For maintaining adequate psychometric properties when reducing the number of items from an instrument, item level psychometrics is crucial. Strategies such as low item correlation or factor loadings, using classical test theory, have traditionally been advocated. The purpose of this study is to describe the development of a new short form assessing the impact of low back pain on physical activity. Rasch measurement model has been applied to the International Classification of Functioning, Disability and Health Activity Measure (ICF-AM). One hundred and one individuals with low back pain aged 19-89 years (mean age: 48.1±17.3) who live in the community were participated in the study. Twenty-seven items of lifting/carrying construct of the ICF-AM were analyzed. Ten items were selected from the construct to create a short form. Item elimination criteria include: 1) high or low mean square (out of the range: .6-1.4 for the fit statistics), 2) similar item calibrations to adjacent items, 3) person separation value, and item-person map for potential gap in person ability continuum. All 10 items of the short form fit to the Rasch model except one item (i.e., carrying toddler on back). Despite its high infit and outfit statistics (1.90/2.17), the item had to be reinstated due to potential gaps at the upper extreme of person ability level. The short form had a slightly better spread of person ability continuum compared to the entire set of item. The created short form separated individuals with low back pain into nearly 4 groups, while the entire set of items separated the individuals into 6 groups. The findings prompted multidimensional models for better explanation of the lifting/carrying domain. The item level psychometrics based on the Rasch model can be useful in developing short forms with rationally retained items.

Differential item functioning (DIF) based on Rasch model can be used to examine whether the items function similarly across different groups and identify items that appear to be too easy or difficult after controlling for the ability levels of the compared groups. The Oswestry low back pain disability (Oswestry) has traditionally been proved as an effective instrument measuring disability resulting from low back pain (LBP). In this study, DIF method was used to explore whether items on the Oswestry perform similarly across two different groups (participants with LBP and no LBP). A series of Rasch analyses on the 10 items of the Oswestry were performed using Winsteps(R) software. Forty-two participants with back pain were recruited from 3 rehabilitation hospitals in Gainesville, Florida. Another 42 participants with no LBP were recruited from several public places in the rehabilitation hospitals. Based on the DIF analysis across the two groups, several items were found to have an uniform DIF. Participants with no LBP had more difficulty on lifting and personal care items and participants with LBP had more difficulty on sleeping and social life items. For non-LBP group, a high ceiling effects (83% of participants with non-LBP) was detected, which was not be able to be effectively measured with the Oswestry items. Although 4 items of the Oswestry function differently across the two groups, all items of the Oswestry were well targeted the LBP group.

Violinists tend to position the neck asymmetrically to hold the violin between the chin and the left shoulder. Asymmetrical neck posture may induce unilateral neck pain. Previous studies have suggested that individuals with unilateral neck pain exhibit reduced muscle strength of the lower trapezius, but no study has investigated violinists with unilateral neck pain. To this end, we recruited 18 violinists with unilateral neck pain for the present study in which the side on which neck pain was experienced, pain duration, and intensity were recorded. Lower trapezius strength was measured bilaterally in each subject using a handheld dynamometer. Significant differences in lower trapezius strength were evident between the ipsilateral and contralateral sides of neck pain (p＜.05). No significant association between neck pain intensity or duration, and the extent of a deficit in lower trapezius strength, was evident (both p＞;.05). The association between the sides of weakened lower trapezius strength and neck pain was significant (p＜.05). In conclusion, violinists with unilateral neck pain exhibited significantly less lower trapezius strength on the ipsilateral compared to the contralateral side of the pain. Unilateral neck pain more frequently involved the left side of the neck, which is used to stabilize the violin during playing. Thus, our study suggests that a possible relationship exists between muscle weakness in the lower trapezius and neck pain.

목적 : 본 연구는 대학생을 대상으로 강의실의 의자 형태와 앉은 자세에 따른 근골격계 통증에 대해 알아보고자 하였다. 연구방법 : 재학 중인 대학생 84명을 대상으로 2014년 3월부터 6월까지 사용하고 있는 강의실 의자에 대한 적합도 측정과 설문을 실시하였다. 결과 : 강의실에서 사용되는 의자 중에는 좌면의 높이, 깊이, 너비가 적절하지 못한 의자가 있었고 학생들은 허리, 어깨, 목 등에 통증을 느끼고 있는 것으로 나타났다. 성별, 나이에 따른 통증 정도의 차이는 나타나지 않았으나 고학년인 경우 1학년보다 허리 부위에 통증을 더 느끼는 것으로 나타났다. 의자의 형태에 따라 허리 부위의 통증에 차이가 있었으며, 스 툴형 의자를 사용하는 경우 허리 통증을 더 많이 느끼는 것으로 나타났다. 그러나 앉은 자세에 따른 통증 정도의 차이는 나타나지 않았다. 결론 : 앞으로 강의실 의자 형태를 보다 적합한 것으로 변경할 필요가 있으며 학생들에게는 올바른 앉는 자세에 대한 적극적인 인식 교육이 실시되어야 한다.

The purpose of this study was to investigate the effects of smartphone use on muscle fatigue and tenderness in the cervical erector spinae (CES) and the upper trapezius (UT) and on the cervical range of motion among subjects with and without neck muscle pain. The subjects were 30 smartphone users in their 20 s who -were assigned to either an experimental group with neck muscle pain or a control group without neck muscle pain. Muscle fatigue and tenderness in the CES and the UT as well as the subjects’ cervical range of motion were measured before and after 20-min smartphone sessions in a sitting position. In a between-group comparison of muscle fatigue, the experimental group showed a significantly greater decrease in median frequency in the CES and the right UT after smartphone use (p<.05). Regarding the assessment of muscle tenderness after smartphone use, the experimental group showed a statistically significant decrease in the pressure-pain threshold (PPT) in all muscles (p<.05), whereas the control group showed a significantly decreased PPT in the right CES and the UT (p<.05). The assessment of the cervical range of motion revealed a statistically significant reduction in the cervical flexion-extension and left lateral flexion in the experimental group (p<.05) after smartphone use. However, there was no significant change in the cervical range of motion in the control group (p>.05) after smartphone use. When compared with the control group, the experimental group demonstrated greater changes in cervical extension, lateral flexion, and rotation, except for cervical flexion (p<.05). In conclusion, when smartphone users have pre-existing neck muscle pain, the use of a smartphone further increased muscle fatigue and tenderness in the neck and reduced PPT and the cervical range of motion.

The aim of this study was to compare the activity of the upper trapezius (UT) and serratus anterior (SA) and ratio of UT to SA during shoulder elevations. Ten subjects with UT pain (UTP) and 13 subjects without UTP participated in this study. Subjects with a UTP of over five in a pain intensity visual analogue scale (0-10 ㎝) for more than 2 months and latent myofascial trigger points (MTrPs) in the UT muscle were included in the UTP group. Electromyography (EMG) data of UT and SA at 1st and 10th elevations were analyzed. Two-way repeated analyses of variance were used to compare the EMG activity of UT and SA and the ratio of UT to SA during shoulder elevations between groups with and without UTP. There was a significant increase in UT/SA ratio in the group with UTP compared to the group without UTP (p=.01). The activity of UT and SA measured at the 10th elevation was significantly greater than that in the first elevation (p<.05). The activity of SA was significantly greater in the group without UTP than the group with UTP (p=.03). However, there was no significant difference between groups with and without UTP in terms of UT activity (p=.28). These results indicate that UTP may have relevance to the increased muscle activity ratio of UT to SA during shoulder elevations.

This study is a cross-sectional study for conscripts with chronic low back pain, where it is designed to investigate general characteristics that conscripts with chronic low back pain carry, and it is also aimed to analyze the correlation as well as discrepancy within pain, depression and body mass index depending on their ranks. In this study, 90 Korean conscripts with chronic low back pain participated. And in order to analyze general characteristics as well as pain, depression and body mass index of the subjects, this study adopted a survey questionnaire upon general characteristics, and it also employed Visual Analogue Scacle(VAS) and Center for Epidemiological Studies Depression(CES-D) Scale which have proven their credibility, where BMI values for the subjects were calculated based on 'Asian Pacific standard' Body Mass Index(BMI). From the general characteristics exhibited by the subjects through this study, average age and average height of the subjects were 20.78±1.41 and 175.97±5.34 respectively; and corporals displayed the highest ratio of 42% with the chronic low back pain while 40% of the total subjects experienced the duration of the illness less than 6 to 9 months. Moreover, 57.8% of all subjects were reportedly suffering moderate pain, and 48% exhibited depression while 49% carried BMI value between 18.5 and 22.9kg/m2(normal range). Based on the analysis of correlation among pain, depression, discrepancy of BMI depending on the ranks and each independent variable, it appears that there is no significant difference amongst the ranks, and there is no correlation between independent variables; however, it was obvious that all groups divided by the ranks had a moderate pain(45-74mm), depression(≥16) and BMI value in normal range(18.5-22.9).

이상의 실험결과들을 요약하면, CFA를 안면영역 피하로 주입하여 발생한 염증성 통증 행위반응은 P2X 수용체의 억제제의 투여로 감소할 수 있었다. 특히 P2X7 수용체 억제제를 투여하면 진통작용 뿐 아니라 활성화된 신경아교세포 발현을 억제하였다. 이러한 실험 결과는 P2X7 수용체가 신경아교세포에 영향을 미쳐 안면에서 발생하는 만성 염증성 통증의 발생과 유지에 관여하고 있다는 것을 보여준다. 따라서 중추신경계의 신경아교세포를 조절할 수 있는 중추성 P2X7 수용체 작용기전은 임상에서 만성 염증성 통증을 보다 효과적으로 치료할 수 있는 새로운 방법을 제시해 줄 수 있다고 생각된다.

Asymmetric sitting posture may cause asymmetric buttock pressure and unilateral low back pain (LBP). The purpose of this study was to compare the differences of buttock pressure between both sides, and pelvic angle (sagittal and coronal planes) during typing in a sitting position on a pressure mat (Baltube) in individuals with and without unilateral LBP. Ten subjects with unilateral LBP and ten subjects without unilateral LBP were recruited for this study. Buttock pressure was measured using a pressure mat and pelvic angles were measured using a palpation meter. The subjects performed typing in a sitting posture for 30 minutes. Pressure data were collected and averaged at initial term (from start to first minutes) and final term (last minutes of 30 minutes). Angles of pelvic tilting were measured after 30 minutes typing. Pressure asymmetry values (difference in pressure between both sides) were calculated at the initial and final terms. A two-way analysis of variance was used to compare the differences between the initial and final pressure asymmetry values in subjects with and without unilateral LBP. An independent t-test was applied to compare the pelvic tilt angles between the two groups. To compare the change of pressure from the initial term to the final term between the symptomatic and asymptomatic sides in the unilateral LBP group, a paired t-test was applied. In the unilateral LBP group, the pressure asymmetric value at the final term was significantly greater than that of the initial term (p<.05). The angle of pelvic tilting in coronal plane was significantly greater in the unilateral back pain group compared to the without unilateral LBP group (p<.05), however, there was no significant difference in the angle of pelvic tilting in the sagittal plane between the two groups (p>.05). In the unilateral LBP group, the change of pressure from the initial term to the final term was significantly less in the symptomatic side (-6.90 ㎜Hg) than the asymptomatic side (5.10 ㎜Hg). This asymmetric sitting posture may contribute to unilateral LBP in the sitting position. Further studies are needed to determine if asymmetric weight bearing in sitting causes unilateral LBP or if unilateral back pain causes asymmetric weight bearing, and if the correction of asymmetric weight bearing in sitting can reduce unilateral LBP.

이상의 실험 결과들을 요약하면, 포르말린을 측두하악관절 내로 주입하여 발생한 염증성 통증 행위반응은 QX-314의 투여로 감소할 수 있었다. 저농도의 QX-314의 진통작용은 TRPV1 통로를 이용하여 세포막 내로 이동하여 작용이 나타났으며 고농도의 QX-314는 TRPV1 통로와 무관하게 진통작용을 나타내었다. 이와 같은 결과는 측두하악관절 장애로 인해 발생되는 염증성 통증에 QX-314가 효과적인 치료제로 사용할 수 있다는 것을 말해주며, 특히 고농도의 QX-314가 세포막을 이동하는 경로에 대한 연구가 더 진행된다면 임상에서 QX-314가 진통제로서 사용할 수 있는 계기가 될 것으로 판단된다.

The aim of the present study was to compare measurement precisions of the Oswestry Back Pain Disability Questionnaire (ODQ) and a computer adaptive testing (CAT) method. The ODQ has been regarded as one of the most reliable condition-specific measure for back pain for decades. Cross-sectional study was carried out with two independent convenient samples from two out-patient rehabilitation clinics for back pain (n1=42) and non-back pain group (n2=42). Participants were asked to fill out the ODQ and CAT of International Classification of Functioning, Disability and Health-Activity Measure (ICF-AM). A series of Rasch analyses were performed to calculate person ability measures. The CAT measures had greater relative precision in discriminating the groups than did the ODQ measure in comparisons of the relative precision. The CAT measure appears to be more effective than did the ODQ measure in terms of measurement precision. By administering test items calibrated in a way, CAT measures using item response theory may promise a means with measurement precision as well as efficiency.

Meanwhile, Korea has continuously promote economic growth strategy large enterprise-oriented under stateled. As a result, the economy has grown remarkably. But domestic industry structure is unbalanced because of the proportion of medium-sized enterprises is low. To growth of small enterprises to mid-sized enterprises, balanced development of the corporate ecosystem is necessary. For this purpose, it is necessary to continue the growth of small enterprises to mid-sized enterprises. But most companies do not escape stagnation phenomenon in the growth phase while experiencing growing pains. In this paper, we will study the concept of growing pains and stagnation cause of domestic small and medium sized enterprises. Through this, classifying small and medium sized enterprises growing step and Find out the factors that lead to growing pains at each step. To overcome growing pain, we suggest plan for conquest.

목적 : 본 연구의 목적은 사무직 근로자들을 대상으로 현재 호소하는 통증 및 증상과 작업환경을 평가하고, 이를 바탕으로한 인간공학 프로그램의 적용이 통증 감소에 미치는 효과에 대해 알아보고자 하였다. 연구방법 : 총 20명의 사무직 근로자가 설문에 참여하였으며, 이들 중 근골격계 통증이 있는 12명의 대상자를 선정하여 인간공학 프로그램을 적용하였다. 인간공학 프로그램은 6주간 실시하였으며, 프로그램 적용 전과 후에 증상 조사(Symptoms Survey)를 이용하여 통증 정도를 측정하였다. 결과 : 인간공학 프로그램을 적용한 후에 어깨, 목, 팔/팔꿈치, 손/손목 부위에 통증이 감소하였고, 가장 많은 대상자들이 통증 감소를 보고한 신체부위는 어깨와 목이었다. 그리고 근골격계 통증 감소를 위한 스트레칭으로 구성된 체조를 실시한 1일 평균 횟수와 통증 감소간의 유의한 상관관계(p<.05)가 있었다. 결론 : 포괄적인 인간공학 프로그램(업무환경 개선, 자세 및 운동 교육 등) 제공이 사무직 근로자의 통증 감소에 영향을 주는 것으로 나타났다. 따라서 지속적인 프로그램 제공을 통해 근로자 본인의 건강 유지와 증진에 대한 관리를 할 수 있도록 해야 할 것이다.

Most patients with chronic low back pain experience functional disability of trunk muscle, and limitations in physical activity. While there are many types of exercise programs available, in recent years sling exercise has been emerging as the exercise program for spinal stabilization. It has been supported by a great amount of research with positive findings on its effectiveness. This research studies the effects of bridging exercise, conducted on a sling, on pain level and trunk muscle activation in supine, sidelying, and prone positions during a 4 weeks period. 10 healthy people(normal group, n=10) and 28 patients with low back pain participated in this study. 28 patients were divided into two groups; one group participated in exercise with the sling(experimental group, n=14) and the other group exercised without the sling(control group, n=14). They were asked to use the Numerical Rating Scale(NRS) to answer to the level of their pain they felt (no pain: 0 point, severe pain: 10 points). During sling bridging exercises, the muscle activity level in each muscle measured in each position was standardized as three seconds of EMG signals during five seconds MVIC. In conclusion, the experimental group with four weeks of sling bridging exercise experienced a statistically significant reduction in the pain level(p<.05) and increase in the muscle activities of erector spinae when in supine position, internal oblique when in sidelying position, and rectus abdominis in prone position(p<.05). Regular sling bridging exercise reduces the low back pain and enhances other trunk muscle activation, thereby positively affect spinal stabilization.

The purpose of this study was to examine the influences of chronic shoulder pain on the muscle tone in trunk muscles. The study's subjects were 40 men and women in their 30 to 50s, which were divided into two groups. A chronic shoulder pain group consisted of 20 subjects who had been diagnosed with chronic shoulder pain by doctors, and a painless group consisted of 20 subjects who had experienced no such pain. An analysis was performed using electromyography on the muscle tone in the rectus abdominalis, external oblique, internal oblique, and erector spinae muscles under the same conditions between the two groups. The analysis results were as follows. The chronic shoulder pain group exhibited an overall high level of trunk muscle tone than the painless group, along with a statistically significant difference in the rectus abdominalis(p<.05). Moreover, the chronic shoulder pain group showed differences in the trunk muscle tone depending on the affected side. The chronic left shoulder pain group yielded higher levels of muscle tone in the right-side trunk muscles. In particular, the group revealed statistically significant differences in the rectus abdominalis and internal oblique(p<.05). The chronic right shoulder pain group exhibited higher levels of muscle tone in the left-side trunk muscles with a statistically significant difference in the internal oblique(p<.05). The above results suggested that chronic shoulder pain influences increases in the muscle tone in the trunk muscles on the opposite side to the affected shoulder.

The purpose of this study was to compare the immediate effects of upper trapezius muscle stretching in more tensed position (MTP) and less tensed position (LTP) on the change of range of motion (ROM) for neck rotation, and the ROM for conjunct neck motions at end-range of neck rotation toward the painful side in patients with unilateral neck pain. Eighteen patients with unilateral neck pain were recruited for the study's MTP group, and 18 age-, weight- and gender-matched patients with unilateral neck pain were recruited for LTP group. The ROM changes in active neck primary and conjunct motions were measured using a cervical ROM inclinometer in the sitting position. Our results showed that both upper trapezius stretching method in MTP and LTP were significantly effective in increasing the ROM of neck rotation toward painful side in patients with unilateral neck pain. However, a significantly greater increase in the ROM for neck rotation and a further decrease in conjunct neck extension during neck rotation toward the painful side were shown in MTP group, compared to LTP group. The upper trapezius stretching in MTP is useful in increasing the ROM of neck rotation and decreasing the range of conjunct neck extension during neck rotation toward the painful side in patients with unilateral neck pain.

The purpose of this study was to determine the effects of warm-up and cool-down exercises on pain and muscle activation of delayed onset muscle soreness after intense exercise. Delayed onset muscle soreness was caused by the eccentric exercise in the elbow flexor muscle of the non-dominant upper limb. Forty-four subjects volunteered to participate in this study and were randomly assigned to one of the following groups: warm-up and cool-down group, only warm-up group, only cool-down group, or control group with no intervention. The level of perceived pain using the visual analogue scale and electromyographic activation change in maximal voluntary isometric contraction were measured 4 times at the following times: 10 min, 24 hr, 48 hr, and 72 hr after the exercise. The results revealed the main effect between the groups and interaction effect between the group and measurement session (p<.05). The warm-up and cool-down group showed most favorable results with respect to reduced perceived pain level and increased muscle strength in most measurement sessions, and the only warm-up group showed significantly more decreased pain level than the control group at 24 hr and 48 hr and more increased muscle activation than the cool-down group at 48 hr (p<.05). However, there were no significant differences in pain level and muscle activation between the only cool-down group and control group at all measurement sessions (p>.05). The findings suggest that the warm-up exercise performed before an intense exercise had beneficial effects on the symptoms of delayed onset muscle soreness, whereas cool-down exercise performed after the intense exercise did not.

목적 : 본 연구는 뇌졸중환자들의 통증파국화, 재활동기와 일상생활활동 간의 상관성을 파악하고 통증파국화와 재활동기가 일상생활활동에 미치는 영향을 알아보고자 하였다. 연구방법 : 본 연구는 2011년 9월 1일부터 11월 30일 까지 서울, 경기, 충남 지역의 11개 재활요양병원에서 재활치료를 받고 있는 한국형간이정신상태검사 24점 이상인 뇌졸중 환자 122명을 대상으로, 인구사회학적 특성 및 의학적 특성, 통증파국화척도, 장애인의 재활동기 측정도구, 수정바델지수를 측정하였다. 그 중 113부를 SPSS12.0을 이용하여 빈도분석, 피어슨상관분석, 단계별다중회귀분석을 실시하였다. 결과 : 통증파국화와 일상생활활동 간에 유의한 상관관계가 있었으며, 또한 통증파국화는 재활동기의 하위항목 중과제지향적 동기, 의무적 동기 및 무동기와도 유의한 상관관계를 보였다. 일상생활동작과 의무적 동기도 유의한 상관관계를 나타냈다. 통증 파국화는 일상생활동작에 영향을 미치는 유의한 요인으로 나타났으며, 설명력은 11%였다. 결론 : 뇌졸중 환자에서 통증파국화가 낮을수록 환자는 재활치료에 대한 내적 동기가 높아지고 일상생활동작에 독립적임을 알 수 있었다. 그러므로 작업치료사는 뇌졸중 환자의 재활동기와 통증관리를 위해 인지적 대처 훈련 및 재활동기 증진 프로그램을 시행할 필요가 있다.

Previous clinical studies have demonstrated that gabapentin, a drug that binds to the voltage-gated calcium channel α2δ1 subunit proteins, is effective in the management of neuropathic pain, but there is limited evidence that addresses the participation of glial cells in the antiallodynic effects of this drug. The present study investigated the participation of glial cells in the anti-nociceptive effects of gabapentin in rats with trigeminal neuropathic pain produced by mal-positioned dental implants. Under anesthesia, the left mandibular second molar was extracted and replaced by a miniature dental implant to induce injury to the inferior alveolar nerve. Mal-positioned dental implants significantly decreased the air-puff thresholds both ipsilateral and contralateral to the injury site. Gabapentin was administered intracisternally beginning on postoperative day (POD) 1 or on POD 7 for three days. Early or late treatment with 0.3, 3, or 30 μg of gabapentin produced significant anti-allodynic effect in the rats with mal-positioned dental implants. On POD 9, in the mal-positioned dental implants group, OX-42, a microglia marker, and GFAP, an astrocyte marker, were found to be up-regulated in the medullary dorsal horn, compared with the naive group. However, the intracisternal administration of gabapentin (30 μg) failed to reduce the number of activated microglia or astrocytes in the medullary dorsal horn. These findings suggest that gabapentin produces significant antinociceptive effects, which are not mediated by the inhibition of glial cell function in the medullary dorsal horn, in a rat model of trigeminal neuropathic pain.