Cross-cultural adaptation, validation and psychometric evaluation of the attitudes to back pain scale in musculoskeletal practitioners - Hebrew version.

BACKGROUND: Research suggests that clinician's attitudes and beliefs towards low back pain (LBP) management may affect their patients' treatment course and outcomes. Attitudes to Back pain Scale in musculoskeletal practitioners (ABS-mp) is a questionnaire developed to assess musculoskeletal clinicians' attitudes and beliefs regarding LBP. OBJECTIVE: This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Hebrew version of the ABS-mp questionnaire. DESIGN: Cross-sectional study with nested prospective sub-sample. METHODS: The translation was performed in several steps following the cross-cultural adaptation process. Test-retest and internal consistency reliability of the scales were evaluated along with convergent validity exploration between the ABS-mp and the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS). A convenience sample of 177 physical therapists were requested to participate in the study, out of which 132 have completed the survey, providing a 74% participation rate. RESULTS: The forward-backward translation process revealed minor discrepancies that were addressed by the expert panel. The test-retest reliability of the Hebrew ABS-mp was excellent (ICC = 0.906). Five items were found to be irrelevant for the Israeli physiotherapy health settings and were omitted. For internal consistency, the average inter-item correlation reached appropriate values for the Psychological, Biomedical, Re-activation, and Limitation on Sessions subscales (0.437, 0.265, 0.341, 0.197, respectively). For convergent validity, the ABS-mp's Biomedical subscale and the HC-PAIRS's total score were moderately correlated (0.535). CONCLUSIONS: The Hebrew version of the ABS-mp has been validated and has demonstrated excellent test-retest reliability, good convergent validity and acceptable internal consistency.

STarT back tool retained its predicting abilities in patients with acute and sub-acute low back pain after a transcultural adaptation and validation to Hebrew.

BACKGROUND: The STarT Back Screening Tool (SBT) distributes low back pain (LBP) patients into three prognostic groups for stratified care. This approach has demonstrated beneficial clinical and cost-effectiveness. OBJECTIVES: To translate and validate the SBT by investigating its psychometric properties among Israelis with acute and sub-acute LBP, and to evaluate its ability to predict disability after three months. DESIGN: Prospective study. METHOD: The SBT was transcultural adapted into Hebrew using published guidelines. A total of 150 patients receiving physical therapy for acute or subacute LBP were administered the SBT. Clinical outcomes included the Roland-Morris Disability Questionnaire (RMDQ), the Hospital Anxiety and Depression Scale (HADS), the Fear-Avoidance Beliefs Questionnaire (FABQ) and a numerical pain rating scale (NPRS), collected by an independent interviewer by phone at the start of the physical therapy treatment and after three months. RESULTS: The test-retest reliability of the SBT total score and psychosocial subscale were excellent (intraclass correlation coefficient 0.89 and 0.82). Spearman's correlation coefficient between SBT total score and RMDQ was 0.82, HADS (Anxiety 0.66, Depression 0.76), FABQ (exercise 0.53), NPRS (severe pain 0.48, average pain 0.53). The SBT baseline score showed excellent predictive abilities in discriminating poor disability after three months (ROC curve = 0.825, P < 0.001, 95% CI 0.756-0.894). CONCLUSION: The Israeli translation and cross-cultural adaptation of the SBT is a valid and reliable instrument. The SBT discriminated low, medium and high-risk groups, and predicts disability after three months.

Manual therapy for plantar heel pain.

BACKGROUND: Manual therapy employed in the treatment of plantar heel pain includes joint or soft tissue mobilizations. Efficacy of these methods is still under debate. AIMS: To determine whether manual therapy, consisting of deep massage, myofascial release or joint mobilization is effective in treating plantar heel pain. METHODS: A critical review of all available studies with an emphasis on randomized controlled trials (RCTs) was performed. PubMed, PEDro, and Google Scholar databases were searched for keywords relating to plantar heel pain, joint, and soft tissue mobilizations. There were no search limitations or language restrictions. The reference lists of all retrieved articles were searched. The PEDro score was used to assess the quality of the reviewed papers. RESULTS: A total of six relevant RCTs were found: two examined the effectiveness of joint mobilization on plantar heel pain and four the effectiveness of soft tissue techniques. Five studies showed a positive short-term effect after manual therapy treatment, mostly soft tissue mobilizations, with or without stretching exercises for patients with plantar heel pain, compared to other treatments. One study observed that adding joint mobilization to the treatment of plantar heel pain was not effective. The quality of all studies was moderate to high. CONCLUSIONS: According to reviewed moderate and high-quality RCTs, soft tissue mobilization is an effective modality for treating plantar heel pain. Outcomes of joint mobilizations are controversial. Further studies are needed to evaluate the short and long-term effect of different soft tissue mobilization techniques.

Translation, Validation, and Crosscultural Adaptation of the Hebrew Version of the Neck Disability Index.

STUDY DESIGN: The present study's design was translation and crosscultural validation of the Neck Disability Index (NDI). OBJECTIVE: The aim of the study was to translate and culturally adapt the NDI into Hebrew language and to evaluate the psychometric properties of this version. SUMMARY OF BACKGROUND DATA: As yet, no Hebrew language neck pain and disability questionnaires exist. The NDI is widely used and validated among different patient populations with neck pain. METHODS: The English version of the NDI was translated into Hebrew according to the published guidelines. A total of 100 patients with neck pain participated in the study. Inclusion criteria were age 18 years and older, neck pain, and ability to read and speak Hebrew. Exclusion criteria were cancer or suspected tumor, neck pain related to vertebral fracture, or neurological disease. Participants were asked to complete the NDI-Hebrew version (NDI-H), Numeric Pain Rating Scale (NPRS), and Patient-Specific Functional Scale (PSFS). Seventy-three patients completed the NDI-H twice in an interval of 2 days. Psychometric properties included test-retest reliability (intraclass correlation coefficient), internal consistency (Cronbach α), convergent validity (Pearson correlation), and factor analysis. RESULTS: The NDI-H demonstrated excellent test-retest reliability (intraclass correlation coefficient ranged from 0.827 to 0.929; Pv < 0.001). Cronbach α value was excellent (0.855). A very good correlation was found between the NDI-H and NPRS scores (r = 0.611, P < 0.001) and a good correlation between the NDI-H and PSFS score (r = 0.417, P < 0.001). Factor analysis revealed a two-factor solution representing daily function and pain and symptoms. CONCLUSION: The NDI-H is a valid and reliable instrument to measure functional limitations and disability in Hebrew-speaking patients with neck pain. LEVEL OF EVIDENCE: NA.

The effect of additional ankle and midfoot mobilizations on plantar fasciitis: a randomized controlled trial.

STUDY DESIGN: A single-blind randomized controlled trial. OBJECTIVE: To evaluate the efficacy of ankle and midfoot mobilization on pain and function of patients with plantar fasciitis (PF). BACKGROUND: Plantar fasciitis is a degenerative process of the plantar fascia, with a lifetime prevalence of approximately 10%. Limited ankle dorsiflexion is a common finding and apparently acts as a contributing factor to the development of PF. METHODS: Fifty patients with PF, aged 23 to 73 years, were randomly assigned to either the intervention or control group. Both groups received 8 treatments, twice a week, consisting of stretching exercises and ultrasound. In addition, the intervention group received mobilization of the ankle and midfoot joints. Dorsiflexion range of motion was measured at the beginning and at the end of treatment. The results were evaluated by 3 outcomes: the numeric pain-rating scale, Lower Extremity Functional Scale, and algometry. RESULTS: No significant difference was found between groups in any of the outcomes. Both groups showed a significant difference in the numeric pain-rating scale and Lower Extremity Functional Scale. Both groups significantly improved in dorsiflexion range of motion, with no difference between groups. CONCLUSION: The addition of ankle and foot joint mobilization aimed at improving dorsiflexion range of motion is not more effective than stretching and ultrasound alone in treating PF. The association between limited ankle dorsiflexion and PF is most probably due to soft tissue limitations, not the joints. Trial registered at ClinicalTrials.gov (registration number NCT01439932). LEVEL OF EVIDENCE: Therapy, level 1b.

A clinical prediction rule to identify patients with low back pain who are likely to experience short-term success following lumbar stabilization exercises: a randomized controlled validation study.

STUDY DESIGN: Randomized controlled trial. OBJECTIVE: To determine the validity of a previously suggested clinical prediction rule (CPR) for identifying patients most likely to experience short-term success following lumbar stabilization exercise (LSE). Background Although LSE is commonly used by physical therapists in the management of low back pain, it does not seem to be more effective than other interventions. A 4-item CPR for identifying patients most likely to benefit from LSE has been previously suggested but has yet to be validated. METHODS: One hundred five patients with low back pain underwent a baseline examination to determine their status on the CPR (positive or negative). Patients were stratified by CPR status and then randomized to receive an LSE program or an intervention consisting of manual therapy (MT) and range-of-motion/flexibility exercises. Both interventions included 11 treatment sessions delivered over 8 weeks. Low back pain-related disability was measured by the modified version of the Oswestry Disability Index at baseline and upon completion of treatment. RESULTS: The statistical significance for the 2-way interaction between treatment group and CPR status for the level of disability at the end of the intervention was P = .17. However, among patients receiving LSE, those with a positive CPR status experienced less disability by the end of treatment compared with those with a negative CPR status (P = .02). Also, among patients with a positive CPR status, those receiving LSE experienced less disability by the end of treatment compared with those receiving MT (P = .03). In addition, there were main effects for treatment and CPR status. Patients receiving LSE experienced less disability by the end of treatment compared to patients receiving MT (P = .05), and patients with a positive CPR status experienced less disability by the end of treatment compared to patients with a negative CPR status, regardless of the treatment received (P = .04). When a modified version of the CPR (mCPR) containing only the presence of aberrant movement and a positive prone instability test was used, a significant interaction with treatment was found for final disability (P = .02). Of the patients who received LSE, those with a positive mCPR status experienced less disability by the end of treatment compared to those with a negative mCPR status (P = .02), and among patients with a positive mCPR status, those who received LSE experienced less disability by the end of treatment compared to those who received MT (P = .005). CONCLUSION: The previously suggested CPR for identifying patients likely to benefit from LSE could not be validated in this study. However, due to its relatively low level of power, this study could not invalidate the CPR, either. A modified version of the CPR that contains only 2 items may possess a better predictive validity to identify those most likely to succeed with an LSE program. Because this modified version was established through post hoc testing, an additional study is recommended to prospectively test its predictive validity. LEVEL OF EVIDENCE: Prognosis, level 1b-.

The interrater reliability of physical examination tests that may predict the outcome or suggest the need for lumbar stabilization exercises.

STUDY DESIGN: Interrater reliability. OBJECTIVES: (1) To examine the interrater reliability of an existing clinical prediction rule (CPR) to predict the success of lumbar stabilization exercises (LSE), and (2) to examine the interrater reliability of 4 clinical tests that may be useful in determining the need for LSE. BACKGROUND: Physical therapists commonly use LSE to manage patients with low back pain. The clinical efficacy of LSE is unclear. A CPR has been previously suggested to identify patients most likely to benefit from LSE. The passive lumbar extension test, lumbar extension load test, active straight leg raise test, and active hip abduction test are 4 clinical tests that may also suggest the need for LSE. The reliability of these tests has not been established sufficiently. METHODS: Thirty patients with low back pain, who participated in a larger randomized clinical trial, underwent all tests by 2 independent examiners. Kappa coefficients with 95% confidence intervals (CIs) were calculated to establish the interrater reliability of the CPR and individual tests. RESULTS: The interrater reliability of the CPR was excellent (κ = 0.86; 95% CI: 0.65, 1.00). The interrater reliability of the individual items making up the CPR, as well as that of the passive lumbar extension test, was substantial (κ = 0.64-0.73 and κ = 0.76, respectively; 95% CI: 0.46, 1.00). The interrater reliability of the active straight leg raise test (κ = 0.53; 95% CI: 0.20, 0.84) and lumbar extension load test (κ = 0.47; 95% CI: 0.14, 0.78) was moderate. The interrater reliability of the active hip abduction test was poor (κ = -0.09; 95% CI; -0.35, 0.27). CONCLUSION: With the exception of the active hip abduction test, all other clinical tests can be considered sufficiently reliable for clinical use. The relatively small sample size likely contributed to the fairly wide confidence intervals around some of the reliability indices.