial muscles, pelvic floor muscles, respiratory maneuvers, functional exercises, or alternative interventions (yoga, suspension training, hypopressive exercise) and adjunct modalities showed promising results in reducing the inter-recti distance and related dysfunction. However, there was great variability in diagnostic criteria and methods, DRA severity, time post-birth, and exercise program design. CONCLUSIONS: Reviewed studies provide valuable insights into exercise therapy, but it is important to recognize their limitations, as variability in diagnostic criteria, sample characteristics, and exercise program design hinder the generalizability of the findings. Further high-quality research is needed to strengthen the evidence in this area and provide reliable recommendations for clinical practice.

Reliability and clinical applicability of lower limp strength using an enhanced paper grip strength.

The enhanced paper grip test (EGPT) quantitatively assesses lower limb strength. EGPT assesses the hallux grip force by reacting a pulling force derived from a card, being positioned underneath the participant's hallux. This study aimed to investigate the repeatability and clinical applicability of the EPGT for assessing foot muscle strength. EPGT force was measured using a dynamometer. The reliability of the measurement of EPGT force was assessed by having two examiners performing the test on the same group of healthy adults. Clinical applicability was assessed in community-dwelling adults of both genders. EPGT force was recorded for both feet using the same standardised protocol for all participants. Regarding reliability, 20 healthy adults aged 23.04±5.5 years participated in the present study. The EGPT demonstrated good to excellent test-retest (ICC1,2 0.8 to 0.86) and interrater reliability (ICC1,2 0.82 to 0.88). A convenience sample of 15 community-dwelling adults (71.6±7.8 years, 68.5% women) was recruited for clinical applicability testing. All participants performed the test with mean score 15±5.7 N. EPGT is a reliable measurement of the hallux grip force strength and can be used for clinical and research purposes.

Manual Therapy and Exercise Have Similar Outcomes to Corticosteroid Injections in the Management of Patients With Subacromial Pain Syndrome: A Systematic Review and Meta-Analysis.

Subacromial pain syndrome (SAPS) is the most frequent diagnosis in patients with shoulder pain presenting with persistent pain and significant functional decline. Although exercise and manual therapy (EMT) and corticosteroid injections provide first-line treatment options, evidence for the best management of SAPS remains inconclusive. We aimed to evaluate the effectiveness of EMT compared with corticosteroid injections on disability, recovery rates, and pain in patients with SAPS through a systematic review and meta-analysis approach. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), ScienceDirect, the Cochrane Library, and grey literature databases were searched. Only randomized controlled trials evaluating the effectiveness of EMT alone or as an additive intervention compared to corticosteroid injections were included. Methodological quality was evaluated with the PEDro score and certainty of evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. In total, 8 trials with 946 patients were included. EMT presented no difference in disability compared with corticosteroid injections at very short- (standardized mean difference {SMD}: 0.19; 95%CI: -0.20, 0.58), short- (SMD: -0.16; 95%CI: -0.58, 0.25), mid- (SMD: -0.14; 95%CI: -0.44, 0.16), and long-term (SMD: 0.00; 95%CI: -0.25, 0.25) follow-up. No difference was found between the comparators in self-perceived recovery at very short- (risk ratio: 0.93; 95%CI: 0.71, 1.21) and mid- (risk ratio: 0.98; 95%CI: 0.90, 1.07) follow-up and in pain rating at very short- (SMD: -0.18; 95%CI: -0.73, 0.38), short- (SMD: 0.05; 95%CI: -0.26, 0.37), and long-term (SMD: 0.04; 95%CI: -0.26, 0.34) follow-ups. The addition of corticosteroid injections to EMT provided no better results in shoulder disability compared with EMT (SMD: 0.45; 95%CI: -0.47, 1.37) or corticosteroid injections alone (MD: 2.70; 95%CI: -7.70, 13.10) in the mid-term. Based on very low to moderate certainty of evidence, EMT has similar effects to corticosteroid injections on improving all outcomes in patients with SAPS at all follow-up periods. Based on low certainty of evidence the combination of both interventions does not change the treatment outcome compared with each intervention alone.

Hard Flaccid Syndrome: A Biopsychosocial Management Approach with Emphasis on Pain Management, Exercise Therapy and Education.

Hard flaccid syndrome (HFS) is a rather rare, acquired clinical entity affecting young men's well-being, sexual and social life. HFS presents with a cluster of symptoms including penile-specific somatosensory disturbances, a semi-rigid penis at the flaccid state without any stimulation or desire, erectile dysfunction, perineal and/or penile pain, associated urinary symptoms, emotional distress as well as other psychosocial and stress-related manifestations. Although its pathophysiology is still not well understood, initial penile trauma causing minor nerve and vascular disturbances to the penis and associated pelvic floor musculature is suggested to trigger the syndrome. Despite the scarcity of research on HFS, the present report describes a case of a young male clinically diagnosed with HFS, who benefited from a biopsychosocial management strategy, focusing on pain management, therapeutic exercise approaches, such as pelvic floor exercise re-education, graded exposure to activity as well as education on lifestyle and stress-related modifications. This holistic management approach has been clinically reasoned in this case report, and the need for more evidence-based studies developing diagnosing criteria, elaborating pathophysiological mechanisms and testing the efficiency of different therapeutic options is highlighted.

Pediatric Balance Scale: Translation and Cross-Cultural Adaptation Into Greek.

PURPOSE: Cross-cultural adaptation of the Pediatric Balance Scale (PBS) into Greek. METHODS: The PBS was forward-back translated and evaluated for content equivalence. The Greek PBS (PBSGR) was administered to children with movement impairments by 2 pediatric physical therapists. The scale was readministered to the same children after 3 weeks (test-retest reliability) and to children with typical development for discriminant validity. The 1-minute walk test was administered to test the scale's concurrent validity. RESULTS: Psychometric testing was completed on 26 children with movement impairments. The scale had excellent interrater and test-retest reliability and internal consistency. Moderate correlation was observed between PBSGR and 1-minute walk. Children with movement impairment had significantly lower PBSGR scores than children with typical development. CONCLUSIONS: Acceptable reliability, concurrent validity, and discriminant validity were observed for the PBSGR.

Attitudes towards people with disabilities across different healthcare undergraduate students: A cluster analysis approach.

BACKGROUND AND PURPOSE: Negative attitudes towards disability amongst healthcare professionals endanger social inclusion of people with disabilities (PwD). This study aimed to investigate the attitude of undergraduate healthcare students of various disciplines towards PwD, including specific aspects of their attitude. METHODS: We assessed the attitudes of university students, including physiotherapy, speech therapy, nursing, social work and medical students, through the Greek Interaction with Disabled Person Scale (IDPS) in a survey. Data were analysed using a two-step clustering technique. RESULTS: Four hundred-eighty undergraduate healthcare students (21.4 ± 5.3 years-old; 135 males, 345 females) were recruited. Two-step cluster analysis identified three homogenous subgroups labelled Least positive attitude (42.3%), Moderately positive attitude (26.9%), and Most positive attitude (30.8%) groups. Τhe main differences in healthcare students' attitudes between the three distinct groups appeared to be in feelings of sympathy, fear and susceptibility towards disability, suggesting that these aspects of attitude needed to be primarily addressed. Results also revealed that females, being in higher semester/year of studies, having completed a clinical module with PwD and having frequent contact with PwD were related to more positive attitudes. CONCLUSION: Taking into account that the majority of the healthcare students' sample yielded least and moderately positive attitudes, towards PwD, further actions should be taken for promoting more positive attitudes towards disability. A social model in teaching to increase student's awareness of PwD and skills to work with these people, having PwD themselves teaching such modules, focussing on positive experiences and reminding the students of the benefits of having positive attitudes towards PwD, as well as promoting ways to increase the contact of healthcare students with PwD (such as teaching in co-operation with organisations of PwD or finding alternative clinical placements with PwD), can be beneficial in promoting more positive attitudes towards disability.

Cross-cultural adaptation of the Greek version of post-COVID-19 Functional Status Scale: assessment of non-hospitalised post-COVID-19 survivors.

The objective of the study was to translate and validate into the Greek language and setting the Post-COVID-19 Functional Status (PCFS) scale. Greeks aged ≥18 years who recovered form COVID-19 (≥ 14 days since diagnosis), were invited to participate. This cross-sectional study followed international guidelines regarding the translation process (forward and backward) and the evaluation of the PCFS. Reliability was assessed by test-retest analyses using the intraclass correlation coefficient (ICC) and 95%CI. For the validation, all participants completed the European Quality of Life-5 (EQ-5D-5L), and the Hospital Anxiety and Depression Scale (HADS) questionnaire. 82 adults (49 females, aged 40.2 ± 6.1) participated in the study. The Greek version of the PCFS demonstrated excellent test-retest reliability, with an ICC of 0.9 (95% CI 0.90- 0.95). The Cronbach's alpha value was 0.9, indicating good internal consistency. The PCFS score was strongly correlated with the EQ-5D-5L (r=0.6, p≤0.001) and weakly correlated with the HADS (r=0.41;p≤0.001). The Greek version of the PCFS was successfully adapted into Greek and is recommended to be used across clinical settings and research.

The effectiveness of blood flow restriction training in cardiovascular disease patients: A scoping review.

Therapeutic exercise is integral to the comprehensive rehabilitation of patients with cardiovascular disease and, as such, is recommended by the American Heart Association as a valuable and effective treatment method for such patients. The type of exercise applied to these patients is aerobic and resistance exercise with mild intensities and loads to avoid overloading the cardiovascular system. Blood flow restriction exercise is a novel exercise modality in clinical settings that has in many studies a similar effect on muscle hypertrophy, strength, and cardiovascular response to training at a 70% strength level without blood flow restriction. Since this exercise mode does not require high-intensity loads, it can be a safe method for improving muscle strength, cardiovascular endurance, and functionality in cardiovascular patients. Given that, the objective of this review is to assess and summarize existing evidence for the use of blood flow restriction in cardiovascular patients. A scoping review of existing clinical trials was conducted. Eleven studies were examined that suggested the use of blood flow restrictions in cardiovascular patients to achieve improvements in muscle strength, functionality, and cardiovascular parameters such as blood pressure decrease.

Manual Therapy versus Localisation (Tactile, Sensory Training) in Patients with Non-Specific Neck Pain: A Randomised Clinical Pilot Trial.

Manual therapy (MT) techniques typically incorporate localised touch on the skin with the application of specific kinetic forces. The contribution of localised touch to the effectiveness of MT techniques has not been evaluated. This study investigated the immediate effects of MT versus localisation training (LT) on pain intensity and range of movement (ROM) for neck pain. In this single-blind randomised controlled trial thirty eligible neck pain volunteers (23 females and 7 males), aged 28.63 ± 12.49 years, were randomly allocated to MT or to a motionless (LT) group. A single three-minute treatment session was delivered to each group's cervico-thoracic area. The LT involved tactile sensory stimulation applied randomly to one out of a nine-block grid. Subjects were asked to identify the number of the square being touched, reflecting a different location on the region of skin. MT involved three-minute anteroposterior (AP) glides and sustained natural apophyseal glides (SNAG) techniques. Pre- and post-intervention pain intensity were assessed using a pressure pain threshold (PPT) algometer and the numeric pain rating scale (NPRS). Neck ROM was recorded with a bubble inclinometer. Improvements in ROM and self-reported pain were recorded in both groups (p < 0.001) without differences in NPRS, ROM or PPT scores between groups (p > 0.05). Tactile sensory training (localisation) was as effective as MT in reducing neck pain, suggesting a component of MT's analgesic effect to be related with the element of localised touch rather than the forces induced during passive movements.

Investigation of Real-Time Diagnostic Ultrasound as a Means of Biofeedback Training in Transversus Abdominus Re-Education of Patients with Non-Specific Low Back Pain: A Prospective Randomized Controlled Pilot Study.

Background: It is believed that ultrasound-guided imaging of activation/contraction of the deep abdominal muscles (such as transervsus abdominis) is useful for assisting deep muscle re-education, which is often dysfunctional in non-specific low back pain (NSLBP). Thus, this pilot study aimed to evaluate the use of real-time ultrasound (US) as a feedback device for transverse abdominis (TrA) activation/contraction during an exercise program in chronic NSLBP patients. Methods: Twenty-three chronic NSLBP patients were recruited and randomly assigned to a US-guided (n = 12, 8 women, 47.6 ± 2.55 years) or control group (n = 11, 9 women, 46.9 ± 4.29 years). The same motor control-based exercise program was applied to both groups. All patients received physiotherapy twice per week for seven weeks. Outcome measures, tested at baseline and post-intervention, included Numeric Pain Rating Scale, TrA activation level (measured through a pressure biofeedback unit-based developed protocol), seven established motor control tests, Roland-Morris Disability Questionnaire and Hospital Anxiety and Depression Scale. Results: For each group, all outcome variables yielded statistical differences post-intervention (p < 0.05), indicating significant improvements. However, there were no significant group x time interactions for any of the outcomes (p > 0.05), thus, indicating no superiority of the US-guided group over the control. Conclusions: The addition of US as a visual feedback device for TrA re-education during a motor control exercise program was not proven superior to traditional physiotherapy.

Psychometric properties of quantitative sensory testing in healthy and patients with shoulder pain: A systematic review.

Quantitative Sensory Testing (QST) is a psychophysical battery of various tests developed to quantify the subjects' self-reported sensory experience. Although the use of QST is valuable for the clinical assessment of pain, standard evaluation protocols have not yet been established. This systematic review aimed to investigate the level of evidence for the psychometric properties of QST in healthy and patients with shoulder pain. Eight databases were searched for peer-reviewed studies published until August 2021. The methodological quality of studies was evaluated using the COSMIN checklist. Twelve studies were included for qualitative synthesis, which included three different tests (Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM) and Temporal Summation (TS)). As the body of evidence consisted of studies of low methodological quality, the psychometric properties of PPT, CPM, and TS in healthy and patients with shoulder pain were classified as unknown. Although there is a risk that the conclusions may be 'superficial' in nature, the reliability seems to be nearly excellent for the PPT, however, the protocols' variation and the low methodological quality of the studies do not allow for clear conclusions. Further studies are required for the CPM and TS in patients with shoulder pain.

Risk of sarcopenia, fear of COVID-19, anxiety, depression and physical activity levels: Associations across patients on hemodialysis within Greece.

Objectives: The purpose of this multicenter cross-sectional study was to investigate the association between SARC-F, fear of COVID 19, anxiety, depression and physical activity in patients undergoing hemodialysis. Methods: This study was conducted in 3 hemodialysis centers in Greece during the period of the COVID-19 pandemic. Sarcopenia risk was assessed using the Greek version of SARC-F (≥4). Demographic and medical history were collected from the patient's medical charts. The participants were also asked to fill the Fear of COVID-19 Scale (FCV-19S), the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ) questionnaire. Results: A hundred and thirty-two (132) patients on hemodialysis (92 men, 70.75±13.14 years) were enrolled. Sarcopenia risk (utilizing the SARC-F) was found in 41.7% of patients on hemodialysis. The average duration of hemodialysis was 3.94±4.58 years. The mean score values for SARC-F, FCV-19S and HADS were 3.9±2.57, 21.08±5.32, and 15.02±6.69, respectively. The majority of patients were physically inactive. The SARC-F scores were strongly associated with age (r=56; p<0.001), HADS (r=0.55; p<0.001), levels of physical activity (r=0.5; p<0.001), but not with FCV-19S (r=0.27; p<0.001). Conclusion: A statistically significant relationship was recorded between sarcopenia risk and age, anxiety/depression and levels of physical inactivity in patients on hemodialysis. Future studies are necessary in order to evaluate the association of specific characteristics of patients.

Pelvic floor muscle training: Novel versus traditional remote rehabilitation methods. A systematic review and meta-analysis on their effectiveness for women with urinary incontinence.

OBJECTIVE: To investigate the effectiveness of supervised remote rehabilitation programs comprising novel methods of pelvic floor muscle (PFM) training for women with urinary incontinence (UI). DESIGN: A systematic review and meta-analysis including randomized controlled trials (RCTs), involving novel supervised PFM rehabilitation programs as intervention groups (e.g., mobile applications programs, web-based programs, vaginal devices) versus more traditional PFM exercise groups (acting as control); both sets of groups being offered remotely. METHODS: Data have been searched and retrieved from the electronic databases of Medline, PUBMED, and PEDro using relevant key words and MeSH terms. All included study data were handled as reported in the Cochrane Handbook for Systematic Reviews of Interventions and the evaluation of their quality was undertaken utilizing the Cochrane risk-of-bias tool 2 (RoB2) for RCTs. The included RCTs, involved adult women with stress UI (SUI) or mixed urinary incontinence, where SUI were the most predominant symptoms. Exclusion criteria involved pregnant women or up to 6-month postpartum, systemic diseases and malignancies, major gynecological surgeries or gynecological problems, neurological dysfunction or mental impairments. The searched outcomes included subjective and objective improvements of SUI and exercise adherence in PFM exercises. Meta-analysis was conducted and included studies pulled by the same outcome measure. RESULTS: The systematic review included 8 RCTs with 977 participants. Novel rehabilitation programs included mobile applications (1 study), web-based programs (1 study) and vaginal devices (6 studies) versus more traditional remote PFM training, involving home-based PFM exercise programs (8 studies). Estimated quality with Cochrane's RoB2, presented the 80% of the included studies as "some concerns" and the 20% as "high risk." Meta-analysis included 3 studies with no heterogeneity (I2 = 0) across them. Weak-evidenced results presented home PFM training equally effective with novel PFM training methods (mean difference: 0.13, 95% confidence interval: -0.47, 0.73), with small total effect size (0.43). CONCLUSIONS: Novel PFM rehabilitation programs presented as effective (but not superior) to traditional ones in women with SUI, both offered remotely. However, individual parameters of novel remote rehabilitation including supervision by the health professional, remains in question and larger RCTs are required. Connection between devices and applications in combination with real-time synchronous communication between patient and clinician during treatment is challenged for further research across novel rehabilitation programs.

Cold-Water Immersion and Sports Massage Can Improve Pain Sensation but Not Functionality in Athletes with Delayed Onset Muscle Soreness.

This study aimed to investigate the effects of cold-water immersion (CWI) and sports massage on delayed-onset muscle soreness (DOMS) in amateur athletes. Sixty male amateur athletes were randomised into four equal groups (n = 15) receiving either CWI, sports massage, their combination, or served as controls after applying plyometric training to their lower extremities. The main outcomes measures were pain, exertion, rectus femoris perimeter, knee flexion range of motion, knee extensors isometric strength and serum creatine phosphokinase (CPK) levels examined before the plyometric training, immediately after the treatment, and 24, 48 and 72 h post exercise. We observed no significant differences between study groups in the most tested variables. CWI improved pain compared to the combined application of CWI and sports massage, and the control group both on the second and third day post exercise. Sports massage combined with CWI also led to a significant reduction in pain sensation compared to the control group. In conclusion the treatment interventions used were effective in reducing pain but were unable to affect other important adaptations of DOMS. Based on the above, sports scientists should reconsider the wide use of these interventions as a recovery strategy for athletes with DOMS.

The Greek version of the Australian Pelvic Floor Questionnaire: Cross-cultural adaptation and validation amongst women with urinary incontinence.

OBJECTIVES: As in Greek settings there is a need to develop validated patient-reported outcomes (PROs) for pelvic floor dysfunction, this study's aim was to cross-culturally adapt and validate the Australian Pelvic Floor Questionnaire (APFQ) into Greek, a 42-item PRO for routine urogynaecological evaluation of four domains; bladder, bowel, prolapse and sexual function. STUDY DESIGN: Cross-cultural translation was completed through official multistage forward and back-translation process. Validation involved administering the adapted APFQ (APFQ_GR) to women visiting Greek community-based healthcare settings. International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was also administered. Comparison between women with and without pelvic floor dysfunction (symptomatic versus control) was also undertaken for exploring discriminatory validity. Test-retest reliability was explored by re-administering APFQ_GR 10-15 days following initial testing and internal consistency was explored against each domain separately as well as total items' score. RESULTS: Greek APFQ translation was successfully performed and piloted to a women sample with varying levels of education for comprehensibility, thus, satisfying the questionnaire's face validity. 100 women (53.7 ± 13.1 years-old) participated in validation, 63 of which predominantly complained of urinary incontinence (UI) and 37 were asymptomatic. There were no ceiling effects. Floor effects were detected for women without symptoms. Moderate to very strong correlations were yielded between APFQ_GR total score and bladder domain, respectively, with ICIQ-UI SF single-item and total score (ρ = 0.403-0.758, p < 0.001), indicating satisfactory criterion-related validity. Moderate correlations were yielded for the sexual function domain with APFQ_GR total score and weaker correlations were found in the other two domains. Independent samples t-test yielded significant differences across the questionnaire's scores (p < 0.001), indicating good discriminatory validity between symptomatic and asymptomatic women. Test-retest reliability was excellent (ICC3,1 = ≥0.998). Internal consistency was very good for each domain and total items' score (Cronbach's α = 0.714-0.924). CONCLUSIONS: The Greek APFQ was proven appropriate, comprehensible, valid and reliable for women with urinary incontinence and can thus, be used across Greek healthcare settings. Prolapse and bowel domains merit further research.