Journal of Modern Rehabilitation

The Relationship between DASS-42 Questionnaire, Salivary Cortisol and Heart Rate Variability

Fatemeh Sangtarash — 2024-11-20

Background and Objectives: Cortisol and heart rate variability (HRV) represent the activity of physiological stress axes. The depression and anxiety stress survey (DASS-42) has been widely used to assess stress. This study examines the correlations between the DASS-42 questionnaire and stress markers, salivary cortisol levels and HRV.
Methods: A total of 195 healthy volunteers (145 males and 50 females) participated in this study. At first, the DASS-42 survey form was completed. The salivary cortisol samples were collected, and the electrocardiograms were recorded, respectively. Differences in cortisol between baseline and post-trier social stress tests were recorded as changes in cortisol after stress (CCAS). Measurements were made to establish whether the overall DASS and its subscales (stress, anxiety, and depression) were correlated with baseline cortisol, CCAS, and HRV indices.
Results: The anxiety-DASS subscale score correlated negatively with the CCAS score in women (r = -0.429, P = 0.002). The DASS score was significantly correlated with heart rate (r = 0.25, P = 0.007) and SD2 of Poincare plot (r = -0.272, P = 0.004) in men. In contrast, women showed significant correlations between total DASS scores with very low-frequency power (r = -0.40, P = 0.005) and detrended fluctuation analysis-α1 (r = -0.30, P = 0.034). The anxiety-DASS subscale correlated with HRV in both genders.
Conclusion: The anxiety-DASS subscale represents the sympathetic-adrenal medulla activity. Clinicians can estimate the activity of this stress axis by using the anxiety subscale of DASS questionnaire. Meanwhile, gender differences should be noted when assessing stress.

A Randomized Clinical Trial: Immediate Respiratory Warm-Up Effect on Dynamic Inspiratory Muscle Strength in Cardiac Surgery Candidates

Bahareh MehreganFar — 2024-11-20

Background: The strength of inspiratory muscles is one of the important factors in preventing postoperative pulmonary complications (POPC). One of the new tools to safely measure the strength of the inspiratory muscles in heart patients, in a dynamic manner and without breath holding, is the use of strength-index (s-index).
Objective: This study aims to evaluate the immediate effects of a respiratory warm-up (RWU) session on the S-index and other lung parameters in cardiac surgery candidates, a subject with limited existing research.
Material & Methods: This study was conducted as a randomized controlled trial. Forty participants scheduled for heart surgeries were randomly assigned to either the study (RWU between two tests) or control (without RWU) groups. RWU consists of threshold loading inspiratory muscle training (TL-IMT) exercises, at 30% of S-index with 30 breathing cycles. Respiratory tests, including S-index, peak inspiratory flow (PIF), and vital capacity (VC), were assessed two times with using an electronic respiratory device (Power Breath K5).
Results: Covariance analysis showed no significant difference in the average and best values of the S-index, PIF, or VC indices, at the second tests, between two groups (P>.05), or in the independent T-test and Mann-Whitney U test for the “rate of changes”, between two tests (P>.05). Finally, intra-group changes, assessed with paired sample T-test between two tests, were mostly non-significant for these indices (P>.05), except for the Best Vital Capacity in the study group (P=.03).
Conclusions: The study results suggest that a respiratory warm-up session does not significantly impact the S-index or other respiratory parameters in cardiac surgery candidates. Thus, incorporating RWU before S-index testing may not be necessary.

The Effect of Sensorimotor Synchronization on Gait Spatiotemporal Parameters in Women with Multiple Sclerosis: A Quasi-Experimental Study

Mozhgan Memarmoghaddam — 2024-11-20

Background: Although gait rehabilitation based on sensorimotor synchronization (auditory and visual) is interesting for other patients with neurological disorders and the elderly, there is little evidence in patients with multiple sclerosis. Therefore, this study investigates the effect of synchronization with rhythmic visual stimulus on gait Spatiotemporal parameters, bilateral symmetry, and locomotor rehabilitation index in women with multiple sclerosis.
Material and Methods: Spatiotemporal parameters, bilateral symmetry, and the locomotor rehabilitation index were obtained before and after six weeks (three times per week, 30 min) of locomotor training, comparing these findings between two groups of 10 patients, each with Expanded disability status scale (EDSS) 3-6 who performed the gait training with vs. without rhythmic visual stimulus.
Results: Time*group interaction effects indicated greater significant improvements in the group with rhythmic visual stimulus in self-selected walking speed (p=0.041), stride frequency (p=0.009), stance time (p=0.021), and locomotor rehabilitation index (p=0.036). stride length, double stance and swing time improved in the group with rhythmic visual stimulus but this change was not significant. Also, bilateral symmetry did not change significantly in the experimental group. Therefore, rhythmic visual stimulation can help improve functional mobility and locomotor rehabilitation index in patients with multiple sclerosis, especially due to the improvements in the temporal parameters of gait.
Conclusions: Therefore, synchronizing gait with a rhythmic visual stimulus can be an effective therapeutic strategy to improve gait and main temporal parameters in patients with multiple sclerosis.

Effects of Core Stability and Mckenzie Exercises in Mechanical Non Specific low Back Pain with Extension Preference

Hamidreza Nemati — 2024-11-20

Objective: Low back pain is a leading cause of disability worldwide. To address this prevalent issue, various treatments have been recommended, with core stability and McKenzie exercises being among the most evidence-based options. However, recent comparison studies lack mechanical assessment and functional tests. This study aims to compare the effects of core stability and McKenzie exercises on range of motion, pain, disability, and function in patients with mechanical low back pain.
Materials & Methods: In this clinical trial, 22 patients received core stability exercises, and 22 patients received McKenzie exercises based on individual mechanical assessments. Before treatment, each patient underwent mechanical assessment via the McKenzie Mechanical Assessment form, pain assessment using the Visual Analog Scale (VAS), disability evaluation with the Oswestry Disability Index (ODI) questionnaire, muscle control and function assessment with unilateral single limb stance, and range of motion evaluation using fingertip-to-floor (FTF) distance measurements. After eight sessions over two weeks of intervention, all variables were measured again.
Results: Both groups showed significant improvements in trunk flexion range of motion, disability, functional status and pain (P > 0.05). However, there were no significant differences between the two groups (P < 0.05).
Conclusion: Both core stabilization and McKenzie exercises are effective in reducing pain, disability, increasing range of motion, and enhancing functional status in patients with mechanical low back pain.

Effect of dynamic neuromuscular stabilization exercises on activity of external oblique muscle in non-specific low back pain

Hediyeh Hosseini — 2024-11-20

Background: The dynamic neuromuscular stabilization (DNS) core stabilization exercises have been used to improve core stability, but its effect on non-specific low back pain (NSLBP) is still not fully understood. This study aimed to investigate the effect of DNS exercises on the electromyography (EMG) activity of the external oblique muscle in people with NSLBP.
Material and Methods: In a randomized clinical trial, 44 people with chronic NSLBP were randomly assigned to two groups: the experimental group and the control group, with 22 participants in each group. The control group received standard physical therapy exercises, while the experimental group performed DNS exercises. Each group underwent an 8-week therapeutic exercise program, consisting of 5 sessions per week, with each session lasting approximately 60 minutes. Surface EMG was utilized to assess the core muscle activity of the external oblique. The EMG activity of the external oblique was measured in both groups before and after the 8-week interventions.
Results: Nineteen people in the control group and 21 in the DNS group were analyzed. The results showed that after the 8-week intervention, patients in the DNS group obtained, on average, an 8.82% (95% CI: 6.53 to 11.10) higher increase in the EMG activity of the external oblique muscle compared to the patients in the control group (P < 0.001, effect size: 0.622).
Conclusion: The use of DNS exercises can be recommended for improving the activation of superficial core muscle like external oblique in individuals with NSLBP.