BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain(LBP)prevention and rehabilitation.High reliability of paraspinal strength and electromyographic(EMG)-fatigue parameters has n...BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain(LBP)prevention and rehabilitation.High reliability of paraspinal strength and electromyographic(EMG)-fatigue parameters has not been universally reported.Moreover,the discriminative validity of these parameters requires further exploration,under the threat of potentially poor reliability of the methods examined.AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants.METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers,for reliability.Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction(MVIC)protocol,performed in a custom-made device.For the fatigue test,participants performed a 60% MIVC level continuous isometric contraction of the paraspinals,in conjunction with EMG analysis from 4 muscle sites of the lumbar spine.Initial median frequency(IMF),the median frequency slope(MFslope),as well as the root mean square(RMS)slope EMG parameters were used as fatigue measures.Data were analysed with repeated measures ANOVA for test-retest differences.For reliability,the intraclass correlation coefficient(ICC3,1),standard error of the measurement(SEM)and the smallest detectable difference(SDD)were reported.Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance,with age,weight and strength as covariates.RESULTS Isometric strength presented statistically significant between-day differences(P<0.01),however these did not exceed 10%(healthy:7.2%/LBP-patients:9.7%)and ICC reliability values were excellent,yet test-retest error was increased for the patient group(healthy:ICC3,1:0.92-0.96,SEM:5.72-5.94 Hz,SDD:18.51%-18.57%/LBP-patients:ICC3,1:0.91-0.96,SEM:6.49-6.96,SDD:30.75%-31.61%).For the frequency data,IMF reliability was excellent(healthy:ICC3,1:0.91-0.94,SEM:3.45-7.27 Hz,SDD:9.56%-20.14%/patients:ICC3,1:0.90-0.94,SEM:6.41-7.59 Hz,SDD:17.75%-21.02%)and of MF raw and normalised slopes was good(healthy:ICC3,1:0.78-0.82,SEM:4.93-6.02 Hz,SDD:13.66-16.67%/LBP-patients:ICC3,1:0.83-0.85,SEM:6.75-7.47 Hz,SDD:18.69%-20.69%).However,the reliability for RMS data presented unacceptably high SDD values and were not considered further.For discriminative validity,less MVIC and less steep MFslopes were registered for the patient group(P<0.01).CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.展开更多
AIM To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists(PTs)on assessing low back pain(LBP)patients.METHODS Three focus groups were undertaken,followed by a structured que...AIM To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists(PTs)on assessing low back pain(LBP)patients.METHODS Three focus groups were undertaken,followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs,respectively.Twenty-nine themes relating to LBP diagnostic practice emerged.These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts.Analysis was performed by percentage agreements andχ2 tests.RESULTS The survey was divided into three subsections;PTs’attitudes on LBP assessment,patients’attitudes and diagnostic/healthcare issues,each constituting 14,7 and 8 statements,respectively.Over half of the statements fell within the 30%-80%agreement between Greece and United Kingdom whereas,5 statements reported low(<10%)and 8 statements demonstrated high(>90%)PT percentage agreement.Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas,re-assessment was undertaken less frequently in Greece.Diagnosis according to 91%of the Greek PTs is considered a“privilege”which is exclusive for doctors in Greece(only 17%British PTs agreed)and is accompanied with a great overuse of medical investigations.Forty percent of Greek PTs(compared to 0%of British)consider themselves as“executers”,being unable to interfere with treatment plan,possibly implying lack of autonomy.CONCLUSION Although similarities on history taking methods and on patients’attitudes were detected across both groups,gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists,highlighting differences in service delivery and professional autonomy.展开更多
基金Supported by Greek State Scholarships Foundation(IKY),Athens,Greece,No.T104830098Hospital Saving Association(HSA),London,United Kingdom,No.99/2.
文摘BACKGROUND Paraspinal muscle strength and fatigue are considered important in low back pain(LBP)prevention and rehabilitation.High reliability of paraspinal strength and electromyographic(EMG)-fatigue parameters has not been universally reported.Moreover,the discriminative validity of these parameters requires further exploration,under the threat of potentially poor reliability of the methods examined.AIM To investigate the reliability and discriminative validity of paraspinal strength and EMG-related fatigue in subjects with recurrent LBP and healthy participants.METHODS Test-retest measurements were performed in 26 healthy and 66 LBP volunteers,for reliability.Paraspinal isometric maximal and mean strength were determined with a maximum voluntary isometric contraction(MVIC)protocol,performed in a custom-made device.For the fatigue test,participants performed a 60% MIVC level continuous isometric contraction of the paraspinals,in conjunction with EMG analysis from 4 muscle sites of the lumbar spine.Initial median frequency(IMF),the median frequency slope(MFslope),as well as the root mean square(RMS)slope EMG parameters were used as fatigue measures.Data were analysed with repeated measures ANOVA for test-retest differences.For reliability,the intraclass correlation coefficient(ICC3,1),standard error of the measurement(SEM)and the smallest detectable difference(SDD)were reported.Group-related differences for fatigue measures were analysed with a Multivariate Analysis of Covariance,with age,weight and strength as covariates.RESULTS Isometric strength presented statistically significant between-day differences(P<0.01),however these did not exceed 10%(healthy:7.2%/LBP-patients:9.7%)and ICC reliability values were excellent,yet test-retest error was increased for the patient group(healthy:ICC3,1:0.92-0.96,SEM:5.72-5.94 Hz,SDD:18.51%-18.57%/LBP-patients:ICC3,1:0.91-0.96,SEM:6.49-6.96,SDD:30.75%-31.61%).For the frequency data,IMF reliability was excellent(healthy:ICC3,1:0.91-0.94,SEM:3.45-7.27 Hz,SDD:9.56%-20.14%/patients:ICC3,1:0.90-0.94,SEM:6.41-7.59 Hz,SDD:17.75%-21.02%)and of MF raw and normalised slopes was good(healthy:ICC3,1:0.78-0.82,SEM:4.93-6.02 Hz,SDD:13.66-16.67%/LBP-patients:ICC3,1:0.83-0.85,SEM:6.75-7.47 Hz,SDD:18.69%-20.69%).However,the reliability for RMS data presented unacceptably high SDD values and were not considered further.For discriminative validity,less MVIC and less steep MFslopes were registered for the patient group(P<0.01).CONCLUSION Reliability and discriminative ability of paraspinal strength and EMG-related frequency parameters were demonstrated in healthy participants and patients with LBP.
基金Supported by The MACP’s Elsevier Science and Doctoral Awards for Research in Manipulative Physiotherapy
文摘AIM To explore current diagnostic practice and attitudes of Greek and United Kingdom physiotherapists(PTs)on assessing low back pain(LBP)patients.METHODS Three focus groups were undertaken,followed by a structured questionnaire-type survey comprising 23 health professionals and a random stratified sample of 150 PTs,respectively.Twenty-nine themes relating to LBP diagnostic practice emerged.These were then given to 30 British PTs assessing their level of agreement with their Greek counterparts.Analysis was performed by percentage agreements andχ2 tests.RESULTS The survey was divided into three subsections;PTs’attitudes on LBP assessment,patients’attitudes and diagnostic/healthcare issues,each constituting 14,7 and 8 statements,respectively.Over half of the statements fell within the 30%-80%agreement between Greece and United Kingdom whereas,5 statements reported low(<10%)and 8 statements demonstrated high(>90%)PT percentage agreement.Similarities across British and Greek PTs were detected in history taking methods and in the way PTs feel patients perceive physiotherapy practice whereas,re-assessment was undertaken less frequently in Greece.Diagnosis according to 91%of the Greek PTs is considered a“privilege”which is exclusive for doctors in Greece(only 17%British PTs agreed)and is accompanied with a great overuse of medical investigations.Forty percent of Greek PTs(compared to 0%of British)consider themselves as“executers”,being unable to interfere with treatment plan,possibly implying lack of autonomy.CONCLUSION Although similarities on history taking methods and on patients’attitudes were detected across both groups,gross differences were found in re-assessment procedures and diagnostic issues between Greek and British physiotherapists,highlighting differences in service delivery and professional autonomy.
