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.

Test-retest reliability of pain extent and pain location using a novel pain drawing analysis software application, on patients with shoulder pain.

OBJECTIVES: A method of pain assessment is the drawing of pain on a specially designed manikin where the patients color the area representing their pain distribution. In recent years, software applications have been developed for the purpose of digital pain drawing data acquisition and processing. Although such specific software applications have already been released, they have been built with obsolete programming tools. The purpose of the study was to investigate the test - retest reliability of a new pain drawing analysis software, in a sample of patients with shoulder pain. METHODS: Data collected from 31 subjects with shoulder pain. Participants were asked twice to color their pain distribution in the painting environment of a tablet software application called 'Pain Distribution.' RESULTS: The reliability of pain extent was found to be good (ICC = 0.80). The Jaccard index for the reliability of pain location was found to be moderate, equal to 42.02 ± 19.13%. CONCLUSION: The results demonstrated good reliability of pain extent and moderate reliability of pain location using the new pain distribution analysis application 'Pain Distribution.' This pain drawing software application could be a reliable, inexpensive, and clinically usable solution for assessing the distribution of pain in patients with shoulder pain.

Efficacy of remote exercise and physiotherapy programs on depressive symptoms in people with multiple sclerosis - A systematic review and meta-analysis.

BACKGROUND: The prevalence of depression in Multiple Sclerosis (MS) is common and negatively affects the quality of life of patients. The studies of the effect of remote forms of treatment conclude that it is a fairly easy process to carry out and with very good results for patients. Thus, the purpose of this systematic review and meta-analysis is to investigate randomized controlled trials on the effectiveness of remote forms of exercise and physiotherapy on the depressive symptoms of people with MS. METHODS: A literature search was conducted in PubMed, Scopus, PsychInfo, SportDiscus, Web of Science and ResearchGate databases. The keywords for the search were: telerehabilitation, telecounseling, tele, telephone, physiotherapy, physical therapy, rehabilitation, therapeutic exercise, exercise, depression, depressive disorders, multiple sclerosis and MS. In addition, some inclusion and exclusion criteria were defined for the selection of the final studies, which were also evaluated with the PEDro scale for their quality. RESULTS: Among the initial 176 studies found, 6 were included in the systematic review. The development of a remote individualized exercise program based on assessment, personal goals and daily life of the patient, as well as a program based on motor imagery training, showed beneficial effects on depression in people with MS, which are considered possibly equivalent to those of in-person intervention. Μeta-analysis revealed that remote exercise and physiotherapy programs are significantly more effective than control group interventions for the management of depression in people with MS (random effects model, Hedges' g = -0.41, 95%CI = -0.74,-0.09, SE = 0.17, p = 0.01). The sub-group analysis showed that studies that had chosen not to have their control group carry out any form of intervention had more significant outcomes than the others. CONCLUSION: Through telephone communication or other electronic monitoring systems, can be achieved an effective treatment of people with depression and MS, based on exercise and physiotherapy. However, more studies are deemed necessary to find the most appropriately designed and therapeutic forms of remote intervention.

Technical Factors That May Influence mHealth Adherence in Children With Chronic Pulmonary Diseases: Scoping Review.

PURPOSE: To synthesize the technical factors influencing adherence to nonpharmacological treatment (NPhT) in children with chronic pulmonary diseases (CPDs), using mobile health (mHealth) technology. METHODS: Five electronic databases were searched from inception to October 12, 2022, with terms related to pediatrics, CPDs, adherence, NPhT, and mHealth. The methodological quality was assessed using the Critical Appraisal Skills Programme and the Mixed Methods Appraisal Tool checklist. RESULTS: Eleven articles were included. Six major technical themes were supported by the evidence that may influence adherence to NPhT: design and context, technical support/business model, connectivity, free availability, privacy and security, and cultural readiness. CONCLUSIONS: The design of mHealth applications (apps) should be done according to the needs of pediatric patients. This may mitigate any barriers and potentially foster adherence to the use of the apps. WHAT THIS ADDS TO THE EVIDENCE: Six major technical themes may influence adherence to NPhT in children with chronic respiratory diseases.Video Abstract: Supplemental digital content available at http://links.lww.com/PPT/A487 .

Effect of selective percutaneous myofascial lengthening and functional physiotherapy on walking in children with cerebral palsy: Three-dimensional gait analysis assessment.

BACKGROUND: Walking is the most affected motor function in children with cerebral palsy (CP). Orthopaedic surgery is regularly used to improve ambulation in children with CP. Selective Percutaneous Myofascial Lengthening (SPML) is considered the state-of-the art technique for surgical lengthening of spastic/contracted muscles in CP. The purpose of this study was to investigate the effect of combined SPML surgery and postoperative functional physiotherapy on gait function and characteristics of children with spastic cerebral palsy (CP). METHODS: Twenty-six children with spastic CP, aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II (n = 6), III (n = 12) and IV (n = 8) participated in a quasi-experimental one-group pretest-posttest study with a 9-month follow-up. The Global Motion Graph Deviation Index (MGDI) (including MGDI sub-indices of each joint in each plane of motion) and spatiotemporal parameters of a three-dimensional kinematic gait analysis were used to assess the gait function and characteristics, respectively. RESULTS: Nine months following SPML and functional physiotherapy, statistically significant improvements (p < 0.05) were noted in the Global MGDI, the MGDIs of sagittal plane knee and ankle motion analysis graphs, and the four most common spatiotemporal measures of gait: walking velocity, stride length, step length, and cadence. CONCLUSION: Children with spastic CP seem to gain better overall gait function following SPML procedure and functional physiotherapy, by achieving higher walking velocity, longer stride length and step length, and faster cadence. Further studies with control group and longer follow-up three-dimensional gait analyses are warranted to validate these positive results.

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.

Reliability and applicability of a low-cost, camera-based gait evaluation method for clinical use.

BACKGROUND: There is the need for the development of reliable and easy to use in clinical setting gait assessment tools. An open-access video analysis software that administers the calculation of kinematical and spatio-temporal characteristics of human movement is Kinovea® however, its repeatability as a gait analysis tool has not been well addressed. The purpose of the study was to examine the applicability and reliability of an objective, quantitative, low-cost and easy to use in the clinical setting, gait evaluation method, using Kinovea® software. METHODS: Data collected from 44 healthy subjects recording gait in sagittal and frontal plane using two smartphones. Time consumption of the procedure was captured. Kinovea® software was used to calculate kinematical and spatial parameters. RESULTS: Intra- and inter-rater reliability of the video processing as well as intra-rater reliability of the measurement procedure represented good to excellent and there were less random measurement errors. There was no measurement error due to random variation for the most of the calculated parameters, except of the pelvis position. CONCLUSIONS: The results suggest that excepting low accuracy in calculation of pelvis position, gait evaluation using Kinovea® software is objective, quantitative, low-cost, reliable and easy to use in the clinical setting.

Randomized Controlled Trial of Group Exercise Intervention for Fall Risk Factors Reduction in Nursing Home Residents.

OBJECTIVE: The aim of this study was to assess the effectiveness of a multidimensional exercise intervention on improving fall risk deterrent factors, such as overall strength and flexibility in nursing home residents. METHODS: A multi-centre, randomized controlled trial was finally utilized in 40 older adults (>65 years) who were randomly allocated to the intervention or the control group (20 subjects in each). The intervention group attended an exercise program twice a week for eight weeks, to improve functional mobility. The control group did not receive any intervention. Measurements before and after intervention included the Hand Grip Strength (HGS) testing, the Sit-to-Stand test (SST), the Back Scratch Test (BST), and the Sit-and-Reach test (SRT). RESULTS: MANOVA revealed significant time effects, V = 0.336, F(6, 33) = 2.78, p = 0.027, partial η2 = 0.336; group effects, V = 0.599, F(6, 33) = 8.22, p < 0.001, partial η2 = 0.599; and group*time interaction, V = 0.908, F(6, 33) = 54.52, p < 0.001, partial η2 = 0.908. A subsequent univariate analysis did not reveal a significant time effect for any variable (p > 0.05). Significant group effects were observed only for SRT (p < 0.05). Significant group*time interactions were observed for all the examined variables (p < 0.05). Dependent t-tests showed that the older adults in the exercise group were significantly improved in all the examined parameters (p < 0.05). Except for SRT (p > 0.05), all the other parameters significantly deteriorated in the control group (p < 0.05). CONCLUSIONS: Significant improvements were demonstrated in strength and flexibility among nursing home residents following an eight-week group exercise training program.

The Greek Version of Mini-Manual Ability Classification System (Mini-MACS): Translation and Reliability Study.

INTRODUCTION: The Mini-Manual Ability Classification System (Mini-MACS) is an adaptation of the MACS for children with cerebral palsy (CP) aged 1-4 years, which classifies children's performance to handle objects that are relevant to their age and development. The availability of a reliable Mini-MACS in Greek would allow for using it safely and properly in the clinical and research context of Greece. Therefore, the purpose of this study was to translate the original English version into Greek and examine its test-retest and interrater reliability. MATERIAL AND METHODS: The English Mini-MACS was translated into Greek using the "forward-backward" method. Sixty-three children with CP, Gross Motor Function Classification System (GMFCS) levels I-V, aged 12 -50 months were included in the reliability study. Test-retest and interrater reliability were assessed using the interclass correlation coefficient (ICC). The association between Mini-MACS and GMFCS level ratings was also assessed using Spearman's rho correlation coefficient (ρ). RESULTS: The translated version was easy to understand and use. The Greek Mini-MACS was found to have excellent test-retest reliability (ICC > 0.96) for both parents and therapists, good interrater reliability (ICC=0.89) between therapists and parents, and moderate-to-strong correlation with the GMFCS (ρ = 0.56-0.64, p < 0.0001). CONCLUSION: The Greek Mini-MACS constitutes a user-friendly and reliable scale for use in the Greek population.

The Effectiveness of Manual Therapy in the Cervical Spine and Diaphragm, in Combination with Breathing Reeducation Exercises, in Patients with Non-Specific Chronic Neck Pain: Protocol for Development of Outcome Measures and a Randomized Controlled Trial.

Until now, non-specific chronic neck pain has mainly been considered as a musculoskeletal system dysfunction, with associated psychological involvement due to its prolonged or recurrent nature. However, patients with non-specific chronic neck pain frequently additionally exhibit respiratory dysfunction. Emerging evidence suggests that addressing the respiratory dysfunction in these patients will provide additional therapeutic benefits in musculoskeletal and respiratory-related outcomes for several reasons (biomechanical, biochemical, and psychological). Motor control dysfunction of the muscles surrounding the spine (diaphragm included) negatively affects the mechanics and biochemistry of breathing (pH-homeostasis). An impaired and ineffective breathing pattern has been recognized as the primary source of many unexplained symptoms (anxiety, depression, confusion, chest pain, hypocapnia, and breathlessness) in patients with non-specific chronic neck pain. The proposed protocol's purpose is dual: to assess the relative effectiveness of manual therapy in the cervical spine and the diaphragm, in combination with breathing reeducation exercises, along with cervical spine manual therapy or usual physical therapy care on the underlying dysfunctions in patients with non-specific chronic neck pain via a randomized controlled clinical trial, and to validate part of the outcome measures. Several musculoskeletal and respiratory dysfunction outcomes will be employed to delimit the initial extent and level of dysfunction and its resolution with the treatments under study.

Electromyographic Activity of Sternocleidomastoid Muscle in Individuals With Neck Pain and Healthy Volunteers: A Reliability and Between-Group Differences Examination.

OBJECTIVES: The purpose of this study was to evaluate the electromyographic activity of the sternocleidomastoid muscle during the performance of the craniocervical flexion test (CCFT) in individuals with neck pain and healthy volunteers, assess the reliability of this method, and examine possible between-population differences. METHODS: Electromyographic activity of the sternocleidomastoid muscles of 22 individuals with neck pain and 22 healthy participants was recorded during the 55 stages of the CCFT. Pain (visual analog scale) and disability (Neck Disability Index) levels and pain duration were recorded for the participants with neck pain. Reliability of electromyography was evaluated with the intraclass correlation coefficient, standard error of measurement, and minimum detectable change. RESULTS: Within-day reliability indices of electromyographic activity were very good to excellent (intraclass correlation coefficients, 0.86-0.98; standard error of measurement, 1.8%-7.6%; minimum detectable change, 5.0%-21.1%). For the head-lift normalization method, 2-way analysis of variance revealed significant between-group differences (P < .02); however, these were not clinically significant when reliability test-retest error was considered. Differences between contraction levels were significant (P < .001); however, the group by contraction level interaction factor was nonsignificant. Therefore, the between-groups electromyographic increases noted with increasing contraction levels were similar. No correlation was identified between participants' electromyography data and pain or disability. CONCLUSION: In participants with moderate pain, disability, and pain duration, no clear alterations in electromyographic activity of the sternocleidomastoid could be detected with the CCFT. Reliability of the test used was very good.

In the Shoulder or in the Brain? Behavioral, Psychosocial and Cognitive Characteristics of Unilateral Chronic Shoulder Pain with Symptoms of Central Sensitization.

The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the "arm endurance" test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP.

The Effectiveness of Spinal, Diaphragmatic, and Specific Stabilization Exercise Manual Therapy and Respiratory-Related Interventions in Patients with Chronic Nonspecific Neck Pain: Systematic Review and Meta-Analysis.

Patients with nonspecific chronic neck pain (NSCNP) exhibit respiratory dysfunction. This systematic review aimed to analyze randomized controlled trials (RCTs) investigating the effect of spinal and/or diaphragmatic and/or specific stabilization exercise manual therapy and/or respiratory exercises on musculoskeletal and respiratory diagnostic outcomes in patients with NSCNP. A systematic search and selection of RCTs was performed in three scientific databases (Pubmed, Scopus, and Physiotherapy Evidence Database (PEDro)) and one search engine (Google Scholar) from inception to April 2022. Relevant studies published in the English language were extracted, evaluated, and independently rated for methodological quality (PEDro scale). The quality of the evidence was assessed with the GRADE approach. Out of 1089 studies collected in total, 1073 were excluded (i.e., did not meet the inclusion criteria or were duplicates). Sixteen RCTs were finally included, rated on 5.62/10 (PEDro score) on average for methodological quality. Overall, there was sparse evidence that spinal and/or diaphragmatic manual therapy and/or trunk stabilization exercises and/or respiratory exercises significantly improved pain, disability, and respiratory outcomes in patients with NSCNP immediately post-treatment. However, the clinical heterogeneity between studies was significant, and the level of certainty of the evidence was low to very low. More, high-quality RCTs are required, contributing to the holistic diagnostic monitoring and management of patients with NSCNP.

Cross-cultural validation of the Oxford Elbow Score and Mayo Elbow Performance Score in Greek.

BACKGROUND: Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS) are two of the most commonly used instruments for the functional assessment of elbow joint. The aim of this study was to cross-culturally validate the OES and MEPS into Greek language and examine their convergent validity, internal consistency, test-retest reliability and floor and ceiling effects. METHODS: The two instruments were translated into Greek with the back translation method. Their final Greek versions (OES-GR and MEPS-GR) were completed by 40 patients with elbow disorders. The patients completed also the Greek version of the Disabilities of the Arm Shoulder and Hand (DASH-GR). The patients re-completed the OES-GR after 24 h. RESULTS: The OES-GR was found to have good internal consistency (Cronbach's α = 0.85, 95%CI = 0.74-0.92), in contrast to the MEPS-GR (Cronbach's α = 0.47, 95%CI = 0.15-0.70). Both instruments were found to have good convergent validity with the DASH-GR (for MEPS-GR rs = -0.64, 95% CI -0.79 to -0.41; for OES-GR rs = -0.84, 95%CI = -0.91 to -0.72). Good was also the convergent validity of the OES-GR with the MEPS-GR (rs = 0.71, 95%CI = 0.51 to 0.84). The test-retest reliability for each domain of the OES-GR was found good to excellent (total score ICC = 0.91, 95%CI = 0.83-0.95; pain ICC = 0.90, 95%CI = 0.81-0.95; function ICC = 0.81, 95%CI = 0.68-0.90; social-psychological ICC = 0.91, 95%CI = 0.84-0.95). CONCLUSION: The findings about the internal consistency, test-retest reliability, convergent validity and ceiling/floor effects of the OES-GR suggest that it is a quite valid and reliable instrument which can be used with confidence in Greek patients with elbow disorders. LEVEL OF EVIDENCE: N/A.

Translation, reliability and validity of the Greek functional mobility scale (FMS) for children with cerebral palsy.

PURPOSE: To translate and investigate the reliability and validity of the Greek version of the Functional Mobility Scale (FMS). METHODS: FMS was translated into Greek. Test-retest reliability (Cohen's weighted kappa coefficient, κw) and concurrent validity (Spearman's rank correlation coefficient, rs) of the Greek version of FMS were assessed in children with Cerebral Palsy (CP). Sixty children (mean age 7.82 ± 3.20 years) were recruited. Physical therapists administered the FMS by interviewing parents about their children's mobility status. The Gross Motor Function Classification System (GMFCS) was additionally used for testing concurrent validity. RESULTS: The translation of the FMS was deemed easy to understand and administer. The Greek FMS was demonstrated to have almost perfect test-retest reliability (κw=0.98-1.00), and very strong correlation with the GMFCS (-0.85 ≤ rs ≤ -0.89, p < 0.001). CONCLUSIONS: The Greek version of the FMS was shown to be a reliable and valid classification system for CP and can be used with confidence by Greek physical therapists.Implications for rehabilitationThe FMS provides a very simple and practical outcome measure of functional mobility in children with CP.The use of the reliable and valid Greek FMS will enhance the physical therapy assessment process in the Greek population, by offering the feasibility to detect the motor performance changes in children with CP as they grow or following interventions.The current study renders the Greek FMS available for utilization by physical therapists in order to quantify the independent mobility in children with CP.

Reliability and Validity of the Double Inclinometer Method for Assessing Thoracolumbar Joint Position Sense and Range of Movement in Patients with a Recent History of Low Back Pain.

The study was aimed at examining the reliability of the Double Inclinometer (DI) method for the assessment of thoracolumbar Range of Movement (ROM) and Joint Position Sense (JPS) in patients with a recent history of Low Back Pain (LBP). Twenty patients with a history of LBP in the last three months participated. The thoracolumbar ROM and JPS were examined from a standing position by using both the DI and the tape measure method. The DI method was found to have moderate to good intra-rater (ICC = 0.68-0.79, SEM = 2.20-2.77°, SDD = 6.09-7.67°), moderate inter-rater (ICC = 0.59-0.62, SEM = 2.96-3.35°, SDD = 8.19-9.27°) and poor test-retest reliability (ICC = 0.13-0.17, SEM = 3.98-4.32°, SDD = 11.02-11.96°) for the assessment of thoracolumbar JPS. For the assessment of thoracolumbar ROM, the DI method was found to have good to excellent intra-rater (ICC = 0.88-0.94, SEM = 4.25-6.20°, SDD = 11.77-17.17°), excellent inter-rater (ICC = 0.90-0.91, SEM = 7.26-7.74°, SDD = 20.11-21.43°) and excellent test-retest reliability (ICC = 0.91-0.93, SEM = 6.03-6.87°, SDD = 16.70-19.02°). The concurrent validity of the DI method with the tape measure method was found to be very weak for the assessment of thoracolumbar JPS (r = 0.02, p = 0.93) and strong for the assessment of thoracolumbar ROM (r = 0.66, p = 0.001). The DI method seems to be a very reliable method for the assessment of thoracolumbar ROM in individuals with a recent history of LBP.

Effects of minimally invasive surgery and functional physiotherapy on motor function of children with cerebral palsy: A non-randomised controlled trial.

PURPOSE: This non-randomised controlled trial investigated whether a combined programme of functional physiotherapy and minimally invasive orthopaedic surgery improves the level and degree of capacity and performance of gross motor function in children with spastic cerebral palsy (CP). METHODS: Fifty-two children with spastic CP aged 5-7 years, Gross Motor Function Classification System (GMFCS) levels II-IV, were allocated to two equal groups: experimental group (selective percutaneous myofascial lengthening [SPML] procedure and 9-month functional strengthening physiotherapy programme) and control (standard physiotherapy) groups. At baseline and at the end of the 9-month intervention, the capacity and performance of gross motor function were assessed with the Gross Motor Function Measure (GMFM) D and E subcategories and Functional Mobility Scale (FMS), respectively. The level of gross motor function was measured with the GMFCS. RESULTS: There was a statistically significant difference in the post-intervention improvements in the GMFM D (experimental mean difference = 19.63 ± 10.46; control mean difference = 2.40 ± 4.62) and E (experimental mean difference = 19.33 ± 11.82; control mean difference = 4.20 ± 6.26) between experimental and control group (p < 0.001). There was a significant improvement in the GMFCS level and each FMS distance for the experimental group (p < 0.001), but not for the control group (p > 0.05). CONCLUSION: SPML procedure combined with functional physiotherapy improves gross motor function in children with spastic CP, by raising the degree and level of motor independence.

Gait Kinetic and Kinematic Changes in Chronic Low Back Pain Patients and the Effect of Manual Therapy: A Randomized Controlled Trial.

Patients with chronic back pain as a result of degenerated disc disease, besides pain, also present with impaired gait. The purpose of the article was to evaluate kinetic and kinematic characteristics during gait analysis in patients with chronic low back pain as a result of degenerated disc disease, before and after the application of physiotherapy, including manual therapy techniques. Seventy-five patients suffering from chronic low back pain were randomly divided into 3 groups of 25 each. Each group received five sessions (one per week) of interventions with the first group receiving manual therapy treatment, the second a sham treatment and the third, classic physiotherapy (stretching exercises, TENS and massage). The effectiveness of each treatment was evaluated using an optoelectronic system for recording and analysis of gait (kinetic and kinematic data). Patients overall showed an impaired gait pattern with a difference in kinetic and kinematic data between the left and the right side. Following the application of the above-named interventions, only the group that received manual therapy showed a tendency towards symmetry between the right and left side. In patients suffering from chronic low back pain as a result of degenerated disc disease, the application of five manual therapy sessions seems to produce a tendency towards symmetry in gait.

Handgrip Force and Maximum Inspiratory and Expiratory Pressures in Critically Ill Patients With a Tracheostomy.

BACKGROUND: The association between peripheral striated muscle strength and respiratory muscle strength has been confirmed in a number of disorders. However, this association is unknown in intensive care unit patients with tracheostomies. OBJECTIVE: To examine correlations between handgrip force, maximum inspiratory pressure (MIP), and maximum expiratory pressure (MEP) in intensive care unit patients with tracheostomies. METHODS: Twenty patients (7 women, 13 men) with tracheostomies, in the intensive care unit longer than 11 days, in stable condition, with functional limbs, and with Glasgow Coma Scale scores of 15 were recruited. Both MIP and MEP were measured with a membrane manometer; handgrip force was measured with a hydraulic hand dynamometer. RESULTS: Handgrip force was significantly correlated with MIP (r = 0.45, P = .04) and MEP (r = 0.78, P = .001). Handgrip force was significantly predicted by MIP and MEP when the effect of sex was controlled for (P < .05). However, when MIP and MEP were included as predictors in a regression model, MEP was the only significant predictor (R = 0.80, R2 = 0.63, adjusted R2 = 0.57). CONCLUSIONS: Strength of the hand flexors and strength of the expiratory muscles (abdominal) were significantly correlated in intensive care unit patients. Handgrip strength appears to be an easy, fast way to evaluate expiratory muscle strength by using a simple handhold command without special equipment. A strong handhold may also correspond to strong expiratory muscles. ClinicalTrials.gov: NCT03457376.

Novel Software for Pain Drawing Analysis.

Introduction Pain drawings (PDs) are an important component of the assessment of a patient with pain. Although analog pain drawings (APDs), such as pen-on-paper drawings, have been extensively used in clinical assessment and clinical research, there is a lack of digital pain drawing (DPD) software that would be able to quantify and analyze the digital pain distribution obtained by the patients. The aim of this work is to describe a method that can quantify the extent and location of pain through novel custom-built software able to analyze data from the digital pain drawings obtained from the patients. Methods The application analysis and software specifications were based on the information gathered from the literature, and the programmers created the custom-built software according to the published needs of the pain scientific community. Results We developed a custom-built software named "Pain Distribution," which, among others, automatically calculates the number of the pixels the patient has chosen and therefore quantifies the pain extent, provides the frequency distribution from a group of images, and has the option to select the threshold over which the patient is considered with central sensitization (CS). Additionally, it delivers results and statistics for both every image and the frequency distribution, providing mean values, standard deviations, and CS indicators, as well as the ability to export them in *.txt file format for further analysis. Conclusion A novel Pain Distribution application was developed, freely available for use in any setting, clinical, research, or academic.