The results of this study strongly support the hypothesis that spinal physical capacity in chronicity is not explained solely by the sensory perception of pain. The anticipation of pain and the fear-avoidance belief about physical activities were the strongest predictors of the variation in physical performance.

Abstract-This study obtained measurements of the spatiotemporal gait parameters of healthy young adult Kuwaiti subjects from both genders and compared the data to those collected in a similar study performed in Sweden. Thirty healthy subjects volunteered to participate in the study (which included being asked to walk at their "free," "slow," and "fast" selfselected speeds). We collected the spatiotemporal gait data using an automated system. Descriptive statistics were calculated for each variable measured at each walking condition. The data were then compared to those from the Swedish study. The results indicate several significant differences between Kuwaiti and Swedish subjects in their manner of walking. These results suggest a need to include data from subjects with diverse cultural backgrounds when a database on normal gait is developed or a need to limit the results of the database to a specified ethnic population.

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health.

The purpose of this study was to examine the influence of anticipation of pain, sensory perception of pain and pain-related fear and disability beliefs on the gait characteristics of patients with chronic low back pain (CLBP). Thirty-one individuals with CLBP (16 men and 15 women) and 24 healthy individuals (11 men and 13 women) between 20 to 56 years of age participated in this study. Anticipated pain and the pain actually felt were measured with two separate visual analogue scales before and after preferred and fast walking performances. Pain-related fear and disability beliefs were measured with the Fear-Avoidance Belief Questionnaire (FABQ) and the Disability Belief Questionnaire (DBQ). Spatial and temporal walking parameters were measured at preferred and fast walking performances using a computerized gait mat. Analysis of variance demonstrated significant differences between patients and healthy individuals in step length, single support time and walking velocity (P<0.05). Within the CLBP group, stepwise regression analysis showed that FABQ (physical activity) and anticipated pain were the strongest predictors of velocity deficits in preferred and fast walking respectively. Anticipation and fear of pain accounted significantly for the velocity deficits in walking. Standard clinical gait assessments must incorporate psychological measures of pain experience.

Study Design. A prospective, interventional case series design.Objectives. To determine the degree to which preintervention measures of anticipated pain and fear avoidance beliefs predict outcome after intervention for patients with delayed recovery from low back pain (LBP) for which they are not receiving workers' compensation.Summary of Background Data. Anticipated pain and fear avoidance beliefs have been suggested as important factors for the classification and treatment of patients with LBP. However, the degree to which they are associated with outcome after intervention is uncertain.Methods. There were 42 subjects with activity limiting LBP for more than 2 months enrolled in an exercise based, physical therapy program. A multidimensional test battery was completed before and after a 10-week program of lumbar extensor muscle strengthening. Correlational analyses, independent t tests, and validity indexes were used to determine relationships of preintervention measures of anticipated pain and the fear avoidance beliefs to clinically meaningful improvements in the Roland-Morris score. Intention-to-treat strategies were used to account for study dropouts.Results. A total of 36 subjects completed the 10-week intervention. The lack of clinically meaningful outcome, as determined by a failure-to-report a minimum of 16% decrease in the Roland-Morris score, was associated with high preintervention scores on the physical activity subscale of the Fear Avoidance Beliefs Questionnaire (FABQP). Subjects with a preintervention score Ն29 on the FABQP had a likelihood ratio of 3.78 (95% confidence interval [CI] 2.4Ϫ5.16) for an increased probability of negative outcome after initial testing when compared to those subjects with low (Ͻ20) scores. The sensitivity and specificity of low scores to predict clinically meaningful outcomes compared to those with high scores were moderate (sensitivity ϭ 0.87 and specificity 0.77); however, the likelihood ratio was inconclusive. Anticipated pain was significantly correlated with but was higher than the reported pain during activity both before and after intervention but not predictive of outcome.Conclusions. In a sample of people from a Middle Eastern culture undergoing exercise intervention for LBP for which they are not receiving workers' compensation, the preintervention physical activity subscale of the FABQ is predictive of negative outcome when the observed scores are Ն29. Despite significant improvements in all variables after intervention, anticipated pain remained significantly higher than reported pain during physical performance testing but did not predict outcome.

Hypermobility spectrum disorders (HSDs) are conditions associated with chronic joint pain and laxity. HSD's diagnostic approach is highly subjective, its validity is not well studied, and it does not consider many of the most commonly affected joints. Strain elastography (SEL) reflects musculoskeletal elasticity with sonographic images. The study explored the impact of HSD on musculoskeletal elasticity using SEL. A cross-sectional design compared 21 participants with HSD against 22 controls. SEL was used to assess the elasticity of the deltoid, biceps brachii, brachioradialis, rectus femoris, and gastrocnemius muscles, and the patellar and Achilles tendon. SEL images were analyzed using strain index, strain ratio, and color pixels. Mean strain index (standard deviation) was significantly reduced in the HSD group compared to the control group in the brachioradialis muscle 0.43 (0.10) vs. 0.59 (0.24), patellar 0.30 (0.10) vs. 0.44 (0.11), and Achilles tendons 0.24 (0.06) vs. 0.49 (0.13). Brachioradialis muscle and patellar tendon's strain ratios were significantly lower in the HSD group compared to the control group, 6.02 (2.11) vs. 8.68 (2.67) and 5.18 (1.67) vs. 7.62 (1.88), respectively. The percentages (%) of red color (soft tissues) in the SEL images were significantly increased in the HSD group compared to the control group in the biceps brachii muscle, 34.72 (7.82) vs. 26.69 (3.89), and Achilles tendon, 18.14 (13.21) vs. 5.59 (8.23) (p ≤ 0.01). The elasticity of the musculoskeletal system seems to be lower in people with HSD. SEL could be a supplementary tool for diagnosing and monitoring HSD.

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Smokers demonstrated reduced grip strength and fast fatigability in comparison with nonsmokers.