In the medication group, the patient took 400 mg ibuprofen
three times a day after each meal and performed muscle
stretching 2 minutes every day for 5 days. The medication
was prescribed by a licensed medical doctor. The primary
outcome was pain intensity rated with a visual analog scale
(VAS). The secondary outcomes included the PPT, tissue
hardness, and CROM. These secondary outcome measures
were measured by a physical therapist that was blinded
with respect to the group allocation of the patients. The pain
intensity was measured with a VAS. The patients were asked
to rate the intensity of pain at the time of measurement and
then marked an “X” on a 10-cm-long straight line that had
the numbers 0 (indicating on pain at all) to 10 (indicating
the most severe pain) marked on it from left to right. The
PPT was measured using a tissue hardness meter/algometer
(OE-220,ITO Co.,Ltd., Tokyo, Japan) with a pressure tip
having a 1 cm diameter. Pressure was exerted vertically at a
constant speed (1 kg/sec) on a TrP of the upper back and was
gradually increased until the patients felt pain and pushed a
button on to the algometer. Then the applied pressure was
recorded. This process was done 3 times, and the reading
were averaged for statistical analysis. Measurement of tissue
hardness was performed using the tissue hardness meter/
algometer (OE-220, ITO Co.,Ltd., Tokyo, Japan) equipped
with a 10-cm diameter plastic disc and the measuring tool
was adjusted to the tissue hardness measuring mode. The
device has a preset pressure sensor, and the displacement
of the 1-cm pressure tip with respect to the disc indicates
the tissue hardness. Pressure was gradually and vertically
exerted from the handle of the tool onto the painful pressure
point to be examined until a beep sounded from the tool, and
the tissue hardness was then automatically recorded. This
was carried out 3 times, and the readings were averaged for
statistical analysis. The CROM of the patients was measured
with a CROM goniometer, and the measurements included
flexion, extension, left lateral flexion, and right lateral flexion.
Each motion was measured 3 times, and the readings
were averaged for statistical analysis. A reliability study was
performed for each outcome measure before the study using
10 upper back pain patients to measure the pain intensity
(VAS, intraclass correlation coefficient [ICC] =0.97), PPT
(ICC=0.92), tissue hardness, and CROM (ICC=0.97). All
outcomes measures showed a high degree of correlation with
an ICC over 0.90
In the medication group, the patient took 400 mg ibuprofenthree times a day after each meal and performed musclestretching 2 minutes every day for 5 days. The medicationwas prescribed by a licensed medical doctor. The primaryoutcome was pain intensity rated with a visual analog scale(VAS). The secondary outcomes included the PPT, tissuehardness, and CROM. These secondary outcome measureswere measured by a physical therapist that was blindedwith respect to the group allocation of the patients. The painintensity was measured with a VAS. The patients were askedto rate the intensity of pain at the time of measurement andthen marked an “X” on a 10-cm-long straight line that hadthe numbers 0 (indicating on pain at all) to 10 (indicatingthe most severe pain) marked on it from left to right. ThePPT was measured using a tissue hardness meter/algometer(OE-220,ITO Co.,Ltd., Tokyo, Japan) with a pressure tiphaving a 1 cm diameter. Pressure was exerted vertically at aconstant speed (1 kg/sec) on a TrP of the upper back and wasgradually increased until the patients felt pain and pushed abutton on to the algometer. Then the applied pressure wasrecorded. This process was done 3 times, and the readingwere averaged for statistical analysis. Measurement of tissuehardness was performed using the tissue hardness meter/algometer (OE-220, ITO Co.,Ltd., Tokyo, Japan) equippedwith a 10-cm diameter plastic disc and the measuring toolwas adjusted to the tissue hardness measuring mode. Thedevice has a preset pressure sensor, and the displacementof the 1-cm pressure tip with respect to the disc indicatesthe tissue hardness. Pressure was gradually and verticallyexerted from the handle of the tool onto the painful pressurepoint to be examined until a beep sounded from the tool, andthe tissue hardness was then automatically recorded. Thiswas carried out 3 times, and the readings were averaged forstatistical analysis. The CROM of the patients was measuredwith a CROM goniometer, and the measurements includedflexion, extension, left lateral flexion, and right lateral flexion.Each motion was measured 3 times, and the readingswere averaged for statistical analysis. A reliability study wasperformed for each outcome measure before the study using10 upper back pain patients to measure the pain intensity(VAS, intraclass correlation coefficient [ICC] =0.97), PPT(ICC=0.92), tissue hardness, and CROM (ICC=0.97). Alloutcomes measures showed a high degree of correlation withan ICC over 0.90
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