Background:Disk herniation is the most common cause of radiating low back pain (LBP) in subjects under 60 years of age. The present study aims to compare the effect of dry needling (DN) and a standard conservative approach on the pain and function in subjects with discogenic radiating LBP.Materials and Methods:Fifty-eight subjects with discogenic radicular LBP were screened and randomized into control (Standard physical therapy, n = 29) and experimental group (Standard physical therapy and DN, n = 29). Radiating pain intensity and disability were measured using visual analog scale (VAS) and Oswestry Disability indices at baseline, at the end of treatment and 2 months after the last intervention session. The changes in pain intensity and disability were studied using a 3 × 2 repeated measures analysis of variance considering time as the within-subject factor and group as the between-subject.Results:Pain intensity and disability scores decreased significantly in both experimental and control groups (experimental group: VAS = 37.24, Oswestry Disability Index [ODI] =28.48, control group: VAS = 45.5, ODI = 32.96), following the intervention. The change continued during the follow-up period (P < 0.001 for all comparisons). Pain and disability improvement, however, were more significant in experimental group, both in post intervention (experimental group: VAS = 25.17, ODI = 22.17, control group: VAS = 42.4, ODI = 30.27) (P = 0.05 and P = 0.03, respectively) and follow-up measures (P = 0.006 and P = 0.002, respectively).Conclusion:Both intervention strategies seem to significantly improve pain and disability immediately following intervention, where the improvement continued during 2 months after the last active intervention. Therefore, supplementary DN application may enhance the effect of the standard intervention considerably.

Background The lower limb spasticity after stroke can affect the balance and gait of patients with stroke. Objective The aim of this study is to assess the effects of ankle plantar flexor spasticity level on balance in patients with stroke. Methods Patients with stroke were recruited from neurology and physiotherapy clinics in Tehran, Iran. Based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS), the eligible patients with stroke were divided into 2 groups: high spasticity (MMAS score≥2) and low spasticity (MMAS score<2). The primary outcome measures were the MMAS scores, Activities-Specific Balance Confidence questionnaire scores, eyes-open and eyes-closed posturography measures, and Timed Up and Go test results. The secondary outcome measures were the ankle passive range of motion and ankle joint proprioception. The t test, mixed model univariate analysis of variance, and Spearman rank correlation were used for statistical analysis. Results Data collection and statistical analysis are complete. The interpretation of results is underway. We expect the results to be published in winter 2020. Conclusions We believe that patients with high ankle plantar flexor spasticity after stroke will demonstrate greater balance dysfunction, which will worsen with impaired proprioception, passive range of motion, and eyes closed. International Registered Report Identifier (IRRID) RR1-10.2196/16045

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS &gt; 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

BACKGROUND Lower limb spasticity, as is common following a cerebrovascular attack (CVA) or stroke, can affect the balance and gait of patients. This then not only affects independence, and quality of life, but also increases the risk for other concerns, such as falling and an increased sedentariness, which could further affect health outcomes. OBJECTIVE We aimed to evaluate the effect of ankle plantar flexor spasticity severity on balance and to determine the relationship between the spasticity severity with ankle proprioception, passive range of motion (ROM), and balance confidence in post-stroke patients. METHODS Twenty-eight post-stroke patients were divided into two groups based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS) as a High Spasticity Group (HSG) (MMAS>2) (n=14) or a Low Spasticity Group (LSG) (MMAS≤2) (n=14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway in the open and closed eyes conditions, timed up and go (TUG) test, ankle dorsiflexion passive range of motion (ROM), and ankle joint proprioception were measured. RESULTS No significant (p>0.05) differences were found between the LSG and HSG in terms of balance confidence, dynamic balance, and ankle dorsiflexion ROM. In addition, postural sway in the open and closed eye conditions was not significantly different in both the LSG and HSG for both the less affected and affected limbs. Similarly, posturography indicators in the open and closed eye conditions were not significantly different in both the LSG and HSG for both the less affected and affected limbs. However, ankle joint proprioception in terms of repositioning error angle was significantly (p≤0.05) better in the LSG compared to the HSG (p=0.01). There was also a significant relationship between TUG scores and balance confidence in the HSG(r=-0.55, p=0.04) CONCLUSIONS Our data suggests that several aspects of balance needs to be considered in the assessment and rehabilitation of post-stroke patients and there is a need to monitor entire patterns of activities to support wider engagement in rehabilitation activities. INTERNATIONAL REGISTERED REPORT RR2-10.2196/16045

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Background: Chronic low back pain (LBP) causes some neuroplastic changes in the brain, which result in body perception impairment. The Fremantle Back Awareness Questionnaire (FreBAQ) is a suggested tool for the diagnosis and evaluation of back perception in people with LBP. The aim of this study is to translate and cross culturally adapt the FreBAQ into Persian language and to assess its reliability and validity in patients with chronic LBP (CLBP). Materials and Methods: Fifty people with CLBP and fifty healthy people participated in this study. To evaluate the discriminant validity, we assessed the ability of the FreBAQ to discriminate between people with and without LBP. After an interval of 1 week, 25 patients with CLBP completed the questionnaire in the retest session. Data obtained from the first test administration were used for internal consistency and data obtained from repeated testing were used for test–retest reliability. Construct validity was assessed by investigating a correlation between the FreBAQ with the Roland–Morris Disability Questionnaire ( RDQ ), Visual Analog Scale, Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale, and Tampa Scale of Kinesiophobia. In addition, the construct validity of Persian FreBAQ was measured by factor analysis. Results: The test–retest reliability of the questionnaire was confirmed by intraclass correlation coefficient = 0.96. Cronbach's alpha was 0.74 for Persian FreBAQ. The standard error of measurement and minimal detectable change were 0.91 and 2.52, respectively. Construct validity was demonstrated by statistically significant relationship between the Persian FreBAQ and questionnaires of PCS ( P < 0.001) and RDQ ( P = 0.01). Conclusion: The Persian version of FreBAQ is a valid and reliable measurement tool for evaluating back perception changes in Persian-speaking patients with LBP.

BACKGROUND The lower limb spasticity after stroke can affect the balance and gait of patients after stroke. OBJECTIVE The aim of this study is to assess the effects of ankle plantar flexors spasticity level on balance in patients after stroke. METHODS Patients with stroke will be recruited from neurology and physiotherapy clinics in Tehran, Iran. The eligible patients with stroke will be divided into two groups based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS) as high (MMAS≥2) and low (MMAS<2). The primary outcome measures will be the MMAS scores, Activities-specific balance confidence questionnaire, posturography measures in open and closed eyes conditions, and the timed up and go test. The secondary outcome measures are the ankle passive range of motion and ankle joint proprioception. RESULTS The patients with high ankle plantar flexor spasticity will show greater impairments in the balance confidence, passive range of motion, ankle proprioception, timed up and go test, and posturography measures. The patients with high spasticity level will show greater balance impairments in the eyes closed condition when compared to patients with low spasticity level and with eyes open. There will be positive relationships between the ankle plantar flexor spasticity level with the balance confidence scores and the impairments in ankle proprioception, ankle passive range of motion, and timed up and go test. CONCLUSIONS The patients with high ankle plantar flexor spasticity after stroke will demonstrate greater balance dysfunction which is worsened with impairments of proprioception, passive range of motion, and eyes closed. CLINICALTRIAL Not a clinical trial.