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The human rotator cuff consists of four muscles, each with a complex, multipennate architecture. Despite the functional and clinical importance, the architecture of the human rotator cuff has yet to be clearly described in humans in vivo. The purpose of this study was to investigate the intramuscular, intermuscular, and interindividual variations in architecture and moment arms of the human rotator cuff. Muscle volumes, fascicle lengths, physiological cross‐sectional areas (PCSAs), pennation angles, and moment arms of all four rotator cuff muscles were measured from mDixon and diffusion tensor imaging (DTI) scans of the right shoulders of 20 young adults. In accordance with the most detailed dissections available to date, we found substantial intramuscular variation in fascicle length (coefficients of variation (CVs) ranged from 26% to 40%) and pennation angles (CVs ranged from 56% to 62%) in all rotator cuff muscles. We also found substantial intermuscular and interindividual variations in muscle volumes, but relatively consistent mean fascicle lengths, pennation angles, and moment arms (CVs for all ≤17%). Moreover, when expressed as a proportion of total rotator cuff muscle volume, the volumes of individual rotator cuff muscles were highly consistent between individuals and sexes (CVs ≤16%), suggesting that rotator cuff muscle volumes scale uniformly, at least in a younger population without musculoskeletal problems. Together, these data indicate limited interindividual and intermuscular variability in architecture, which may simplify scaling routines for musculoskeletal models. However, the substantial intramuscular variation in architecture questions the validity of previously reported mean architectural parameters to adequately describe rotator cuff function. [ABSTRACT FROM AUTHOR]

Detailed analysis of skeletal muscle architecture provides insights into skeletal muscle function. To date, measurements of the human subscapularis architecture have been limited to cadaveric measurements. In this study we demonstrate the feasibility of using anatomically constrained fibre tractography to reconstruct and quantify the 3D architecture of the human subscapularis muscle , and provide the first quantitative measurements of the architecture of the human subscapularis muscle in vivo. mDixon and diffusion tensor magnetic resonance images were obtained from the right shoulders of 20 healthy young adults. Anatomically constrained fibre tractography, in which fascicle reconstructions were forced to terminate on the internal aponeurosis of the subscapularis, was used to reconstruct muscle fibre architecture of the subscapularis muscles. Qualitatively, architectural reconstructions resembled the known subscapularis anatomy well, demonstrating face validity of the reconstructions. Muscle architectural parameters (means ± SDs) were: muscle volume 138 ± 42 cm3, fascicle length 63.6 ± 5.9 mm, physiological cross-sectional area (PCSA) 22 ± 6 cm2, and pennation angle 16 ± 2°. Architectural measurements of the subscapularis fell within the range reported in cadaver studies and were relatively insensitive to variations in fibre tractography parameters. The anatomically detailed whole-muscle reconstructions can be used to quantify the effects of joint surgery on muscle architecture and to advance computational models of the human shoulder. [ABSTRACT FROM AUTHOR]

Background & aims: Prophylactic injections of factor VIII reduce the incidence of bleeds and slow the development of joint damage in people with hemophilia. The aim of this study was to identify optimal person-specific prophylaxis regimens for children with hemophilia A. Methods: Analytic and numerical methods were used to identify prophylaxis regimens which maximize the time for which plasma factor VIII concentrations exceed a threshold, maximize the lowest plasma factor VIII concentrations, and minimize risk of bleeds. Results: It was demonstrated analytically that, for any injection schedule, the regimen that maximizes the lowest factor VIII concentration involves sharing doses between injections so that all of the trough concentrations in a prophylaxis cycle are equal. Numerical methods were used to identify optimal prophylaxis schedules and explore the trade-offs between efficacy and acceptability of different prophylaxis regimens. The prophylaxis regimen which minimizes risk of bleeds depends on the person’s pattern of physical activity and may differ greatly from prophylaxis regimens that optimize pharmacokinetic parameters. Prophylaxis regimens which minimize risk of bleeds also differ from prophylaxis regimens that are typically prescribed. Predictions about which regimen is optimal are sensitive to estimates of the effects on risk of bleeds of factor VIII concentration and physical activity. Conclusion: The methods described here can be used to identify optimal, person-specific prophylaxis regimens for children with hemophilia A. [ABSTRACT FROM AUTHOR]

Objectives: To explore the theoretical justification for blinding in randomized trials and make recommendations concerning the implementation and interpretation of blinded randomized trials. Study Design and Setting: A theoretical analysis was conducted of the potential for bias in randomized trials with successful blinding (ie, trials in which beliefs about allocation to treatment or control groups are independent of actual allocation). The analysis identified conditions that must be satisfied to ensure that blinding eliminates the potential for bias associated with beliefs about allocation. Results: Even when beliefs about allocation are independent of actual allocation, they can still cause bias. The potential for bias is eliminated when the belief is uniformly one of complete ambivalence about allocation. Conclusion: Even when blinding succeeds in making beliefs about allocation independent of actual allocation, beliefs about allocation may still cause bias. It is difficult to determine the extent of bias in any particular trial. Bias could be eliminated by establishing a state of complete ambivalence about the allocation of every trial participant, but universal ambivalence may be difficult to achieve and may reduce the generalizability of the trial's findings. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the smallest worthwhile effects of two treatments for nonspecific low back pain (LBP). Study Design and Setting: The benefiteharm trade-off method was used to estimate the smallest worthwhile effect of nonsteroidal anti-inflammatory drugs (NSAIDs) and physiotherapy for LBP. Patients seeking care for chronic LBP were interviewed by telephone before treatment commenced and 4 weeks later. Results: Patients need to see a median of 30% (interquartile range [IQR]: 10e40) more improvement in pain and 20% (IQR: 10e40) more improvement in disability than would occur without intervention to perceive the effect of NSAIDs are worthwhile. They would need to see 20% (IQR: 0e30) more improvement on pain and disability over natural recovery to perceive that the effect of physiotherapy was worthwhile. There was no difference in estimates of the smallest worthwhile effect elicited at baseline and 4 weeks later. Conclusions: People with chronic back pain need to see larger effects on pain of NSAIDS than physiotherapy to consider the effects of these interventions worthwhile. These estimates of the smallest worthwhile effect can be used to interpret the findings of clinical trials and to design adequately powered clinical trials. [ABSTRACT FROM AUTHOR]

The article discusses that high quality randomized trials provide unbiased estimates of the effects of health interventions compared to a single trial. It reveals that 'benefit-harm trade-off method' can be used to define the smallest effect of intervention and for identifying the smallest hypothetical effect for patients to receive intervention. Extended funnel plots and graphs are used to explore the potential influence of a new trial on the findings, when meta-analysis of existing trials does not provide clear findings. These procedure should be considered for carrying out a further clinical trial and such evidences from the above analysis will help the granting bodies to request for funding to conduct a further trial.

Abstract: Background: People with spinal cord injury sometimes develop abnormally compliant hamstring muscle-tendon units. This study investigated whether the increased muscle-tendon compliance is due to a change in the passive properties of the muscle fascicles or tendons, or to muscle tears. Methods: Semimembranosus muscle fascicle lengths were measured from ultrasound images obtained from 15 spinal cord injured subjects and 20 control subjects while the hip was passively flexed with the knee extended. Semimembranosus muscles of spinal cord injured subjects were inspected for tears using ultrasound imaging. Findings: The mean (SD) hip angle at 30Nm was 97 (SD 24) degrees in spinal cord injured subjects and 70 (SD 11) degrees in control subjects, indicating that spinal cord injured subjects had very compliant hamstring muscle-tendon units. The ratio of change in fascicle length to change in muscle-tendon length was not statistically different between spinal cord injured subjects and control subjects: muscle fascicles lengthened by 0.30 (SD 0.24) mm/mm in spinal cord injured subjects and 0.42 (SD 0.29) mm/mm in control subjects. These data were used to show that there was evidence of increased tendon compliance of spinal cord injured subjects compared to control subjects, but no evidence of increased muscle fascicle compliance. No tears were observed in semimembranosus muscles of spinal cord injured subjects. Interpretation: The increased hamstring muscle-tendon compliance apparent in some spinal cord injured subjects is due, at least in part, to increased tendon compliance. There was no evidence that the increased muscle-tendon compliance was due to muscle tears. [Copyright &y& Elsevier]

The article presents a research which aims to quantify the transient increase in risk of bleeds associated with physical activity in children with hemophilia. It informs that excessive physical activity is thought to increase risk of bleeds in children with hemophilia. It further informs that the severity of hemophilia is classified according to levels of clotting factor in the blood which are expressed as a percentage of normal values. The methodology included a prospective cohort study was conducted at three pediatric hemophilia centers in Australia. It is concluded that vigorous physical activity is associated with increase in risk of bleeding in hemophiliacs because the increased relative risk is transient.

Introduction: In this study we compared passive mechanical properties of gastrocnemius muscle-tendon units, muscle fascicles, and tendons in control subjects and people with ankle contractures after spinal cord injury. Methods: Passive gastrocnemius length-tension curves were derived from passive ankle torque-angle data obtained from 20 spinal cord injured subjects with ankle contractures and 30 control subjects. Ultrasound images of muscle fascicles were used to partition length-tension curves into fascicular and tendinous components. Results: Spinal cord injured subjects had stiffer gastrocnemius muscle-tendon units (stiffness index: 74.8 ± 27.0 m−1) than control subjects (54.4 ± 17.7 m−1) ( P = 0.004). Muscle-tendon slack lengths, as well as slack lengths and changes in length of fascicles and tendons, were similar in the two groups. Conclusions: People with ankle contractures after spinal cord injury have stiff gastrocnemius muscle-tendon units. It is not clear whether this reflects changes in properties of muscle fascicles or tendons. Muscle Nerve 46: 237-245, 2012 [ABSTRACT FROM AUTHOR]

Abstract: Objective: To critically and systematically review methods used to estimate the smallest worthwhile effect of interventions for nonspecific low back pain. Study Design and Setting: A computerized search was conducted of MEDLINE, CINAHL, LILACS, and EMBASE up to May 2011. Studies were included if they were primary reports intended to measure the smallest worthwhile effect of a health intervention (although they did not need to use this terminology) for nonspecific low back pain. Results: The search located 31 studies, which provided a total of 129 estimates of the smallest worthwhile effect. The estimates were given a variety of names, including the Minimum Clinically Important Difference, Minimum Important Difference, Minimum Worthwhile Reductions, and Minimum Important Change. Most estimates were obtained using anchor- or distribution-based methods. These methods are not (or not directly) based on patients’ perceptions, are not intervention-specific, and are not formulated in terms of differences in outcomes with and without intervention. Conclusion: The methods used to estimate the smallest worthwhile effect of interventions for low back pain have important limitations. We recommend that the benefit–harm trade-off method be used to estimate the smallest worthwhile effects of intervention because it overcomes these limitations. [Copyright &y& Elsevier]

Non-Technical Summary Relaxed skeletal muscles behave like springs that resist joint motion. There have been few in vivo studies of the spring-like properties of relaxed muscles. In this study, ultrasound was used to image human calf muscles while muscle length was changed by rotating the ankle of relaxed subjects. The muscles of some subjects buckled at short lengths. At short lengths most muscle fascicles (bundles of muscle cells) are slack. As the muscle is lengthened the slack is progressively taken up, first in some fascicles then in others. The increase in muscle length is due partly to increases in the length of muscle fascicles but most of the increase in muscle length occurs in the tendons. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the change with time of the reported methodological quality of randomized controlled trials of physiotherapy interventions. Study Design and Setting: For all trials of physiotherapy interventions indexed on the Physiotherapy Evidence Database (PEDro), year of publication, and methodological quality scores (11-item PEDro scale and total PEDro score [range, 0–10]) were extracted. The relationship between trial quality and time was evaluated using regression analyses for the PEDro total score and individual quality items. The study was carried out in a university research center. Results: Data from 10,025 trials published since 1960 were analyzed. The total PEDro score was related to time (year of publication), with the total score increasing by an average of ∼0.6 points each decade between 1960 and 2009. The reported use of eight of the 11 individual items from the PEDro scale (intention-to-treat analysis, concealed allocation, groups similar at baseline, reporting of results of between-group statistical comparisons, point measures and measures of variability reported, subjects randomly allocated to groups, eligibility criteria specified, and blinding of assessors) also improved with time. Conclusion: The reported methodological quality of randomized controlled trials of physiotherapy interventions has improved over time. Further improvement is still necessary. [Copyright &y& Elsevier]

Background: People with tetraplegia often have extensive paralysis of the hand yet retain crude hand function. Their hand function is dependent on manipulating wrist position with the neurally-intact wrist extensor muscles to change the passive tension in paralysed thumb muscles. This moves the thumb in relation to the paralysed index finger enabling basic grasp. The aim of this study was to quantify the effect of wrist position on thumb flexor and adductor torques generated in paralysed hands of people with tetraplegia. Methods: Thumb flexor and adductor torques were measured as the wrist was passively moved from a fully flexed to a fully extended position in 10 people with tetraplegia who had paralysis of all thumb muscles. The relationships between thumb torques and wrist angles were quantified with torque–angle curves. Findings: There was a consistent curvilinear relationship between wrist angle and both thumb flexor and thumb adductor torques. Thumb flexor torques were greatest and thumb adductor torques were smallest when the wrist was fully extended. Interpretation: Wrist position influences the thumb flexor and adductor torques generated in the paralysed hand. This is probably due to the effect of wrist position on the passive tension of the thumb muscles spanning the wrist. These findings have implications for people with C6 and C7 tetraplegia who rely on the passive torques generated by the paralysed thumb muscles for hand function. [Copyright &y& Elsevier]

Background: Although it is widely appreciated that vigorous physical activity can increase the risk of bleeding episodes in children with haemophilia, the magnitude of the increase in risk is not known. Accurate risk estimates could inform decisions made by children with haemophilia and their parents about participation in physical activity and aid the development of optimal prophylactic schedules. The aim of this study is to provide an accurate estimate of the risks of bleeding associated with vigorous physical activity in children with haemophilia. Methods/Design: The study will be a case-crossover study nested within a prospective cohort study. Children with moderate or severe haemophilia A or B, recruited from two paediatric haematology departments in Australia, will participate in the study. The child, or the child's parent or guardian, will report bleeding episodes experienced over a 12-month period. Following a bleeding episode, the participant will be interviewed by telephone about exposures to physical activity in the case period (8 hours before the bleed) and 2 control periods (an 8 hour period at the same time on the day preceding the bleed and an 8 hour period two days preceding the bleed). Conditional logistic regression will be used to estimate the risk of participating in vigorous physical activity from measures of exposure to physical activity in the case and control periods. Discussion: This case-control study will provide estimates of the risk of participation in vigorous physical activity in children with haemophilia. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effect of eccentric exercise on passive mechanical properties of human gastrocnemius. Here, the twelve subjects executed an eccentric exercise on their right leg for 1 hour by walking backward downhill on a treadmill. The subjects were examined before exercise, an hour after the activity and 24 hours later. Moreover, their ankle torque was evaluated as the ankle was rotated within its available domain. The authors also examined the potential tension in the gastrocnemius at various times after the exercise. Results showed that muscle stiffness increased after the exercise.

Background: Children with haemophilia have lower levels of fitness and strength than their healthy peers. We present the protocol of a study designed to determine whether an exercise intervention improves quality of life, aerobic fitness and strength in children with haemophilia. Methods/Design: The study will be a randomised, assessor-blinded, controlled trial of exercise treatment. Seventy children aged between 6 and 18 years with haemophilia or von Willebrand disease will be recruited from two paediatric haemophilia clinics in NSW. Each participant will be allocated to an exercise group or a control group using a concealed allocation procedure. The control group will receive usual medical care while the intervention group will receive usual medical care plus an exercise program for 12 weeks. Outcomes (VO2peak, knee extensor strength and quality of life) will be measured at baseline and on completion of the exercise program by a blinded assessor. The primary analysis will be conducted on an intention to treat basis. The effects of the exercise intervention on each of the three primary outcomes will be estimated from between-group differences in the mean outcome adjusted for baseline scores. Discussion: This study will be the first randomised controlled trial to examine the effects of a structured exercise program on fitness and quality of life in children with haemophilia. [ABSTRACT FROM AUTHOR]

Purpose: To compare effects on strength in the early phase of resistance training with one or three sets and fast or slow speeds. Methods: A total of 115 healthy, untrained subjects were randomized to a control group or one of four training groups: one set fast (∼140°·s-1), three sets fast, one set slow (∼50°·s-1), or three sets slow. All subjects attended training 3× wk-1 for 6 wk. Subjects in the training groups performed unilateral elbow flexion contractions with a target six- to eight-repetition maximum load. Control subjects sat at the training bench but did not train. One repetition maximum strength, arm circumference, and biceps skinfold thickness were measured before and after training. Results: One slow set increased strength by 25% (95% CI 13-36%, P < 0.001). Three sets of training produced greater increases in strength than one set (difference = 23% of initial strength, 95% CI 12-34%, P < 0.001) and fast training resulted in a greater increase in strength than slow training (difference = 11%, 95% CI 0.2-23%, P = 0.046). The interaction between sets and speed was negative (-15%) and of borderline significance (P = 0.052), suggesting there is a benefit of training with three sets or fast speeds, but there is not an additive benefit of training with both. Conclusions: Three sets of exercise produce twice the strength increase of one set in the early phase of resistance training. Training fast produces greater strength increases than training slow; however, there does not appear to be any additional benefit of training with both three sets and fast contractions. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Evidence-based practice requires access to systematic reviews and randomized controlled trials; however, most literature databases index primarily English-language journals. We sought to determine the extent and quality of Portuguese- and Spanish-language reports of randomized trials relevant to physiotherapy by searching the LILACS database (Literatura Latino Americana e do Caribe em Ciências da Saúde). A secondary aim was to compare the sensitivity of three strategies for searching for Portuguese- and Spanish-language randomized trials in physiotherapy. Study design and setting: The LILACS database was searched for randomized trials using three search strategies. Results: Three search strategies returned 5,262 records, of which only 47 were randomized trials. Most trials reported treatments for pain or cardiopulmonary disease, and most were of moderate to high quality. The sensitivity of the three search strategies varied from 2% to 53%. Conclusion: A small number of moderate- to high-quality randomized trials in physiotherapy are published in Spanish and Portuguese languages, but they are difficult to find. [Copyright &y& Elsevier]

Evidence-based practice implies the systematic use of best evidence, usually in the form of high quality clinical research, to solve clinical problems. This article considers a series of objections to evidence-based physiotherapy including that (1), it is too time-consuming, (2), there is not enough evidence, (3), the evidence is not good enough, (4), readers of clinical research cannot distinguish between high and low quality studies, (5), clinical research does not provide certainty when it is most needed, (6), findings of clinical research cannot be applied to individual patients, (7), clinical research does not tell us about patients' true experiences, and (8), evidence-based practice removes responsibility for decision making from individual physiotherapists. We argue that, while there is some truth in each of these objections, they need to be weighed against the potential benefits of evidence-based practice. The overwhelming strength of the evidence-based approach to clinical practice is that it takes full advantage of the only potentially unbiased estimates of effects of therapy - those which are derived from carefully conducted clinical research. The evidence-based practice model may be imperfect, but it may be the best model of clinical practice that is currently available. [ABSTRACT FROM AUTHOR]

Background: Complex Regional Pain Syndrome (CRPS) is a disabling pain disorder that is most common after a distal limb fracture. While the acute systemic immune response to the injury is thought to play a role in the development of CRPS, this hypothesis has never been tested directly. Thus, we evaluated whether elevated levels of circulating pro-inflammatory cytokines early after a fracture were associated with the development of CRPS.Methods: We conducted a case-control study nested within a prospective cohort study. Individuals with wrist and/or hand fractures were recruited from specialist hand units. Baseline clinical data were obtained from participants within 28 days of fracture. CRPS status was determined 16 weeks after the fracture using a two-stage diagnostic process. Cytokine assays were obtained from all cases (defined using the Budapest criteria) and a random sample of those who did not have CRPS at 16 weeks. We calculated odds ratios with 95% confidence intervals to determine the risk of CRPS associated with the expression of each of 25 cytokines.Results: Baseline data were collected for 702 consenting participants, of whom 535 provided blood samples. Follow-up at 16 weeks was 97.2%. 15 (2.2% of the cohort) met the Budapest CRPS criteria and 69 (including those who met the Budapest criteria; 9.8%) met the International Association for the Study of Pain (IASP) CRPS criteria. In all of the primary analyses (using Budapest criteria) and 49/50 secondary analyses (using IASP criteria), 95% confidence intervals for the association between cytokine levels and the risk of subsequently developing CRPS included the null value (OR = 1). However, the confidence intervals were wide.Conclusion: There was no evidence that early post-injury expression of systemic cytokines was associated with a CRPS diagnosis 16 weeks after injury. This study does not provide support for the hypothesis that innate immune activation has a determinative role in the development of CRPS. [ABSTRACT FROM AUTHOR]

• The DiTA database, launched in 2019, is freely accessible at dita.org.au. • DiTA indexes physical therapy relevant diagnostic test accuracy research. • There are more than 2400 primary studies and systematic reviews indexed on DiTA. • This Masterclass provides tips on how to best search this database. Physical therapists use diagnostic tests in a variety of settings. Choosing the best diagnostic test to apply in a particular situation can be difficult. The choice of diagnostic test should be informed, at least in part, by evidence of test accuracy. Finding evidence of diagnostic test accuracy has, until recently, been challenging. Ideally, there would exist a database that comprehensively indexes evidence on diagnostic tests relevant to physical therapy practice, is free to access, and is easy to use. This Masterclass will describe the DiTA (Di agnostic T est A ccuracy) database (dita.org.au) including its development and search interface, and provide advice on how to search and retrieve records. DiTA indexes more than 2400 primary studies and systematic reviews of diagnostic test accuracy relevant to physical therapy practice. Users can search DiTA using text fields and dropdown lists to find evidence of diagnostic test accuracy. The database is freely accessible on the internet. Since its launch, DiTA has been accessed from almost every country in the world, the largest number of searches having been conducted from Brazil. [ABSTRACT FROM AUTHOR]

Evaluates the efficiency of a physical therapy treatment approach to the treatment of shoulder pain. Methodology used in the evaluation; Participants in the evaluation; Symptoms of shoulder pain; Conclusions reached; Provision of statistical information.

This JAMA Guide to Statistics and Methods reviews the use of mediation analysis to evaluate possible mechanisms that the effects of interventions are presumed to work through. [ABSTRACT FROM AUTHOR]

Introduction: In some randomised trials, the primary interest is in the mechanisms by which an intervention exerts its effects on health outcomes. That is, clinicians and policy-makers may be interested in how the intervention works (or why it does not work) through hypothesised causal mechanisms. In this article, we highlight the value of understanding causal mechanisms in randomised trials by applying causal mediation analysis to two randomised trials of complex interventions.Main Body: In the first example, we examine a potential mechanism by which an exercise programme for rheumatoid arthritis of the hand could improve hand function. In the second example, we explore why a rehabilitation programme for ankle fractures failed to improve lower-limb function through hypothesised mechanisms. We outline critical assumptions that are required for making valid causal inferences from these analyses, and provide results of sensitivity analyses that are used to assess the degree to which the estimated causal mediation effects could have been biased by residual confounding.Conclusion: This paper demonstrates how the application of causal mediation analyses to randomised trials can identify the mechanisms by which complex interventions exert their effects. We discuss methodological issues and assumptions that should be considered when mediation analyses of randomised trials are used to inform clinical practice and policy decisions. [ABSTRACT FROM AUTHOR]

Presents a study that argues that systematic reviews of complex interventions should assess the quality of interventions. Suggestions for how to make such assessments; Description of complex health interventions and how they are administered; Effect of the quality of these interventions.

Abstract Objectives To describe the course of acute low back pain and sciatica and to identify clinically important prognostic factors for these conditions. Design Systematic review. Data sources Searches of Medline, Embase, Cinahl, and Science Citation Index, and iterative searches of bibliographies. Main outcome measures Pain, disability, and return to work. Results 15 studies of variable methodological quality were included. Rapid improvements in pain (mean reduction 58% of initial scores), disability (58%), and return to work (82% of those initially off work) occurred in one month. Further improvement was apparent until about three months. Thereafter levels for pain, disability, and return to work remained almost constant. 73% of patients had at least one recurrence within 12 months. Conclusions People with acute low back pain and associated disability usually improve rapidly within weeks. None the less, pain and disability are typically ongoing, and recurrences are common. [ABSTRACT FROM AUTHOR]

Discusses lessons to be learned from the results of clinical trials on physiotherapy. Choice of reviews; Management of musculoskeletal disorders; Exercises for pelvic floor muscles to reduce urinary incontinence in women; Physical therapy for stroke victims with movement dysfunction; Prevention and management of pulmonary disease; Prevention of falls in elderly people.

Muscle volume must increase substantially during childhood growth to generate the power required to propel the growing body. One unresolved but fundamental question about childhood muscle growth is whether muscles grow at equal rates; that is, if muscles grow in synchrony with each other. In this study, we used magnetic resonance imaging (MRI) and advances in artificial intelligence methods (deep learning) for medical image segmentation to investigate whether human lower leg muscles grow in synchrony. Muscle volumes were measured in 10 lower leg muscles in 208 typically developing children (eight infants aged less than 3 months and 200 children aged 5 to 15 years). We tested the hypothesis that human lower leg muscles grow synchronously by investigating whether the volume of individual lower leg muscles, expressed as a proportion of total lower leg muscle volume, remains constant with age. There were substantial age‐related changes in the relative volume of most muscles in both boys and girls (p < 0.001). This was most evident between birth and five years of age but was still evident after five years. The medial gastrocnemius and soleus muscles, the largest muscles in infancy, grew faster than other muscles in the first five years. The findings demonstrate that muscles in the human lower leg grow asynchronously. This finding may assist early detection of atypical growth and allow targeted muscle‐specific interventions to improve the quality of life, particularly for children with neuromotor conditions such as cerebral palsy. [ABSTRACT FROM AUTHOR]

Background: People who sustain spinal cord injuries in low- and middle-income countries are vulnerable to life-threatening complications after discharge. The aim of this trial is to determine the effect on all-cause mortality of a sustainable model of community-based care provided over the first 2 years after discharge.Methods and Analysis: The CIVIC trial is a single centre, parallel group trial with concealed and stratified randomisation. The protocol has been previously published (BMJ Open 2016;6:e010350). This paper provides the accompanying detailed statistical plan. In total, 410 people with recent spinal cord injury who are wheelchair dependent and about to be discharged from the Centre for the Rehabilitation of the Paralysed in Bangladesh are randomised to intervention or control groups. Participants assigned to the intervention group receive a model of community-based care in which a case manager provides ongoing telephone-based support and visits participants in their homes over a 2-year period. Participants assigned to the control group receive usual care which may involve a follow-up phone call or a home visit. The primary outcome is all-cause mortality at 2 years as determined by a blinded assessor (Bangladesh does not have a death registry). The primary effectiveness analysis will compare Kaplan-Meier survival curves (time from allocation to death) in the intervention and control groups using the log-rank test (two-tailed α = 0.05). Participants will be censored at the time they were last known to be alive or at the time of the follow-up assessment. Recruitment finished in March 2018 and the last assessment will be conducted in March 2020.Discussion: The CIVIC trial will provide unbiased and precise estimates of the effectiveness of a model of community-based care for people with spinal cord injuries in Bangladesh. The results will have implications for provision of health services for people with spinal cord injuries and other conditions that cause serious disability in low-income and middle-income countries.Trial Registration: ANZCTR, ACTRN12615000630516, U1111-1171-1876. Registered on 17 June 2015. [ABSTRACT FROM AUTHOR]

Randomised trials with long-term follow-up can provide estimates of the long-term effects of health interventions. However, analysis of long-term outcomes in randomised trials may be complicated by problems with the administration of treatment such as non-adherence, treatment switching and co-intervention, and problems obtaining outcome measurements arising from loss to follow-up and death of participants. Methods for dealing with these issues that involve conditioning on post-randomisation variables are unsatisfactory because they may involve the comparison of non-exchangeable groups and generate estimates that do not have a valid causal interpretation. We describe approaches to analysis that potentially provide estimates of causal effects when such issues arise. Brief descriptions are provided of the use of instrumental variable and propensity score methods in trials with imperfect adherence, marginal structural models and g-estimation in trials with treatment switching, mixed longitudinal models and multiple imputation in trials with loss to follow-up, and a sensitivity analysis that can be used when trial follow-up is truncated by death or other events. Clinical trialists might consider these methods both at the design and analysis stages of randomised trials with long-term follow-up. [ABSTRACT FROM AUTHOR]

Background and Purpose: PEDro (the Physiotherapy Evidence Database) is a widely used, comprehensive, freely available, online database that indexes studies of the effectiveness of physiotherapy interventions. We have recently built another database, called DiTA, on the same platform as PEDro. DiTA provides a comprehensive index of studies of the accuracy of diagnostic tests used by physiotherapists. This study aims to describe the number and scope of such studies. Methods: A comprehensive search was conducted for studies of the accuracy of diagnostic tests. The search was conducted on the MEDLINE, EMBASE and CINAHL databases from their inceptions to November 2018. Subsequently, monthly searches have updated the database. To be included on DiTA, studies need to investigate (a) both a pathology and patients that a physiotherapist could assess in clinical practice, and (b) an index test that a physiotherapist would perform themselves rather than one which they would request. Results: To date, the searches have yielded 44,884 titles. Screening has identified 1,419 reports that meet the inclusion criteria. The most frequently studied subdisciplines are "musculoskeletal" (1,050/1,419; 74.0%) and "cardiothoracics" (241; 17.0%); the most frequently studied categories of pathologies are joint pathologies (463; 32.6%) and nervous system pathologies (175; 12.3%); and the most frequently studied body part is the "lower leg or knee" (232; 16.3%). Most studies investigate index tests which are "physical examination" procedures (851; 60.0%); fewer investigate "questions or questionnaires" (420; 29.6%) and "health technologies" (351; 24.7%). Discussion: There is a rapidly growing body of evidence on the accuracy of diagnostic tests relevant to most physiotherapy subdisciplines. While the volume of evidence is substantial, it is not yet clear how much of the evidence is of good enough quality to support clinical decision‐making. [ABSTRACT FROM AUTHOR]

People who have had a stroke often develop ankle contractures which may be caused by changes in architecture of calf muscles. Anatomically constrained diffusion tensor imaging has recently been used to make three-dimensional, whole-muscle measurements of muscle architecture. Here, we compared the architecture of the medial gastrocnemius muscle in the paretic and non-paretic sides of people who have had a hemiparetic stroke and control participants using novel imaging techniques. MRI techniques (diffusion tensor imaging and mDixon imaging) were used to obtain muscle volume, fascicle length, pennation angle, physiological cross-sectional area and curvature in 14 stroke patients (mean age 60 SD 13 years) and 18 control participants (mean age 66 SD 12 years). On average, the ankle on the paretic side had 11° (95% confidence interval 8 to 13°) less dorsiflexion range than on the non-paretic side, and 6° (1 to 13°) less dorsiflexion range than ankles of control participants. The medial gastrocnemius muscles on the paretic side were, on average, 15% (35.2 cm3, 95% confidence interval 5.2 to 65.2 cm3) smaller in volume than the muscles on the non-paretic side, and 16% (36.9 cm3, 95% confidence interval 3.1 to 70.6 cm3) smaller than in control participants. No statistically significant differences between paretic, non-paretic and control muscles were detected for fascicle length, pennation angle, physiological cross-sectional area or curvature. People with hemiparetic stroke and reduced range of motion have, on average, a smaller medial gastrocnemius muscle on the paretic side than on the non-paretic side. Other muscle architectural parameters appear unchanged. • Muscle architecture measurements were made using diffusion tensor imaging. • Muscles from stroke patients have smaller volumes. • Fascicle length and physiological cross-sectional area were not different. [ABSTRACT FROM AUTHOR]

Resistance training increases muscle size (i.e., causes hypertrophy) and muscle strength, particularly in untrained individuals. Hypertrophy is widely believed to be one of the mechanisms (i.e., a mediator) by which resistance training increases strength. However, some researchers have questioned whether training-induced hypertrophy causes increases in strength. One approach to resolving this issue has been to use correlations between training-induced changes in muscle size and strength to infer the effect of hypertrophy on strength. This is problematic because correlations between changes in muscle size and strength may be confounded (i.e., correlation is not causation). Another approach has involved randomizing participants to different volumes of exercise to create different levels of hypertrophy and then comparing the strength increases associated with different levels of hypertrophy. This approach is also problematic because the unit of randomization is exercise volume rather than hypertrophy, and the potential for confounding remains. Thus, a new approach is needed to determine the extent to which hypertrophy increases muscle strength. Here, we introduce resistance training researchers to causal mediation analysis and recommend that it be used to resolve the current debate. Causal mediation analysis potentially provides an unconfounded estimate of the effect of a mediating variable (hypertrophy) on an outcome (strength). This analysis is supplemented by causal maps that help conceptualize research questions and identify potential confounders. In addition to resolving the debate on hypertrophy, causal mediation analysis can be used to answer a host of other questions about mechanisms in the health sciences. [ABSTRACT FROM AUTHOR]

Abstract For detailed analyses of muscle adaptation mechanisms during growth, ageing or disease, reliable measurements of muscle architecture are required. Diffusion tensor imaging (DTI) and DTI tractography have been used to reconstruct the architecture of human muscles in vivo. However, muscle architecture measurements reconstructed with conventional DTI techniques are often anatomically implausible because the reconstructed fascicles do not terminate on aponeuroses, as real muscle fascicles are known to do. In this study, we tested the reliability of an anatomically constrained DTI-based method for measuring three-dimensional muscle architecture. Anatomical magnetic resonance images and diffusion tensor images were obtained from the left legs of eight healthy participants on two occasions one week apart. Muscle volumes, fascicle lengths, pennation angles and fascicle curvatures were measured in the medial and lateral gastrocnemius, soleus and the tibialis anterior muscles. Averaged across muscles, the intraclass correlation coefficient was 0.99 for muscle volume, 0.81 for fascicle length, 0.73 for pennation angle and 0.76 for fascicle curvature. Measurements of muscle architecture obtained using conventional DTI tractography were highly sensitive to variations in the stopping criteria for DTI tractography. The application of anatomical constraints reduced this sensitivity significantly. This study demonstrates that anatomically constrained DTI tractography can provide reliable and robust three-dimensional measurements of whole-muscle architecture. The algorithms used to constrain tractography have been made publicly available. [ABSTRACT FROM AUTHOR]

This paper presents ‘Tips’ for researchers of brain impairment who are interested in conducting randomised controlled trials. The paper is intended for researchers who are planning to undertake their first trial, but may also be of interest to more experienced trialists or clinicians who want to further their understandings of clinical trials. The Tips include suggestions for how to design, conduct, analyse and report clinical trials. [ABSTRACT FROM PUBLISHER]

Precise estimates of muscle architecture are necessary to understand and model muscle mechanics. The primary aim of this study was to estimate continuous changes in fascicle length and pennation angle in human gastrocnemius muscles during ramped plantar flexor contractions at two ankle angles. The secondary aim was to determine whether these changes differ between proximal and distal fascicles. Fifteen healthy subjects performed ramped contractions (0-25% MVC) as ultrasound images were recorded from the medial ( MG, eight sites) and lateral ( LG, six sites) gastrocnemius muscle with the ankle at 90° and 120° (larger angles correspond to shorter muscle lengths). In all subjects, fascicles progressively shortened with increasing torque. MG fascicles shortened 5.8 mm (11.1%) at 90° and 4.5 mm (12.1%) at 120°, whereas LG muscle fascicles shortened 5.1 mm (8.8%) at both ankle angles. MG pennation angle increased 1.4° at 90° and 4.9° at 120°, and LG pennation angle decreased 0.3° at 90° and increased 2.6° at 120°. Muscle architecture changes were similar in proximal and distal fascicles at both ankle angles. This is the first study to describe continuous changes in fascicle length and pennation angle in the human gastrocnemius muscle during ramped isometric contractions. Very similar changes occurred in proximal and distal muscle regions. These findings are relevant to studies modeling active muscle mechanics. [ABSTRACT FROM AUTHOR]

An abstract of the article "Passive mechanical properties of human gastrocnemius muscle-tendon units," by Robert D. Herbert and Joanna Diong is presented.

A response is presented by Johanne Munn and Simon C. Gandevia to a letter to the editor aboput their article "Resistance Training for Strength: Effect of Number of Sets and Contraction Speed."

Importance: The effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear.Objective: To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain.Design, Setting, and Participants: This parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020.Interventions: Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation.Main Outcomes and Measures: The primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point.Results: Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of -1.0 point ([95% CI, -1.5 to -0.4]; P = .001), favoring the intervention group.Conclusions and Relevance: In this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings.Trial Registration: ANZCTR Identifier: ACTRN12615000610538. [ABSTRACT FROM AUTHOR]

Ultrasound imaging is often used to measure muscle fascicle lengths and pennation angles in human muscles in vivo. Theoretically the most accurate measurements are made when the transducer is oriented so that the image plane aligns with muscle fascicles and, for measurements of pennation, when the image plane also intersects the aponeuroses perpendicularly. However this orientation is difficult to achieve and usually there is some degree of misalignment. Here, we used simulated ultrasound images based on three-dimensional models of the human medial gastrocnemius, derived from magnetic resonance and diffusion tensor images, to describe the relationship between transducer orientation and measurement errors. With the transducer oriented perpendicular to the surface of the leg, the error in measurement of fascicle lengths was about 0.4 mm per degree of misalignment of the ultrasound image with the muscle fascicles. If the transducer is then tipped by 20°, the error increases to 1.1 mm per degree of misalignment. For a given degree of misalignment of muscle fascicles with the image plane, the smallest absolute error in fascicle length measurements occurs when the transducer is held perpendicular to the surface of the leg. Misalignment of the transducer with the fascicles may cause fascicle length measurements to be underestimated or overestimated. Contrary to widely held beliefs, it is shown that pennation angles are always overestimated if the image is not perpendicular to the aponeurosis, even when the image is perfectly aligned with the fascicles. An analytical explanation is provided for this finding. [ABSTRACT FROM AUTHOR]

The length and pennation of muscle fascicles are frequently measured using ultrasonography. Conventional ultrasonography imaging methods only provide two-dimensional images of muscles, but muscles have complex three-dimensional arrangements. The most accurate measurements will be obtained when the ultrasound transducer is oriented so that endpoints of a fascicle lie on the ultrasound image plane and the image plane is oriented perpendicular to the aponeurosis, but little is known about how to find this optimal transducer orientation in the frequently-studied medial gastrocnemius muscle. In the current study, we determined the optimal transducer orientation at 9 sites in the medial gastrocnemius muscle of 8 human subjects by calculating the angle of misalignment between three-dimensional muscle fascicles, reconstructed from diffusion tensor images, and the plane of a virtual ultrasound image. The misalignment angle was calculated for a range of tilts and rotations of the ultrasound transducer relative to a reference orientation that was perpendicular to the skin and parallel to the tibia. With the transducer in the reference orientation, the misalignment was substantial (mean across sites and subjects of 6.5°, range 1.4 to 20.2°). However for all sites and subjects a near-optimal alignment (on average 2.6°, range 0.5° to 6.0°) could be achieved by maintaining 0° tilt and applying a small rotation (typically less than 10°). On the basis of these data we recommend that ultrasonographic measurements of medial gastrocnemius muscle fascicle architecture be obtained, at least for relaxed muscles under static conditions, with the transducer oriented perpendicular to the skin and nearly parallel to the tibia. [ABSTRACT FROM AUTHOR]

Opinion. Responses to the commentary made by researcher Kevin E. Wilk, to the study conducted by researchers Karen A. Ginn and her colleges on physical therapy for shoulder pain. Discussion on two issues raised by Wilk; Indepth look at the comments made by Wilk; Suggested answers to these comments.

Objectives: To investigate the prevalence of joint contracture (limited passive range of joint motion) and muscle weakness in a population with multiple sclerosis (MS). A secondary aim was to establish normative data of functional tests of mobility and balance of people with MS who are still ambulant. Design: Cross-sectional study. Setting: People with MS living in metropolitan Sydney, Australia. Participants: 330 people with MS living in metropolitan Sydney, Australia were randomly sampled on 23 July 2009 from the MS Australia register and invited to participate. Main outcome measures: Passive range of motion of large joints of the limbs and muscle strength. Tests of walking and balance were also conducted. Results: 156 people (109 females, 47 males; mean age 54.2 years; mean time since diagnosis 14.9 years) agreed to participate and were assessed. Fifty-six per cent (56%) of participants had contracture in at least one major joint of upper or lower limb. The most common site of contracture was the ankle (43.9%). Seventy per cent (70%) of participants had muscle weakness in one or more muscle groups. As muscle weakness, joint contractures were present at early stage of MS and the prevalence was associated with the progression of the disease. Conclusions: These data show that in addition to muscle weakness joint contractures are highly prevalent among people with MS, especially in the ankle joint. This implicates that prevention of contracture is crucial in providing rehabilitation to people with MS. [ABSTRACT FROM AUTHOR]

Purpose: There have been contradictory reports of the effects of epimuscular myofascial force transmission in humans. This study investigated the transmission of myofascial force to the human vastus lateralis muscle by determining whether vastus lateralis slack angle changed with hip angle. Since the distance between the origin and insertion of the vastus lateralis muscle does not change when hip angle changes, any change in vastus lateralis slack angle with hip position can be attributed to epimuscular myofascial force transmission. Methods: Nineteen young adults were tested in hip flexed ( 80 ∘ ) and neutral ( 0 ∘ ) positions. Ultrasound images of the vastus lateralis muscle were obtained as the knee was passively flexed at 5 ∘ /s. The knee angle at which vastus lateralis muscle fascicles began to lengthen was used to identify muscle slack angle. Results: Overall, there was a negligible effect of hip position on vastus lateralis slack angle ( 0. 6 ∘ [ - 0.7 to 1.9]; mean [95% confidence interval]). However, a small and variable effect was noted in 3/19 participants. Conclusion: This result indicates that, over the range of joint angles tested here, there is little or no epimuscular myofascial force transmission between the vastus lateralis muscle and neighbouring bi-articular structures under passive conditions. More broadly, this result provides additional evidence that epimuscular myofascial force transmission tends to be small and variable under passive conditions in healthy human muscle. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The cortical silent period refers to a period of near silence in the electromyogram (EMG) after transcranial magnetic stimulation (TMS) of the motor cortex during contraction. However, low-level EMG of unknown origin is often present. We hypothesised that it arises through spinal reflexes. Sudden lengthening of the muscle as force drops during the silent period could excite muscle spindles and facilitate motoneurones. Methods: Subjects (n =8) performed maximal isometric, shortening and lengthening contractions of the elbow flexors during which TMS (90–100% output) was delivered over the motor cortex. The rate of flexion during shortening contractions reduced muscle lengthening caused by muscle relaxation. Surface EMG was recorded from biceps brachii and brachioradialis, and the low-level EMG during silent periods produced by TMS was measured. Results: Low-level EMG activity was reduced on average by 68% in biceps and 63% in brachioradialis in the shortening contraction compared to all other contraction conditions (p <0.001). Levels of pre-stimulus EMG were similar between conditions. Conclusions: Muscle lengthening contributes to low-level EMG activity in the silent period, through spinal reflex facilitation by muscle spindle afferents. Significance: The silent period depth is not only dependent on cortical output but also reflex effects evoked by muscle lengthening. [Copyright &y& Elsevier]

Background: Ankle fractures are common. Management of ankle fractures generally involves a period of immobilisation followed by rehabilitation to reduce pain, stiffness, weakness and swelling. The effects of a rehabilitation program are still unclear. However, it has been shown that important components of rehabilitation programs may not confer additional benefits over exercise alone. The primary aim of this trial is to determine the effectiveness and cost-effectiveness of an exercise-based rehabilitation program after ankle fracture, compared to advice alone. Methods/Design: A pragmatic randomised trial will be conducted. Participants will be 342 adults with stiff, painful ankles after ankle fracture treated with immobilisation. They will be randomly allocated using a concealed randomisation procedure to either an Advice or Rehabilitation group. Participants in the Advice group will receive verbal and written advice about exercise at the time of removal of immobilisation. Participants in the Rehabilitation group will be provided with a 4-week rehabilitation program that is designed, monitored and progressed by a physiotherapist, in addition to verbal and written advice. Outcomes will be measured by a blinded assessor at 1, 3 and 6 months. The primary outcomes will be activity limitation and quality-adjusted life years. Discussion: This pragmatic trial will determine if a rehabilitation program reduces activity limitation and improves quality of life, compared to advice alone, after immobilisation for ankle fracture. [ABSTRACT FROM AUTHOR]

Background. Contractures are a disabling complication of neurological conditions that are commonly managed with stretch. Objective. The purpose of this systematic review was to determine the effectiveness of stretch for the treatment and prevention of contractures. The review is part of a more-detailed Cochrane review. Only the results of the studies including patients with neurological conditions are reported here. Data Sources. Electronic searches were conducted in June 2010 in the following computerized databases: Cochrane CENTRAL Register of Controlled Trials, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA), MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, SCI-EXPANDED, and Physiotherapy Evidence Database (PEDro). Study Eligibility Criteria. The review included randomized controlled trials and controlled clinical trials of stretch applied for the purposes of treating or preventing contractures in people with neurological conditions. Study Appraisal and Synthesis Methods. Two reviewers independently selected studies, extracted data, and assessed risk of bias. The primary outcome measures were joint mobility (range of motion) and quality of life. Secondary outcome measures were pain, spasticity, activity limitation, and participation restriction. Meta-analyses were conducted using random-effects models. Results. Twenty-five studies met the inclusion criteria. These studies provide moderate-quality evidence that stretch has a small immediate effect on joint mobility (mean difference=3°, 95% confidence interval [CI]=0° to 5°) and high-quality evidence that stretch has little or no short-term or long-term effects on joint mobility (mean difference=1° and 0°, respectively, 95% CI=0° to 3° and −2° to 2°, respectively). There is little or no effect of stretch on pain, spasticity, and activity limitation. Limitations. No studies were retrieved that investigated the effects of stretch for longer than 6 months. Conclusion. Regular stretch does not produce clinically important changes in joint mobility, pain, spasticity, or activity limitation in people with neurological conditions. INSET: The Bottom Line. [ABSTRACT FROM AUTHOR]

Epidemiological and clinical studies of people with low back pain (LBP) commonly measure the incidence of recovery. The pain numerical rating scale (NRS), scores from 0 to 10, and Roland Morris disability questionnaire (RMDQ), scores from 0 to 24, are two instruments often used to define recovery. On both scales higher scores indicate greater severity. There is no consensus, however, on the cutoff scores on these scales that classify people as having recovered. The aim of this study was to determine which cutoff scores most accurately classify those who had recovered from LBP. Subjects from four clinical studies were categorized as ‘recovered’ or ‘unrecovered’ according to their self-rating on a global perceived effect scale. Odd ratios were calculated for scores of 0, 1, 2, 3 and 4 on the NRS and RMDQ to predict perceived recovery. Scores of 0 on the NRS and ≤2 on the RMDQ most accurately identify patients who consider themselves completely recovered. The diagnostic odds ratio (OR) for predicting recovery was 43.9 for a score of 0 on the NRS and 17.6 for a score of ≤2 on the RMDQ. There was no apparent effect of LBP duration or length of follow-up period on the optimal cutoff score. OR for the NRS were generally higher than those for RMDQ. Cutoffs of 0 on the NRS and 2 on the RMDQ most accurately classify subjects as recovered from LBP. Subjects consider pain more than disability when determining their recovery status. [ABSTRACT FROM AUTHOR]