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BackgroundUltrasound (US) imaging has been considered as a non-invasive technique to measure thickness and estimate relative abdominal muscle activity. Although some studies have assessed the reliability of US imaging, no study has assessed the reliability of US measurement of automatic activity of abdominal muscles in positions with different levels of stability in participants with chronic low back pain (cLBP). The purpose of this study was to investigate within-day and between-days reliability of US thickness measurements of automatic activity of the abdominal muscles in asymptomatic participants and within-day reliability in those with cLBP.MethodsA total of 20 participants (10 with cLBP, 10 healthy) participated in the study. The reliability of US thickness measurements at supine lying and sitting positions (sitting on a chair, sitting on a gym ball with both feet on the ground or lifting one foot off the floor) were assessed. We evaluated within-day reliability in all participants and between-days reliability in asymptomatic participants.ResultsWe found high ICC scores (0.85-0.95) and also small SEM and MDC scores in both groups. The reliability of the measurements was comparable between participants with and without LBP in each position but the SEMs and MDCs was slightly higher in patient group compared with healthy group. It indicates high intra-tester reliability for the US measurement of the thickness of abdominal muscles in all positions.ConclusionUS imaging can be used as a reliable method for assessment of automatic activity of abdominal muscles in positions with low levels of stability in participants with and without LBP.

Objective: This study aimed to explore the relationship between self-reported cognitive difficulties, objective neuropsychological test performances, and subjective health complaints in chronic fatigue syndrome (CFS) and to examine the degree of impaired cognitive functions. Method:A total of 236 consecutively recruited outpatients, aged between 18 and 62 years, completed the tests. Self-administered questionnaires were used for assessing fatigue, pain, depression, anxiety and subjective cognitive complaints (Everyday Memory Questionnaire, EMQ). Also, neuropsychological tests, i.e., Stroop I-IV, CVLT-II learning/delay, WAIS-III L-N Sequencing, and PASAT were performed to examine whether these objective measures correlated with subjective complaints and were compared with normative data. Results: There was a trend of association (p<0.05) between unadjusted EMQ with Stroop IV (inhibition and shifting attention), CVLT-II learning/delay (verbal learning and memory) and WAIS-III L-N Sequencing (working memory), but none were statistically significant at the 0.001 level. EMQ was positively associated with fatigue, pain, and depression (p<0.001). PASAT (working memory) was negatively associated with pain (p<0.001). Between 21% and 38% of the patients performed below the 1.5 SD cut-off for clinically significant impairment on the Stroop tests. Conclusion:The self-reported cognitive performance was not strongly associated with the objective cognitive performances on any domains in patients with CFS. Patients with higher fatigue, pain and depression levels reported greater subjective cognitive difficulties, also higher pain related to lower objective working memory function. The CFS patients had problems mainly in domains of psychomotor speed and attention measured by the objective neuropsychological tests. Public Significance Statements:In patients with chronic fatigue syndrome, their self-reported cognitive performance reflects, to some extent, the objective cognitive performances on certain domains. They report a high level of cognitive difficulties, which are positively correlated with fatigue, pain, and depression; however, the relationships with objective tests are weak. They display problems mainly in domains of psychomotor speed and attentional control measured by objective neuropsychological performance tests.

Background It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. Methods The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. Results Analysis of variance 2 × 2 revealed greater improvements in pain (p < 0.001), static stability (p < 0.001), and dynamic balance (p < 0.01) in the experimental group compared to the control group. Function was improved in both groups following the interventions (p < 0.001), and there was a trend of a larger improvement in the experimental group than the control group (p = 0.09). Fisher’s exact test showed that the experimental group reported ≥50% improvement only in the pain score, not function, compared to the group that received TENS alone (p = 0.005). Conclusions Pain, function, static stability, and dynamic balance were improved in both groups following 12 intervention sessions. However, pain, static stability, and dynamic balance were improved to a greater extent in diaphragm training plus TENS than TENS alone in amateur athletes with CLBP. Therefore, it seems beneficial to add diaphragm training to the rehabilitation program for athletes with nonspecific CLBP. Trial registration The trial was retrospectively registered in the Iranian Registry of Clinical Trials (www.irct.ir) on September 10, 2020 as IRCT20090228001719N8.

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