Khalid Alkhathami

Purpose: This exploratory study aimed to examine (1) the effects of a single session of repetitive transcranial magnetic stimulation (rTMS) on pain thresholds in patients with high vs. low central sensitization (CS) levels, and (2) whether individuals with high vs. low CS levels exhibit different cortical excitability responses to rTMS compared with age- and sex-matched asymptomatic controls. Patients and Methods: Twenty participants who had low back pain (LBP) for longer than 6 months were dichotomized into the high CS group (n = 10) and the low CS group (n = 10) using a Central Sensitization Inventory cutoff score of 33.5. In addition, 16 age- and sex-matched asymptomatic controls (8 for each CS group) were enrolled. Outcome measures, including pressure pain threshold (PPT), thermal pain threshold, and motor evoked potential (MEP) were collected before and after a single session of rTMS (10 Hz, 10-second pulse trains with a 50-second inter-train interval for 20 minutes). Non-parametric statistics were performed for within-group and between-group comparisons with p < 0.05 for significance. Results: Only the high CS group had significantly improved PPTs after rTMS (p = 0.037), with a moderate effect size. The low CS group and both matched asymptomatic control groups had an increase of MEPs after rTMS, whereas the high CS group had a decrease of MEPs after rTMS, although none of these MEP changes were statistically significant. Conclusion: This study identifies a patient population that may benefit from rTMS for reduction of pressure sensitivity. The decreased sensitivity to pressure in participants with high levels of CS corresponded to a decrease of cortical excitability after rTMS, which was in contrast with the rTMS effects observed in participants with low levels of CS and asymptomatic controls. Plain Language Summary: Central sensitization is a phenomenon that may be an underlying mechanism contributing to chronic pain in some patients. This article explores whether a single session of non-invasive brain stimulation would affect pain sensitivity and brain activity in patients who have different levels of central sensitization. We examined 20 participants who had LBP for longer than 6 months and divided them into two groups, a high CS group and a low CS group, based on their scores on the Central Sensitization Inventory questionnaire. In addition, we enrolled 16 age- and sex-matched asymptomatic controls (8 for each CS group) for the study. We collected pressure pain threshold (PPT), thermal pain threshold and motor evoked potential (MEP) from each participant before and after a single session of non-invasive brain stimulation. The results indicate that non-invasive brain stimulation may reduce sensitivity to pressure in patients with high levels of central sensitization. In addition, patients with high and low levels of central sensitization appeared to respond differently to non-invasive brain stimulation.

Background and Aim: Current evidence suggests that both arthritis and hypertension (HTN) can contribute to an increase in pain severity, potentially owing to shared pathophysiological pathways. However, the extent to which these conditions jointly affect pain severity has not been well studied. The aim of this study was to explore the association between the coexistence of HTN and arthritis and their impact on pain severity among community-dwelling older adults. Methods: A cross-sectional design was used. Data from the Wave 2 (2010–2011) of the National Social Life, Health, and Aging Project (NSHAP) were used. Participants were community-dwelling older adults and categorized based on self-reported diagnoses into four groups: combined HTN and arthritis, HTN only, arthritis only, and neither. Pain severity was measured using the Verbal Descriptor Scale (VDS). Multiple generalized linear regression analyses were conducted with adjustments for age, sex, race, body mass index, educational level, and the use of pain and hypertension medications. Results: Data for 1754 participants were analyzed. The prevalence of combined HTN and arthritis was 28.4%. The prevalence of HTN only and arthritis only was 35.2% and 14.2%, respectively. Participants with both HTN and arthritis had higher pain severity compared to those with neither or only one of these conditions. After covariate adjustment, the combined HTN and arthritis group showed a significant association with higher pain severity (B = 0.39, p < 0.001). Similarly, the arthritis-only group also demonstrated a significant association with increased pain severity (B = 0.26, p = 0.002). However, the HTN alone showed no significant associations with pain severity (B = 0.014, p = 0.83). Compared to the arthritis-only group, combined HTN and arthritis showed a significant association with pain severity (B = 0.16, p = 0.049) in an unadjusted model only, and this association disappeared after adjusting for covariates (B = 0.15, p = 0.08). Conclusions: This study found no significant association between coexisting HTN and arthritis compared to arthritis alone after adjusting for covariates among community-dwelling older adults. The influence of covariates highlights the multifaceted nature of pain determinants, which emphasize the need for a multidisciplinary approach to pain management to enhance their functional capacity and overall quality of life.

Objective: The aim was to investigate the association between baseline coexistence of hypertension (HTN) and arthritis, HTN alone, or arthritis alone, and their impact on longitudinal physical function measures among community-dwelling older adults over 5 years of follow-up. Methods: Ours was a longitudinal prospective cohort study from the second wave (2010–2011) and third wave (2015–2016) of the National Social Life, Health, and Aging Project (NSHAP). Data for older adults were used. Participants were categorized based on self-reported diagnoses into four groups: coexisting HTN and arthritis, HTN only, arthritis only, or neither. Physical performance measures included walking speed using the 3-Meter Walk Test and the Five Times Sit-to-Stand Test (FTSST). Multiple generalized estimating equations with linear regression analyses were conducted, adjusting for age, sex, race, body mass index (BMI) educational level, pain severity, and baseline use of pain and hypertension medications. Results: Data for 1769 participants were analyzed. Slower walking speed was only associated with coexisting HTN and arthritis (B = −0.43, p < 0.001) after accounting for covariates. The coexisting HTN and arthritis group showed no significant association with FTSST (B = 0.80, p = 0.072) after accounting for covariates. Conclusions: The coexistence of baseline HTN and arthritis in older adults is associated with a gradual decline in only walking speed as a physical performance measure in older adults.

Background: Osteoarthritis (OA) is a common and debilitating musculoskeletal condition that significantly impacts the quality of life of affected individuals. Various interventions, including weight training and exercise (WTE), have been … Background: Osteoarthritis (OA) is a common and debilitating musculoskeletal condition that significantly impacts the quality of life of affected individuals. Various interventions, including weight training and exercise (WTE), have been …

Context: With the high prevalence of anterior cruciate ligament rupture among young and active individuals, rehabilitation after the injury and surgery should meet the current evidence-based recommendations to restore knee function and reduce the risk of further injury. This study aimed to investigate the current rehabilitation practices and return to sports (RTS) criteria after anterior cruciate ligament reconstruction (ACLR) among physical therapists in Saudi Arabia. Design: Online cross-sectional survey-based study. Methods: A total of 177 physical therapists in Saudi Arabia participated in this survey. The survey included questions about the preferred postoperative timing and frequency of rehabilitation, current views on the importance of preoperative and postoperative rehabilitation to the overall outcomes, the timeframe of RTS, and the decision-making process to RTS. Results: Most therapists (96.6%) believed preoperative rehabilitation was essential/important to postoperative outcomes. Two-thirds encouraged patients to start rehabilitation program within 1 to 4 days immediately post-ACLR. RTS was permitted 6 to 9 months post-ACLR by 60% of therapists if satisfied with patient progress and capacity. Factors considered before RTS included knee strength (72.9%), functional capacity (86.4%), lower limb and trunk mechanics (62.7%), and psychological readiness (42.2%). Knee strength was assessed by manual muscle testing (39%), handheld dynamometry (15.3%), and isokinetic dynamometer (13.6%). While 60% of the therapists used single-limbed hop for distance for evaluating functional capacity, only 27.1% used a hop test battery. Conclusions: The surveyed physical therapists in Saudi Arabia demonstrated variations in the current rehabilitation practices and RTS criteria post-ACLR. Over half of the surveyed therapists considered preoperative rehabilitation essential to postoperative outcomes. However, the therapists should update their perspective with current evidence-based practice regarding the RTS timeframe, psychological readiness assessment for RTS, and knee strength evaluation using objective measurements.

The aim of this study was to investigate the dose–response relationship between physical activity and health-related quality of life (HRQoL) in a large population-based sample of people with chronic disease. We analysed the data of 29,271 adults (15,315 women) who were diagnosed with chronic diseases and participated in the Welsh Health Survey (Wales, UK; data collection 2011–2015). Participants were classified, based on their weekly minutes of moderate-to-vigorous physical activity (MVPA), into four groups as follows: inactive (no MVPA), insufficiently active (<150 min/week), sufficiently active (≥150–<300), and very active (≥300). The main outcome was HRQoL measured via the Short-Form 36 Health Survey (SF-36). This study found a curvilinear association between MVPA and HRQoL and a dose–response relationship for the perception of general health and vitality domains. Compared to inactive participants, those who were very active had higher HRQoL scores (coefficient = 12.54; 95% confidence interval [CI] 11.39–13.70), followed by sufficiently active (coefficient = 11.70; 95% CI 10.91–12.49) and insufficiently active (coefficient = 9.83; 95% CI 9.15–10.51) participants. The fully adjusted regression model showed curvilinear associations between MVPA and the domains of SF-36. Future research should find ways to motivate people with chronic diseases to engage in physical activity. The evidence to support regular exercise in individuals with chronic diseases in all age groups is strong and compelling, and patients should be encouraged to regularly devote more time to physical activity in order to improve their health and well-being.

Background Football is a highly competitive sport, and participants can experience various contact and non-contact sports injuries in the sporting process. In any elite sport, screening players using different scientific tools is an important injury prevention strategy. The Y- Balance test (YBT) was found to be a predictive tool for non-contact injury. However, the use of criteria from these tests to predict injuries has not been substantiated and should be further investigated. Purpose The aim of this study was to determine the predictors for injury among athletes using baseline YBT, number of matches, and minutes of physical activity; the cutoff scores for predictors of injury, including baseline YBT, number of matches, and minutes of physical activity; and the clinical prediction rules for predicting injury in this population. Methods A total of 39 young student football players were included in this study. The mean age was 20.28 years, and the mean body mass index (BMI) was 23.83 kg/m2. A baseline assessment of the participant’s characteristics was taken and each participant performed the YBT once before starting the league. After the university league football players had finished their tournament, we asked them questions related to non-contact injuries. Results The results showed that the prevalence of injury was 17.95% among this population. An increase in the YBT score was significantly associated with a decrease in the odds of having an injury [odds ratio (OR) 95% confidence interval (CI): 0.94 (0.88, 0.99), p = 0.047). In addition, the number of matches was significantly associated with an increase in the odds of having an injury p = 0.012. However, the minutes of physical activity were not statistically significant p = 0.065. The highest Youden index was ≤97.89, with a sensitivity of 87.50% and specificity of 71.43%, for the posterior medial reach and ≤92.88, with a sensitivity of 90.62% and specificity of 57.14%, for the posterior lateral reach. The clinical prediction rule was an area under the curve (AUC) of 0.88. Conclusions The results of the study provide evidence for the potential utility of the YBT as a predictor tool for evaluating non-contact injuries in university league football players. By identifying players with lower YBT scores who were at higher risk for injury, targeted interventions could be implemented to address functional movement deficits and potentially reduce injury risk.

Background: Tai Chi Chuan (TCC) is popular in exercise, but little research has been done on limb and joint strength after the exercise. This study aimed to investigate whether TCC players have different limb and joint strengths in the upper and lower limbs from non-Tai Chi Chuan (NTCC). Methods: Twenty TCC players who have at least one year of experience playing TCC were compared with a group of 25 NTCC participants. A force sensor was used to measure forces in the lower and upper limbs. Maximum forces produced by the lower limbs was measured during a standing position with straight legs or were measured in a seated position. The maximum forces produced by the upper limbs were measured in a standing position at elbow and shoulder levels. Results: The forces of the knee extensors in the TCC group were significantly higher (7.4%) than in the NTCC group; however, the forces of the knee flexors in the TCC group were significantly lower than the NTCC group. The heel-force in hip extension in the NTCC group was significantly higher (9.3%) than in TCC; the toe-force in the plantar flexion in the NTCC was significantly higher than in the TCC group. There were no significant differences between the two groups in the hand-forces in the upper limbs. Conclusions: TCC routine movements strengthen the muscles related to knee extension, which are mainly related to bending knee performance during TCC exercise. For the healthy people between 42 and 78 years old, TCC benefits the enhancement of the strength for knee extension but not for the knee flexion, ankle plantar flexion and hip extension. There is no significant difference between the TCC and NTCC groups on the strength of upper limbs and joints. As a whole, the effect of Tai Chi Chuan exercise on the strengths in the limbs and joints is compromised. In the future, a study with larger sample size than this study is highly recommended.

Background and Aims: Retro walking has been shown to acquire a greater metabolic cost, placing a higher cardiopulmonary demand on the body, when compared with forward walking at a similar speed. The aim of this study was to compare the effect of retro walking with that of forward walking on C‐reactive protein (CRP) levels, body mass index (BMI) and blood pressure (BP) and to understand the influence of independent factors namely systolic blood pressure (SBP), diastolic blood pressure (DBP) and BMI on CRP in untrained overweight and obese young adults.Methods: This was a randomised controlled trial whereby 106 participants underwent either retro walking (n = 53) or forward walking (n = 53) treadmill training four times a week for 12 weeks before and after which CRP, BMI, and BP levels were measured. Comparison of the measured values before and after intervention and between the groups was done and influence of BMI and BP on CRP levels was determined.Results: Both groups recorded a significant decrease (p < 0.001) in CRP, BMI, and BP levels postintervention. The participants who underwent retro walking training showed a significantly (p < 0.001) higher decrease in all the outcomes as compared with the forward walking group. C‐reactive protein levels were seen to be influenced by BMI and DBP.Conclusion: Retro‐walking training leads to greater decrease in CRP, BMI, and BP when compared with forward walking, and CRP levels are influenced by BMI and DBP. Retro walking treadmill training can be used preferentially to bring about reduction in cardiovascular risk factors.