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Volume 49(2); April 2025

Original Articles

Sports medicine

Squatting Posture Grading System for Screening of Limited Ankle Dorsiflexion
Ji Young Kim, Oh Kyung Lim, Ki Deok Park, Haeun Na, Ju Kang Lee
Ann Rehabil Med 2025;49(2):61-71.   Published online April 7, 2025
DOI: https://doi.org/10.5535/arm.230008
Objective
To evaluate the effectiveness of a squatting posture grading system established to screen for limited ankle dorsiflexion.
Methods
The squat posture grading system categorizes subjects’ squat posture into three grades. Grade 1 is defined as being able to maintain a squatting posture with heels on the ground in full ankle dorsiflexion without effort. Grade 2 is defined as being able to perform the same position, but unable to maintain the position for more than 5 seconds or requiring trunk and leg muscle efforts to maintain the position. Grade 3 is defined as being unable to maintain the same position and falling backwards immediately if attempted to touch the ground with heels. Next, subjects’ ankle dorsiflexion angles were directly measured in knee flexed and extended position by goniometer.
Results
Out of the 92 total subjects, 35 were in grade 1, 18 were in grade 2, and 39 were in grade 3. The average ankle dorsiflexion angle with knee flexed position were 23.13° for grade 1, 16.03° for grade 2, and 9.31° for grade 3. The average ankle dorsiflexion angle with knee extended position were 15.16° for grade 1, 7.92° for grade 2, and 3.40° for grade 3. Ankle dorsiflexion angles showed a significant decrease from grade 1 to 3 (p<0.05).
Conclusion
The squatting posture grading system defined in this study effectively graded the subjects based on the difference in their average ankle dorsiflexion angle. This system could be used as a quick screening method for limited ankle dorsiflexion.
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Orthosis & Prosthesis

Korean Translation and Psychometric Properties of Self-Report Instrument for Mobility Measuring for Adults With Lower Limb Amputation
Jin Hong Kim, Sohye Jo, Gangpyo Lee
Ann Rehabil Med 2025;49(2):72-80.   Published online April 30, 2025
DOI: https://doi.org/10.5535/arm.240087
Objective
To assess mobility in prosthetic limb users, the Prosthetic Limb Users Survey of Mobility (PLUS-M) was developed as a brief item bank. The PLUS-M exhibits good reliability and has been translated into more than 15 languages; however, a Korean translation is not yet available. Therefore, this study translated the 44 items of PLUS-M into the Korean language and analysed the psychometric properties of the PLUS-M/Short Form 12 (PLUS-M/SF- 12) instrument through official procedures.
Methods
The process of Korean translation began with a consultation with the developer of the PLUS-M and included the first and second compatibility verification, back-translation, back-translation verification by the developer, and the final approval of the Korean version. This study tested validity using different instruments such as Activities-specific Balance Confidence scale, 2-Minute Walk Test, Timed Up and Go Test to assess various characteristics related to mobility. The translated version PLUS-M was then sent to two physical therapists working at Incheon Hospital and one prosthetist working at a Rehabilitation Engineering Center for them to assess the appropriateness of term use and understanding of the instrument.
Results
The study found excellent internal consistency and test-retest reliability of the PLUS-M/SF-12 Korean version questionnaire, indicating its reliability and predictability across repeated measurements.
Conclusion
This study provided a tool to assess the mobility of individuals with lower limb amputations.
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Physical therapy

Effect of Extracorporeal Shock Wave Therapy on Post-Laminectomy Lumbar Epidural Fibrosis
Usama M. Rashad, Marwa Hany Abousenna, Amr K. Elsamman, Nagwa Ibrahim Rehab
Ann Rehabil Med 2025;49(2):81-90.   Published online April 30, 2025
DOI: https://doi.org/10.5535/arm.240118
Objective
To investigate the effectiveness of radial extracorporeal shock wave therapy (rESWT) on pain, lumbar range of motion (ROM) and F-wave minimal latency and F-chronodispersion in patients with post laminectomy epidural fibrosis.
Methods
Sixty patients complaining of low back pain and sciatica secondary to lumbar post laminectomy epidural fibrosis were allocated to one of the two equal groups (study and control groups). Pain intensity, lumbar ROM, and F-wave latency and F-chronodispersion were assessed pre- and posttreatment using visual analogue scale (VAS), Back ROM II device, and Neuro-MEP-Micro electromyography device, respectively.
Results
Posttreatment mean values showed statistically significant decrease in VAS mean scores in both groups, with more significant decrease posttreatment in favor of the study group. There was statistically significant increase in all lumbar ROM mean scores and statistically significant decrease in F-minimal latency and F-chronodispersion for both peroneal and tibial nerves in the study group only posttreatment. Also, the results showed that significant positive moderate correlation between VAS scores and F-chronodispersion for peroneal nerve, strong negative correlation between right side bending scores and F-wave minimal latency for peroneal nerve and moderate negative correlation between left side bending scores and F-wave minimal latency for peroneal nerve after treatment.
Conclusion
It was concluded that rESWT is a new and convenient modality, that would be beneficial if added to the conventional physical therapy protocols in managing patients with lumbar post-laminectomy epidural fibrosis.
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Pain & Musculoskeletal rehabilitation

Effect of Soft Surface Stepping Exercise on Physical Activity Among Community-Dwelling Elderly: Prospective a Randomized Controlled Trial
Chonticha Kaewjoho, Puttipong Poncumhak, Pacharee Manoy, Suphannika Ladawan, Narongsak Khamnon
Ann Rehabil Med 2025;49(2):91-103.   Published online April 22, 2025
DOI: https://doi.org/10.5535/arm.240119
Objective
To investigate the effects of modified stepping exercises over six weeks on functional mobility and individual lower extremity muscle strength in community-dwelling older individuals.
Methods
This prospective randomized controlled trial design was conducted in thirty-two older adults who completed a modified stepping exercises program (n=16 for soft-surface stepping exercise; n=16 for firm-surface stepping exercise). These exercises were practiced for 50 minutes/day, three days/week, over six weeks. They were assessed for their functional mobility relating to levels of independence at baseline, after 4 weeks, after 6 weeks of intervention, and at 1 month after the last intervention sessions.
Results
Both groups showed significant improvements in functional mobility, lower extremity muscle strength, and walking speed after 4 and 6 weeks of intervention, as well as at the one-month follow-up. However, the soft-surface stepping exercise group exhibited significantly greater improvements in dynamic balance (p=0.035) and lower extremity muscle strength (p=0.015) compared to the firm-surface stepping exercise group after 6 weeks of intervention. Additionally, the soft-surface group demonstrated superior gains in hip flexor (p=0.041), hip extensor (p=0.047), hip adductor (p=0.026), and hip abductor strength (p=0.046), with these enhancements maintained at the one-month follow-up.
Conclusion
Soft-surface stepping exercise that involves whole-body movements offers a promising alternative to promote independence and safety among community-dwelling older adults. This study underscores the need for future research to evaluate the sustained impact of these benefits post-intervention, particularly during a retention period following the intervention.
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Brain disorders

Korean Version of the Confidence of Arm and Hand Movement Scale and Its Psychometric Properties
Hanna Kim, Yeajin Ham, Joon-Ho Shin
Ann Rehabil Med 2025;49(2):104-112.   Published online April 30, 2025
DOI: https://doi.org/10.5535/arm.240077
Objective
To investigate the impact of self-efficacy in using one’s upper limbs on the overall wellbeing of stroke patients, we developed the Korean version of the Confidence of Arm and Hand Movement (K-CAHM) scale by modifying the original CAHM to suit Korean cultural conditions.
Methods
This study was conducted from May 2022 to June 2023 at a rehabilitation hospital with 54 stroke patients. Participants with sufficient cognitive and verbal abilities were included, while those with severe comorbidities were excluded. For the translation and cultural adaptation of CAHM into Korean, permission was obtained from the original author. Two translators independently translated the questionnaire, followed by a consensus discussion and expert review to create K-CAHM version 1.0. After back-translation and further review, the final Korean version was completed. Reliability and validity were assessed using Cronbach’s alpha, intraclass correlation coefficient (ICC), exploratory factor analysis, Bland–Altman analysis, and Pearson correlation.
Results
The K-CAHM showed good reliability (Cronbach’s alpha=0.97; ICC=0.895). Bland–Altman plot analysis showed good agreement, indicating test-retest reliability. Moreover, K-CAHM showed good concurrent validity, demonstrated by its correlation with three domains of the International Classification of Functioning, Disability and Health: Fugl-Meyer assessment, the Jebsen-Taylor Hand Function Test, personal hygiene and bathing in the modified Barthel Index, and hand and stroke recovery domain in the Stroke Impact Scale.
Conclusion
The newly developed K-CAHM could complement other outcome measures, facilitating patient-centered rehabilitation in the Korean context.
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