The aim of this study was to investigate the effects of a 12-week rehabilitation program on body composition, shoulder pain, and isokinetic internal/external torques of pitchers with impingement syndrome. A total of 30 pitchers were divided into 2 groups: experimental group (EG, n = 16) and control group (CG, n= 14). The rehabilitation program consisted of physical therapy, warm-up, work-out, and cool-down. As results, body weight and fat mass of EG were decreased whereas muscle mass of EG was significantly increased after the experiment. The pain degrees in resting, normal daily activity, and strenuous activity on the numeric pain rating scale were significantly decreased in the EG. The internal and external peak torques (PTs) of uninvolved and involved sides of EG were increased in EG after 12 weeks. Such results provide a deficit ratio of both sides in EG close to normal values. The ratios of internal/external PTs in EG were also close to the reference values. The internal and external total works of both sides in EG were similar to the values of PT. The fatigue indices of internal and external rotators of both sides in EG were decreased. As a conclusion, a 12-week rehabilitation program reduced the shoulder pain, improved the body composition and enhanced the isokinetic shoulder internal/external rotators in EG with impingement symptoms. Also the study suggested that the rehabilitation program evened out the ratio between internal and external rotators and lowered the fatigue level after the experiment.
Shoulder injuries are responsible for the majority of injuries in baseball players. Most of these injuries occur during the throwing motion and due to overuse.
Actually, a shoulder joint is unstable because of its normal configuration and the composition of the geometry and ligamentous restraints of the joint (
Thus, the purpose of this study was to investigate the deficit part of an injured shoulder in isokinetic shoulder internal/external rotators and to assess the changes of pain degrees and body composition in baseball amateur pitchers after a 12-week rehabilitation program.
A total of 30 young men participated in this study. All of the subjects were baseball players with impingement symptoms without any previous shoulder or neck surgery. The subjects underwent a physical examination including medical history and orthopedic evaluation by an orthopedic surgeon. The inclusion criteria for baseball players with impingement symptoms were as follows: complaints of posterosuperior shoulder pain during the throwing motion; pain during the apprehension test and pain relief during the relocation test; or a positive response in one of the above-mentioned tests associated with another of the following diagnostic indicators: Neer, Hawkins, or Jobe (
After the physical examination, the subjects were randomly divided into two groups: the experimental group (EG, n=16) with rehabilitation exercise and the control group (CG, n=14) without rehabilitation exercise. No dropouts were noticed during this study. For all subjects an informed consent form was provided before the study. The informed consent form was approved by the Ethic Committee of Hanseo University Institute and the Korean Academy of Medical Sciences for Health, Korea. The exclusion criteria were as follows: generalized joint laxity according to the Beighton and Horan score; 17 systemic or neurological illnesses; previous shoulder dislocation; previous shoulder or neck surgery or physical therapy treatment in the 12 months prior to the study (
All subjects came to the hospital on the 1st day to sign an informed consent form and to complete the self-report questionnaires (Numeric Pain Rating Scale) which were designed to identify subjects with syndrome. After the procedure, each subject returned to the physical care center in the hospital to measure the body composition and for the shoulder isokinetic test. All subjects started with the rehabilitation program accompanied by test results. After 12 weeks, the subjects were examined again with the same measurements as before the treatment. The results of body composition, pain degrees and isokinetic shoulder internal/external rotation tests were selected for this study.
To measure weight, fat mass, and muscle mass of the subjects, we used the bioelectrical impedance analysis method assessed by InBody 320 Body Composition Analyzer (BioSpace, Korea), and measured height using BMS 330 anthropometer (BioSpace, Korea). The Body Composition Analyzer is a segmental impedance device measuring the voltage drop in the upper and lower body. The electrodes were made of stainless steel and the electrical interfaces were created as the subject stood upright while gripping hand electrodes and stepping onto foot electrodes. Eight tactile electrodes were placed in contact with the surfaces of both hands and feet: thumb, palm and fingers, front sole, and rear sole (
All subjects completed the numeric pain rating scale (NPRS) to measure self-reported their pain. The scale was broken down into centimeters and was numerically expressed from 0 to 10 cm. This is a reliable pain assessment tool that requires the subject to place a
An isokinetic dynamometer (HUMAC®/NORM™ Testing & Rehabilitation System, CSMI, MA, US) was used for this study. All subjects were submitted to a warm up program including stretching before the test. Subjects were placed on the shoulder internal/external rotation modular component in a standing position. Initial testing of the shoulder typically involved the modified neutral position. This position was obtained by tilting the dynamometer approximately 70° from a horizontal base position. To install the wrist/shoulder adapter on the dynamometer input arm, an investigator inserted the wrist/shoulder adapter into the long end of input arm and secured the handgrip at shoulder position and then installed elbow stabilizer pad on the short end of input arm. To confirm the test position for sure, the subjects were asked from monorail deck. To lock hips, the subjects were asked to stand with the opposite leg slightly forward and with the hand resting on their thigh. The dynamometer height was then adjusted to the position of subject’s test arm with elbow flexed to 90° and shoulder slightly abducted.
The range of motion (ROM) of internal/external rotation was nearly from 80° to 60°. However, if the subjects did not fit into a normal ROM, an expert tried to give as much as possible according to their ROM. Subjects performed 4 maximal warm-up repetitions and 4 maximal test repetitions at 60°/sec, and then performed 4 maximal warm-up repetitions and 15 maximal test repetitions at 180°/sec. The rest time between the test velocities was 60 sec. All tests were supervised by only one trained researcher. The peak torque (PT) of shoulder internal and external rotation was analyzed at 60°/sec and then the ratio of internal and external rotation of PT was calculated as well as the deficit ratio on the right and left sides in internal and external rotations, respectively. Furthermore, the measured results of isokinetic torques at 180°/sec have been analyzed by total work (TW) and then the ratio of internal and external rotation of TW were calculated as well as the deficit ratio on the right and left sides in internal and external rotations, respectively.
The study subjects participated in a supervised progressive rehabilitation program for 12 weeks (
The work-out was performed on Monday, Wednesday and Friday depending on the program schedule and was followed by the 1st work-out phase (from 1 day to 12 weeks). It involved prone horizontal abduction at 90°–100° with external rotation, prone extension with external rotation, prone horizontal abduction at 90° elbow flexion with external rotation, forward flexion, abduction, and shrug on floor at an intensity of less than 13 (somewhat difficult) on the rating of perceived exertion (RPE) scale. This stage focused on the pain reduction, the tolerance of weight bearing and the ROM improvement. Following this, all subjects performed the 2nd work-out phase, which included internal rotation scaption, external rotation scaption, military press, internal horizontal abduction, external horizontal abduction, triceps extension, biceps curl and shoulder rowing. Finally the 3rd phase included horizontal abduction, straight arm press, internal rotation, external rotation and press-ups. Both phases focused on the tolerance of full weight bearing, on the passive ROM improvement and on the neuromuscular control. The cool-down after the rehabilitation program consisted of two therapeutic modalities. First, all subjects performed the static and dynamic stretching on mattress for about 20 min. Then they were managed by icing (10 min), electrotherapy (10 min) and air compression (15 min). The rehabilitation exercises and their repetitions and sets used in this study were extracted from the contents of several former studies and applied as the means to manage the shoulder condition and to prevent re-injuries (
Data were analyzed using the SPSS program (version 18.0; SPSS Inc, Chicago, IL, USA). Values reported are means±standard deviation. The descriptive statistics were calculated for all dependent variables prior to the comparison of measurements including NPRS, body composition, and isokinetic torque variables in 60°/sec and in 180°/sec. The data were analyzed using non-parametric tests, because the data for this study were not normally distributed. Details of statistical methods were as follows; Firstly, the delta values were analyzed to control the effects of pre-time on post-time score using the formula: (variables at post-time–variables at pre-time)/ variables at pre-time×100. Secondly, the Mann-Whitney U test was performed to examine the difference between both groups using the delta value. Lastly, the significance level for all analyses was set a priori at
The data derived from 2 groups were analyzed regarding differences in pre- and post-exercise after 12 weeks (
To ascertain the effects of the rehabilitation program on pain degree, the values were gained using NPRS, which involved points felt at resting, normal daily activity and strenuous activity. The data from 2 groups were analyzed for differences in pre- and post-exercise after 12 weeks (
At pre-status, no significant difference was shown in the uninvolved and involved sides of the groups. However, there were significant differences in internal/external PT of the uninvolved and involved sides of the groups after 12 weeks. The delta percent values in internal PT of uninvolved and involved sides of CG were significantly decreased, however, the delta percent values in internal PT of the uninvolved (Z=−2.620;
At pre-status, there were no significant differences in the uninvolved and involved sides of both groups. However, there were significant differences in the internal/external TW of the uninvolved and involved sides of both groups after 12 weeks. The delta percent values in internal TW of uninvolved and involved sides of CG were significantly decreased, however, the delta percent values in internal TW of uninvolved (Z=−3.326;
At pre-status, there were no significant differences in the uninvolved and involved sides of both groups. However, there were significant differences in the internal/external fatigue index of un-involved and involved sides of both groups after 12 weeks. The delta percent values in the fatigue index of internal rotator of the uninvolved and involved sides of CG were significantly increased, however, the delta percent values in the fatigue index of internal rotator of the uninvolved (Z=−3.972;
The principal findings of this study represented the 12-weeks rehabilitation program improved the body composition, reduced shoulder pain and enhanced the isokinetic shoulder internal/external rotators in the EG group with shoulder impingement symptoms compared to the CG group. And it was also found that a 12-weeks rehabilitation program balanced between internal rotator and external rotator and eventually lowered the fatigue level of the involved and uninvolved shoulder sides after the experiment.
Prior to the entry in the rehabilitation program, the subjects of the EG were transferred to the physical therapy for the reduction of shoulder pain. In this study, the work-out performed in the present study depended on the program schedule for the baseball pitchers after this procedure. This was followed by the 1st work-out phase, which included prone horizontal abduction at 90°–100° with external rotation, prone extension with external rotation, prone horizontal abduction at 90°/elbow flexion with external rotation, forward flexion, abduction, and shoulder shrug on floor at an intensity of less than 13 (somewhat difficult) on the rating of perceived exertion scale. This stage focused on the reduction of pain, the tolerance of weight bearing and the improvement of motion range. The pain degrees of EG were decreased in three conditions of NPRS due to the rehabilitation program. In other words, there were no significant differences between three pain conditions in the both groups at pre-status, while there were significant decreases in three pain conditions in the EG after 12 weeks. Especially, almost all of the baseball pitchers in EG reported that the pain values of normal daily activity and strenuous activity conditions were gradually decreased during the course of time. As results of the present study, the NPRS of EG were significantly decreased −61.32±26.60% in resting condition, −49.86±18.91% in normal daily activity, and −53.00±20.61% in strenuous activity after the experiment.
Actually, a lot of baseball pitchers played not only a few games in a season and throw many pitches in a game at a high velocity (
In regards of usefulness and reliability of NPRS,
Recently, several clinicians and investigators are becoming an increasing interest in isokinetic exercise and assessment of the upper extremity as shown in the previous documentation. In fact, the shoulder joint consists of the articulation of the humerus head and the glenoid cavity of the scapula. The glenohumeral joint is a complex multiaxial articulation which is capable of movement through each of the cardinal planes and through a variety of diagonal and horizontal patterns. The Joint stability is primarily provided by capsular and muscular soft tissue structures rather than by the configuration of this rather shallow ball-and-socket articulation (
To develop the internal and external rotators as well as other rotational functions, this study provided the subjects of EG with the 2nd work-out phase, which included internal rotation scaption, external rotation scaption, military press, internal horizontal abduction, external horizontal abduction, triceps extension, biceps curl and shoulder rowing. Thereafter the study provided the EG also with the 3rd work-out phase which included horizontal abduction, straight arm press, internal rotation, external rotation and press-ups. As shown in the results above and if compared to the pre-status, the 2nd and 3rd work-out from the rehabilitation program for EG significantly decreased the fat mass −4.70±11.26% along with and decreasing pain sensation of the involved shoulder site, while the muscle mass significantly increased 7.41±8.54% after 12 weeks. By improving the body composition almost all of isokinetic PT and TW were increased in EG. In detail, at pre-status, there was no significant difference in the uninvolved and involved sides of the groups. The delta percent values in internal PT of uninvolved and involved sides of CG were significantly decreased, however, the delta percent values in internal PT of uninvolved (15.87±16.00%) and involved (13.75±14.86%) sides of EG were significantly increased after 12 weeks. Such results provide a deficit ratio of both shoulder sides of EG close to normal values (±10%). The ratios of internal/external PT of EG were also close to reference values (±60%) after 12 weeks. The results of the external rotator were similar to the results of the internal rotator in both sides after 12 weeks. In regards to this result,
In general, the external rotator muscles produce approximately 60% to 80% of the torque values generated by the internal rotator muscles, and a comparison of the bilateral strength values of these muscle groups indicates a dominant/non-dominant relationship usually within 10% (
In conclusion, it was found that the rehabilitation program balanced between internal and external rotators and lowered the fatigue level after the study. Detail results are as follows; Firstly, the body weight and fat mass of body composition were increased in CG. However, those of EG were decreased after 12 weeks. The muscle mass of CG was significantly decreased, whereas that of EG was increased after the study. Secondly, the pain degree in the resting status of NPRS was significantly decreased in the EG compared to CG. Similar to the changes of pain degree in the status of rest, the pain values of normal daily activity and strenuous activity status were significantly decreased in EG after 12 weeks. Thirdly, the internal and external PT of uninvolved and involved sides of CG were significantly decreased, however, those of both sides of EG were significantly increased after 12 weeks. Such results show a deficit ratio of both sides of EG close to normal values. The ratios of internal/external PT of EG were also close to reference values after 12 weeks. Lastly, the internal and external TW of uninvolved and involved sides of CG were significantly decreased, however, those of both sides of EG were significantly increased after 12 weeks. Such results show a deficit ratio of both sides of EG close to normal values. Although the ratios of internal/external TW of CG were not close to reference values, those of EG were close to that values after 12 weeks. Meanwhile, the fatigue indices of internal and external rotators of uninvolved and involved sides of CG were higher than in the pre-status, however, those of internal and external rotators of both sides of EG were significantly lower than in the pre-status after 12 weeks.
This research was supported by the grant of 2013 Hanseo University, Republic of Korea.
No potential conflict of interest relevant to this article was reported.
Physical characteristics of the subjects
Groups |
CG | EG | Z ( |
---|---|---|---|
Age (yr) | 22.57± 1.79 | 21.31± 1.74 | −2.009 (0.052) |
Height (cm) | 171.57± 4.38 | 176.50± 5.11 | −2.400 (0.015) |
Weight (kg) | 67.79± 5.90 | 68.50± 8.18 | −0.229 (0.822) |
Muscle mass (kg) | 32.07± 2.86 | 31.64± 4.55 | −0.312 (0.759) |
Percent mass (kg) | 13.95± 4.97 | 13.48± 4.26 | −0.187 (0.854) |
Pain (months) | 5.64± 1.22 | 6.06± 1.44 | −0.640 (0.552) |
All values are expressed as mean± standard deviation.
CG and EG represent groups control group and experimental group, respectively;
Results from non-parametric Mann-Whitney U test.
Rehabilitation programs for the subjects
Types | Program types | Intensity/Time | Period |
---|---|---|---|
Warm-up | Ultrasonic wave | 5 min | 1d–12 wk |
Laser therapy | 10 min | ||
Stationary cycling at 60% VO2max | 15 min | ||
Standing stretching | 10 min | ||
Work-out 1st phase (Monday) | Prone horizontal abduction at 90°–100° with external rotation (ER) | 10 reps× 3 sets | 1d–12 wk |
Prone extension with ER | 10 reps× 3 sets | ||
Prone horizontal abduction at 90°/elbow flexion with ER | 10 reps× 3 sets | ||
Forward flexion | 12 reps× 3 sets | ||
Abduction | 12 reps× 3 sets | ||
Shrug | 15 reps× 3 sets | ||
Work-out 2nd phase (Wednesday) | Internal rotation scaption | 10 reps× 3 sets | 1d–12 wk |
ER scaption | 10 reps× 3 sets | ||
Military press | 12 reps× 3 sets | ||
Internal horizontal abduction | 10 reps× 3 sets | ||
External horizontal abduction | 10 reps× 3 sets | ||
Triceps extension | 15 reps× 3 sets | ||
Biceps curl | 15 reps× 3 sets | ||
Shoulder rowing | 15 reps× 3 sets | ||
Work-out 3rd phase (Friday) | Horizontal abduction | 10 reps× 3 sets | 1d–12 wk |
Straight arm press | 15 reps× 3 sets | ||
Internal rotation | 15 reps× 3 sets | ||
ER | 15 reps× 3 sets | ||
Press-ups | 12 reps× 3 sets | ||
Cool-down | Stretching on met | 20 min | 1d–12 wk |
Icing | 10 min | ||
Electrotherapy | 10 min | ||
Air compressor | 15 min |
Changes of body composition between 2 groups after 12 weeks
Items | Groups |
Pre | Post | Δ% |
---|---|---|---|---|
Body weight (kg) | CG | 67.79± 5.90 | 69.34± 5.29 | 2.41± 2.54 |
EG | 68.50± 8.18 | 68.21± 7.87 | −0.38± 1.92 | |
Z ( |
−.229 (.822) | −.229 (.822) | −2.910 (.003) | |
Muscle mass (kg) | CG | 32.07± 2.86 | 31.72± 2.70 | −0.99± 3.73 |
EG | 31.64± 4.55 | 33.81± 4.20 | 7.41± 8.54 | |
Z ( |
−.312 (.759) | −1.414 (.166) | −3.533 (.000) | |
Fat mass (kg) | CG | 13.95± 4.97 | 14.60± 4.97 | 5.57± 9.41 |
EG | 13.48± 4.26 | 12.53± 3.23 | −4.70± 11.26 | |
Z ( |
−.187 (.854) | −1.123 (.275) | −2.411 (.015) |
All values are expressed as mean± standard deviation.
CG and EG represent control group and experimental group, respectively;
Results from non-parametric Mann-Whitney U test.
Changes of pain degrees between 2 groups after 12 weeks
Items | Groups |
Pre | Post | Δ% |
---|---|---|---|---|
Resting | CG | 5.64± 1.22 | 5.36± 1.01 | −2.13± 21.38 |
EG | 6.06± 1.44 | 2.13± 1.09 | −61.32± 26.60 | |
Z ( |
−0.640 (.552) | −4.586 (.000) | −4.122 (.000) | |
Normal daily activity | CG | 6.50± 0.76 | 6.64± 1.01 | 3.20± 17.98 |
EG | 7.13± 1.15 | 3.44± 1.03 | −49.86± 18.91 | |
Z ( |
−1.821 (.085) | −4.632 (.000) | −4.545 (.000) | |
Activity strenuous activity | CG | 7.71± 0.83 | 8.00± 0.88 | 4.32± 12.27 |
EG | 7.88± 1.02 | 3.56± 1.31 | −53.00± 20.61 | |
Z ( |
−0.616 (.580) | −4.694 (.000) | −4.672 (.000) |
All values are expressed as mean± standard deviation.
CG and EG represent control group and experimental group, respectively;
Results from non-parametric Mann-Whitney U test.
Changes of peak torque (PT) in shoulder internal and external rotators at 60°/sec
Items | Groups | Uninvolved | Involved | Deficit ratio | ||||||
---|---|---|---|---|---|---|---|---|---|---|
|
|
| ||||||||
Pre | Post | Δ% | Pre | Post | Δ% | Pre | Post | Δ% | ||
Internal PT (Nm) | CG | 48.29± 8.53 | 47.21± 8.82 | −0.95± 16.51 | 43.43± 7.56 | 42.64± 8.97 | −1.09± 16.97 | 15.07± 8.97 | 15.93± 12.90 | 29.39± 61.40 |
EG | 54.06± 1.54 | 62.13± 13.13 | 15.87± 16.00 | 47.63± 12.04 | 53.69± 12.47 | 13.75± 14.86 | 16.63± 8.48 | 10.06± 6.04 | −37.61± 32.40 | |
Z ( |
−1.397 (0.166) | −3.163 (0.001) | −2.620 (0.008) | −0.917 (0.377) | −2.417 (0.015) | −2.224 (0.025) | −0.021 (0.984) | −2.461 (0.013) | −3.535 (0.000) | |
External PT (Nm) | CG | 31.29± 7.28 | 29.29± 5.04 | −1.78± 26.95 | 28.50± 8.00 | 26.79± 8.29 | −3.77± 23.24 | 19.79± 5.47 | 21.14± 5.93 | 8.63± 20.56 |
EG | 28.31± 5.76 | 34.63± 7.81 | 22.78± 16.26 | 24.75± 5.93 | 31.81± 8.37 | 28.76± 17.92 | 21.50± 9.58 | 14.31± 6.65 | −25.17± 37.15 | |
Z ( |
−1.084 (0.294) | −2.024 (0.043) | −2.682 (0.006) | −1.356 (0.179) | −1.833 (0.070) | −3.410 (0.000) | −.292 (0.790) | −2.727 (0.005) | −2.370 (0.017) | |
Internal/External PT ratio (%) | CG | 66.79± 6.05 | 50.79± 7.47 | −33.98± 22.56 | 67.07± 11.57 | 51.14± 7.63 | −33.02± 25.00 | |||
EG | 61.56± 10.63 | 62.31± 9.78 | 0.30± 16.79 | 66.06± 13.38 | 62.31± 15.79 | −8.50± 20.25 | ||||
Z ( |
−1.229 (0.224) | −2.977 (0.002) | −3.741 (0.000) | −.333 (0.759) | −2.082 (0.038) | −2.453 (0.013) |
All values are expressed as mean± standard deviation.
CG and EG represent control group and experimental group, respectively;
Results from non-parametric Mann-Whitney U test.
Changes of total work (TW) in shoulder internal and external rotators at 180°/sec
Items | Groups | Uninvolved | Involved | Deficit ratio | ||||||
---|---|---|---|---|---|---|---|---|---|---|
|
|
| ||||||||
Pre | Post | Δ% | Pre | Post | Δ% | Pre | Post | Δ% | ||
Internal TW (J) | CG | 619.79± 182.12 | 537.64± 144.42 | −10.98± 19.46 | 541.14± 87.85 | 528.21± 136.98 | −2.93± 16.16 | 16.86± 7.29 | 18.21± 8.13 | 14.37± 52.27 |
EG | 665.63± 182.04 | 763.38± 215.23 | 15.90± 18.89 | 605.56± 157.86 | 684.13± 174.50 | 14.51± 18.66 | 17.06± 6.86 | 10.56± 6.10 | −33.86± 38.23 | |
Z ( |
−0.748 (0.473) | −2.912 (0.003) | −3.326 (0.001) | −1.019 (0.313) | −2.266 (0.022) | −2.432 (0.013) | −0.188 (0.854) | −2.456 (0.013) | −2.474 (0.012) | |
External TW (J) | CG | 357.07± 113.47 | 304.64± 125.93 | −14.23± 28.02 | 315.71± 115.38 | 291.00± 115.00 | −5.41± 20.47 | 17.36± 11.59 | 18.21± 11.36 | 10.52± 39.36 |
EG | 328.06± 88.57 | 382.06± 117.75 | 17.64± 22.40 | 267.00± 104.10 | 342.56± 149.47 | 29.26± 36.20 | 25.25± 10.93 | 12.69± 5.13 | −37.92± 41.40 | |
Z ( |
−0.582 (0.580) | −1.622 (0.110) | −3.159 (0.001) | −1.434 (0.154) | −1.227 (0.224) | −3.118 (0.001) | −1.811 (0.070) | −2.625 (0.008) | −3.160 (0.001) | |
Internal/External TW ratio (%) | CG | 51.07± 6.53 | 46.00± 8.61 | −9.21± 16.97 | 41.43± 9.48 | 53.21± 9.69 | 32.02± 26.88 | |||
EG | 55.88± 14.49 | 55.25± 9.76 | 2.14± 21.52 | 50.50± 12.80 | 52.38± 10.35 | 6.44± 19.08 | ||||
Z ( |
−0.583 (0.580) | −2.477 (0.012) | −1.268 (0.208) | −1.873 (0.064) | −.708 (0.498) | −2.411 (0.015) |
All values are expressed as mean± standard deviation.
CG and EG represent control group and experimental group, respectively;
Results from non-parametric Mann-Whitney U test.
Changes of fatigue index (FI) in shoulder internal and external rotators at 180°/sec
Items | Groups | Uninvolved | Involved | ||||
---|---|---|---|---|---|---|---|
|
| ||||||
Pre | Post | Δ% | Pre | Post | Δ% | ||
Internal FI | CG | 17.43± 12.01 | 20.29± 12.11 | 30.89± 39.41 | 12.14± 9.32 | 16.29± 9.68 | 46.80± 78.01 |
EG | 11.44± 18.58 | 6.63± 10.92 | −43.34± 23.84 | 14.25± 17.86 | 6.81± 8.28 | −45.31± 38.03 | |
Z ( |
−0.999 (0.334) | −3.329 (0.001) | −3.972 (0.000) | −0.770 (0.448) | −2.727 (0.005) | −3.639 (0.000) | |
External FI | CG | 16.14± 9.35 | 12.07± 11.95 | −11.26± 111.34 | 11.93± 9.80 | 15.57± 10.20 | 30.93± 45.55 |
EG | 18.00± 12.13 | 12.25± 7.03 | −37.32± 42.61 | 20.19± 9.71 | 11.50± 7.52 | −43.36± 32.92 | |
Z ( |
−0.708 (0.498) | −.208 (0.854) | −0.707 (0.498) | −2.601 (0.008) | −1.483 (0.142) | −3.659 (0.000) |
All values are expressed as mean± standard deviation.
CG and EG represent control group and experimental group, respectively;
Results from non-parametric Mann-Whitney U test.