1
|
Jia CQ, Wu YJ, Hu FQ, Yang XQ, Zhang Z, Cao SQ, Zhang XS. Cross-cultural adaptation and validation of the simplified Chinese version of the Exercise-Induced Leg Pain Questionnaire (EILP). Disabil Rehabil 2023; 45:3930-3936. [PMID: 36286230 DOI: 10.1080/09638288.2022.2138991] [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: 04/16/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study cross-culturally adapted and psychometrically validated a simplified Chinese version of the Exercise-Induced Leg Pain Questionnaire (SC-EILP) for evaluating the severity of symptoms and sports ability among individuals with exercise-induced leg pain. MATERIALS AND METHODS One hundred and fourteen participants with exercise-induced leg pain were included. To assess reliability, we calculated Cronbach's α and intra-class correlation coefficient (ICC). Construct validity was analysed by assessing the correlations between SC-EILP and visual analogue scale (VAS), University of California Los Angeles activity score (UCLA), and short form (36) health survey (SF-36). Factorial validity was used to establish the factor structure of the questionnaire. RESULTS The EILP was cross-culturally well-adapted and translated into simplified Chinese. Each item was appropriately correlated with the total items. SC-EILP had nearly good reliability [Cronbach's α = 0.798, ICC = 0.897, 95% confidence interval 0.851-0.929]. The elimination of any one item in all did not result in a value of Cronbach's α of <0.80. SC-EILP had a very good correlation with VAS (-0.607, p < 0.01) and a moderate correlation with UCLA (0.581, p < 0.01) and physical domains of SF-36 (0.499-0.528, p < 0.01). Exploratory factor analysis revealed the 3-factor loading explained 74.736% of the total variance [Kaiser-Mayer-Olkin (KMO) = 0.672, C2 = 665.34, p < 0.001]. CONCLUSIONS SC-EILP showed excellent acceptability, internal consistency, reliability, and construct validity, and could be recommended for individuals in Mainland China.
Collapse
Affiliation(s)
- Cheng-Qi Jia
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Yu-Jie Wu
- Department of Nursing, The Third People's Hospital of Datong, Datong, China
| | - Fan-Qi Hu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Qing Yang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Zhen Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Shi-Qi Cao
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
- Department of Orthopedics of TCM Clinical Unit, 6th Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xue-Song Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
2
|
Castillo-Domínguez A, Alvero-Cruz JR, Páez-Moguer J, Nauck T, Lohrer H, Scheer V, García-Romero J. Cross-Cultural adaptation and validation of the Exercise-Induced Leg Pain questionnaire for Spanish speaking patients. Clin Rehabil 2022; 36:968-979. [PMID: 35350924 DOI: 10.1177/02692155221088933] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To cross-culturally adapt and validate a Spanish version of the Exercise-Induced Leg Pain questionnaire. DESIGN Clinical measurement study. PARTICIPANTS The validity and reliability of the adapted version were assessed in four groups of 40 patients with exercise-induced leg pain, 40 physically active healthy individuals (control group), 40 athletes with other leg conditions and 40 athletes, military personnel and candidates with no history of injury (risk group). MAIN MEASURE Exercise-Induced Leg Pain questionnaire. REFERENCE MEASURES Spanish version of the Short-Form 36 and Schepsis postsurgical classification scale. RESULTS In patients with exercise-induced leg pain, the mean age was 24.9 (± 6.7) years and the mean score of the questionnaire was 62.8 (± 10.9). The standard error of measurement and minimum detectable change threshold were 1.67 and 4.63 points, respectively. Excellent internal consistency (Cronbach's α = 0.942) and test-retest reliability (intraclass correlation coefficient = 0.995) were found. The exploratory and confirmatory factor analyses indicated that a one-factor solution explained 66.84% of the variance. For construct validity, 87.5% of the previously stated hypotheses were fulfilled between the total score of the questionnaire and Short-Form 36 dimensions. Concurrent validity, assessed by the Schepsis scale, was almost perfect (r = 0.92, p < 0.001). The predictive validity of the questionnaire was demonstrated using the receiving operating curve (area of 0.992; 95% CI: 0.983-1, p < 0.001). CONCLUSION The Spanish version of the Exercise-Induced Leg Pain questionnaire resulted in a reliable and valid instrument to assess patients with exercise-induced leg pain.
Collapse
Affiliation(s)
| | - José Ramón Alvero-Cruz
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, 16752University of Málaga, 29071, Spain
| | | | - Tanja Nauck
- European SportsCare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, 65205, Germany
| | - Heinz Lohrer
- European SportsCare Network (ESN), Zentrum für Sportorthopädie, Borsigstrasse 2, 65205, Germany.,Department of Sport and Sport Science, Albert-Ludwigs-Universität Freiburg i. Brsg., Schwarzwaldstraße 175, 79117, Germany
| | - Volker Scheer
- Ultra Sports Science Foundation, 109 Boulevard de l'Europe, 69310, France
| | - Jerónimo García-Romero
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, 16752University of Málaga, 29071, Spain
| |
Collapse
|
3
|
Padhiar N, Curtin M, Aweid O, Aweid B, Morrissey D, Chan O, Malliaras P, Crisp T. The effectiveness of PROLOTHERAPY for recalcitrant Medial TIBIAL Stress Syndrome: a prospective consecutive CASE series. J Foot Ankle Res 2021; 14:32. [PMID: 33863355 PMCID: PMC8052809 DOI: 10.1186/s13047-021-00453-z] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6 and 16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option. OBJECTIVE To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport. METHOD The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age = 31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment. INTERVENTION An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area. MAIN OUTCOME MEASURES Pain was assessed using a 10-cm visual analog scale (VAS) at baseline, short-term, medium-term (mean 18 weeks), and long-term (mean 52 weeks) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro-Wilk test was used to evaluate the normality of the distribution of data. Friedman's non-parametric test was used to compare the within-patient treatment response over time. Post-hoc Wilcoxon signed-rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods. RESULTS Patients reported a significant (p < 0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as 'much improved' at medium-term follow-up and the median return to sports score was 'returned to desired but not pre-injury level' at medium-term and long-term follow-up. No adverse events were reported. CONCLUSIONS Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term; however, more robust trials are required to validate these findings in the absence of controls. CLINICAL RELEVANCE Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant MTSS.
Collapse
Affiliation(s)
- Nat Padhiar
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
- London SportsCare, London Independent Hospital, London, UK
- European SportsCare, London, UK
| | - Mark Curtin
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Osama Aweid
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Bashaar Aweid
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Dylan Morrissey
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Otto Chan
- London SportsCare, London Independent Hospital, London, UK
| | - Peter Malliaras
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
- Monash University, Melbourne, Australia
| | - Tom Crisp
- Centre for Sports and Exercise Medicine, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
- London SportsCare, London Independent Hospital, London, UK
| |
Collapse
|
4
|
Roberts A, Hulse D, Bennett AN, Dixon S. Plantar pressure differences between cases with symptoms of clinically diagnosed chronic exertional compartment syndrome and asymptomatic controls. Clin Biomech (Bristol, Avon) 2017; 50:27-31. [PMID: 28985488 DOI: 10.1016/j.clinbiomech.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/19/2017] [Accepted: 10/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior chronic exertional compartment syndrome of the leg has been hypothesised to develop due to excessive muscle activity and foot pronation. Plantar pressure variables related to lower limb muscle activity and foot type may therefore provide insight into this condition. METHODS 70 male cases and 70 asymptomatic controls participated. A clinical diagnosis was established from typical symptoms, with clinical examination excluding other pathologies. Plantar pressure variables during walking, hypothesised to be related to foot type, toe extensor activity or had shown predictive validity for general exercise-related lower leg pain, were extracted. FINDINGS Cases were shorter in height (mean difference 2.4cm), had greater body mass (mean difference 4.4kg) and had reduced ankle dorsiflexion range of motion than controls (mean difference 1.5cm). Plantar pressure variables indicative of foot-type and toe extensor activity did not differ between groups (P>0.05). The magnitude of medial forefoot loading was the strongest plantar pressure predictor of the presence of chronic exertional compartment syndrome (Odds ratio:0.87, P=0.005). There was also some evidence of greater lateral heel loading at 5% of stance time (P=0.049-0.054). INTERPRETATION The lack of association with foottype-related and toe extensor activity-related plantar pressure variables suggest that these are not risk factors for the development of chronic exertional compartment syndrome, contrary to earlier hypotheses. The greater lateral to medial loading could theoretically represent increased Tibialis anterior muscle activity at heel strike but a subsequent loss of control as the ankle is lowered. Future studies directly investigating muscle activity and function are now required.
Collapse
|
5
|
Roberts A, Roscoe D, Hulse D, Bennett AN, Dixon S. Biomechanical differences between cases with suspected chronic exertional compartment syndrome and asymptomatic controls during running. Gait Posture 2017; 58:374-9. [PMID: 28869903 DOI: 10.1016/j.gaitpost.2017.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/20/2017] [Accepted: 08/27/2017] [Indexed: 02/02/2023]
Abstract
Chronic exertional compartment syndrome (CECS) has been hypothesised, following clinical observations, to be the result of abnormal biomechanics predominantly at the ankle. Treatment of CECS through running re-education to correct these abnormalities has been reported to improve symptoms. However no primary research has been carried out to investigate the movement patterns of those with CECS. This study aimed to compare the running kinematics and muscle activity of cases with CECS and asymptomatic controls. 20 men with bilateral symptoms of CECS of the anterior compartment and 20 asymptomatic controls participated. Barefoot and shod running 3D kinematics and muscle activity of the left and right legs; and anthropometry were compared. Cases displayed less anterior trunk lean and less anterior pelvic tilt throughout the whole gait cycle and a more upright shank inclination angle during late swing (peak mean difference 3.5°, 4.1° and 7.3° respectively). Cases demonstrated greater step length and stance time, although this was not consistent across analyses. There were no consistent differences in Tibialis anterior or Gastrocnemius medialis muscle activity. Cases were heavier (mean difference 7.9kg, p=0.02) than controls with no differences in height (p>0.05) These differences only partially match the clinical observations previously described. However, no consistent differences were found at the ankle joint suggesting that current running re-education interventions which focus on adjusting ankle kinematics are not modifying pathological aspects of gait. The longer step length is a continuing theme in this population and as such may be a key component in the development of CECS.
Collapse
|
6
|
Roberts A, Roscoe D, Hulse D, Bennett AN, Dixon S. Biomechanical differences between cases with chronic exertional compartment syndrome and asymptomatic controls during walking and marching gait. Gait Posture 2017; 58:66-71. [PMID: 28750263 DOI: 10.1016/j.gaitpost.2017.07.044] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 07/12/2017] [Accepted: 07/16/2017] [Indexed: 02/02/2023]
Abstract
Chronic exertional compartment syndrome is a significant problem in military populations that may be caused by specific military activities. This study aimed to investigate the kinematic and kinetic differences in military cases with chronic exertional compartment syndrome and asymptomatic controls. 20 males with symptoms of chronic exertional compartment syndrome of the anterior compartment and 20 asymptomatic controls were studied. Three-dimensional lower limb kinematics and kinetics were compared during walking and marching. Cases were significantly shorter in stature and took a relatively longer stride in relation to leg length than controls. All kinematic differences identified were at the ankle. Cases demonstrated increased ankle plantarflexion from mid-stance to toe-off. Cases also demonstrated less ankle inversion at the end of stance and early swing phases. Lower ankle inversion moments were observed during mid-stance. The anthropometric and biomechanical differences demonstrated provide a plausible mechanism for the development of chronic exertional compartment syndrome in this population. The shorter stature in combination with the relatively longer stride length observed in cases may result in an increased demand on the anterior compartment musculature during ambulation. The results of this study, together with clinical insights and the literature suggest that the suppression of the walk-to-run stimulus during group marches may play a significant role in the development of chronic exertional compartment syndrome within a military population. The differences in joint angles and moments also suggest an impairment of the muscular control of ankle joint function, such as a reduced effectiveness of tibialis anterior. It is unclear whether this is a cause or consequence of chronic exertional compartment syndrome.
Collapse
Affiliation(s)
- Andrew Roberts
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, KT18 6JW, UK; Sport and Health Sciences, College of Life and Environmental Sciences, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - David Roscoe
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, KT18 6JW, UK
| | - David Hulse
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, KT18 6JW, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Epsom, Surrey, KT18 6JW, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY, UK
| | - Sharon Dixon
- Sport and Health Sciences, College of Life and Environmental Sciences, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| |
Collapse
|