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The objectives of this study were to estimate the intra-rater and inter-rater reliability of the Pressure Pain Threshold (PPT) and Conditioned Pain Modulation (CPM) in healthy participants and patients with chronic shoulder pain. Additionally, the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were calculated. Thirty-one healthy volunteers and twenty patients with chronic shoulder pain were assessed using the PPT and CPM by two raters, with a 24 h interval between sessions. Excellent intra-rater reliability was demonstrated for PPT, with similar SEM and SDC when assessed by the same rater. The inter-rater reliability for PPTs in patients was moderate to good (ICC = 0.59–0.89) with higher SEM (73.83–121.98 kPa) and SDC (61.58–97.59) values than the asymptomatic group (ICC = 0.92–0.96, SEM = 49.61–103.12 kPa, SDC = 42.01–56.30) respectively. CPM's intra-rater reliability was good (ICC = 0.82) in the patients and moderate (ICC = 0.67) in the asymptomatic group, while inter-rater reliability was low for the asymptomatic group (ICC = 0.37) and extremely low (ICC = 0.074) for the patients, with comparable SEM and SDC outcomes in both groups. PPT and CPM measurements are highly reliable when conducted by the same rater on the same day. Patients had lower inter-rater PPT reliability but better intra-rater CPM reliability. Clinicians need to be mindful of potential variability when interpreting these test results. [ABSTRACT FROM AUTHOR]

Background: Pole dancing is a physically demanding sport that combines dance and acrobatic movements on a vertical pole. Despite its highly growing popularity, there is currently limited research in the field. The aim of this study was to create and evaluate a strength assessment protocol for athletes in pole dancing, with a specific focus on functional positions on the pole. Methods: Thirty-two female pole dancing athletes participated in this study. Maximal voluntary isometric contractions (MVIC) were measured at three different sport-specific positions on the pole (shoulder abduction and adduction, and hip adduction), on two separate days (test and re-test) with a five to seven day interval between them. A hand-held dynamometer (Activ5- Activbody) stabilized on the pole was used for this study. Results: The intra-session reliability was good to excellent for all sports-specific positions and for both sides of the body, across all different movements (ICC = 0.837–0.960, SEM = 5.02 Kg–2.24 Kg, and SDD = 27.46%–14.92%). Slightly better results were found regarding inter-session reliability (ICC = 0.927–0.970, SEM = 3.72 Kg–1.97 Kg, and SDD = 22.86%–15.19%). There was not a statistically significant difference between the MVICs between the left and right or dominant and non-dominant side in shoulder abduction (p = 0.105) and hip adduction (p = 0.282), in contrast to shoulder adduction (p = 0.00). Conclusion: The strength assessment protocol developed in the current study has proven to be a reliable and functional tool, with the potential for utilization in clinical practice as part of objective strength testing. Further studies are needed in order to expand the protocol to other muscle groups and positions and to generalize the results in all pole dancing populations such as male athletes. [ABSTRACT FROM AUTHOR]

Background: Exercise has indisputable advantages for people with chronic conditions. Engaging in physical activity within natural environments, known as green exercise, contributes to both physical and mental well-being. The aim of this study was to investigate the perceptions of people with chronic conditions and health professionals and the perceived facilitators and barriers to therapeutic green exercise. Methods: This was a qualitative study based on two focus groups. Ethical approval was received, and a thematic analysis was used to analyze the discussions. Results: Seven patients and eight health professionals participated in the study. The thematic analysis yielded thirteen main themes. Safety concerns and inadequate infrastructures were key barriers. Core facilitators were socialization, and multisensory exposure. Conclusions: Patients with chronic conditions and health professionals believe that green exercise improves physical activity engagement, and it would be beneficial if incorporated in the rehabilitation process. There are challenges to overcome to make therapeutic green exercise for people with chronic conditions more accessible. [ABSTRACT FROM AUTHOR]

This scoping review aimed to identify interventions utilizing virtual-reality-based exercise therapy in patients with chronic musculoskeletal pain. Searches were conducted in four databases using descriptors related to virtual reality, exercise, and chronic musculoskeletal pain. Two reviewers screened the titles and abstracts of the studies to assess eligibility, with a third author resolving any discrepancies. Data were extracted and summarized in a narrative format by three independent raters. Clinical trials were evaluated using the PEDro scale to assess the effectiveness of virtual-reality-based exercise therapy in chronic musculoskeletal pain patients. A total of 162 articles were identified from the databases. After applying the inclusion criteria, nine articles were considered suitable for analysis, including six randomized clinical trials. The selected articles were categorized based on study characteristics, virtual-reality-based exercise therapy interventions (including technologies and equipment used), exercise interventions, outcome measures, and effectiveness. The findings indicate that virtual-reality-based exercise therapy shows promising results in reducing pain, improving disability, enhancing range of motion, and increasing treatment satisfaction in patients with chronic musculoskeletal pain. However, it is not possible to conclude that virtual-reality-based exercise therapy is superior to other treatments due to the limited number of available studies, heterogeneity in application protocols, and varying methodological quality. Further research is needed to draw more definitive conclusions. [ABSTRACT FROM AUTHOR]

The recognition of central sensitization (CS) is crucial, as it determines the results of rehabilitation. The aim of this study was to examine associations between CS and catastrophizing, functionality, disability, illness perceptions, kinesiophobia, anxiety, and depression in people with chronic shoulder pain (SP). In this cross-sectional study, 64 patients with unilateral chronic SP completed a few questionnaires including the Central Sensitization Inventory, the Oxford Shoulder Score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, the Pain Catastrophizing Scale, the Brief Illness Perception Questionnaire and the "arm endurance" test. On the basis of three constructed linear regression models, it was found that pain catastrophizing and depression (model 1: p < 0.001, R = 0.57, R2 = 0.33), functionality (model 2: p < 0.001, R = 0.50, R2 = 0.25), and helplessness (model 3: p < 0.001, R = 0.53, R2 = 0.28) were significant predictors for CS symptoms in chronic SP. Two additional logistic regression models also showed that depression (model 4: p < 0.001, Nagelkerke R2 = 0.43, overall correct prediction 87.5%) and functionality (model 5: p < 0.001, Nagelkerke R2 = 0.26, overall correct prediction 84.4%) can significantly predict the classification of chronic SP as centrally sensitized. Patients who were classified as centrally sensitized (n = 10) were found to have significantly worse functionality, psychological factors (anxiety, depression, kinesiophobia, catastrophizing), and pain intensity (p < 0.05). Catastrophizing, depression, and functionality are predictive factors of CS symptoms in patients with chronic shoulder pain. Health care providers should adopt a precision medicine approach during assessment and a holistic rehabilitation of patients with unilateral chronic SP. [ABSTRACT FROM AUTHOR]

Abstract Background Mulligan's mobilisation techniques are thought to increase the range of movement (ROM) in patients with low back pain. The primary aim of this study was to investigate the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure. Methods 49 asymptomatic volunteers participated in this double-blinded study. Subjects were randomly assigned to receive either SNAG mobilisation (n = 25), or a sham mobilisation (n = 24). The SNAG technique was applied at the L3and L4 spinal levels with active flexion in sitting by an experienced manual therapist. Three sets of 10 repetitions at each of the two spinal levels were performed. The sham mobilisation was similar to the SNAG but did not apply the appropriate direction or force. Lumbar ROM was measured by a three dimensional electronic goniometer (Zebris CMS20), before and after each technique. For the reliability, five measurements in two different days (one week apart) were performed in 20 healthy subjects. Results When both interventions were compared, independent t tests yielded no statistically significant results in ROM between groups (p = 0.673). Furthermore no significant within group differences were observed: SNAG (p = 0.842), sham (p = 0.169). Intra- and inter-day reliability of flexion measurements was high (ICC1,1 > 0.82, SEM < 4.0°, SDD Conclusion While the Zebris proved to be a reliable device for measuring lumbar flexion ROM, SNAG mobilisation did not demonstrate significant differences in flexion ROM when compared to sham mobilisation. Trial registration Current Controlled Trials NCT00678093.

Objectives: Recent studies support the opinion that central sensitization (CS) plays an important role in the pathophysiology of many chronic pain conditions. CS refers to hyperexcitability of the central nervous system, which can result in pain hypersensitivity and other somatosensory symptoms. Recognition of CS‐related symptomology is crucial in chronic pain evaluation and rehabilitation. The Central Sensitization Inventory (CSI) was created to evaluate symptoms that have been found to be associated with CS. The aim of the current study was the cross‐cultural adaptation of the CSI into Greek (CSI‐Gr). Methods: To evaluate discriminate validity, 200 patients with chronic pain and 50 healthy control subjects participated. The sample was divided into 4 diagnostic groups (fibromyalgia, single pain complaints, multiple pain complaints, and a control group) and into 5 CSI severity subgroups, from subclinical to extreme. Convergent validity was determined by evaluation of the relationship between the CSI‐Gr and the Pain Catastrophizing Scale (PCS). Additionally, 30 patients completed the CSI a second time for the purpose of a test/retest analysis. Results: The results showed high internal consistency (Cronbach's alpha = 0.994) and test‐retest reliability (intraclass correlation coefficient = 0.993). The standard error of measurement was 2.1. The CSI‐Gr correlated moderately with the PCS (r = 0.68). Statistically significant differences were found among the 3 comparison groups, with patients who had fibromyalgia reporting the highest CSI severity and healthy control subjects reporting the lowest severity. Conclusions: As determined in the present study, the CSI‐Gr was found to be a reliable and valid tool for recognition of CS‐related symptomology. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the association between the performance in two clinical tests for the endurance of deep neck flexors [Craniocervical Flexion Test (CCFT) and Chin Tuck Neck Flexion Test (CTNFT)] and the motivation of participants to continue and complete physical activities. Twenty-one healthy volunteers participated (men/women 13/8, age 21.11.37 years). Participants were asked to complete the Assessment Scale for Completion of Usual Physical Activities (ASCUPA), the Short Scale of Physical Activity Motives (SSPAM), a visual analog scale for the recording of their motivation to complete a physical activity (VAS motivation) and then they performed the CCFT and CTNFT. The CCFT did not present any significant correlation with either VAS motivation or ASCUPA. The CTNFT was not significantly associated with VAS motivation, but it was significantly correlated with ASCUPA (, ). Furthermore, the CTNFT was significantly correlated with the total number of motives for physical activity (). The correlation between the performance of the two tests was not significant (, ). The findings suggest that only the CTNFT is dependent on participants' motivation to complete an activity. [ABSTRACT FROM AUTHOR]

Summary Respiratory function of patients with neck pain has not been given much consideration in usual clinical practice. The problem has however been highlighted occasionally by renown clinical scientists and recently there is a growing interest in the investigation of respiratory function in this clinical population. The aim of this review is to critically present the emerging evidence and discuss the similarities and differences observed. Although the evidence for some respiratory parameters is conflicting, it seems to be generally agreed that others such as maximal voluntary ventilation, strength of respiratory muscles, chest mechanics and partial pressure of arterial carbon dioxide are affected in patients with chronic neck pain. The effect size of the respiratory dysfunction regarding these respiratory parameters can be approximately described as moderate. These findings not only suggest a more thoughtful drug prescription, but they may lead to consideration of incorporation of respiratory assessment and treatment into routine physiotherapy practice. Indeed preliminary studies exploring the incorporation of such a treatment into usual practice have provided very promising results not only in relation to respiratory function, but also for other parameters of clinical interest. There remains however imminent need for randomized controlled trials to confirm the evidence base for such an approach. [ABSTRACT FROM AUTHOR]

The article presents a study that investigates the association between psychological states of patients with idiopathic neck pain and self-reported pain and disability. It uses the Hospital Anxiety and Depression scale, Pain Catastrophizing scale and Neck Disability Index. It is suggested that anxiety, depression and catastrophizing are associated with self-reported disability while anxiety is linked to pain intensity.

Objectives: The aim of the study was to examine of the intra-rater reliability of the chin tuck neck flexion (CTNF) test for assessing the endurance of neck flexors. Materials and methods: The study was performed at the Cardiorespiratory laboratory of the Physiotherapy Department, School of Health and Caring Professions, TEI Lamia, Greece. Twenty healthy volunteers (males/females: 9/11, age: 22.2 ± 1.7 y ears) with no known musculoskeletal, cardiovascular, pulmonary, neurological, or psychiatric disorder were recruited. The participants were positioned in a supine position and were asked to raise their head 2.5 cm above the plinth and to maintain this position for as long as possible without losing craniocervical or cervical flexion. This test was repeated three times with 5-min intervals between the trials. Results: The results showed that this test could discriminate between neck flexor endurance in men and women. However, although the test seems to be highly reliable (ICC: 0.81-0.88), it presents unsatisfactory standard error of measurement (SEM: 10.7-14.7 s) and smallest detectable differences (SDD: 80.5-110.9%). Furthermore, subgroup analysis showed the test seems to be more reliable for women (ICC: 0.93-0.94) than for men (ICC: 0.68-0.8), but the SEM and SDD values for them remain unsatisfactory (SEM: 4.4-5.3 s, SDD: 57.5-63.99%). Conclusions: Due to high reproducibility and discriminant validity, clinicians and researchers might want to consider using the CTNF test for the assessment of neck flexor endurance. However, they should seek alternative measurement tools when they want to avoid a large measurement error. [ABSTRACT FROM AUTHOR]

An editorial is presented on the progress report on planetary health, environmental and sustainability education in physiotherapy. The article discusses that health and health care can no longer be thought of and practiced in an isolated manner; and all healthcare professions must educate their current and future colleagues with the necessary understanding and skills to develop and implement integrated responses to today's inseparable social.

BACKGROUND: Chronic neck pain is one of the most common musculoskeletal pain conditions experienced by many people during their lives. Although patients with neck pain are managed predominantly as musculoskeletal patients, there are indications that they also have poor pulmonary function. The aim of this study was to examine whether patients with chronic neck pain have spirometric abnormalities and whether neck pain problems and psychological states are associated with these abnormalities. METHODS: Forty-five participants with chronic neck pain and 45 well-matched healthy controls were recruited. Spirometry was used to assess participants' pulmonary function. Neck muscle strength, endurance of deep neck flexors, cervical range of motion, forward head posture, psychological states, disability, and pain intensity were also evaluated. RESULTS: The results showed that patients with chronic neck pain yielded significantly reduced vital capacity, FVC, expiratory reserve volume, and maximum voluntary ventilation (P < .05), but peak expiratory flow, FEV1, and FEV1/FVC ratio were not affected (P > .05). Strength of neck muscles, pain intensity, and kinesiophobia were found to be significantly correlated (r > 0.3, P < .05) with respiratory function. CONCLUSIONS: Patients with chronic neck pain do not have optimal pulmonary function. Cervical spine muscle dysfunction in parallel with pain intensity and kinesiophobia are factors that are associated mainly with this respiratory dysfunction. [ABSTRACT FROM AUTHOR]

Abstract: Quantitative documentation of physical deficits such as muscle strength and endurance/fatigue in the cervical spine may provide objective information, not only helping the diagnostic procedures, but also monitoring rehabilitation progress and documenting permanent impairments. The reliable and valid evaluation of muscle strength and endurance both in clinical and research environments are a difficult task since there are many factors that could affect the assessment procedure and the obtained values. The aim of the second part of this critical review is to identify the factors influencing the assessment of strength and endurance/fatigue of the muscles in the cervical spine. [Copyright &y& Elsevier]

Purpose. The cross-cultural adaptation and validation of Falls Efficacy Scale-International (FES-I) in community-dwelling seniors in Greece. Method. For cross-cultural adaptation, the back-translation procedure was utilised by four bi-lingual translators. For validation, 89 community-dwellings (50 males, 39 females) aged 61-90 years old (mean: 72.87 ± 6.04) completed four questionnaires adapted into Greek; two instrument specific ones, FES-I and Confidence in Maintaining Balance (CONFbal), and two generic Questionnaires, Short-form Health Survey (SF-36v2) and General Health Questionnaire (GHQ30). Additionally, three functional/balance tests were compared against the FES-I. All questionnaires and measurements were repeated after 7-10 days to explore repeatability. Results. Content validity was achieved as all participants found the questionnaire appropriate and comprehensible. Validity of the FES-I yielded moderate to strong correlations with CONFbal ( r == 0.694, p<0.01), three SF-36 subscales ( r ranging between 0.560 and 6.55, p<0.01), GHQ30 ( r == 0.584, p<0.01) and one functional test ( r == 0.638, p<0.01 for Timed Up and Go test). FES-I's test-retest reliability (ICC:0.951, SEM: 1.79, SDD:20.44%%, r == 0.950) and internal consistency (Cronbach's α == 0.925) were excellent, and responsiveness across fallers and non-fallers yielded a large effect size (0.89), indicating good discriminant validity. Conclusions. The Greek FES-I was valid, reliable, comprehensible and acceptable for the sample tested and may thus, be used in cross-cultural rehabilitation research and practice. [ABSTRACT FROM AUTHOR]

BACKGROUND: Respiratory muscle strength is an important part of lung function. Assessment of the respiratory muscles' ability to generate force is important for recognizing respiratory muscle weakness in both sick and healthy people. OBJECTIVE: To assess the test/retest reliability of the MicroRPM portable manometer's measurements of maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in the sitting and standing positions; the number of expiratory maneuvers needed with the MicroRPM for reliability in MIP and MEP measurement; and the MicroRPM's test/retest reliability in other respiratory function indices, such as the maximum rate of pressure development (MRPD), the time constant of relaxation (tau), and the maximum relaxation rate (MRR). METHODS: We recruited 15 healthy volunteers (mean age 21.6 ± 1.1 years). We assessed respiratory muscle strength on 3 separate occasions, each a week apart. We calculated reliability with the intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable difference (SDD). RESULTS: MicroRPM reliably measured MIP and MEP in both the sitting position (ICC 0.86-0.90, SEM 9-10, SDD 18-22) and standing position (ICC 0.78-0.83, SEM 12-14, SDD 23-26). After a 5-breath practice, 2 expiratory/inspiratory maneuvers on each testing occasion gave adequate MIP and MEP reliability (ICC > 0.90). MRR reliability was moderate to excellent (ICC 0.58-0.87), MRPD reliability was moderate (ICC 0.59-0.64), and tau reliability was insufficient (ICC 0.27- 0.67). CONCLUSIONS: The MicroRPM reliably measures MIP and MEP, but its MRPD, MRR, and tau measurements should be considered with caution. [ABSTRACT FROM AUTHOR]

Summary: Neck pain and headache of cervical origin are complaints affecting an increasing number of the general population. Mechanical factors such as sustained neck postures or movements and long-term “abnormal” physiologic loads on the neck are believed to affect the cervical structures and compromise neck function. A comprehensive assessment of neck function requires evaluation of its physical parameters such as range of motion, proprioception, strength and endurance/fatigue. The complicated structure of the cervical spine however, makes it difficult for any clinician to obtain reliable and valid results. The aim of the first part of this systematic critical review is to identify the factors influencing the assessment of range of motion and proprioception of the cervical spine. [Copyright &y& Elsevier]

Background: Mulligan's mobilisation techniques are thought to increase the range of movement (ROM) in patients with low back pain. The primary aim of this study was to investigate the application of the Mulligan's Sustained Natural Apophyseal Glide (SNAG) technique on lumbar flexion ROM. The secondary aim was to measure the intra- and inter-day reliability of lumbar ROM employing the same procedure. Methods: 49 asymptomatic volunteers participated in this double-blinded study. Subjects were randomly assigned to receive either SNAG mobilisation (n = 25), or a sham mobilisation (n = 24). The SNAG technique was applied at the L3and L4 spinal levels with active flexion in sitting by an experienced manual therapist. Three sets of 10 repetitions at each of the two spinal levels were performed. The sham mobilisation was similar to the SNAG but did not apply the appropriate direction or force. Lumbar ROM was measured by a three dimensional electronic goniometer (Zebris CMS20), before and after each technique. For the reliability, five measurements in two different days (one week apart) were performed in 20 healthy subjects. Results: When both interventions were compared, independent t tests yielded no statistically significant results in ROM between groups (p = 0.673). Furthermore no significant within group differences were observed: SNAG (p = 0.842), sham (p = 0.169). Intra- and inter-day reliability of flexion measurements was high (ICC1,1 > 0.82, SEM < 4.0°, SDD<16.3%) indicating acceptable clinical applicability. Conclusion: While the Zebris proved to be a reliable device for measuring lumbar flexion ROM, SNAG mobilisation did not demonstrate significant differences in flexion ROM when compared to sham mobilisation. Trial registration: Current Controlled Trials NCT00678093. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To evaluate the intra- and inter-examiner reliability of neck active joint position sense measurements in different head movements. Methods: Participants had to reproduce actively a specific angle-target in all movements (flexion, right/left rotation, right/left side flexion) from two initial positions, sitting and standing by using a 3D ultrasound-based motion analysis device. Three tests were employed to assess intra-examiner reliability and two examiners used for the inter-examiner reliability. Absolute error (AE) and variable error (VE) indices were used to assess the repositioning accuracy. Intraclass correlation coefficient (I.C.C.(1,1)), standard error of measurement (S.E.M.), smallest detectable difference (S.D.D.) indices were calculated for the analysis of the results. Results: Both AE and VE yielded poor to moderate I.C.C.s in any movement and position (−0.01 to 0.50 and 0.01–0.25, respectively). AE presented higher I.C.C.s estimates than the VE but the S.D.D.s were similar for both indices. Regarding the AE, the standing position yielded higher I.C.C. estimates (0.15–0.68) than the sitting position (−0.01 to 0.43) but the S.E.M. (1.2–3.0° and 1.5–3.5°, respectively) and S.D.D. values (123.3–191.8% and 139.9–203.8%, respectively) showed no specific trend in favour of any position. The VE reliability indices showed that standing position was more reliable with less error than sitting. The inter-examiner data showed similar results to the intra-examiner study. Conclusions: The statistical analysis of the present experiments showed that the method employed for measuring cervical joint position sense is unreliable. However, it needs further research to identify the discriminatory power of these tests or if they are clinically unacceptable. [Copyright &y& Elsevier]

Abstract: Introduction: The repeatability of subjective and objective assessments of neck muscle fatigue is very important with regard to the clinical applicability of these methods. Method: To establish between-days reliability, 33 healthy volunteers performed a 60% maximum voluntary isometric contraction test from a standing position in all neck movements. Cervical muscle fatigue was assessed on three separate occasions from the spectral (median frequency, MF) and amplitude (root mean square, RMS) analysis of the electromyogram (EMG) signal recorded from the cervical paraspinal group, splenius capitis, levator scapulae and sternocleidomastoid. Subjective assessment of fatigue was rated by employing the Borg scale. Intraclass correlation coefficient ICC(1,1), standard error of measurement (SEM), smallest detectable difference (SDD) indices and Pearson’s correlation co-efficient were calculated for the analysis of the results. Results: Normalised median frequency (MF) slope had low repeatability and large between-day error (ICC(1,1) =0.28–0.61; SEM=0.33–0.60%/s; SDD=132.7–703.2%) for the protagonist muscles of each movement. Initial median frequency (IMF) had moderate to good reliability and small error (ICC(1,1) =0.64–0.81; SEM=2.8–8.8Hz; SDD=19.9–38.5%). The RMS slope yielded also poor repeatability. The Borg assessment was more reliable than the EMG estimate though variability between sessions was still quite high (SDD=29.2–136.5%). No correlation was found between the EMG and Borg assessment of neck muscle fatigue (r =−0.01–0.39). Conclusion: The protocol used for assessing neck muscle fatigue proved to be reliable only for the IMF but the clinical usefulness of this measure remains questionable. The lack of correlation between objective and subjective estimation of neck muscle fatigue was possibly a consequence of the poor measurement repeatability. Further research is needed to identify the factors responsible for these results on neck area. [Copyright &y& Elsevier]

Study design: Numerous authors have attempted to sub-classify low back pain in order that valid homogenous subsets of low back pain presentations might be recognised. This review systematically appraises these papers. Methods: Medline, Embase, Cinahl, AMED and PEDro electronic databases were searched with subsequent hand searching of bibliographies. Papers were included between June 1983 and June 2003. Two reviewers independently reviewed 32 papers using a standard scoring criteria for assessment. A third reviewer mediated disagreements. Results: Thirty-two papers were reviewed, with classification systems being grouped by method of classification. Classification has been attempted by implication of patho-anatomical source, by clinical features, by psychological features, by health and work status and in one case by a biopsychosocial weighting system. Scores were generally higher for systems using a statistical cluster analysis approach to classification than a judgemental approach. Both approaches have specific advantages and disadvantages with a synthesis of both methodologies being most likely to generate an optimal classification system. Conclusions: The classification of NSLBP has traditionally involved the use of one paradigm. In the present era of biopsychosocial management of NSLBP, there is a need for an integrated classification system that will allow rational assessment of NSLBP from biomedical, psychological and social constructs. [ABSTRACT FROM AUTHOR]

Green exercise, defined as physical activity in natural settings, shows promise for enhancing exercise participation and improving health. This systematic review aimed to assess the effectiveness of green exercise in people with chronic conditions. Seven electronic databases were searched and of the 7801 screened articles, 14 trials met the inclusion criteria. Green exercise was a safe and well-tolerated intervention, with low drop-out levels. It was found to positively affect participants’ quality of life in three studies and mental health in four studies. Compared to non-exercise groups, green exercise significantly improved physical and mental health in patients with breast cancer, COPD, cardiovascular disease risk, chronic low back pain, obesity, and diabetes. However, it had no impact on the physical health of stroke patients or the cognitive performance of those with ADHD. Green exercise appears to be a safe intervention that can improve various chronic health issues. [ABSTRACT FROM AUTHOR]

The author discusses the two most widely used and accepted tests to assess the endurance of deep neck flexors namely the chin tuck neck flexion test and the craniocervical flexion test. The chin tuck neck flexion test assesses short neck flexor muscle endurance and involves the patient lying in the supine position without the help of a pillow. The craniocervical flexion test is a highly reproducible test with satisfactory inter-rater and test-retest reliability and low measurement error.

Comments on an article which compared three kinematic systems for assessing spinal range of movement. Main issue in estimating spinal mobility; Health risk posed by radiology; Information on three-dimensional motion systems.

Background: Artificial Intelligence (AI) tools are gaining popularity in healthcare. OpenAI released ChatGPT on November 30, 2022. ChatGPT is a language model that comprehends and generates human language, providing instant data analysis and recommendations. This is particularly significant in the dynamic field of physiotherapy, where its integration has the potential to enhance healthcare efficiency., Objectives: This study aims to evaluate whether ChatGPT-3.5 (free version) provides consistent and accurate clinical responses, its ability to imitate human clinical reasoning in simple and complex scenarios, and its capability to produce a differential diagnosis., Methods: Two studies were conducted using the ChatGPT-3.5. Study 1 evaluated the consistency and accuracy of ChatGPT's responses in clinical assessment using ten user-participants who submitted the phrase "Which are the main steps for a completed physiotherapy assessment?" Study 2 assessed ChatGPT's differential diagnostic ability using published case studies by 2 independent participants. The case reports consisted of one simple and one complex scenario., Results: Study 1 underscored the variability in ChatGPT's responses, which ranged from comprehensive to concise. Notably, essential steps such as re-assessment and subjective examination were omitted in 30% and 40% of the responses, respectively. In Study 2, ChatGPT demonstrated its capability to develop evidence-based clinical reasoning, particularly evident in simple clinical scenarios. Question phrasing significantly impacted the generated answers., Conclusions: This study highlights the potential benefits of using ChatGPT in healthcare. It also provides a balanced perspective on ChatGPT's strengths and limitations and emphasizes the importance of using AI tools in a responsible and informed manner.

Introduction Pain drawings (PDs) are an important component of the assessment of a patient with pain. Although analog pain drawings (APDs), such as pen-on-paper drawings, have been extensively used in clinical assessment and clinical research, there is a lack of digital pain drawing (DPD) software that would be able to quantify and analyze the digital pain distribution obtained by the patients. The aim of this work is to describe a method that can quantify the extent and location of pain through novel custom-built software able to analyze data from the digital pain drawings obtained from the patients. Methods The application analysis and software specifications were based on the information gathered from the literature, and the programmers created the custom-built software according to the published needs of the pain scientific community. Results We developed a custom-built software named "Pain Distribution," which, among others, automatically calculates the number of the pixels the patient has chosen and therefore quantifies the pain extent, provides the frequency distribution from a group of images, and has the option to select the threshold over which the patient is considered with central sensitization (CS). Additionally, it delivers results and statistics for both every image and the frequency distribution, providing mean values, standard deviations, and CS indicators, as well as the ability to export them in *.txt file format for further analysis. Conclusion A novel Pain Distribution application was developed, freely available for use in any setting, clinical, research, or academic., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Kanellopoulos et al.)

Background: Universities have halted non-essential services, with many restricting campus-based teaching, and continuing courses through online resources, including (controversially) lab-work. Such technologically enhanced approaches have been proven to have high levels of engagement among university students., Objective: This study focuses on the perception of quality of online learning by first-year university students, between two semesters, amidst the COVID-19 pandemic., Methods: A 24-item questionnaire was designed with Likert response scale. It consisted of general perception questions of academic life and questions specific to the quality of delivery of a specific class. Eighty one eligible students were asked to fill the same questionnaire for each semester. Students' responses and their grades from the final exams in each semester were compared., Results: Out of 81 eligible students, 75.31% of students responded to the survey. They were less interested in their studies in the second "online" semester (p=0.05). Students expressed dissatisfaction with the quality of online classes (p=0.03). Academic life fulfillment was also affected (p=0.02). Students' perception of the amount of free time they had between semesters did not change significantly (p=0.16). Students appeared dissatisfied with their active participation during the online class (p=0.007), even though they felt less stressed attending lectures from home (p=0.041). However, they found that workload was bearable and similar between semesters (p=0.83). Students also had significantly more trouble concentrating during online lectures (p<0.001). Students' grades significantly improved by an average of 1.07 (out of 10) in the final exams at the end of the second semester (p<0.001)., Conclusion: These unprecedented circumstances require innovation and cooperation on the part of university programs to maintain rigorous standards of higher education, taking into account students' evolving perception and needs., Competing Interests: There are no conflicts of interest., (© 2021 Apostolos Fyllos,, Asimakis Kanellopoulos, Pavlos Kitixis, Daniel-Valentin Cojocari, Alexandra Markou, Vasileios Raoulis, Nikolaos Strimpakos, Aristeidis Zibis.)