[Purpose] The aim of this study was to investigate what outcome measures are reliable in the evaluation of adherence to home exercises among patients with chronic low back pain. [Methods] A systematic review on articles related to adherence to home exercises for patients with chronic low back pain was conducted, and outcome measures and psychometric properties were extracted and evaluated in terms of validity and reliability. [Results] A total of 4,583 articles were identified, and eight articles were finally included after screening. The identified outcome measures were self-reported frequency, duration and intensity of home exercises and Treatment Self-Regulation Questionnaire results. Although the internal consistency and criterion validity of the Treatment Self-Regulation Questionnaire results have been proven in the literature, none of the included articles validated the self-reported frequency, duration, and intensity of the home exercises. [Conclusion] Only the Treatment Self-Regulation Questionnaire results were found to be a reliable measure, and further research to validate self-reported outcome measures is required.
The aim of this case study is to reconsider the method for preventing orthostatic hypotension in multiple system atrophy. [Participant and Methods] The case was that of a 70-year-old female with multiple system atrophy who experienced frequent falls and orthostatic hypotension. An orthostatic test was performed, and the effect of cold oral stimulation before standing was compared with no stimulation. Outcome measures were blood pressure, heart rate variability and autonomic variables. [Results] In the control test, blood pressure decreased from 150/72 mmHg in the supine position to 98/58 mmHg in the standing position. Heart rate increased from 71 bpm to 82 bpm, high frequency declined from 16.48 msec 2 to 14.07 msec 2 , and low/high frequency increased from 2.56 to 5.13. Cold stimulation in the standing position induced changes in blood pressure from 168/82 mmHg to 104/72 mmHg, heart rate from 73 bpm to 83 bpm, high frequency from 61.29 msec 2 to 24.56 msec 2 , and low/high frequency from 1.45 to 6.33 msec 2. [Conclusion] Standing after cold stimulation affected autonomic variables, but did not affect the heart rate or blood pressure, possibly because of damaged peripheral blood vessels. Further research is required to demonstrate the effect of cold stimulation on orthostatic hypotension.
Purpose Conditioned pain modulation (CPM) is a measurement of the descending pain pathways that inhibit or facilitate afferent noxious stimuli. The reliability of CPM in older individuals with or without chronic musculoskeletal pain has not been sufficiently reported. This study aimed to examine the inter-session reliability of CPM in these cohorts and the factors in CPM reliability. Patients and Methods Individuals aged 65 or older were recruited in Narita, Japan. The measurements were performed on separate days 2 weeks apart (sessions 1 and 2). Each participant’s hand was immersed in cold water, and we measured pressure pain threshold (PPT) before and after the immersion. The ratio before and after PPT measurements was presented as CPM index. The autonomic activities (heart rate variability, heart rate, and blood pressure) were simultaneously measured. An absolute reliability of CPM index was analyzed by the adjusted two-way analysis of variance (ANOVA) and the Bland Altman plot, and relative reliability was analyzed by intraclass correlation coefficient (ICC). Spearman’s rho correlation and the adjusted multivariate regression analysis were utilized for examining the CPM reliability factors. Results Thirty-two participants were divided into two groups: chronic pain (n=19) and non-chronic pain (n=13) groups. The mean difference between session 1 and 2 in CPM index showed a systematic error in the chronic pain group at 17.3 (confidence interval, CI: 15.0 to 19.7), but none in the non-chronic pain group at 3.7 (CI: −0.02 to 7.4). The adjusted two-way ANOVA for CPM index did not identify any differences. ICC was not significant at p=−0.247 in the non-chronic and 0.167 in chronic pain. Multivariate regression analysis revealed total power and low/high frequencies as significant factors for CPM index. Conclusion This study identified low inter-session reliability in older adults with chronic musculoskeletal pain and autonomic nervous system activities as factors in CPM reliability.
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