Background The COVID-19 pandemic significantly disrupted healthcare services globally, particularly in low-resource settings. This study explores the impact of the pandemic on physiotherapy services in Nepal. Methods A cross-sectional study was conducted. Qualitative data were collected through semi-structured interviews with 12 physiotherapists, while quantitative data were gathered from an on-site survey of 29 health facilities in six different districts of Province III of Nepal. Inductive thematic analysis approach was used to analyze the qualitative data, and descriptive statistics were used for the closed-ended questions. Results The findings were categorized into sub-themes under two major themes: i) Pandemic effect on physiotherapy services and patient care and ii) Adaptation, innovation and collaboration. The study revealed a significant disruption in physiotherapy services with a notable decline in patient flow and service availability. Most patients, especially those with disabilities and post-operative needs, experienced worsening conditions due to limited access to care. There was an increased recognition of the role of physiotherapy in acute respiratory care and post-COVID-19 recovery. Tele-rehabilitation was explored as an alternative care method but faced challenges in implementation. More than half (62.07%) of the centers reported uninterrupted physiotherapy services, whereas almost one third (31.03%) experienced service suspension. Most centers (89.7%) had personal protective equipment available, and majority (86.2%) of the physiotherapists worked in multidisciplinary teams: fever clinics, triage, emergency care, respiratory physical therapy, and nursing and administrative support were among the expanded roles. Several centers (37.9%) used virtual care with telephone consultation serving as the primary modality. Virtual service was mostly absent in centers where in-person services persisted. Conclusion The COVID-19 pandemic significantly impacted physiotherapy services in Nepal, leading to service disruptions and compromised patient care. It highlighted the need to further incorporate physiotherapy into the healthcare system and enhance rehabilitation services to improve continued patient care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Approvals were granted by the Nepal Health Research Council (NHRC-ERB Protocol No. 455/19), the Institutional Review Committee of Kathmandu University School of Medical Sciences / Dhulikhel Hospital (IRC-KUSMS 281/19, 213/24), and the Norwegian Centre for Research Data (NSD 383963). Participants received verbal and written information. Written informed consent was obtained from the participants of interview and health facility survey. Participation was voluntary and participants were free to withdraw from the study at any time. Survey responses were anonymous, and without person identifiable data. Handling of personal data followed the EU General Data Protection Regulation (GDPR) and Norwegian center for research data (NSD) regulations on privacy policy. The study was performed in accordance with the Helsinki Declaration I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.

A global rising burden of non-communicable diseases and disability increases the need of and demand on physiotherapy. In Nepal, knowledge is lacking about provision and utilisation of physiotherapy. This study aimed to explore patients’ perception about physiotherapy and the service received at their outpatient physiotherapy clinic. The rationale was to understand the needs and identify areas of potential improvement in service delivery. A cross-sectional survey with closed and open-ended questions was performed in the Bagmati province of Nepal at 29 health-centres of 6 districts including 20 patients per facility (n = 580). Descriptive and regression analysis were performed for closed ended questions and thematic content analysis used for the open-ended questions. Among patients receiving physiotherapy, 55.3

Background: Kinematic studies suggest that injury of the anterior cruciate ligament (ACL) leads to long-lasting movement deficits or compensations to unload the injured knee. This study evaluated lower body kinematics during squats in individuals who suffered unilateral ACL-injury more than 20 years ago. Method: Using motion capture, we compared maximum squat depth, time to complete the squat task, detailed kinematics, estimated kinetic-chain joint moments 0- 80 degrees knee flexion, and weight distribution between legs across three groups with (ACL R , n = 27) and without ACL-reconstructive surgery (ACL PT , physiotherapy only, n = 28), and age-matched non-injured asymptomatic Controls (n = 31, average age across groups 47 years). Results: ACL PT demonstrated significantly reduced squat depth compared to Controls (p = 0.004), whereas ACL R performed similarly to Controls (p = 1.000). Other outcome variables were comparable between groups. All participants nevertheless demonstrated asymmetric weight distribution between legs but without systematic unloading of the injured side in the ACLgroups. Conclusion: Expected compensatory strategies were not found in the ACL-groups, while poorer squat performance in the ACL-deficient group may depend on pure knee-joint mechanics, or lifestyle factors attributed to a less stable knee decades after ACL-injury.

BACKGROUND:Physiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes. Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy. OBJECTIVE:This qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal. METHODS:Forty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators. RESULTS:The study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central. CONCLUSIONS:The results provide information for the development of physiotherapy by pointing out key elements that need attention. Our broad and structured investigation strategy is applicable to others for a comprehensive analysis of barriers and facilitators for physiotherapy services.

Background Physiotherapy is a growing profession in Nepal. Despite efforts to promote strengthening and development, there are still challenges in providing equitable access and availability to services, particularly in underserved areas. Updated information is needed to address challenges to provide proper planning for resource allocation. Objective To assess implementation of physiotherapy services and to explore plans, policies and the general status of physiotherapy in Nepal. Method Implementation was assessed with a cross-sectional survey conducted in Province III containing closed-ended questions addressing physiotherapy services, human resources, charging and record-keeping systems, and accessibility. Stratified purposive sampling was used to select eligible facilities from the list of Department of Health Services. Official records were explored through visits to governing institutions and by reviews of registers and reports to obtain data and information on status, plans and policy. Results The survey included 25 urban and 4 rural facilities, covering hospitals and rehabilitation centres; both public (37.9%) and non-public (62.1%). Most facilities (79.3%) employed physiotherapists with bachelor’s degrees. Average number of visits were 29.55 physiotherapy outpatients and 14.17 inpatients per day. Patient records were mainly paper based. Most (69%) used the hospital main card, while others (31%) had their own physiotherapy assessment card. Most referrals came from doctors. The most offered services were musculoskeletal, neurological, and paediatric physiotherapy. Daily basis charging was common. A single visit averaged 311 Nepalese rupees ≈ 2.33 US$. Convenience for persons with disabilities was reported as partial by 79% of outpatient departments. Official register data showed 313 master’s and 2003 bachelor’s graduates. Six colleges offered physiotherapy bachelor’s degree, whereof one also offered a master’s program. Government records revealed significant progress in physiotherapy in Nepal. Conclusion The study highlights variations in physiotherapy services within a province owing to type, size and location, but also unwarranted variations. Despite the progress, implementation of physiotherapy services in the perspective of official records imply a need of systems for proper planning and monitoring. Physiotherapy provision in underserved areas warrants further attention.

Background: In Europe, arthroplasty surgeries are increasing while the level of physical activity is decreasing and overweight is rising. A transeuropean project promoting physical activity after total knee- or hip replacement was conducted. As a part of that project, this study has surveyed factors contributing to explain attitudes toward physical activity in patients in Norway after total knee- or hip replacement. Method: A survey consisting of background information on demographics, lifestyle, health, and health-service with questions on attitudes toward physical activity within the domains of Quality of life, Physical activity level, Function and Kinesiophobia was sent to 947 persons aged >18 years who had received total hip- or knee replacement 6-12 months earlier. MANOVA compared data between men and women and between hip - and knee operated. A regression analysis investigated which background variables that explained the attitudes toward physical activity. Results: The responses (n=714) were similar independent on men, women, or type of prosthesis. Most respondents had a positive attitude. For all domains, high former level of physical activity was the strongest positive factor, while old age, high body weight, and walking aids contributed to a less positive attitude. Participation in pre- and rehabilitation contributed positively to Physical activity level. Information from the health-service contributed positively to Quality of life and Physical activity level, but not to Function or Kinesiophobia. Implications and conclusion: For a positive attitude toward physical activity, focus should be directed to the importance of former physical activity engagement. Information from the health-service need to be individually adapted to make the patient feel safe with regard to being physically active, particularly for elderly and users of walking aids.

Error analysis of electromagnetic motion tracking systems is of growing interest to many researchers. Under sensor movement, it is logical to presume that the error in position and orientation measurements will increase due to the linearization used in the algorithms, among other reasons. In this article, we analyze theoretically the error, that results from linearization, in position measurement of the Polhemus tracking system for a moving sensor. We derive formulas to estimate this error in terms of the sensor position and speed. Then, we verify these formulas by numerical simulations.

BACKGROUND:Difficulty descending stairs is common in persons with knee osteoarthritis (OA). Clinically, it is important to know if and how this is explained by objectively measured difficulty to descend stairs, muscle weakness, pain, fear of movement, or knee joint status.OBJECTIVE:To identify the potential of these factors to explain self-reported difficulty descending stairs.DESIGN:Cross sectional, case-control.SETTING:Hospital outpatient and physiotherapy clinic.PARTICIPANTS:Twenty-eight men and women with knee OA (age 62.2 SD 5.9 years) and 31 controls (age 50.0 SD 8.5 years).INTERVENTION:Not applicable.MAIN OUTCOME MEASURES:Using multivariate statistics, group comparisons were made for lower extremity kinematics (incorporating hip, knee, and ankle angles) and stance time in stair descent and lower extremity muscle strength. Then, a stepwise linear regression analysis was performed within the OA group to explain self-reported difficulties in stair descent where pain, kinesiophobia, radiographic signs, and outcomes that differed from controls for stair-descent kinematics and muscle strength were independent variables.RESULTS:Multivariate statistics showed that the OA group displayed different all-over lower extremity kinematics (F8,42 = 2.44 p = .029, η2  = 0.32) and a longer stance time (F3,50 = 6.46; p = .001, η2  = 0.28) in stair descent and lower muscle strength (F7,47 = 2.39; p = .035, η2  = 0.26) compared to controls. Regression analysis within the OA group to explain self-rated difficulties to descend stairs showed that the strongest association with kinesiophobia (ß = 0.607, p = .001) that combined with pain last week and radiographic signs explained almost 100% (ß = 0.972). Stair descent kinematics and strength variables that differed between groups did not explain self-rated difficulties to descend stairs.CONCLUSION:Kinesiophobia and pain rather than stair-descent kinematics and reduced muscle-strength explained self-rated difficulties in stair descent in the OA group.

Background In Nepal, pelvic floor disorders affect about 24% of the women in reproductive age whereof 10% suffer from pelvic organ prolapse (POP). Still, many do not seek health care. Strengthening exercises for the pelvic floor muscles for prevention and treatment of POP has shown strong evidence internationally, but for women in Nepal surgery is primarily offered. To amend this, a novel pelvic floor muscle training (PFMT) program for pregnant women was introduced. Objective To learn about how the PFMT-program was received by the participating women, their understanding of the importance of doing the exercises, and the constraints of daily life for performing the program. Methods A qualitative study design based on a sub-sample (N = 10) from a strategic sample (N = 235) who participated in the PFMT-program. Ten semi-structured in-depth interviews were interpreted according to a phenomenological analytical tradition. Results The 10 women were representative for the women who had participated in the PFMT-program with regard to urban residence, socioeconomic, and educational standing. The program was well received and compliance satisfactory. In line with the PFMT's learning outcomes, the women described risk factors, showed knowledge about the pelvic floor muscles, and understood the importance of doing the exercises. They had managed to fit the exercises into their busy daily routines. Meeting peers in exercise groups and understanding from family were positive factors for compliance. Conclusion The Nepalese women appear interested in self-care and are making an effort to fit the exercises into their busy schedule. Although the communicative validity was satisfactory, the pragmatic validity cannot be generalized to women in rural areas and under less fortunate socioeconomic and educational circumstances.

Objectives The objective was to determine the predictive potential of anthropometric indices to screen prevalent diabetes mellitus type 2 in a Norwegian population. Design This is a cross-sectional design to determine the potential association of waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), waist circumference (WC) and body mass index (BMI) with prevalent diabetes mellitus type 2 through logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine the predictive potential of the anthropometric indices. Youden’s index was applied to determine the optimal cut-off points for each anthropometric index. Setting This study used cross-sectional data from the populations-based Health Study in Nord-Trøndelag which invited all citizens in the county above 20 years of age. Participants This study included all those who were non-pregnant and had complete data (N=50 042), 98.5% of the participants. The sample is to be considered representative for the population of Norway. Primary and secondary outcome measures OR and ROC of the potential association between diabetes mellitus type 2 and anthropometric indices were the main planned and performed outcome measures. Results The results suggest that the anthropometric indices performed differently within the Norwegian population with WHR and WHtR being the stronger predictor with (ROC) of 0.746 (0.735 to 0.757) and 0.741 (0.730 to 0.752). The predictive potential for the investigated anthropometric indices was generally stronger for women than men. Conclusion Anthropometric indices of size BMI and the highly correlated WC are less associated with prevalent diabetes mellitus type 2 than WHR (WC adjusted for hip circumference) or WHtR (WC adjusted for height) in a Norwegian population.

In a previous study we have shown that patients with long standing non-specific neck-pain display more rigid neck movement behavior than controls in response to unpredictable perturbations. In the present study we investigated head/neck motor control in patients with neck-pain during a course of physiotherapy intervention and the associations with pain, neck disability and kinesiophobia. In this longitudinal observational study, 72 patients with non-specific neck-pain were exposed to unpredictable horizontal rotations by means of an actuated chair in three conditions; with a visual reference, and without vision with and without a cognitive task before first consultation with physiotherapist, after 2 weeks and 2 months of intervention. The neck movements were analyzed in the frequency domain to cover voluntarily and reflex controlled responses. Questionnaires encompassed Neck Disability Index, Tampa Scale of Kinesiophobia, and the Numerical Rating Scale for current pain. The results showed that the response pattern for the amplitudes of movement between head and trunk across frequencies did not change over time, whereas some changes in timing were found for some frequencies. Pain, neck disability, and kinesiophobia improved after intervention, but were not significantly associated with neck movement responses to perturbations across time or condition. Although physiotherapy intervention improved self-reported function, the rigid responses to unpredictable perturbations remained unchanged. This indicates altered function in reflex mediated control mechanisms, i.e., the vestibulocollic and the cervicocollic reflex systems that control the head in space and on the trunk. Future research should further investigate pain related changes in reflex systems and whether alterations in these systems are modifiable.

The authors have requested that this preprint be withdrawn due to author disagreement.

Background The association of overweight and diabetes mellitus type 2 varies with geographical area and ethnicity, and there is incoherent evidence as to which anthropometric index best predicts prevalent diabetes mellitus type 2 in different populations. The rationale for this study was to contribute to the understanding of how anthropometric indices perform as a screening tool for diabetes mellitus type 2. Hence, the objective was to determine the predictive potential of anthropometric indices to screen prevalent diabetes mellitus type 2 in the Norwegian population.Methods This study used cross-sectional data from the Health Study in Nord-Trøndelag (HUNT) to determine the potential association of waist-to-height ratio, waist-to-hip ratio, waist-circumference and body mass index with prevalent diabetes mellitus type 2 through logistic regression analysis. Receiver Operating Characteristic (ROC) curves were used to determinate the predictive potential of the anthropometric indices. Youden’s index was applied to determinate the optimal cut-off points for each anthropometric index.Results The results suggest that the anthropometric indices performed differently within the Norwegian population with waist-to-hip ratio and waist-to-height ratio being the strongest predictors with (ROC) of 0.746 (0.735 - 0.757) and 0.741(0.730 - 0.752). The predictive potential for the investigated anthropometric indices was generally stronger for women than men.Interpretation When using anthropometric indices to screen prevalent diabetes mellitus type 2, the choice of anthropometric index and cut-off points should be considered based on country and the ethnic characteristics of the population.

Motor control impairments are reported in patients with nonspecific neck pain but the particular deficits in underlying regulatory systems are not known. Head steadiness is controlled both by voluntary and reflex systems that are predominantly effective within different frequency intervals. The aim of the present study was to investigate within which frequency range(s) potential motor control deficits may reside. The ability to keep the head stationary in space in response to unpredictable perturbations was tested in 71 patients with nonspecific neck pain and 17 healthy controls. Participants were exposed to pseudorandom horizontal rotations across 10 superimposed frequencies (0.185-4.115 Hz) by means of an actuated chair in three conditions; with a visual reference, and without vision with, and without a cognitive task. Below 1 Hz, patients kept the head less stable in space compared to healthy controls. Between 1 and 2 Hz, the head was stabilized on the trunk in both groups. Patients kept the head more stable relative to the trunk than relative to space compared to healthy controls. This was interpreted as higher general neck muscle co-activation in patients, which may be explained by altered voluntary control, or/and upregulated gamma motor neuron activity which increases the contribution of reflex-mediated muscle activation. Alternatively, increased muscle activity is secondary to vestibular deficits.

Background To raise the effectiveness of interventions, clinicians should evaluate important biopsychosocial aspects of the patient’s situation. There is limited knowledge of which factors according to the International Classification of Function, Disability, and Health (ICF) are most deviant between patients with knee osteoarthritis (KOA) and healthy individuals. To assist in measures’ selection, we aimed to quantify the differences between patients with KOA and healthy controls on various measures across the ICF dimensions of body function, activity, and participation. Methods We performed an exploratory cross-sectional case-control study. In total, 28 patients with mild-to-moderate KOA (mean age 61 years, 64% women) referred by general physicians to a hospital’s osteoarthritis-school, and 31 healthy participants (mean age 55 years, 52% women), volunteered. We compared between-group differences on 27 physical and self-reported measures derived from treatment guidelines, trial recommendations, and trial/outcome reviews. Independent t-test, Chi-square, and Mann-Whitney U test evaluated the significance for continuous parametric, dichotomous, and ordinal data, respectively. For parametric data, effect sizes were calculated as Cohen’s d . For non-parametric data, d s were estimated by p -values and sample sizes according to statistical formulas. Finally, all d s were ranked and interpreted after Hopkins’ scale. An age-adjusted sensitivity-analysis on parametric data validated those conclusions. Results Very large differences between patients and controls were found on the Pain numeric rating scale 1 , the Knee Injury and Osteoarthritis Scale (KOOS, all subscales) 2 , as well as the Örebro Musculoskeletal psychosocial scale 3 ( P < 0.0001). Large differences were found on the Timed 10-steps-up-and-down stair climb test 4 and Accelerometer registered vigorous-intensity physical activity in daily life 5 ( P < 0.001). Respectively, these measures clustered on ICF as follows: 1 body function, 2 all three ICF-dimensions, 3 body function and participation, 4 activity, and 5 participation. Limitations The limited sample excluded elderly patients with severe obesity. Conclusions Very large differences across all ICF dimensions were indicated for the KOOS and Örebro questionnaires together for patients aged 45–70 with KOA. Clinicians are suggested to use them as means of selecting supplementary measures with appropriate discriminative characteristics and clear links to effective therapy. Confirmative studies are needed to further validate these explorative and partly age-unadjusted conclusions.

Background To improve the goal-directedness of strength exercises for patients with knee osteoarthritis (KOA), physical rehabilitation specialists need to know which muscle-groups are most substantially weakened across the kinetic chain of both lower extremities. The purpose was to improve the knowledge base for strength exercise therapy. The objective was to explore the relative differences in muscle strength in the main directions bilaterally across the hip, knee, and ankle joints between patients with light-to-moderate symptomatic and radiographic KOA and people without knee complaints. Methods The design was an exploratory, patient vs. healthy control, and cross-sectional study in primary/secondary care. Twenty-eight patients with mild to moderate KOA (18 females, mean age 61) and 31 matched healthy participants (16 females, mean age 55), participated. Peak strength was tested concentrically or isometrically in all main directions for the hip, knee, and ankle joints bilaterally, and compared between groups. Strength was measured by a Biodex Dynamometer or a Commander II Muscle Tester (Hand-Held Dynamometer). Effect sizes (ES) as Cohen’s d were applied to scale and rank the difference in strength measures between the groups. Adjustment for age was performed by analysis of covariance. Results The most substantial muscle weaknesses were found for ankle eversion and hip external and internal rotation in the involved leg in the KOA-group compared to the control-group (ES [95% CI] −0.73 [−1.26,-0.20], − 0.74 [−1.26,-0.21], −0.71 [−1.24,-0.19], respectively; p < 0.01). Additionally, smaller but still significant moderate muscle weaknesses were indicated in four joint–strength directions: the involved leg’s ankle inversion, ankle plantar flexion, and knee extension, as well as the uninvolved leg’s ankle dorsal flexion ( p < 0.05). There was no significant difference for 17 of 24 tests. Conclusions For patients with KOA between 45 and 70 years old, these explorative findings indicate the most substantial weaknesses of the involved leg to be in ankle and hip muscles with main actions in the frontal and transverse plane in the kinetic chain of importance during gait. Slightly less substantial, they also indicate important weakness of the knee extensor muscles. Confirmatory studies are needed to further validate these exploratory findings.

Although the physical therapist profession is the leading established, largely nonpharmacological health profession in the world and is committed to health promotion and noncommunicable disease (NCD) prevention, these have yet to be designated as core physical therapist competencies. Based on findings of 3 Physical Therapy Summits on Global Health, addressing NCDs (heart disease, cancer, hypertension, stroke, diabetes, obesity, and chronic lung disease) has been declared an urgent professional priority. The Third Summit established the status of health competencies in physical therapist practice across the 5 World Confederation for Physical Therapy (WCPT) regions with a view to establish health competency standards, this article's focus. Three general principles related to health-focused practice emerged, along with 3 recommendations for its inclusion. Participants acknowledged that specific competencies are needed to ensure that health promotion and NCD prevention are practiced consistently by physical therapists within and across WCPT regions (ie, effective counseling for smoking cessation, basic nutrition, weight control, and reduced sitting and increased activity/exercise in patients and clients, irrespective of their presenting complaints/diagnoses). Minimum accreditable health competency standards within the profession, including use of the WCPT-supported Health Improvement Card, were recommended for inclusion into practice, entry-to-practice education, and research. Such standards are highly consistent with the mission of the WCPT and the World Health Organization. The physical therapist profession needs to assume a leadership role vis-à-vis eliminating the gap between what we know unequivocally about the causes of and contributors to NCDs and the long-term benefits of effective, sustained, nonpharmacological lifestyle behavior change, which no drug nor many surgical procedures have been reported to match.

OBJECTIVEThis 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.METHODA total of 236 consecutively recruited outpatients, 18-62 years of age, 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, that is, Stroop I-IV, California Verbal Learning Test-Second Edition (CVLT-II) learning and delay, Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) Letter Number (L-N) Sequencing, and the Paced Auditory Serial Addition Task were performed to examine whether these objective measures correlated with subjective complaints and were compared with normative data.RESULTSThere was a trend of association (p < .05) between the unadjusted EMQ with Stroop IV (inhibition and shifting attention), the CVLT-II learning and delay (verbal learning and memory), and the WAIS-III L-N Sequencing (working memory), but none were statistically significant at the .001 level. The EMQ was positively associated with fatigue, pain, and depression (p < .001). The PASAT (working memory) was negatively associated with pain (p < .001). Between 21% and 38% of the patients performed below the 1.5-SD cutoff for clinically significant impairment on the Stroop tests.CONCLUSIONThe 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, as well as higher pain related to lower objective working memory function. The CFS patients had problems mainly in the domains of psychomotor speed and attention measured by the objective neuropsychological tests. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rotations of the Cartesian reference frames are used extensively in many fields of research such as navigation and guidance systems, and motion tracking systems. Of particular interest is the case when an infinitesimal rotation is followed or preceded by a large rotation. If the order of rotations is required to be changed, there is no formula to describe a good approximation. Instead, researchers usually use dot product of the unit vectors of the coordinate systems before and after the reversal. In this work, we provide a direct formula for such approximation. Further, we show that the proposed formulae can be used to construct the inverse of any transformation comprising two successive rotations about different axes by taking many successive infinitesimal rotations approximated properly. Moreover, we present a case study for which the proposed formulae can be used to find the solution in a direct way compared to other techniques.

As many similar symptoms are reported in fibromyalgia (FM) and chronic fatigue syndrome (CFS), underlying defcits may potentially also be similar. Postural disequilibrium reported in both conditions may thus be explained by similar deviations in postural control strategies. 75 females (25/group FM, CFS and control, age 19-49 years) performed 60 s of quiet standing on a force platform in each of three conditions: 1) firm surface with vision, 2) firm surface without vision and, 3) compliant surface with vision. Migration of center of pressure was decomposed into a slow and a fast component denoting postural sway and lateral forces controlling postural sway, analyzed in the time and frequency domains. Main effects of group for the antero-posterior (AP) and medio-lateral (ML) directions showed that patients displayed larger amplitudes (AP, p= 0.002; ML, p= 0.021) and lower frequencies (AP, p< 0.001; ML, p< 0.001) for the slow component, as well as for the fast component (amplitudes: AP, p = 0.010; ML, p= 0.001 and frequencies: AP, p = 0.001; ML, p= 0.029) compared to controls. Post hoc analyses showed no significant differences between patient groups. In conclusion, both the CFS- and the FM-group differed from the control group. Larger postural sway and insufficient control was found in patients compared to controls, with no significant differences between the two patient groups.