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Moutzouri M, Koumantakis GA, Hurley M, Kladouchou AG, Gioftsos G. Effectiveness of a Web-Guided Self-Managed Telerehabilitation Program Enhanced with Outdoor Physical Activity on Physical Function, Physical Activity Levels and Pain in Patients with Knee Osteoarthritis: A Randomized Controlled Trial. J Clin Med 2024; 13:934. [PMID: 38398248 PMCID: PMC10889528 DOI: 10.3390/jcm13040934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Telerehabilitation to guide self-management has been shown to be a feasible care strategy for knee osteoarthritis (KOA). The aim of this study was to explore the effectiveness of a blended web-based rehabilitation program enhanced with outdoor physical activity (BWR-OPA) and consultation versus an OPA (usual care) program in KOA patients. Methods: Forty-four KOA participants were prescribed to follow the programs five times/week for 6 weeks. The primary outcome was self-reported physical function, measured by the Knee Injury and Osteoarthritis Outcome Score (KOOS). The secondary outcomes were pain, PA, function (timed up-and-go (TUG) test, 30 s chair rise test (30 s CRT)), psychological functioning and QoL. Results: There was a significant difference between the groups' KOOSs for pain and symptom subscales at the 6- and 12-week post-intervention assessments compared to baseline (p < 0.005) favoring the BWR-OPA group. There was a superior improvement in PA in the BWR-OPA training group (p < 0.05). Statistical and clinical improvements were found (p < 0.001) with effect sizes over 2.0 for objective measures of function. Similar improvements were recorded over time (p < 0.005) at 12 weeks for QoL, KOOS subscales for ADL, QoL and sports/recreation and psychological functioning for both groups. Conclusions: A blended web-based self-managed care program with outdoor PA was superior in many respects to usual care in KOA participants.
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Affiliation(s)
- Maria Moutzouri
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (G.A.K.); (G.G.)
| | - George A. Koumantakis
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (G.A.K.); (G.G.)
| | - Michael Hurley
- Centre for Allied Health, St George’s University of London, Cranmer Terrace, London SW17 0RE, UK;
- Department of Rehabilitation Sciences, Kingston University, Holmwood House, Grove Crescent, Kingston upon Thames KT1 2EE, UK
- Orthopaedic Research UK, Furlong House, 10a Chandos Street, London W1G 9DQ, UK
| | | | - George Gioftsos
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece; (G.A.K.); (G.G.)
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Patsaki I, Avgeri V, Rigoulia T, Zekis T, Koumantakis GA, Grammatopoulou E. Correction: Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324-336. Adv Respir Med 2024; 92:89-91. [PMID: 38392037 PMCID: PMC10870836 DOI: 10.3390/arm92010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024]
Abstract
Error in Figure 3 [...].
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Affiliation(s)
- Irini Patsaki
- Department of Physiotherapy, University of West Attica, 11521 Athens, Greece
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Patsaki I, Avgeri V, Rigoulia T, Zekis T, Koumantakis GA, Grammatopoulou E. Reply to Salimi, M. Comment on "Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv. Respir. Med. 2023, 91, 324-336". Adv Respir Med 2023; 92:25-26. [PMID: 38247548 PMCID: PMC10801588 DOI: 10.3390/arm92010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 01/23/2024]
Abstract
We are writing in response to the comment [...].
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Affiliation(s)
- Irini Patsaki
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece (E.G.)
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Koumantakis GA, Galazoulas A, Stefanakis M, Paraskevopoulos E, Gioftsos G, Papandreou M. Greek Cross-Cultural Adaptation, Reliability, and Validity of the Quick Foot and Ankle Ability Measure Questionnaire. J Sport Rehabil 2023; 32:855-862. [PMID: 37591505 DOI: 10.1123/jsr.2022-0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 08/19/2023]
Abstract
CONTEXT An easy-to-administer, function-based questionnaire to assess patients with various foot problems was required for a Greek-speaking population. This study aimed to translate and cross-culturally adapt the Quick Foot and Ankle Ability Measure (Quick-FAAM) into Greek and evaluate its reliability and validity. DESIGN Cross-sectional study. METHODS Established international guidelines for the cross-cultural adaptation of questionnaires were followed. The face and content validity of the Greek version of the Quick-FAAM (Quick-FAAM-GR), as well as the internal consistency and test-retest reliability upon repeated administration after 5 days, were examined. In addition, the construct validity of the scale was examined via exploratory factor analysis as well as by testing for associations with the Manchester Foot Pain and Disability Index, the 12-item Short-Form Survey (version 2), and a functional balance assessment test-the Y-Balance Test. RESULTS Sixty participants (18 women) with self-reported chronic ankle instability symptoms, with a median (interquartile range) age of 27 (7.7) years, participated in the study. Half of the participants were included in the test-retest reliability study. The Quick-FAAM-GR demonstrated face and content validity. Excellent internal consistency (Cronbach α = .961) and intrarater test-retest reliability (intraclass correlation coefficient ICC[2,1] = .93) were demonstrated, with a comparable error margin to the original version (standard error of the measurement = 2.1, 95% minimum detectable change = 5.9). Associations of the Quick-FAAM-GR scores to other questionnaires ranged from weak to strong (Spearman rho), all being statistically significant (Manchester Foot Pain and Disability Index from -.26, P = .04, to -.67, P < .001, and 12-item Short-Form Survey, version 2, between .41 and .72, P < .001), and to the Y-Balance Test between lower-limb differences (-.35 to -.58, P < .001). The exploratory factor analysis confirmed the single-factor structure of this scale. No floor/ceiling effects were observed. CONCLUSIONS The Greek Quick-FAAM has proven to be a valid and reliable tool for evaluating chronic ankle instability and can be used for clinical and research purposes in Greek-speaking individuals.
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Affiliation(s)
- George A Koumantakis
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Anastasios Galazoulas
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Marios Stefanakis
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Eleftherios Paraskevopoulos
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - George Gioftsos
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
| | - Maria Papandreou
- Department of Physiotherapy, Laboratory of Advanced Physiotherapy, School of Health & Care Sciences, University of West Attica (UNIWA), Athens,Greece
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Tazji MK, Sadeghi H, Abbasi A, Aziminia M, Shahhosseini A, Marjani ME, Koumantakis GA. The Effects of Core Stabilization Trunk Muscle Fatigue on Lower Limb Stiffness of Basketball Players. Sports (Basel) 2023; 11:200. [PMID: 37888527 PMCID: PMC10611050 DOI: 10.3390/sports11100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/25/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Core stability is the ability to control the position and motion of the trunk over the pelvis and legs to allow the optimum production and transfer of force to the terminal segment in sporting activities. The effect of fatigue, especially core muscle fatigue, on stiffness as a performance index requires more study. This research aimed to investigate the effect of the core stabilization muscles' fatigue on lower limb stiffness during hopping. Thirty active basketball players participated in this study (age: 20.90 ± 1.49 years; weight: 60.30 ± 3.10 kg; height: 163.2 ± 5.04 cm). The hopping test (15 jumps) was performed before and after the fatigue protocol in three states including at a preferred (no frequency control), maximum, and 2.2 Hz frequency on the force plate. The stiffness of the lower extremities was measured before and after the fatigue protocol. The results of the dependent t-test showed core muscle fatigue led to reduced lower extremity stiffness under all three hopping-test conditions by 15.3-15.9% (p ≤ 0.005). It seems that core muscle function affects lower extremity stiffness, and can function as a performance index in athletes. Although performed in healthy volunteers, this study may have implications for injury prevention, highlighting the necessity to perform interspersed endurance training using the different body parts of the kinetic chain.
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Affiliation(s)
- Mehdi Khaleghi Tazji
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran 1544733111, Iran; (M.K.T.); (A.A.); (M.A.)
| | - Hassan Sadeghi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran 1544733111, Iran; (M.K.T.); (A.A.); (M.A.)
| | - Ali Abbasi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran 1544733111, Iran; (M.K.T.); (A.A.); (M.A.)
| | - Mohammad Aziminia
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran 1544733111, Iran; (M.K.T.); (A.A.); (M.A.)
| | - Ali Shahhosseini
- Department of Coaching, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran 1544733111, Iran;
| | - Mohammad Ebrahim Marjani
- Department of Physical Education, Shahid Chamran Campus, Farhangian University, Tehran 1939614464, Iran;
| | - George A. Koumantakis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health and Care Sciences, University of West Attica, 12243 Athens, Greece;
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Koumantakis GA, Sifakis E, Stathis P, Gigourtakis S, Tatsios PI, Paraskevopoulos E, Moutzouri M, Vrouva S. Cross-Cultural Adaptation, Reliability, and Validity of the Greek Version of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ-GR) in Patients with Chronic Shoulder Pain. Healthcare (Basel) 2023; 11:2512. [PMID: 37761710 PMCID: PMC10531340 DOI: 10.3390/healthcare11182512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Shoulder pain is one of the most common musculoskeletal pathologies. The association of shoulder pain with impaired proprioception and bodily self-awareness called for the cross-cultural adaptation of the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) in Greek. The FreSHAQ is a relatively new self-assessment 9-item scale for impaired somatic awareness in patients with shoulder pain. The study included 100 participants (54 women) between 20 and 80 years old, with chronic shoulder pain (>3 months duration), able to comprehend and speak Greek, and recruited from three private physical therapy practices. The cross-cultural adaptation process was followed to develop the Greek version of the questionnaire (FreSHAQ-GR). Further testing for construct validity via exploratory factor analysis and correlational analysis with the Shoulder Pain and Disability Index (SPADI), the Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH), the pain catastrophizing scale (PCS), a pain intensity visual analog scale (PI-VAS) in the last week, and the demographic characteristics followed. Test-retest reliability of the FreSHAQ-GR in a sub-sample of patients (n = 25) was tested upon repeated completion of the scale after a week and examined with the intraclass correlation coefficient (ICC2,1), the standard error of the measurement (SEM), and the minimum detectable change (MDC) indices. The internal consistency of the scale was also assessed. The factor analysis revealed that the scale comprised one factor relevant to shoulder awareness but with fewer items (first 6 items) than the original FreSHAQ. Additionally, the FreSHAQ-GR (both versions) demonstrated statistically significant correlations (Spearman's r) with participants' age (r = -0.31/-0.29, p < 0.002), the PI-VAS (r = 0.54/0.52, p < 0.001), the SPADI total score and both of its subscales (r = 0.39-0.45/0.34-0.39, p < 0.001), the QuickDASH (r = 0.37/0.34, p < 0.001), and the PCS (r = 0.50/0.40, p < 0.001). The questionnaire's internal consistency (Cronbach's α/McDonald's ω) was 0.833/0.827 for the 9-item and 0.871/0.867 for the 6-item FreSHAQ-GR. Test-retest reliability was excellent for both versions of the FreSHAQ-GR (ICC2,1(95% CI) = 0.97/0.98 (0.91-0.99/0.94-0.99), and with a low error margin (SEM = 1.31/0.94 and MDC95% = 3.63/2.61). Therefore, the FreSHAQ-GR (6-item version) possesses very good measurement properties and can be administered to Greek-speaking patients with chronic shoulder pain.
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Affiliation(s)
- George A. Koumantakis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Emmanouil Sifakis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Panagiotis Stathis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | | | - Petros I. Tatsios
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Eleftherios Paraskevopoulos
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Maria Moutzouri
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.S.); (P.S.); (P.I.T.); (E.P.); (M.M.)
| | - Sotiria Vrouva
- Department of Physical Therapy, 401 Army General Hospital of Athens, 11525 Athens, Greece;
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Patsaki I, Avgeri V, Rigoulia T, Zekis T, Koumantakis GA, Grammatopoulou E. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. Adv Respir Med 2023; 91:324-336. [PMID: 37622840 PMCID: PMC10451922 DOI: 10.3390/arm91040026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow limitation. Patient participation in Pulmonary Rehabilitation (PR) programs has a beneficial effect on disease management, improving patients' functional capacity and quality of life. As an alternative to traditional programs or as a complementary activity, the inclusion of virtual reality (VR) games is proposed. The aim of this research study was to investigate the effectiveness of incorporating VR in the pulmonary rehabilitation program of patients with COPD. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, and Pedro from January 2014 to March 2022. The search involved screening for studies examining the effectiveness of enhancing PR with VR. The PEDro (Physiotherapy Evidence Database) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. Six studies were included in this systematic review. The PEDro scale showed five studies of good methodological quality and one of fair quality. The variables examined were: aerobic capacity for exercise, lung function, anxiety and depression, with non-significant improvement for the MRC Dyspnea scale, marginally non-significant improvement regarding 6MWT (p = 0.05) and significant improvement for FEV1 (p < 0.05). There was variability noted in the VR applications and the proposed rehabilitation that the experimental groups followed. The application of VR is recommended for COPD patients, in combination with conventional PR. VR was found to be effective in increasing therapeutic effect and should be considered as a mean of increasing accessibility to PR. Therefore, further research, as well as additional RCTs regarding the effectiveness of VR in patients with COPD, seems necessary.
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Affiliation(s)
- Irini Patsaki
- Department of Physiotherapy, University of West Attica, 11521 Athens, Greece; (V.A.); (T.R.); (T.Z.); (G.A.K.); (E.G.)
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Khaleghi Tazji M, Valizadeh Ghale-Beig A, Sadeghi H, Koumantakis GA, Chrysagis N, Abbasi A. Effects of Running-induced Fatigue on the Trunk-pelvis-hip Coordination Variability During Treadmill Running at Different Speeds. J Musculoskelet Neuronal Interact 2023; 23:189-195. [PMID: 37259658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The objective of this study was to examine the effects of fatigue on the coordination variability between the trunk, pelvis, and hips during treadmill running. METHODS The kinematics data were recorded during ten successive treadmill steps running at the preferred speed and at 80% and 120% of the preferred speed. The angle segment data obtained during the running cycles were normalized to 100 data points, and they were split into ten periods. The coordination variability was calculated using the continuous relative phase (CRP) and variability (VCRP) methods for the trunk, pelvic and hip segments before and after the fatigue protocol. RESULTS The repeated measures analysis of variance showed significant differences in the trunk-pelvic and trunk-hip CRPs and in the CRP variability during the last 30% of the treadmill running cycles after fatigue (p≤0.05). In addition, significant differences were observed in the pelvic-hip CRP and the CRP variability in 40% of the initial treadmill running cycles after fatigue (p≤0.05). CONCLUSION According to the results of this study, fatigue reduces coordination and increases variability. The central nervous system probably exerts more control on the distal segments for maintaining moving patterns in fatigue conditions.
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Affiliation(s)
- Mehdi Khaleghi Tazji
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Azam Valizadeh Ghale-Beig
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - Hassan Sadeghi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
| | - George A Koumantakis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Nikolaos Chrysagis
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Ali Abbasi
- Department of Biomechanics and Sports Injuries, Faculty of Physical Education and Sport Sciences, Kharazmi University, Tehran, Iran
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Paraskevopoulos E, Koumantakis GA, Papandreou M. A Systematic Review of the Aerobic Exercise Program Variables for Patients with Non-Specific Neck Pain: Effectiveness and Clinical Applications. Healthcare (Basel) 2023; 11:healthcare11030339. [PMID: 36766914 PMCID: PMC9914281 DOI: 10.3390/healthcare11030339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/22/2023] [Accepted: 01/23/2023] [Indexed: 01/26/2023] Open
Abstract
Studies have shown that aerobic exercise (AE) may improve symptoms related to non-specific neck pain (NNP); however, the variables of the exercise programs and the overall effectiveness of AE have not been evaluated in a systematic review. Therefore, this review aimed to describe and discuss the variables of the AE programs used in clinical trials for patients with NNP. Included studies were analyzed for the selected AE variables such as intensity, frequency, duration, delivery, supervision, and adherence. The PEDro scale was used to assess the methodological quality of the studies. From the literature search, six studies met the inclusion criteria and were evaluated. After reviewing all the included studies, it was found that a range of AE interventions were used such as cycling, brisk walking, aerobics, stationary bike, treadmill running, circuit training, and swimming. Further, the duration was between 30 and 45 min for each session, with or without progressive increases from week to week. The intervention periods ranged from 1 month to 6 months in duration. Most studies used AE three times per week. Furthermore, exercise intensity was measured with either subjective (BORG) or objective measures (heartrate reserve). Justification for the specified intensity and reporting of adverse events was reported only in two studies and differed between studies. Exercise interventions were poorly reported. This review showed that moderate-intensity AE undertaken three times per week, in patients with NNP, may be beneficial for pain and function; however, the development of reporting standards is essential for the successful replication of studies.
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Affiliation(s)
- Eleftherios Paraskevopoulos
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, 12243 Athens, Greece
- Correspondence:
| | - George A. Koumantakis
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, 12243 Athens, Greece
| | - Maria Papandreou
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
- Laboratory of Advanced Physiotherapy, University of West Attica, 12243 Athens, Greece
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Tatsios PI, Grammatopoulou E, Dimitriadis Z, Papandreou M, Paraskevopoulos E, Spanos S, Karakasidou P, Koumantakis GA. 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. Diagnostics (Basel) 2022; 12:1598. [PMID: 35885502 PMCID: PMC9316964 DOI: 10.3390/diagnostics12071598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Petros I. Tatsios
- Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.G.); (M.P.); (E.P.); (P.K.); (G.A.K.)
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | - Eirini Grammatopoulou
- Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.G.); (M.P.); (E.P.); (P.K.); (G.A.K.)
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | - Zacharias Dimitriadis
- Health Assessment & Quality of Life Laboratory, Physiotherapy Department, University of Thessaly, 35100 Lamia, Greece;
| | - Maria Papandreou
- Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.G.); (M.P.); (E.P.); (P.K.); (G.A.K.)
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | - Eleftherios Paraskevopoulos
- Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.G.); (M.P.); (E.P.); (P.K.); (G.A.K.)
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
| | - Savvas Spanos
- Human Performance & Rehabilitation Laboratory, Physiotherapy Department, University of Thessaly, 35100 Lamia, Greece;
| | - Palina Karakasidou
- Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.G.); (M.P.); (E.P.); (P.K.); (G.A.K.)
| | - George A. Koumantakis
- Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece; (E.G.); (M.P.); (E.P.); (P.K.); (G.A.K.)
- Laboratory of Advanced Physiotherapy, Physiotherapy Department, School of Health & Care Sciences, University of West Attica (UNIWA), 12243 Athens, Greece
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Vrouva SD, Sopidou VK, Chanopoulos KP, Bakalidou DF, Papatsimpas VC, Sorras N, Ziogas MC, Koumantakis GA. Is Shoulder Pain and Disability Index a Prognostic Factor for Neuropathic Shoulder Pain? Cureus 2021; 13:e19173. [PMID: 34873516 PMCID: PMC8636184 DOI: 10.7759/cureus.19173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction So far, investigations in patients with rotator cuff diseases have used pain measurement tools such as visual analog scale (VAS) for nociceptive pain as well as neuropathic pain (NeuP) specialized ones like Douleur Neuropathique 4 Question (DN4) and Pain Detect. The study’s goal was to look at the existence of NeuP in patients with chronic shoulder pain, as well as variables that may be predictive of its progression. Methods There were 112 outpatients in all. Current and previous pain intensity levels were documented with the numerical rating scale (NRS), the Shoulder Pain and Disability Index (SPADI) was used to assess pain and disability levels, and the S-LANSS (self-completed Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale) was used to diagnose NeuP. The Pearson Chi-Square test was employed to check for any relationships between variables. The Mann-Whitney U test was also employed to check for between-group differences (with or without NeuP). To investigate factors that may be utilized as a prognostic for NeuP, logistic regression was performed, with those components (from the univariate analysis) that were statistically significant being included. Results According to the S-LANSS questionnaire for NeuP diagnosis, 21 patients had NeuP. According to S-LANSS, chi-square test findings revealed that NeuP is independent of sex, smoking, size, and location or rotator cuff tear. Univariate analysis with Mann-Whitney U test revealed statistically significant differences in SPADI and NRS scores between the two patient groups (p < 0.001). Α multivariate analysis using S-LANSS as the binary dependent variable and NRS currently, NRS average last month and SPADI total score as independent variables (with statistical significance) revealed that total SPADI score may be considered as an independent prognostic factor for NeuP (odds ratio = 1.189, p < 0.001). Limitations Due to the limited number of patients who participated in the study, the findings were deemed insufficient in terms of statistical power. In particular, the power analysis of the study (type I error probability being [a] = .05) was less than 80% (for the total SPADI score), hence relatively small. As a result, there is a limited probability of a type I error. Conclusions Using S-LANSS, we discovered that 18.8% of patients with rotator cuff tears had NeuP. The SPADI scores (pain and disability) in the NeuP group were substantially greater than in the nociceptive pain group. As previous studies have suggested utilizing certain levels of the VAS for pain assessment and specialized questionnaires for NeuP evaluation, we recommend that SPADI be included as a tool for emphasizing the neuropathic features of shoulder pain.
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Affiliation(s)
- Sotiria D Vrouva
- Physical Therapy/Pain Management, 401 General Army Hospital of Athens, Athens, GRC.,Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Varvara K Sopidou
- Department of Biomedical Sciences, Faculty of Health and Caring Professions University of West Attica, Athens, GRC
| | | | - Daphne F Bakalidou
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Vasileios C Papatsimpas
- Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM) Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Athens, GRC
| | - Nikolaos Sorras
- Pain Management, 401 Army General Hospital of Athens, Athens, GRC
| | - Miltiades C Ziogas
- 1st Department of Orthopedics, 401 Army General Hospital of Athens, Athens, GRC
| | - George A Koumantakis
- Physiotherapy Department, School of Health and Care Sciences, University of West Attica, Athens, GRC
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Koumantakis GA, Oldham JA. Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls: Reliability, clinical applicability and between-group differences. World J Orthop 2021; 12:816-832. [PMID: 34888142 PMCID: PMC8613684 DOI: 10.5312/wjo.v12.i11.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 06/27/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- George A Koumantakis
- Laboratory of Advanced Physiotherapy (LAdPhys), Physiotherapy Department, University of West Attica (UNIWA), Athens 12243, Attiki, Greece
| | - Jacqueline A Oldham
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M1 7DN, Lancs, United Kingdom
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Abstract
Objective The aim of the study was to examine the differences in joint position sense at the elbow joint between 15 children with unilateral cerebral palsy (CP) and 15 typically developing (TD) controls without neurological or other health deficits. Methodology Joint position sense, a major proprioceptive component, was evaluated actively using a Kin Com 125 AP isokinetic dynamometer (Chattanooga Group, Chattanooga, TN). Results A significant interaction was found (p<0.05) between disability and side, with respect to the active reproduction movement scores. Post-hoc independent t-tests, with Bonferroni adjustments, revealed significant differences for the dominant (t=-3.63, p=0.001) and non-dominant sides respectively (t=-6.19, p=0.000). Repeated measures t-test revealed wider errors with the non-dominant (affected side) in the active reproduction test, compared to the dominant (nonaffected) side for the CP group of children (t=-4.73, p=0.000). A positive correlation was evident between the level of spasticity and joint position sense (Rho=0.71, p=0.003). Conclusions Based on our findings, joint position sense is impaired at the elbow joint in children with spastic hemiplegia. The proprioceptive deficit is present at both the affected and unaffected sides and is related to the level of spasticity.
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Affiliation(s)
- Nikolaos Chrysagis
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - George A Koumantakis
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - Eirini Grammatopoulou
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - Emmanouil Skordilis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, GRC
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Koumantakis GA, Malkotsis A, Pappas S, Manetta M, Anastopoulos T, Kakouris A, Kiourtsidakis E. Lumbopelvic sagittal standing posture associations with anthropometry, physical activity levels and trunk muscle endurance in healthy adults. Hong Kong Physiother J 2021; 41:127-137. [PMID: 34177201 PMCID: PMC8221983 DOI: 10.1142/s1013702521500128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background Various factors, inherited and acquired, are associated with habitual spinal postures. Objective The purpose of this study was to identify the relationships between trunk muscle endurance, anthropometry and physical activity/inactivity and the sagittal standing lumbopelvic posture in pain-free young participants. Methods In this study, 112 healthy young adults (66 females), with median (IQR) age of 20 years (18.2-22 years), without low back pain, injury or trauma were included. Lumbar curve (LC) and sacral slope (SS) angles were measured in standing with a mobile phone application (iHandy level). Anthropometric, physical activity/inactivity levels (leisure-time sport involvement and sitting hours/day) and abdominal (plank prone bridge test) and paraspinal (Sorensen test) isometric muscle endurance measures were collected. Results LC and SS angles correlated significantly ( r = 0 . 80 , p < 0 . 001 ). Statistically significant differences for both LC ( p = 0 . 023 ) and SS ( p = 0 . 013 ) angles were identified between the male and female participants. A significant negative correlation was identified between the abdominal endurance time and LC ( r =- 0 . 27 , p = 0 . 004 ); however, the power of this result (56%) was not sufficiently high. The correlation between abdominal endurance and SS was non-significant ( r =- 0 . 17 , p = 0 . 08 ). In addition, no significant associations were identified between either of the sagittal lumbopelvic angles (LC-SS) in standing and the participants' body mass index (BMI), paraspinal endurance, leisure-time sport involvement or sitting hours/day. Conclusion The potential role of preventive exercise in controlling lumbar lordosis via enhancement of the abdominal muscle endurance characteristics requires further confirmation. A subsequent study, performed in a larger population of more diverse occupational involvement and leisure-time physical activity levels, is proposed.
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Affiliation(s)
- George A Koumantakis
- Department of Physiotherapy, 401 General Army Hospital of Athens, Panagioti Kanellopoulou 1, Athens, Greece.,School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Antonios Malkotsis
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Stefanos Pappas
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Maria Manetta
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Timotheos Anastopoulos
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Apollon Kakouris
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
| | - Eleutherios Kiourtsidakis
- School of Physiotherapy, Faculty of Health Sciences, Metropolitan College (Affiliated to Queen Margaret University, Edinburgh, UK), Athens, Greece
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Makrogkikas M, Ntenezakos N, Koumantakis GA, Dimitriadis Z. Reliability of a laser beam device for the assessment of head repositioning accuracy in patients with chronic neck pain. Acta Gymnica 2021. [DOI: 10.5507/ag.2021.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Koumantakis GA, Roussou E, Angoules GA, Angoules NA, Alexandropoulos T, Mavrokosta G, Nikolaou P, Karathanassi F, Papadopoulou M. The immediate effect of IASTM vs. Vibration vs. Light Hand Massage on knee angle repositioning accuracy and hamstrings flexibility: A pilot study. J Bodyw Mov Ther 2020; 24:96-104. [PMID: 32826015 DOI: 10.1016/j.jbmt.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The effectiveness of novel soft-tissue interventions relative to traditional ones requires further exploration. The purpose of this pilot study was to evaluate the immediate effect of Instrument Assisted Soft Tissue Mobilization (IASTM) compared to Vibration Massage or Light Hand Massage on hamstrings' flexibility and knee proprioception. METHODS 16 healthy non-injured male participants (mean age 23.7 years, height 1.80 cms and body mass 77.7 kg) were randomly assigned to the following interventions: (a) 5min IASTM, (b) 5min Vibration Massage and (c) 8min Light Hand-Massage, sequentially delivered to all participants with an in-between 1-week time interval. A single application of each intervention was given over the hamstrings of their dominant leg (repeated measures under 3 different experimental conditions). An active knee angle reproduction proprioception test and the back-saver sit and reach flexibility test were performed before and immediately after each intervention. Reliability of outcomes was also assessed. RESULTS Reliability for flexibility (ICC3,1 = 0.97-0.99/SEM = 0.83-1.52 cm) and proprioception (ICC3,1 = 0.83-0.88/SEM = 1.63-2.02°) was very good. For flexibility, statistically significant immediate improvement (p < 0.001) was noted in all 3 groups (1.61-3.23 cm), with no between-group differences. For proprioception, improvement in the IASTM (2.12°), Vibration Massage (0.32°) and Light Hand-Massage (1.17°) conditions was not statistically significant; no between-group differences were also evident. CONCLUSIONS Our findings indicate that muscle flexibility was positively influenced immediately after a single intervention of IASTM, Vibration Massage or Light Hand Massage. Proprioception changes were not statistically significant either within or between groups. Further evaluation of those interventions in a larger population with hamstrings pathology is required.
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Affiliation(s)
- George A Koumantakis
- 401 General Army Hospital of Athens, Physiotherapy Department, Pan. Kanellopoulou 1, Athens, Greece; Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK.
| | - Eleonora Roussou
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Georgios A Angoules
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Nikolaos A Angoules
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Theodoros Alexandropoulos
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Georgia Mavrokosta
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Prokopios Nikolaou
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Filippi Karathanassi
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
| | - Maria Papadopoulou
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Affiliated Institution with Queen Margaret University, Edinburgh, UK
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Hayden JA, Wilson MN, Stewart S, Cartwright JL, Smith AO, Riley RD, van Tulder M, Bendix T, Cecchi F, Costa LOP, Dufour N, Ferreira ML, Foster NE, Gudavalli MR, Hartvigsen J, Helmhout P, Kool J, Koumantakis GA, Kovacs FM, Kuukkanen T, Long A, Macedo LG, Machado LAC, Maher CG, Mehling W, Morone G, Peterson T, Rasmussen-Barr E, Ryan CG, Sjögren T, Smeets R, Staal JB, Unsgaard-Tøndel M, Wajswelner H, Yeung EW. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. Br J Sports Med 2019; 54:1277-1278. [DOI: 10.1136/bjsports-2019-101205] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 01/26/2023]
Abstract
BackgroundLow back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise.MethodsIn parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers.ResultsWe received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) −10.7 (−14.1 to –7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) −10.2 (−13.2 to –7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers—these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics.ConclusionsThis study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups.Protocol publicationhttps://doi.org/10.1186/2046-4053-1-64
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Stathopoulos N, Dimitriadis Z, Koumantakis GA. Erratum to "Effectiveness of Mulligan's mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008-2017" [Physiotherapy 105 (March (1)) (2019) 1-9]. Physiotherapy 2019; 106:219. [PMID: 31477334 DOI: 10.1016/j.physio.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nikolaos Stathopoulos
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK.
| | - Zacharias Dimitriadis
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK
| | - George A Koumantakis
- Metropolitan College, Health Sciences Faculty, School of Physiotherapy, Athens, Greece - Franchised Institution with University of East London (UEL), London, UK; 401General Army Hospital of Athens, Pan. Kanellopoulou 1, Athens, Greece
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Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan’s Mobilization With Movement Techniques on Range of Motion in Peripheral Joint Pathologies: A Systematic Review With Meta-analysis Between 2008 and 2018. J Manipulative Physiol Ther 2019; 42:439-449. [DOI: 10.1016/j.jmpt.2019.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/13/2022]
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Koumantakis GA, Lountzis D, Papatsimpas G, Kentritas O, Katsiki X, Michaleas P. Effects of a functional lower extremity fatigue protocol and a 5-minute recovery period on the performance of a single leg hop test for distance in healthy participants. J Sports Med Phys Fitness 2019; 59:916-924. [DOI: 10.23736/s0022-4707.18.08837-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Stathopoulos N, Dimitriadis Z, Koumantakis GA. Effectiveness of Mulligan’s mobilization with movement techniques on pain and disability of peripheral joints: a systematic review with meta-analysis between 2008–2017. Physiotherapy 2019; 105:1-9. [DOI: 10.1016/j.physio.2018.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 10/07/2018] [Indexed: 01/22/2023]
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Koumantakis GA, Tsoligkas K, Papoutsidakis A, Ververidis A, Drosos GI. Cross-cultural adaptation and validation of the International Knee Documentation Committee Subjective Knee Form in Greek. J Orthop Traumatol 2015; 17:123-9. [PMID: 26093603 PMCID: PMC4882291 DOI: 10.1007/s10195-015-0362-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background Patient-reported outcomes require validation in a particular language and culture before administration for clinical use. Materials and methods A systematic translation of the IKDC Subjective Knee Form was initially tested in 30 patients with various knee pathologies to develop the first Greek version (IKDC/SKF-GR). It was then administered to another 80 patients. The test–retest reliability (n = 35) and internal consistency (n = 80) were examined. Construct validity was tested by correlating the IKDC/SKF-GR with the SF-36 subscales (n = 80) and content validity by measuring floor/ceiling effects. Responsiveness was measured in patients with meniscus pathology (n = 24). Results Patients filled the form without omissions/questions regarding the phrasing of items. Internal consistency was good (Cronbach’s α = 0.87) and test–retest reliability very good (ICC2,1 = 0.95, SEM = 4.4 and SDC = 12.2). Correlations with the SF-36 subscales confirmed its construct validity. No floor/ceiling effects were recorded. The effect size was large (ES = 1.26). Conclusions The IKDC/SKF-GR has comparable measurement properties to the original form. Level of evidence Level II.
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Affiliation(s)
- George A Koumantakis
- Department of Physical Therapy, 401 Army General Hospital of Athens, 1 Panagioti Kanellopoulou Avenue, 11525, Athens, Greece.
| | - Konstantinos Tsoligkas
- 2nd Department of Anesthesiology-Pain Unit, ATTIKON University General Hospital, School of Medicine, University of Athens, Athens, Greece
| | | | - Athanasios Ververidis
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Georgios I Drosos
- Department of Orthopaedic Surgery, University General Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Michaelidis M, Koumantakis GA. Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review. Phys Ther Sport 2013; 15:200-10. [PMID: 24703497 DOI: 10.1016/j.ptsp.2013.12.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 10/01/2013] [Accepted: 12/06/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports. PURPOSE To analyze the effects of ACL injury prevention programs on injury rates in female athletes between different sports. METHODS A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: 'anterior cruciate ligament', 'ACL', 'knee joint', 'knee injuries', 'female', 'athletes', 'neuromuscular', 'training', 'prevention'. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete-exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes. RESULTS 13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results. CONCLUSION Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery.
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Koumantakis GA, Watson PJ, Oldham JA. Supplementation of general endurance exercise with stabilisation training versus general exercise only. Physiological and functional outcomes of a randomised controlled trial of patients with recurrent low back pain. Clin Biomech (Bristol, Avon) 2005; 20:474-82. [PMID: 15836934 DOI: 10.1016/j.clinbiomech.2004.12.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2004] [Revised: 12/25/2004] [Accepted: 12/30/2004] [Indexed: 02/07/2023]
Abstract
BACKGROUND Determination of the mode of action of new exercise techniques in different back pain populations is lacking. The effectiveness of supplementing an exercise programme with stabilisation exercises concerning physiological and functional parameters in non-specific back pain patients is unknown. METHODS Randomised controlled trial, comparing a general trunk muscle endurance exercise approach enhanced with specific muscle stabilisation exercises (S&G group) with a general exercise approach only (G group). 55 patients with recurrent back pain were randomised in S&G group (n=29) and G group (n=26). Both groups received an 8-week exercise intervention and written advice. Paraspinal muscle strength and electromyographic fatigue of the erector spinae and multifidus were measured. Additionally, 3 functional speed tests were assessed. Outcomes were collected pre- and post-intervention. FINDINGS No differences were detected for any of the paraspinal fatigue characteristics either within or between groups, apart from a significant decrease in normalised median frequency slope of the erector spinae for the G group. Paraspinal muscle strength and all functional tests have demonstrated significant within-group improvements for both groups, without any between-group differences. INTERPRETATION An 8-week stabilisation exercise-enhanced approach presented equal benefits to a general endurance-based exercise programme for patients with recurrent non-specific back pain. A slightly steeper slope for the erector spinae in the G group was the only electromyographic fatigue alteration noted. Concomitant strength improvement probably reflects neural input changes rather than histochemical muscle changes. Physical exercise alone and not the exercise type was the key determinant for improvement in this patient group.
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Affiliation(s)
- George A Koumantakis
- Centre for Rehabilitation Science, University of Manchester, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK.
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Arnall FA, Koumantakis GA, Oldham JA, Cooper RG. Between-days reliability of electromyographic measures of paraspinal muscle fatigue at 40, 50 and 60% levels of maximal voluntary contractile force. Clin Rehabil 2002; 16:761-71. [PMID: 12428825 DOI: 10.1191/0269215502cr551oa] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To ascertain which percentage of maximal voluntary contractile force of the paraspinal muscles, when tested in a functional position, is most reliable for assessing electromyographic (EMG) fatigue changes. SUBJECTS Ten healthy volunteers with no history of low back pain (six males). MAIN OUTCOME MEASURES The surface EMG signal during 60-second isometric contractions of the paraspinal muscles at 40, 50 and 60% levels of maximal voluntary contractile force was captured and analysed. Each contraction level was assessed on two occasions, at least three days apart. The initial median frequency, the decline in median frequency slope and the increase in root mean square values were assessed for between-days reliability, using intraclass correlation coefficients (ICCs) and standard errors of measurements (SEM). Normalized median frequency and root mean square values were also assessed. RESULTS At 40% of maximal voluntary contraction, little or no EMG fatigue changes occurred in any of the observed parameters. At 50% maximal voluntary contraction the initial mean frequency and root mean square changes proved highly reliable, with ICCs ranging from 0.74 to 0.86 and 0.75 to 1.00 respectively. Normalizing the root mean square data reduced the reliability, but this was still acceptable with ICCs 0.70-0.83. The median frequency decline slope proved less reliable with ICCs 0.24-0.74 for raw and 0.26-0.77 for normalized data. At 60% maximal voluntary contraction the initial mean frequency proved as reliable as initial median frequency at 50% with ICCs 0.70-0.89. The raw and normalized root mean squares (ICCs 0.43-0.89 and 0.30-0.87 respectively) and raw and normalized median frequency (ICCs 0.27-0.51 and 0.24-0.53 respectively) changes were less reliable than at 50% MVC. Overall, the reliability is better at the L4/5 than at the L2/3 level. CONCLUSION Outcome measures taken at 50% maximal voluntary contraction are the most reliable in functional testing the paraspinal muscles of healthy volunteers. With initial median frequency and root mean square values being more reliable parameters than median frequency decline. At the L4/5 level, however, all parameters were acceptably reliable at 50% of maximum effort. However the between-subject variability of the median frequency decline and root mean square incline slopes suggest that these parameters are not yet fully suitable for monitoring fatigue changes during prolonged isometric contraction.
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Affiliation(s)
- Frances A Arnall
- Musculoskeletal Research Group, University of Manchester, Manchester Royal Infirmary, UK.
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Koumantakis GA, Winstanley J, Oldham JA. Thoracolumbar proprioception in individuals with and without low back pain: intratester reliability, clinical applicability, and validity. J Orthop Sports Phys Ther 2002; 32:327-35. [PMID: 12113467 DOI: 10.2519/jospt.2002.32.7.327] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Repeated measures design of active spinal position sense in individuals with and without low back pain (LBP). OBJECTIVES Reproducibility and validity evaluation of thoracolumbar proprioception measurement. BACKGROUND Proprioception studies in peripheral joints and the spine suggest that there may be proprioception deficits due to injury, pain, or degeneration. Kinesthetic retraining may be useful in rehabilitation of patients with LBP, but appropriate measures are required to objectively quantify spinal proprioception. METHODS AND MEASURES Active-target reproduction in the sagittal, horizontal, and coronal planes was assessed (3 separate occasions for 18 asymptomatic volunteers and 2 occasions for 62 patients with LBP). Repositioning accuracy was expressed as absolute errors (AE) and variable errors (VE). Reliability was analyzed with intraclass correlation coefficient (ICC) and precision with standard error of measurement (SEM) and calculation of the smallest detectable difference (SDD) index. Repeated measures ANOVA and correlations were used for within-group comparisons and discriminant analysis for between-group comparisons. RESULTS Reproducibility was better for the asymptomatic group, with AE for flexion and rotation being the most reliable (ICC = 0.76-0.80, SEM = 0.91 degrees-1.34 degrees). SDDs were high for all tests, suggesting limited clinical applicability. Reproducibility for the same tests was poor-moderate (ICC = 0.31-0.64, SEM = 0.45 degrees-3.90 degrees) for the patient group. AE for right-side rotation could discriminate between subject groups with 83.3% specificity but only 54.8% sensitivity. CONCLUSIONS Proprioception testing, with the methods employed, did not demonstrate good measurement properties in a sample of patients with recurrent LBP. Neither could it sufficiently discriminate between individuals with and without LBP. Possible reasons for these findings are discussed.
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Affiliation(s)
- George A Koumantakis
- Centre for Rehabilitation Science, University of Manchester, Central Manchester Healthcare Trust, UK.
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Koumantakis GA, Oldham JA, Winstanley J. Intermittent isometric fatigue study of the lumbar multifidus muscle in four-point kneeling: an intra-rater reliability investigation. Man Ther 2001; 6:97-105. [PMID: 11414779 DOI: 10.1054/math.2001.0392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Back muscle endurance is considered important in low back pain (LBP) rehabilitation. Specific training of multifidus may also be necessary to restore normal low back function. The reliability of surface electromyogram (EMG) to assess endurance of the multifidus muscle during intermittent isometric exercise was evaluated. Multifidus endurance was monitored in the four-point kneeling exercise position using the power spectral analysis method. Twenty healthy volunteers were tested on three separate occasions. Subjects performed repeat 10 s high-intensity voluntary contractions of multifidus for 3 min. The median frequency (MF) and the integrated-rectified (I-R) EMG signal displayed the fatigue pattern of multifidus. Intraclass correlation coefficients indicated fair-good reproducibility for MF (0.48-0.67) but poor reliability for IR-EMG. In conclusion, problems concerning functional testing protocols for the back muscles remain and careful development is necessary for more realistic rehabilitation monitoring.
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Affiliation(s)
- G A Koumantakis
- Centre for Rehabilitation Science, University of Manchester, UK.
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Koumantakis GA, Arnall F, Cooper RG, Oldham JA. Paraspinal muscle EMG fatigue testing with two methods in healthy volunteers. Reliability in the context of clinical applications. Clin Biomech (Bristol, Avon) 2001; 16:263-6. [PMID: 11240063 DOI: 10.1016/s0268-0033(00)00113-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Comparison of the accuracy of surface electromyogram for back muscle endurance assessment with two different tests. DESIGN Test-retest measurements in 16 healthy volunteers on two separate occasions for each test under controlled conditions. BACKGROUND Back muscle endurance is considered important in low back pain rehabilitation. Reliability of paraspinal muscle endurance assessment is a pre-requisite for accurate and meaningful clinical applications of the technique. METHODS All participants performed each test twice. A direct comparison was made between two popular fatigue testing methods, the modified Biering-Sørensen and a 60% maximum voluntary isometric contraction in the upright position during which time fatigue was assessed from the electromyogram spectral and amplitude analysis. RESULTS Reproducibility of initial median frequency was excellent for both tests. Normalised median frequency slope values were more reliable with the 60% maximum voluntary contraction upright test. The clinical applicability of these measures in detecting significant differences after patient rehabilitation is recommended. Root mean square had very large between-day error for both tests.
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Affiliation(s)
- G A Koumantakis
- Centre for Rehabilitation Science, Central Manchester Healthcare Trust, University of Manchester, Oxford Road, Manchester M13 9WL, UK.
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