Personal Summary
I am an assistant professor at Faculty of Rehabilitation Sciences, Isfahan University of Medical Science, Isfahan, Iran. My main subject is basic and clinical research on osteoarthritis. According to my masters thesis and my clinical experience I am also interested in research on cardiovascular rehabilitation and SI joint biomechanics and treatment
ORCID: 0000-0002-7315-9851 Supervisors: Dr. Giti Torkaman, Dr. Ali Esteki, Dr. Alireza Sabaghian, and Dr. Roya Ravanbod
Muscles, Ligaments and Tendons Journal, Dec 16, 2020
Introduction. This systematic review protocol aims to evaluate the effect of rehabilitation for c... more Introduction. This systematic review protocol aims to evaluate the effect of rehabilitation for chronic non-specific low back pain with sacroiliac joint origin.
Methods. Search will be done in Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, the MOH Thesis, MOH Articles, Magiran, and SID. Google Scholar search engine will also be used. All types of Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation in English and Persian published prior to September 2019 will be included. The articles recruiting 18 to 60 years old will be included. Considering PICO, the finally retrieved articles will be assessed qualitatively by CONSORT, STROBE, PEDro, NIH and CASP checklists. Changes in pain and function will be favorable.
Dissemination. The protocol presented in present paper will be used to summarize and qualify present literatures on conservative therapy for chronic non-specific low back pain with sacroiliac joint origin.
Muscle, Ligaments and Tendons Journal, Sep 30, 2020
Background. The adhesive taping is supposed to improve joint stability and proprioception and enh... more Background. The adhesive taping is supposed to improve joint stability and proprioception and enhance the physical protection in unpredictable situations.
Hypothesis/purpose. The aim of present study was to compare the effect of facilitatory gastrocnemius taping on dynamic balance and muscle activity during Y-balance test in healthy middle-age men.
Study design. Double-blinded (participant, assessor) randomized control trial.
Methods. 30 healthy middle-age men who were not routinely involved in exercise program were randomly assigned in Kinesio Taping® and sham group. They took part in Y-balance test before, immediately, 20 minutes and 24 hours after taping. Y-balance records and medial and lateral gastrocnemius activity were reported for each test. Between group and within group changes were analyzed using independent T test and repeated measures. Correlation between Y-balance record and gastrocnemius activity were be analyzed using pearson correlation test.
Muscles, Ligaments and Tendons Journal, Sep 30, 2020
Introduction. The aim of this study will be to evaluate the effect of electrical stimulation curr... more Introduction. The aim of this study will be to evaluate the effect of electrical stimulation currents on the pain and function in subjects with chronic non-specific low back pain.
Methods. Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, and also the MOH Thesis, MOH Articles, Magiran, and SID as the national databases will be searched. Also, Google Scholar search engine will be used. All study types except Qualitative Studies, and Narrative Reviews, i.e. Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation, in English and Persian will be retrieved. The publication date should not be after August 2019. To ensure all the publication has been reached, search will be extended to three years before the publication date of first article found for each type of electrical stimulation currents. The search will be limited to human studies of subjects between 18-65, regardless of gender and race. The search strategy will cover PICO. The quality of studies will be determined using Consort, STROBE, NHLBI, PEDro and CASP checklists in expert consensus.
Dissemination. The results of this plan will clarify which electrical stimulation current will improve pain and function in chronic non-specific low back pain. This is valuable in clinical practice to optimize therapeutic planning.
Background: The knee outcome survey-activities of daily living (KOS-ADL) scale is a self-reported... more Background: The knee outcome survey-activities of daily living (KOS-ADL) scale is a self-reported measure to determine knee function and symptoms in individuals suffering from a variety of knee disorders. The present study aimed to assess the validity, reliability, and cross-cultural adaptation of the Persian version of the KOS-ADL scale. Methods: In this cross-sectional and psychometric study, 130 patients (14 men and 116 women) with different grades of knee osteoarthritis were recruited. The construct validity of the scale was examined through the correlation between the domains of KOS-ADL and the subclasses of the knee injury and osteoarthritis outcome score (KOOS). To assess the test-retest reliability, 40 of the participants were requested to fill in the questionnaire again with an 8-day interval. The internal consistency of the questionnaire and its subclasses was evaluated with Cronbach's alpha coefficient. To evaluate construct validity, concurrent construct validity was examined with a correlation matrix using Pearson's correlation coefficients between the KOS-ADL domains and KOOS total score and subclasses. The test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). The Kappa coefficient was used to determine the intra-rater agreement. Results: The Persian version of the KOS-ADL scale had good reliability (ICC=0.79) and internal consistency (α=0.92). There was a good correlation between the KOS-ADL total score and KOOS subclasses (r≥0.71, P≤0.001). Conclusion: The Persian version of the KOS-ADL scale is a valid and reliable instrument to evaluate the symptoms and functional status of people suffering from knee osteoarthritis.
Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to... more Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to old age. KOA also results in many complications like changes in gait. Nowadays, changes in lifestyle and the reduced physical activity make people more vulnerable to KOA. Therefore, considering the increasing prevalence of KOA in many societies and the costs imposed on the afflicted people and their governments, providing conservative management approaches with a view to saving time and money is important. There are an assortment of conservative strategies in the management of KOA including low level laser therapy (LLLT). Since the introduction of lasers in the medical field in 1960, various types of lasers with widespread administration programs are used for medical conditions from cosmetics to surgery. However, there are conflicting findings on the application of lasers in osteoarthritis. To discuss the basis of the highest level of evidence, only systematic reviews with or without meta-analyses published up to January 2019 were included in the present work. In this regard, Scopus, PEDro, Medline, ISI Web of Science, Cochrane, PubMed, Irandoc, Iran Medex, Magiran, and SID were searched to retrieve articles in English or Persian. A total of 22 systematic reviews and meta-analyses were found, 14 of which were included in this study. The accepted articles were published between 1991 and up to 2019. The purpose of this narrative review was to investigate the effect of LLLT on pain and function in subjects with KOA. The result of the present review may help clinicians in making evidence-based decisions on optimal care in relation to administering LLLT.
Background
It has been shown that cognitive loading affects postural control in different populat... more Background It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI).
Research Question Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects?
Methods A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions.
Results The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05).
Significance Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.
Journal of Research in Rehabilitation Sciences, Dec 6, 2018
Introduction: We aimed to design a triple-blinded randomized clinical trial study to asssess the ... more Introduction: We aimed to design a triple-blinded randomized clinical trial study to asssess the effect of low-level laser (LLL) on pain and function in patients with patellofemoral pain syndrome (PFPS).
Materials and Methods: This designed study will involve 60 patients with PFP syndrome. Eligible subjects will be divided randomly into control (physical therapy), physical therapy plus active LLL, and physical therapy plus placebo laser. The physical therapy program will be exactly the same for all groups including exercise and education for ten sessions, every other day. The LLL group will receive 808 nm, 200 mW, 4 J Ga-Al-As laser over 5 points for 20 seconds per point. The laser will be deactivated in placebo group, and for the control group, the laser will not be used. The outcomes include pain and function, which will be measured using visual analogue scale (VAS), the Persian version of the Kujala patellofemoral questionnaire, and the step down test. Following Shapiro-Wilk test, the paired t and one-way ANOVA tests, if data distribution followed normal distribution, or the Kruskal-Wallis and Mann Whitney tests, if data distribution did not follow normal distribution, will be administered at the significance level of less than 0.05.
Conclusion: Therapeutic exercises is the treatment of choice for PFP syndrome. LLL is a commonly favorable modality prescribed as a part of physical therapy program for musculoskeletal disorders. However, the effect of laser in subjects with PFPS has not been thoroughly investigated. In designed study, it will be examined whether adding LLL to standard physical therapy has a clinical benefit in subjects with PFPS.
Keywords: Low-level laser therapy, Patellofemoral pain syndrome, Pain, Function
Journal of Resaerch in Rehabiliation Sciences, Sep 10, 2006
Introduction: Myocardial infarction and coronary heart diseases are major causes of mortality and... more Introduction: Myocardial infarction and coronary heart diseases are major causes of mortality and disability before reaching old age. High expenses of treatment and rehabilitation in these diseases and also economic loss due to productivity damages clearly confirm the importance of preventing such diseases. Heart disease has too many risk factors among which sedentary life style is the most important one. Epidemiological studies suggest that acute heavy physical exercise especially in sedentary people increases the risk of cardiovascular events. In contrast, there are fewer risks in athletes or people who exercise habitually during the day. The aim of this study was to identify the effect of aerobic training on the cardiovascular response of healthy young men. Methods: Sixteen non-athlete healthy young men aged 20 to 30 without any familial history of cardiovascular problems were studied. Ten participants were randomly selected and involved in an aerobic training program on ergometer cycle, 3 times a week, for a period of two months. Each session continued for 30 minutes; consisting of 1 minute warm up, 15 minutes aerobic exercise, 8 minutes active recovery and 5 minutes passive recovery. The other 6 volunteers form the control group did not take part in any exercise during these 8 weeks. Cardiovascular response of all participants was evaluated before and after the training period by means of Bruce test. Results: Before starting the program, there was no significant difference between experiment and control groups based on Bruce test parameters including speed, slope and energy expenditure (METS). After 8 weeks aerobic training, there were significant increases in Bruce parameters of the experiment group in comparison to pre training data and to the control group. Similar changes were observed in ergometer workload which was necessary for achieving and maintaining threshold heart rate for 10 minutes, the distance (Km) and the energy (Kcal). Conclusion: Aerobic training improves people’s performance due to its effects on cardiovascular system. These effects were evaluated with Bruce test as an index of VO2MAX. Key words: Cardiovascular function; Bruce test; Aerobic training, Cycle ergometer.
Journal of Research in Rehabilitation Sciences, Oct 7, 2018
Introduction: Osteoarthritis is the most common type of joint disorder. The present study compare... more Introduction: Osteoarthritis is the most common type of joint disorder. The present study compared the effects of continuous and intermittent physiotherapy on the pain and function of the individuals with moderate knee osteoarthritis.
Materials and Methods: This randomized clinical trial study included 20 patients with moderate knee osteoarthritis randomly assigned into continuous and intermittent physiotherapy groups. The intervention was exactly the same for both groups including 10 sessions of conventional physical therapy. The treatment frequency was 6 and 3 sessions per week for continuous and intermittent groups, respectively. Using Knee injury and Osteoarthritis Outcome Score (KOOS) and Intermittent and Constant Osteoarthritis Pain (ICOAP) questioners, 6-minute-walking test, timed get up and go test, pain based on visual analogue scale (VAS), and function were assessed before, after 10 sessions, and after one month of follow up. The outcome was analyzed using independent t-test and, repeated measures ANOVA.
Results: Prior to the study, there was no significant difference between groups (P > 0.05). At the end of the 10th treatment session (P = 0.048), and after 1 month of follow up (P = 0.030), only the daily activity subscale of the KOOS questionnaire was significantly less in the continuous group. The records of 6-minute-walk test (P = 0.046), timed get up and go test (P = 0.040), continuous pain (P = 0.006), symptoms (P = 0.020), pain (P = 0.003), and quality of life (P = 0.010) subclasses of KOOS improved significantly in continuous group. After one month of follow up, daily activity subclass and pain based on VAS score were significantly better than baseline records (P = 0.002). In intermittent group, pain based on VAS score (P = 0.002) and continuous pain (P = 0.030) improved significantly after 10th session and follow up period).
Conclusion: It seems that the frequency of the treatment sessions has no significant effect on the treatment results in short term. Thus, the physiotherapist may take the subject's preference and their time limitations for scheduling the sessions. Continuous intervention may probably be the better choice to reach better results while intermittent protocol may result in more lasting effects
Keywords: Osteoarthritis of knee; Pain; Functional performance; Physiotherapy (Techniques)
Journal of Research in Rehabilitation Sciences, Aug 6, 2018
Introduction: The sense of force is one of the three main components of proprioception, associate... more Introduction: The sense of force is one of the three main components of proprioception, associated with the realization of the force within the muscles during contraction. The purpose of this study was to investigate the static force sense of the knee flexor muscles after reconstruction of the anterior cruciate ligament (ACL) in comparison to healthy person's knee.
Materials and Methods: This cross-sectional study was carried out on 32 non-athletic men aged 19-40 years who were assigned into two groups of 16 participants purposefully, ACL reconstruction and healthy. Using a Biodex machine 3.0, maximum voluntary isometric contraction of hamstring muscles was measured in 30°, 60°, and 90° angles in a random order. Then, 20% and 60% of maximum muscle contraction were calculated for each subject. The participants were requested to produce 20% and 60% contraction force randomly in aforementioned angles with and without visual feedback. This way the difference between subject’ performance with and without visual feedback was calculated. The average of static force sense and the maximum voluntary isometric contraction (MVIC) were compared between the groups using Mann-Whitney U test. Using the Kendall's tau-b Correlation Coefficient, the correlation between MIVC and mean error of static force sense was determined.
Results: There was no statistically significant difference between the groups in the term of average error of knee flexor static force sense in 30°, 60°, and 90° angles with target forces of 20% and 60% (P < 0.05). Moreover, the average error of flexor static force sense in 30°, 60°, and 90° angles and the maximum voluntary isometric contraction of knee flexor were not significantly correlated in either group (r ≤ 0.82, P > 0.05)
Conclusion: It seems that the static force sense of knee flexor muscles of the knee will be similar to healthy subjects, 6 months after ACL reconstruction surgery.
Keywords: Static force sense; Flexor muscles of knee; Anterior cruciate ligament reconstruction
McGill tests are popular and practical clinical tests for evaluating the isometric endurance of c... more McGill tests are popular and practical clinical tests for evaluating the isometric endurance of core muscles. Previous studies have reported the mean or maximum rate of the McGill tests from one to three times of Mc Gill tests. Objective: To assess the number of repetitions of the McGill tests to reliably determine core muscle endurance in subjects with and without nonspecific low back pain. Methods: The participants were 50 (24 males and 26 females) sedentary subjects with and without chronic nonspecific low back pain. Isometric core muscle endurance of the trunk flexion, extension and lateral flexion (right and left) was measured using the McGill tests. The order of the test was set randomly and each test was repeated three times with 5-minute rest intervals. The subjects were recruited from state and private companies and organizations and were purposefully assigned into low back pain and without low back Pain group. In each test, three trial scores, maximal score and mean score were reported. The frequency of reporting maximal score in first, second and third trial was determined and compared within groups using McNemar test and between groups using Mann-Whitney U test. Results: For all Mc Gill test, the maximum score trials was significantly greater than the mean score in both groups (P≤ 0.001). For trunk flexion endurance, the probability of obtaining the maximal score in the first couple of trials was up to 80% and 92%, 76% and 84% for the trunk extension endurance, 72% and 76% for right lateral flexion endurance and 92% and 76% for left lateral flexion endurance in LBP and WLBP subjects respectively. Conclusion: Two repetitions of McGill tests seem to be sufficient to detect core muscle endurance in subjects with and without chronic nonspecific low back pain.
Introduction and hypothesis: The aim of this study was to evaluate the psychometric properties of... more Introduction and hypothesis: The aim of this study was to evaluate the psychometric properties of the Persian version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) in patients with urinary tract dysfunction. Methods: After gaining permission from the International Consultation on Incontinence Modular Questionnaire (ICIQ) advisory board, the English Female Lower Urinary Tract Symptoms (FLUTS) questionnaire was translated into Persian and then translated back into English. One hundred fourteen women with pelvic floor dysfunction were asked to complete the Persian FLUTS and International Consultation on Incontinence Modular Questionnaire Overactive Bladder Questionnaire (ICIQ-OAB). The Persian FLUTS questionnaire was also readministered to 20 patients 2 weeks after their initial visit. Study data were analyzed using SPSS V16.0. To validate the translated questionnaire, we assayed content/face validity, internal consistency/reliability, and construct validity. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and the intraclass correlation coefficient (ICC) respectively. Results: The mean age of the patients was 48.8 years old, 84% were married, and 59% had at least one Caesarean. Except for very few missing data, there is no any ambiguity in the Persian version of the FLUTS questionnaire. The Cronbach’s alpha was 0.83, indicating a high internal consistency. Concerning criterion validity, correlation between the Persian FLUTS and the OAB was 0.77 (p<0.001). Conclusion: The initial testing of the Persian version of the FLUTS questionnaire demonstrates good internal consistency, content validity, and reliability. Keywords: Female Lower Urinary Tracts Symptoms; Validation; Persian; Questionnaire; Linguistics; Quality of life.
Iranian Quarterly Journal of Breast Disease, Feb 18, 2019
Introduction: Breast cancer is the most common cancer in women. Surgery is the main treatment, an... more Introduction: Breast cancer is the most common cancer in women. Surgery is the main treatment, and patients may experience some complications after surgery, including pain and shoulder function limitation. The severity of these complications is greater in modified radical mastectomy. In various studies, Kinesio Tape (KT) has been introduced as a supporting and complementary method in rehabilitation after surgeries. The aim of the present study was to compare the effects of a rehabilitation program with or without KT on shoulder pain and function after mastectomy in women with breast cancer. Methods: This study was a double-blind randomized clinical trial (RCT). In this study, 20 participants were randomly assigned to 2 groups. The intervention started the first day after surgery. One of the groups (n = 10) received therapeutic exercise program, and the other group (n = 10) received therapeutic exercise program as well as lymphatic correction with fan-shaped KT over a four-week period. KT was attached to the upper limb of the surgical side, the effects of the interventions were examined from two aspects of shoulder pain and function (based on the SPADI questionnaire). Results: The findings of the study indicated that both groups had significant improvements in pain and function after the four-week period of intervention. The improvement in shoulder function was significantly greater in the exercise + KT group (p < 0.05), although there was no significant difference between the two groups in shoulder pain (p > 0.05). Conclusion: The use of fan-shaped KT with therapeutic exercises is recommended for improving the shoulder function after a modified radical mastectomy.
Introduction: Forward head posture (FHP) is a common postural deviation
and chin tuck exercise ha... more Introduction: Forward head posture (FHP) is a common postural deviation and chin tuck exercise has been traditionally prescribed to manage this condition. On the other hand, turtle is one of the common exercises in tai chi. Although, recently the physiotherapists are more interested in including tai chi in exercise therapy, there is no study comparing the effect of chin tuck and turtle exercise. Aim: The aim of this study was comparison of chin tuck and turtle exercise effects on FHP. Material and methods: 46 asymptomatic FHP subjects aged 22.45 ± 1.70 years were randomly assigned into two groups of chin tuck and turtle exercise. Cervical curve was measured before and after a 6-week intervention. The measures were compared by Mann-Whitney U test, paired sample T test and Wilcoxon. Results: 40 subjects completed the study. Within group analysis showed significant cervical curve increase. Interestingly, between group analysis showed equal cervical curve improvement. Conclusions: Both chin tuck and turtle exercises improved the cervical curve in subjects with FHP. However, the effects of these two approaches seemed to be the same. Keywords: Forward head posture; Chin tuck; Turtle exercise
[Purpose] The purpose of this review was to summarize available methods and equipment which are a... more [Purpose] The purpose of this review was to summarize available methods and equipment which are administered to evaluate the balance in anterior cruciate ligament reconstruction. [Subjects and Methods] A literature search was performed and reviewed using the narrative approach. This study reviewed English articles concerning balance assessment methods in anterior cruciate ligament reconstruction subjects from 1985 to 2015 using the following key words: Anterior Cruciate Ligament Injury, Anterior Cruciate Ligament Reconstruction, Postural Control, Equilibrium , Balance and Stability. [Results] This review included 44 studies out of 117 initially retrieved articles. These articles were discussed in balance measurement procedure without comparing the effect of various surgical, medical or rehabilitation approaches. [Conclusion] Biodex and EquiTest, functional dynamic tests are of choice in the evaluation and tracking of anterior cruciate ligament reconstruction subjects. Force plate parameters provide information regarding strategies of static postural control and is not sensitive enough to challenge postural control system in physical activities.
Introduction: Osteoarthritis is one of the most common musculoskeletal disorders. Analyzing the e... more Introduction: Osteoarthritis is one of the most common musculoskeletal disorders. Analyzing the energy expenditure in people who suffer from musculoskeletal disorders provides objective evidence to measure individual’s disability and the effect of therapeutic interventions. Present study investigated the effect of various severities of knee osteoarthritis on mechanical energy of lower extremities.
Materials and Methods: 48 women aged between 40-70 years were purposefully divided into mild, moderate and sever osteoarthritis and healthy control group according to simple X-ray features of their knee joints. The participants walked at their convenient self-selected speed to collect five clean trials. The data were recorded using a motion analysis system and a 3-dimentional model of lower extremity segments was developed from motion capture data using visual 3-D software. Mechanical energy of lower extremity was calculated using this model.
Results: The study groups were significantly different in age (P ≤ 0.001) and walking speed (P ≤ 0.001). One-way analysis of variances (ANOVA) and post-hoc Tukey test revealed that there was significant difference between the study groups regarding mechanical energy. However, univariate general linear models with adjustments to age and to walking speed were developed; in addition, a bivariate general linear model was adjusted to age and walking speed. All the models confirmed that the differences were not imposed by the severity of knee osteoarthritis.
Conclusion: It seems that increase in mechanical energy of lower extremity in subjects with knee osteoarthritis intensifies with the progression of the disease; this is not a direct effect of the level of joint deterioration but is an indirect effect of older age and lower walking speed in subjects suffering from more advanced knee osteoarthritis.
Keywords: Knee osteoarthritis; Severity; Gait analysis; Mechanical energy
Background: Active exercise therapy is recommended as an efficient conservative approach to impro... more Background: Active exercise therapy is recommended as an efficient conservative approach to improve functional disability in subjects suffering from nonspecific low back pains. The aim of this study is comparing the effects of standard rehabilitation protocol with without exercise therapy in acute nonspecific low back pain.
Methods: 43 volunteers with acute nonspecific low back pain were randomly assigned into experimental group (spinal manipulation plus active exercise, n=21) and control group (spinal manipulation n = 22).After signing formal consent, demographic information was obtained. Immediate analgesic effect was reported measuring pain intensity (VAS) before and immediately after the manipulation in either group. Pain intensity and disability score according to Oswestry Disability Index were reported at the beginning, after the 10th therapeutic session, and at one month follow-up.
Results: Forty subjects completed the study. Pain and functional disability score decreases significantly over time in both groups (P<0.001), although intergroup difference were not significant for pain severity (P=0.24) and functional disability score (P=0.42). Also, in this study, the results showed that the pain after a session of manipulation (P <0.001) was significantly lower than before treatment.
Conclusion: It seems that in spite of immediate significant improvement in pain and functional disability following supplementary exercise therapy protocol, it is not significantly different from manipulation. More studies are recommended to investigate the effect of various exercise protocols in different types of low back pain.
Keywords: Acute low back pain; spinal manipulation; active exercise; pain; functional disability.
Background: Disk herniation is the most common cause of radiating LBP in subjects under 60 years ... more Background: Disk herniation is the most common cause of radiating LBP in subjects under 60 years of age. The present study aims to compare the effect of dry needling and a standard conservative approach on the pain and function in subjects with discogenic radiating low back pain. Materials and Methods: Fifty-eight subjects with discogenic radicular low back pain were screened and randomized into control (Standard physical therapy, N = 29) and experimental group (Standard physical therapy & Dry needling, N = 29). Radiating pain intensity and disability were measured using Visual Analogue Scale and Oswestry Disability indices at baseline, at the end of treatment and two months after the last intervention session. the changes in pain intensity and disability were studied using a 3×2 repeated measures analysis of variance considering time as the within-subject factor and group as the between-subject. Results: Pain intensity and disability scores decreased significantly in both experimental and control groups (experimental group: VAS=37.24, ODI=28.48, control group: VAS=45.5, ODI=32.96), following the intervention. The change continued during the follow-up period (P<0.001 for all comparisons). Pain and disability improvement, however, were more significant in experimental group, both in post intervention (experimental group: VAS=25.17, ODI=22.17, control group: VAS=42.4, ODI=30.27) (P=0.05 and P=0.03, respectively) and in follow-up measures (P=0.006 and P=0.002, respectively).Conclusions: Both intervention strategies seem to significantly improve pain and disability immediately following intervention, where the improvement continued during two months after the last active intervention. Therefore, supplementary DN application may enhance the effect of the standard intervention considerably.
Key Words: Low Back Pain, Discogenic, Dry needling.
Abstract
Objective: The present study aimed to translate and evaluate the reliability and validi... more Abstract Objective: The present study aimed to translate and evaluate the reliability and validity of the Persian version of the 11-item Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in Iranian subjects with Knee Osteoarthritis (KOA). Materials and Methods: The ICOAP questionnaire was translated according to the Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. The procedure consisted of forward and backward translation, as well as the assessment of the psychometric properties of the Persian version of the questionnaire. A sample of 230 subjects with KOA was asked to complete the Persian versions of ICOAP and Knee injury and Osteoarthritis Outcome Score (KOOS). The ICOAP was readministered to forty subjects five days after the first visit. Test–retest reliability was assessed using Intraclass Correlation Coefficient (ICC), and internal consistency was assessed by Cronbach's alpha and item-total correlation. The correlation between ICOAP and KOOS was determined using Spearman's correlation coefficient. Result: Subjects found the Persian-version of the ICOAP to be clear, simple, and unambiguous, confirming its face validity. Spearman correlations between ICOAP total and subscale scores with KOOS scores were between 0.5 and 0.7, confirming construct validity. Cronbach's alpha, used to assess internal consistency, was 0.89, 0.93, and 0.92 for constant pain, intermittent pain, and total pain scores, respectively. The ICC was 0.90 for constant pain and 0.91 for the intermittent pain and total pain score. Conclusion: The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA. Keywords: Intermittent and constant osteoarthritis pain measure, knee osteoarthritis, pain, pain questionnaire, Persian, reliability, validity DOI: 10.4103/1735-9066.185595
Muscles, Ligaments and Tendons Journal, Dec 16, 2020
Introduction. This systematic review protocol aims to evaluate the effect of rehabilitation for c... more Introduction. This systematic review protocol aims to evaluate the effect of rehabilitation for chronic non-specific low back pain with sacroiliac joint origin.
Methods. Search will be done in Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, the MOH Thesis, MOH Articles, Magiran, and SID. Google Scholar search engine will also be used. All types of Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation in English and Persian published prior to September 2019 will be included. The articles recruiting 18 to 60 years old will be included. Considering PICO, the finally retrieved articles will be assessed qualitatively by CONSORT, STROBE, PEDro, NIH and CASP checklists. Changes in pain and function will be favorable.
Dissemination. The protocol presented in present paper will be used to summarize and qualify present literatures on conservative therapy for chronic non-specific low back pain with sacroiliac joint origin.
Muscle, Ligaments and Tendons Journal, Sep 30, 2020
Background. The adhesive taping is supposed to improve joint stability and proprioception and enh... more Background. The adhesive taping is supposed to improve joint stability and proprioception and enhance the physical protection in unpredictable situations.
Hypothesis/purpose. The aim of present study was to compare the effect of facilitatory gastrocnemius taping on dynamic balance and muscle activity during Y-balance test in healthy middle-age men.
Study design. Double-blinded (participant, assessor) randomized control trial.
Methods. 30 healthy middle-age men who were not routinely involved in exercise program were randomly assigned in Kinesio Taping® and sham group. They took part in Y-balance test before, immediately, 20 minutes and 24 hours after taping. Y-balance records and medial and lateral gastrocnemius activity were reported for each test. Between group and within group changes were analyzed using independent T test and repeated measures. Correlation between Y-balance record and gastrocnemius activity were be analyzed using pearson correlation test.
Muscles, Ligaments and Tendons Journal, Sep 30, 2020
Introduction. The aim of this study will be to evaluate the effect of electrical stimulation curr... more Introduction. The aim of this study will be to evaluate the effect of electrical stimulation currents on the pain and function in subjects with chronic non-specific low back pain.
Methods. Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, and also the MOH Thesis, MOH Articles, Magiran, and SID as the national databases will be searched. Also, Google Scholar search engine will be used. All study types except Qualitative Studies, and Narrative Reviews, i.e. Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation, in English and Persian will be retrieved. The publication date should not be after August 2019. To ensure all the publication has been reached, search will be extended to three years before the publication date of first article found for each type of electrical stimulation currents. The search will be limited to human studies of subjects between 18-65, regardless of gender and race. The search strategy will cover PICO. The quality of studies will be determined using Consort, STROBE, NHLBI, PEDro and CASP checklists in expert consensus.
Dissemination. The results of this plan will clarify which electrical stimulation current will improve pain and function in chronic non-specific low back pain. This is valuable in clinical practice to optimize therapeutic planning.
Background: The knee outcome survey-activities of daily living (KOS-ADL) scale is a self-reported... more Background: The knee outcome survey-activities of daily living (KOS-ADL) scale is a self-reported measure to determine knee function and symptoms in individuals suffering from a variety of knee disorders. The present study aimed to assess the validity, reliability, and cross-cultural adaptation of the Persian version of the KOS-ADL scale. Methods: In this cross-sectional and psychometric study, 130 patients (14 men and 116 women) with different grades of knee osteoarthritis were recruited. The construct validity of the scale was examined through the correlation between the domains of KOS-ADL and the subclasses of the knee injury and osteoarthritis outcome score (KOOS). To assess the test-retest reliability, 40 of the participants were requested to fill in the questionnaire again with an 8-day interval. The internal consistency of the questionnaire and its subclasses was evaluated with Cronbach's alpha coefficient. To evaluate construct validity, concurrent construct validity was examined with a correlation matrix using Pearson's correlation coefficients between the KOS-ADL domains and KOOS total score and subclasses. The test-retest reliability was analyzed using the intra-class correlation coefficient (ICC). The Kappa coefficient was used to determine the intra-rater agreement. Results: The Persian version of the KOS-ADL scale had good reliability (ICC=0.79) and internal consistency (α=0.92). There was a good correlation between the KOS-ADL total score and KOOS subclasses (r≥0.71, P≤0.001). Conclusion: The Persian version of the KOS-ADL scale is a valid and reliable instrument to evaluate the symptoms and functional status of people suffering from knee osteoarthritis.
Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to... more Knee osteoarthritis (KOA) is the most common musculoskeletal disorder, especially in middle up to old age. KOA also results in many complications like changes in gait. Nowadays, changes in lifestyle and the reduced physical activity make people more vulnerable to KOA. Therefore, considering the increasing prevalence of KOA in many societies and the costs imposed on the afflicted people and their governments, providing conservative management approaches with a view to saving time and money is important. There are an assortment of conservative strategies in the management of KOA including low level laser therapy (LLLT). Since the introduction of lasers in the medical field in 1960, various types of lasers with widespread administration programs are used for medical conditions from cosmetics to surgery. However, there are conflicting findings on the application of lasers in osteoarthritis. To discuss the basis of the highest level of evidence, only systematic reviews with or without meta-analyses published up to January 2019 were included in the present work. In this regard, Scopus, PEDro, Medline, ISI Web of Science, Cochrane, PubMed, Irandoc, Iran Medex, Magiran, and SID were searched to retrieve articles in English or Persian. A total of 22 systematic reviews and meta-analyses were found, 14 of which were included in this study. The accepted articles were published between 1991 and up to 2019. The purpose of this narrative review was to investigate the effect of LLLT on pain and function in subjects with KOA. The result of the present review may help clinicians in making evidence-based decisions on optimal care in relation to administering LLLT.
Background
It has been shown that cognitive loading affects postural control in different populat... more Background It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI).
Research Question Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects?
Methods A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions.
Results The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05).
Significance Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.
Journal of Research in Rehabilitation Sciences, Dec 6, 2018
Introduction: We aimed to design a triple-blinded randomized clinical trial study to asssess the ... more Introduction: We aimed to design a triple-blinded randomized clinical trial study to asssess the effect of low-level laser (LLL) on pain and function in patients with patellofemoral pain syndrome (PFPS).
Materials and Methods: This designed study will involve 60 patients with PFP syndrome. Eligible subjects will be divided randomly into control (physical therapy), physical therapy plus active LLL, and physical therapy plus placebo laser. The physical therapy program will be exactly the same for all groups including exercise and education for ten sessions, every other day. The LLL group will receive 808 nm, 200 mW, 4 J Ga-Al-As laser over 5 points for 20 seconds per point. The laser will be deactivated in placebo group, and for the control group, the laser will not be used. The outcomes include pain and function, which will be measured using visual analogue scale (VAS), the Persian version of the Kujala patellofemoral questionnaire, and the step down test. Following Shapiro-Wilk test, the paired t and one-way ANOVA tests, if data distribution followed normal distribution, or the Kruskal-Wallis and Mann Whitney tests, if data distribution did not follow normal distribution, will be administered at the significance level of less than 0.05.
Conclusion: Therapeutic exercises is the treatment of choice for PFP syndrome. LLL is a commonly favorable modality prescribed as a part of physical therapy program for musculoskeletal disorders. However, the effect of laser in subjects with PFPS has not been thoroughly investigated. In designed study, it will be examined whether adding LLL to standard physical therapy has a clinical benefit in subjects with PFPS.
Keywords: Low-level laser therapy, Patellofemoral pain syndrome, Pain, Function
Journal of Resaerch in Rehabiliation Sciences, Sep 10, 2006
Introduction: Myocardial infarction and coronary heart diseases are major causes of mortality and... more Introduction: Myocardial infarction and coronary heart diseases are major causes of mortality and disability before reaching old age. High expenses of treatment and rehabilitation in these diseases and also economic loss due to productivity damages clearly confirm the importance of preventing such diseases. Heart disease has too many risk factors among which sedentary life style is the most important one. Epidemiological studies suggest that acute heavy physical exercise especially in sedentary people increases the risk of cardiovascular events. In contrast, there are fewer risks in athletes or people who exercise habitually during the day. The aim of this study was to identify the effect of aerobic training on the cardiovascular response of healthy young men. Methods: Sixteen non-athlete healthy young men aged 20 to 30 without any familial history of cardiovascular problems were studied. Ten participants were randomly selected and involved in an aerobic training program on ergometer cycle, 3 times a week, for a period of two months. Each session continued for 30 minutes; consisting of 1 minute warm up, 15 minutes aerobic exercise, 8 minutes active recovery and 5 minutes passive recovery. The other 6 volunteers form the control group did not take part in any exercise during these 8 weeks. Cardiovascular response of all participants was evaluated before and after the training period by means of Bruce test. Results: Before starting the program, there was no significant difference between experiment and control groups based on Bruce test parameters including speed, slope and energy expenditure (METS). After 8 weeks aerobic training, there were significant increases in Bruce parameters of the experiment group in comparison to pre training data and to the control group. Similar changes were observed in ergometer workload which was necessary for achieving and maintaining threshold heart rate for 10 minutes, the distance (Km) and the energy (Kcal). Conclusion: Aerobic training improves people’s performance due to its effects on cardiovascular system. These effects were evaluated with Bruce test as an index of VO2MAX. Key words: Cardiovascular function; Bruce test; Aerobic training, Cycle ergometer.
Journal of Research in Rehabilitation Sciences, Oct 7, 2018
Introduction: Osteoarthritis is the most common type of joint disorder. The present study compare... more Introduction: Osteoarthritis is the most common type of joint disorder. The present study compared the effects of continuous and intermittent physiotherapy on the pain and function of the individuals with moderate knee osteoarthritis.
Materials and Methods: This randomized clinical trial study included 20 patients with moderate knee osteoarthritis randomly assigned into continuous and intermittent physiotherapy groups. The intervention was exactly the same for both groups including 10 sessions of conventional physical therapy. The treatment frequency was 6 and 3 sessions per week for continuous and intermittent groups, respectively. Using Knee injury and Osteoarthritis Outcome Score (KOOS) and Intermittent and Constant Osteoarthritis Pain (ICOAP) questioners, 6-minute-walking test, timed get up and go test, pain based on visual analogue scale (VAS), and function were assessed before, after 10 sessions, and after one month of follow up. The outcome was analyzed using independent t-test and, repeated measures ANOVA.
Results: Prior to the study, there was no significant difference between groups (P > 0.05). At the end of the 10th treatment session (P = 0.048), and after 1 month of follow up (P = 0.030), only the daily activity subscale of the KOOS questionnaire was significantly less in the continuous group. The records of 6-minute-walk test (P = 0.046), timed get up and go test (P = 0.040), continuous pain (P = 0.006), symptoms (P = 0.020), pain (P = 0.003), and quality of life (P = 0.010) subclasses of KOOS improved significantly in continuous group. After one month of follow up, daily activity subclass and pain based on VAS score were significantly better than baseline records (P = 0.002). In intermittent group, pain based on VAS score (P = 0.002) and continuous pain (P = 0.030) improved significantly after 10th session and follow up period).
Conclusion: It seems that the frequency of the treatment sessions has no significant effect on the treatment results in short term. Thus, the physiotherapist may take the subject's preference and their time limitations for scheduling the sessions. Continuous intervention may probably be the better choice to reach better results while intermittent protocol may result in more lasting effects
Keywords: Osteoarthritis of knee; Pain; Functional performance; Physiotherapy (Techniques)
Journal of Research in Rehabilitation Sciences, Aug 6, 2018
Introduction: The sense of force is one of the three main components of proprioception, associate... more Introduction: The sense of force is one of the three main components of proprioception, associated with the realization of the force within the muscles during contraction. The purpose of this study was to investigate the static force sense of the knee flexor muscles after reconstruction of the anterior cruciate ligament (ACL) in comparison to healthy person's knee.
Materials and Methods: This cross-sectional study was carried out on 32 non-athletic men aged 19-40 years who were assigned into two groups of 16 participants purposefully, ACL reconstruction and healthy. Using a Biodex machine 3.0, maximum voluntary isometric contraction of hamstring muscles was measured in 30°, 60°, and 90° angles in a random order. Then, 20% and 60% of maximum muscle contraction were calculated for each subject. The participants were requested to produce 20% and 60% contraction force randomly in aforementioned angles with and without visual feedback. This way the difference between subject’ performance with and without visual feedback was calculated. The average of static force sense and the maximum voluntary isometric contraction (MVIC) were compared between the groups using Mann-Whitney U test. Using the Kendall's tau-b Correlation Coefficient, the correlation between MIVC and mean error of static force sense was determined.
Results: There was no statistically significant difference between the groups in the term of average error of knee flexor static force sense in 30°, 60°, and 90° angles with target forces of 20% and 60% (P < 0.05). Moreover, the average error of flexor static force sense in 30°, 60°, and 90° angles and the maximum voluntary isometric contraction of knee flexor were not significantly correlated in either group (r ≤ 0.82, P > 0.05)
Conclusion: It seems that the static force sense of knee flexor muscles of the knee will be similar to healthy subjects, 6 months after ACL reconstruction surgery.
Keywords: Static force sense; Flexor muscles of knee; Anterior cruciate ligament reconstruction
McGill tests are popular and practical clinical tests for evaluating the isometric endurance of c... more McGill tests are popular and practical clinical tests for evaluating the isometric endurance of core muscles. Previous studies have reported the mean or maximum rate of the McGill tests from one to three times of Mc Gill tests. Objective: To assess the number of repetitions of the McGill tests to reliably determine core muscle endurance in subjects with and without nonspecific low back pain. Methods: The participants were 50 (24 males and 26 females) sedentary subjects with and without chronic nonspecific low back pain. Isometric core muscle endurance of the trunk flexion, extension and lateral flexion (right and left) was measured using the McGill tests. The order of the test was set randomly and each test was repeated three times with 5-minute rest intervals. The subjects were recruited from state and private companies and organizations and were purposefully assigned into low back pain and without low back Pain group. In each test, three trial scores, maximal score and mean score were reported. The frequency of reporting maximal score in first, second and third trial was determined and compared within groups using McNemar test and between groups using Mann-Whitney U test. Results: For all Mc Gill test, the maximum score trials was significantly greater than the mean score in both groups (P≤ 0.001). For trunk flexion endurance, the probability of obtaining the maximal score in the first couple of trials was up to 80% and 92%, 76% and 84% for the trunk extension endurance, 72% and 76% for right lateral flexion endurance and 92% and 76% for left lateral flexion endurance in LBP and WLBP subjects respectively. Conclusion: Two repetitions of McGill tests seem to be sufficient to detect core muscle endurance in subjects with and without chronic nonspecific low back pain.
Introduction and hypothesis: The aim of this study was to evaluate the psychometric properties of... more Introduction and hypothesis: The aim of this study was to evaluate the psychometric properties of the Persian version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) in patients with urinary tract dysfunction. Methods: After gaining permission from the International Consultation on Incontinence Modular Questionnaire (ICIQ) advisory board, the English Female Lower Urinary Tract Symptoms (FLUTS) questionnaire was translated into Persian and then translated back into English. One hundred fourteen women with pelvic floor dysfunction were asked to complete the Persian FLUTS and International Consultation on Incontinence Modular Questionnaire Overactive Bladder Questionnaire (ICIQ-OAB). The Persian FLUTS questionnaire was also readministered to 20 patients 2 weeks after their initial visit. Study data were analyzed using SPSS V16.0. To validate the translated questionnaire, we assayed content/face validity, internal consistency/reliability, and construct validity. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and the intraclass correlation coefficient (ICC) respectively. Results: The mean age of the patients was 48.8 years old, 84% were married, and 59% had at least one Caesarean. Except for very few missing data, there is no any ambiguity in the Persian version of the FLUTS questionnaire. The Cronbach’s alpha was 0.83, indicating a high internal consistency. Concerning criterion validity, correlation between the Persian FLUTS and the OAB was 0.77 (p<0.001). Conclusion: The initial testing of the Persian version of the FLUTS questionnaire demonstrates good internal consistency, content validity, and reliability. Keywords: Female Lower Urinary Tracts Symptoms; Validation; Persian; Questionnaire; Linguistics; Quality of life.
Iranian Quarterly Journal of Breast Disease, Feb 18, 2019
Introduction: Breast cancer is the most common cancer in women. Surgery is the main treatment, an... more Introduction: Breast cancer is the most common cancer in women. Surgery is the main treatment, and patients may experience some complications after surgery, including pain and shoulder function limitation. The severity of these complications is greater in modified radical mastectomy. In various studies, Kinesio Tape (KT) has been introduced as a supporting and complementary method in rehabilitation after surgeries. The aim of the present study was to compare the effects of a rehabilitation program with or without KT on shoulder pain and function after mastectomy in women with breast cancer. Methods: This study was a double-blind randomized clinical trial (RCT). In this study, 20 participants were randomly assigned to 2 groups. The intervention started the first day after surgery. One of the groups (n = 10) received therapeutic exercise program, and the other group (n = 10) received therapeutic exercise program as well as lymphatic correction with fan-shaped KT over a four-week period. KT was attached to the upper limb of the surgical side, the effects of the interventions were examined from two aspects of shoulder pain and function (based on the SPADI questionnaire). Results: The findings of the study indicated that both groups had significant improvements in pain and function after the four-week period of intervention. The improvement in shoulder function was significantly greater in the exercise + KT group (p < 0.05), although there was no significant difference between the two groups in shoulder pain (p > 0.05). Conclusion: The use of fan-shaped KT with therapeutic exercises is recommended for improving the shoulder function after a modified radical mastectomy.
Introduction: Forward head posture (FHP) is a common postural deviation
and chin tuck exercise ha... more Introduction: Forward head posture (FHP) is a common postural deviation and chin tuck exercise has been traditionally prescribed to manage this condition. On the other hand, turtle is one of the common exercises in tai chi. Although, recently the physiotherapists are more interested in including tai chi in exercise therapy, there is no study comparing the effect of chin tuck and turtle exercise. Aim: The aim of this study was comparison of chin tuck and turtle exercise effects on FHP. Material and methods: 46 asymptomatic FHP subjects aged 22.45 ± 1.70 years were randomly assigned into two groups of chin tuck and turtle exercise. Cervical curve was measured before and after a 6-week intervention. The measures were compared by Mann-Whitney U test, paired sample T test and Wilcoxon. Results: 40 subjects completed the study. Within group analysis showed significant cervical curve increase. Interestingly, between group analysis showed equal cervical curve improvement. Conclusions: Both chin tuck and turtle exercises improved the cervical curve in subjects with FHP. However, the effects of these two approaches seemed to be the same. Keywords: Forward head posture; Chin tuck; Turtle exercise
[Purpose] The purpose of this review was to summarize available methods and equipment which are a... more [Purpose] The purpose of this review was to summarize available methods and equipment which are administered to evaluate the balance in anterior cruciate ligament reconstruction. [Subjects and Methods] A literature search was performed and reviewed using the narrative approach. This study reviewed English articles concerning balance assessment methods in anterior cruciate ligament reconstruction subjects from 1985 to 2015 using the following key words: Anterior Cruciate Ligament Injury, Anterior Cruciate Ligament Reconstruction, Postural Control, Equilibrium , Balance and Stability. [Results] This review included 44 studies out of 117 initially retrieved articles. These articles were discussed in balance measurement procedure without comparing the effect of various surgical, medical or rehabilitation approaches. [Conclusion] Biodex and EquiTest, functional dynamic tests are of choice in the evaluation and tracking of anterior cruciate ligament reconstruction subjects. Force plate parameters provide information regarding strategies of static postural control and is not sensitive enough to challenge postural control system in physical activities.
Introduction: Osteoarthritis is one of the most common musculoskeletal disorders. Analyzing the e... more Introduction: Osteoarthritis is one of the most common musculoskeletal disorders. Analyzing the energy expenditure in people who suffer from musculoskeletal disorders provides objective evidence to measure individual’s disability and the effect of therapeutic interventions. Present study investigated the effect of various severities of knee osteoarthritis on mechanical energy of lower extremities.
Materials and Methods: 48 women aged between 40-70 years were purposefully divided into mild, moderate and sever osteoarthritis and healthy control group according to simple X-ray features of their knee joints. The participants walked at their convenient self-selected speed to collect five clean trials. The data were recorded using a motion analysis system and a 3-dimentional model of lower extremity segments was developed from motion capture data using visual 3-D software. Mechanical energy of lower extremity was calculated using this model.
Results: The study groups were significantly different in age (P ≤ 0.001) and walking speed (P ≤ 0.001). One-way analysis of variances (ANOVA) and post-hoc Tukey test revealed that there was significant difference between the study groups regarding mechanical energy. However, univariate general linear models with adjustments to age and to walking speed were developed; in addition, a bivariate general linear model was adjusted to age and walking speed. All the models confirmed that the differences were not imposed by the severity of knee osteoarthritis.
Conclusion: It seems that increase in mechanical energy of lower extremity in subjects with knee osteoarthritis intensifies with the progression of the disease; this is not a direct effect of the level of joint deterioration but is an indirect effect of older age and lower walking speed in subjects suffering from more advanced knee osteoarthritis.
Keywords: Knee osteoarthritis; Severity; Gait analysis; Mechanical energy
Background: Active exercise therapy is recommended as an efficient conservative approach to impro... more Background: Active exercise therapy is recommended as an efficient conservative approach to improve functional disability in subjects suffering from nonspecific low back pains. The aim of this study is comparing the effects of standard rehabilitation protocol with without exercise therapy in acute nonspecific low back pain.
Methods: 43 volunteers with acute nonspecific low back pain were randomly assigned into experimental group (spinal manipulation plus active exercise, n=21) and control group (spinal manipulation n = 22).After signing formal consent, demographic information was obtained. Immediate analgesic effect was reported measuring pain intensity (VAS) before and immediately after the manipulation in either group. Pain intensity and disability score according to Oswestry Disability Index were reported at the beginning, after the 10th therapeutic session, and at one month follow-up.
Results: Forty subjects completed the study. Pain and functional disability score decreases significantly over time in both groups (P<0.001), although intergroup difference were not significant for pain severity (P=0.24) and functional disability score (P=0.42). Also, in this study, the results showed that the pain after a session of manipulation (P <0.001) was significantly lower than before treatment.
Conclusion: It seems that in spite of immediate significant improvement in pain and functional disability following supplementary exercise therapy protocol, it is not significantly different from manipulation. More studies are recommended to investigate the effect of various exercise protocols in different types of low back pain.
Keywords: Acute low back pain; spinal manipulation; active exercise; pain; functional disability.
Background: Disk herniation is the most common cause of radiating LBP in subjects under 60 years ... more Background: Disk herniation is the most common cause of radiating LBP in subjects under 60 years of age. The present study aims to compare the effect of dry needling and a standard conservative approach on the pain and function in subjects with discogenic radiating low back pain. Materials and Methods: Fifty-eight subjects with discogenic radicular low back pain were screened and randomized into control (Standard physical therapy, N = 29) and experimental group (Standard physical therapy & Dry needling, N = 29). Radiating pain intensity and disability were measured using Visual Analogue Scale and Oswestry Disability indices at baseline, at the end of treatment and two months after the last intervention session. the changes in pain intensity and disability were studied using a 3×2 repeated measures analysis of variance considering time as the within-subject factor and group as the between-subject. Results: Pain intensity and disability scores decreased significantly in both experimental and control groups (experimental group: VAS=37.24, ODI=28.48, control group: VAS=45.5, ODI=32.96), following the intervention. The change continued during the follow-up period (P<0.001 for all comparisons). Pain and disability improvement, however, were more significant in experimental group, both in post intervention (experimental group: VAS=25.17, ODI=22.17, control group: VAS=42.4, ODI=30.27) (P=0.05 and P=0.03, respectively) and in follow-up measures (P=0.006 and P=0.002, respectively).Conclusions: Both intervention strategies seem to significantly improve pain and disability immediately following intervention, where the improvement continued during two months after the last active intervention. Therefore, supplementary DN application may enhance the effect of the standard intervention considerably.
Key Words: Low Back Pain, Discogenic, Dry needling.
Abstract
Objective: The present study aimed to translate and evaluate the reliability and validi... more Abstract Objective: The present study aimed to translate and evaluate the reliability and validity of the Persian version of the 11-item Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in Iranian subjects with Knee Osteoarthritis (KOA). Materials and Methods: The ICOAP questionnaire was translated according to the Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. The procedure consisted of forward and backward translation, as well as the assessment of the psychometric properties of the Persian version of the questionnaire. A sample of 230 subjects with KOA was asked to complete the Persian versions of ICOAP and Knee injury and Osteoarthritis Outcome Score (KOOS). The ICOAP was readministered to forty subjects five days after the first visit. Test–retest reliability was assessed using Intraclass Correlation Coefficient (ICC), and internal consistency was assessed by Cronbach's alpha and item-total correlation. The correlation between ICOAP and KOOS was determined using Spearman's correlation coefficient. Result: Subjects found the Persian-version of the ICOAP to be clear, simple, and unambiguous, confirming its face validity. Spearman correlations between ICOAP total and subscale scores with KOOS scores were between 0.5 and 0.7, confirming construct validity. Cronbach's alpha, used to assess internal consistency, was 0.89, 0.93, and 0.92 for constant pain, intermittent pain, and total pain scores, respectively. The ICC was 0.90 for constant pain and 0.91 for the intermittent pain and total pain score. Conclusion: The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA. Keywords: Intermittent and constant osteoarthritis pain measure, knee osteoarthritis, pain, pain questionnaire, Persian, reliability, validity DOI: 10.4103/1735-9066.185595
The normal healthy tissue is the one that along with structurally specialized characteristics may... more The normal healthy tissue is the one that along with structurally specialized characteristics may function efficiently in its specific mechanical environment in the body. With regard to this fact, in last two decades, research institutes have allocated considerable financial and scientific resources on the study of the biomechanical properties of various tissues worldwide.
The biomechanical factors regulate and propel growth, development, survival, degeneration, healing and repair of the tissues significantly. Advancements in understanding cell and tissue conscious and their adaptations with mechanical environment has been recently immixed with in vivo regenerative strategies adopted by injured or degenerated tissues and in vitro production of live tissue replacements.
Undoubtedly, precise understanding of that various aspects of tissue biomechanical behavior is essential to improve clinical therapeutics based on principals of tissue engineering and regenerative medicine in a variety of tissues including musculoskeletal, cardiovascular, craniofascial, urinary tract, skin and nervous systems.
On the other hand, biomechanical models are the keystone of producing regenerated tissue of high strength and endurance although there are many unsolved problems especially concerning function of tissues with complicated high demand mechanical environment.
The cases which full replacement approaches (such as joint replacement, prosthesis, etc.) afford unfavorable clinical outcome heighten the value of Regenerative Medicine approaches. In this context, the main challenge is to select the right combination of scafolds, cells, soluble environmental regulators and amplifiers of cell performance, growth and differentiation in each specific disease and disability.
In various musculoskeletal connective tissues, in vivo tissue regeneration (facilitating tissue healing) is more practical than replacing the engineered tissue. Many physical modalities and exercise interventions commonly administered in physical therapy are naturally capable of enhancing tissue resistance against destructive forces and may even expedite the process of tissue repair. The effect of these interventions may be measured by studying tissue and cell biomechanical models to upgrade the evidence bases of their administration.
Some clinical interventions change the function or titer of the regulatory proteins such as growth factors; others directly alter the function and survival of the specialized cells of the body. Understanding these effects help the therapists to arrange a logical and realistic management protocol to achieve the intended purpose. For this purpose the researchers analyze the biomechanical behavior of cells and tissues by means of a variety of biomechanical models from computer simulations to cadaver models and even in situ artificially produced tissues.
Keywords: biomechanics, survival, stress
Background: Knee osteoarthritis (KOA) is one of the most common joint diseases in elderly individ... more Background: Knee osteoarthritis (KOA) is one of the most common joint diseases in elderly individuals (1). Various grades of KOA lead to change in gait pattern by different compensatory mechanisms. Spatiotemporal parameters of gait can be influenced by KOA maybe as a strategy to reduce pain and functional adaptation. Most researches are agreed on
reduction of gait stride length (2-5) and cadence (6, 7) in KOA patients in comparison to control normal groups. But there is controversy about them. The present study will discuss the
effect of KOA severity on gait spatiotemporal parameters.
Aim: To determine how KOA severity will affect stride length, walking speed and cadence.
Materials and Methods: Thirty four women aged between 40-70 years diagnosed with medial KOA were systematically divided in to three groups of mild, moderate and severe OA and a group of normal subjects. KOA severity was classified according to the (K–L scale) using atlas of the Osteoarthritis Research Society International (OARSI). Data collected using the motion analysis system in the Musculoskeletal Research Center of Faculty of
Rehabilitation Sciences, Isfahan University of Medical Sciences. The subjects were asked to walk with a comfortable self-selected speed along the 10-meter walking path to collect five successful trials and sampled at frequency of 120 Hz. The normality of all parameters was evaluated by Shapiro Wilk test and parametric test used for statistical evaluation to determined difference between the mean values of the parameters between groups by SPSS software (SPSS, version 16, SPSS Inc. Chicago, IL, USA)
Results: The ANOVA results of spatiotemporal parameters and post hoc analysis shown "stride length" is the only parameter that is significantly different in normal groups with all of the OA subjects (P<0.05). Walking speed in healthy people was significantly more than moderate and severe KOA groups (P=0.003, P= 0.00 respectively) however, difference to
mild KOA was not significant (P=0.81). Speed was not different between mild and moderate KOA groups (P=.41), but there was a significant difference in mild and severe OA subjects (P=0.007). The cadence was significantly different only between healthy persons and severe osteoarthritis subjects (P=.005).
Conclusions and clinical implication: It seems that "stride-length" is the key parameter to distinguish normal subjects from KOA client even in early stages. We recommend practitioners to observe patient’s apparent gait pattern with more focus on their stride length in clinics
References:
1. Zhang. et al. Clinics in geriatric medicine (2010).
2. Al-Zahrani. et al. Disability and rehabilitation (2002)
3. Esrafilian. et al. Rheumatology international (2013).
4. Gok. et al. Acta orthopaedica Scandinavica (2002).
5. Miller. et al. Journal of biomechanical engineering (2013).
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Background: Knee osteoarthritis (KOA) is a major common form of osteoarthritis (1) with higher ra... more Background: Knee osteoarthritis (KOA) is a major common form of osteoarthritis (1) with higher ratio in women than men (2). Gait alterations are of the most common complications of KOA and may lead to functional dependency and work disability (3).
Aim: The purpose of this study is to review the gait differences between osteoarthritic patients and healthy individuals.
Materials and Methods: In this study we have searched from April 2012 in Pub Med data base for relevant studies published in two recent decades from 1990 until now. The key words used in this article include "knee osteoarthritis" AND "gait" in combination with "severity" and "knee adduction moment". Abstracts articles that analyzed Kallgren and Lawrence progression in examination of KOA and evaluated the kinetic and kinematic parameters from 3D gait analysis, were eligible for inclusion.
Results: More than 100 articles are published about KOA severity and changes of knee adduction moment in osteoarthritic patients' gait. The major differences in kinetic and kinematic parameters between osteoarthritis patients and healthy subjects are in coronal plane (4). Most of the researchers believe that External knee adduction moment is a valid index for medial knee osteoarthritis(5) and increasing of this parameter has a correlation to disease progression(6) but some of them have shown that this correlation is only in severe degrees not in low grades. It seems that knee adduction angular impulse is more sensitive in mild osteoarthritis (7, 8).
Conclusion: Gait changes are the most common variation of knee osteoarthritis. The changes that most of the researches agreed with them are increase of KAM. There is no consensus about which factors have the greatest impact on disease progression yet and there is need for further studies.
References:
1. Sims EL. et al. Journal of women & aging (2009).
2. Zhang Y. et al. Clinics in geriatric medicine (2010).
3. Broström EW. et al. Best Practice & Research Clinical Rheumatology (2012).
4. Mundermann A. et al. Arthritis and rheumatism (2005).
5. Birmingham TB. et al. Arthritis and rheumatism (2007).
6. Barrios JA. et al. Clinical biomechanics (Bristol, Avon) (2009).
7. Kean CO. et al. Clinical biomechanics (Bristol, Avon) (2012).
8. Thorp LE. et al. Arthritis and rheumatism (2006).
Purpose
Any articular motion results in different compressive and shear loads on cartilage; cart... more Purpose
Any articular motion results in different compressive and shear loads on cartilage; cartilage is an avascular and anervous tissue therefore, cartilage wear and tear proceeds regeneration and results in cartilage degeneration phenomenon known as oseteoarthritis (OA).
The question is that can therapeutic pulsed ultrasound improve tibial cartilage strength if LIPUS is applied according to guidelines for physiotherapy clinical practice? The importance of tibial articular cartilage is that degenerative process in the knee joint is mor sever in load bearing surfaces of tibial plateaues
Methods
Total of 15 male white skeletally mature dutch rabbits weighting 1.5 to 2 kg divided into 3 accurately matched group. The ACL were cut in left knee and the rabbits were housed for 9 weeks afterward. On 9th week following surgery, the Control group was scarified, the LIPUS group received LIPUS every other day for 10 sessions according to clinical guidelines for LIUPS application in rehabilitation of OA patients and NonLIUPS group undergo no intervention for the same period. Biomechanical test protocol was accurately adopted from a previous study on experimental knee joint hemarthrosis[10]. the ex vivo biphasic viscoelastic unconfined stress–relaxation test was performed at the central point of the medial plateau of the tibia using a 100N load cell and impervious plane-ended indenter of 1.46 mm in diameter (Zwick Universal Testing Machine; Zwick 2.5/ Roell GmbH & Co., Ulm, Germany)[4,11,12].
To ensure perfect contact between cartilage and indenter, 0.01N preload applied. The main test conducted applying 0.1 mm displacement at constant rate of 0.5 mm/min. This strain sustained for 1000 seconds to obtain equilibrium status of cartilage. Then another stress-strain test was done up to maximum stress of 6 MPa [5-7]. All the data were processed in MATLAB (R2009a; the Math-Works, Inc., Natick, MA, USA). Maximal force as maximal load in the requested displacement point (0.1 mm) and equilibrium force as recorded load after equilibrium status (after 1000 s) were extracted from these data
Cartilage thickness measured after indentation test using needle probing compression test with a 0.12 mm needle that compressed cartilage at constant rate of 0.5 mm/min[10]. Reliability of the thickness measurements was evaluated for the each sample by measuring thickness in 2-3 points away from the indentation contact. During the tests the sample was kept moist by spraying normal saline [11].
Using SPSS 17.0 (SPSS Inc., Chicago, IL, USA) Kruskal wallis test used with alpha=0.05. To determine which 2 groups are significantly different Mann-Withney test was used.
Results
The animals’ weight at the start day of study was not significantly different showing the groups were similar in basic characteristics.
The macroscopic & histological findings in control group confirmed successful induction of OA like changes in left knee of samples 9 weeks following ACLT. Following 10 sessions of LIPUS therapy, there was significantly more synovial fluid inside the joint and the synovial membrane was extremely hypertrophic. In addition, the histological sections showed improvement in OA characteristics toward normal cartilage.
Cronbach's alpha for thickness in each group was ≥ 0.7 that is a good reliability. LIUPS prevented further deterioration of cartilage thickness however no significant differences were recorded in either biomechanical parameters. Elastic Modulus in LIPUS group was significantly more than NounLIPUS group (P=0.043)
Conclusion
It seems that 10 sessions of LIPUS with the clinical characteristics suggested for OA patients in clinical guidelines can effectively save cartilage thickness from further deteriorations but it is not enough for improving biomechanical characteristics of the articular cartilage. Insignificant improvement of all biomechanical properties of articular cartilage can be of clinical value especially with regard to maximal force and elastic modulus and can imply that may be continuing suggested therapeutic procedure for further duration can improve functional properties of cartilage along with saving its material volume. This can be because of facilitation of cellular repair due to mechanical stress induced by ultrasound[1-3,8,9]
"Abstract:
Objective: Myocardial Infarction (MI) is the major cause of death in the industrial c... more "Abstract:
Objective: Myocardial Infarction (MI) is the major cause of death in the industrial countries. In addition to the clinical and economic burden, MI affects health related quality of life. Original version of the SAQ was developed cross-sectionally and may be used for measuring clinically important dimensions of coronary artery disease. However, the Persian version has not been validated for patients with Myocardial Infarction patients.
Materials and Methods: After multi-stage translating based on Manufacturers Alliance for Productivity and Innovation protocol, the reliability examined on 130 patients with MI. The SF-36 was used to assess the validity of the SAQ. To assess test-retest reliability, the patients refilled the SAQ after 5 days. Reliability of the SAQ was assessed by Cronbach’s Alpha and the Intra-class Correlation Coefficient. Validity was determined using Pearson correlation matrix for the subclasses and the total scores (ρ).
Results: Internal consistency was between 0/58 and 0/89 ICC over a 5-day period exceeded 0.6 in all domains. The weighted kappa ranged from 0.492 to 0.853.
Conclusion: Reliability and validity of the Persian version of the SAQ is acceptable and it seems that this questionnaire is a useful tool in assessing health related quality of life in Persian speaking patients with myocardial infarction suffering from angina.
Keywords: Seattle Angina Questionnaire (SAQ), myocardial infarction, health related quality of life, reliability, validity."
Coronary Heart Disease (CHD) is the most common causes of the premature deaths in western societi... more Coronary Heart Disease (CHD) is the most common causes of the premature deaths in western societies. Sudden and acute chest pain, known as angina, is one of the common symptoms of myocardial infarction.
Health Related Quality of Life (HRQL) instruments include subjective and objective assessments therefore; they are more proficient measures to determine the efficiency of prevention and treatment strategies in CHD. In our country, researches in quality of Life (QoL) are restricted as a result of the lack of sensitive tools in Persian language. There are a variety of outcome measure to study the quality of life in cardiac and angina patients.
Short Form-36 and Sickness Impact Profile are two generic instruments commonly used for HRQL assessment in MI patients. There are also disease specific questionnaires for this group of patients including MacNew, Rose Angina and Seattle Angina Questionnaires (SAQ). SAQ is a 19 item self-administered commonly used measure of HRQL for patients suffering angina in Europe and USA. It measures physical activity, angina stability and frequency, treatment satisfaction and disease perception. In addition to brevity, SAQ measures a range of functional status directly resulted from CAD. SAQ is more responsiveness than MacNew 12 months following coronary artery disease in terms of angina frequency and disease perception. In 2010, the Patient-Reported Outcome Measures Group admitted SAQ assesses more physical symptoms and less emotional and cognitive changes. The Persian translation of this valuable outcome measure has been recently validated by our research group at Isfahan University of Medical Sciences.
Background: Gait adaptations in persons with anterior cruciate ligament (ACL) injuries have been
... more Background: Gait adaptations in persons with anterior cruciate ligament (ACL) injuries have been
debated. Many studies have examined gait analysis to compare knee joint torque during activities of daily
living.
Methods: We performed a systematic review of the literature for published papers that reported saggital
plane knee joint kinetics and kinematics in ACL deficient individuals. Our objective was to explore the gait
adaptations in subjects with Anterior Cruciate Ligament Deficiency (ACLD)
Results: we found 35 articles with the following keywords: ACL, ACL Deficiency, ACL Injury, Moment,
Torque, Quadriceps and Quadriceps Avoidance Gait, 18 of which were excluded because of scarcity of
relevance.
Discussion: Literature suggests that ACLD patients tend to adopt different strategies after ACL injury,
such as Quadriceps Avoidance Gait, Hamstring Facilitation and Muscle co-contraction
"Introduction
Anterior cruciate ligament transection (ACLT) is a recognized method to induce ost... more "Introduction
Anterior cruciate ligament transection (ACLT) is a recognized method to induce osteoarthritis (OA) in animal models1-3. ACLT changes the loading patterns of the knee joint, leading to changes in the material properties of articular cartilage. However, it is not known how the biomechanical properties and orientation of the collagen fibers of cartilage change at different sites of the knee joint in early OA. The aim of this study was to investigate the equilibrium and dynamic mechanical properties and the collagen matrix organization of articular cartilage in the lapine knee joint at a very early stage of OA, created experimentally by ACLT.
Methods
SAMPLES: Thirteen skeletally mature New Zealand white rabbits were used. Unilateral ACLT was performed in 10 rabbits. Contralateral (C-L) joints were also prepared for the analysis and the non-transected joints were used as a control group (CTRL). Animals were sacrificed at four weeks after ACLT. Femoral groove (FG), medial and lateral femoral condyles (FC) and tibial plateaus (TP) were harvested and used for analysis. All procedures were approved by the Animal Ethics committee at the University of Calgary.
BIOMECHANICAL TESTING: Loading was applied using indentation testing (indenter dia. 1 mm). Pre-conditioning was done using a 2 % cyclic strain and stress-relaxation protocol using a ramp rate of 100 %/s (3 x 5 % step, 15 min relaxation time). Then, a sinusoidal load was applied (1 Hz, 4 cycles). The equilibrium (eq) elastic modulus was calculated from the slope of the equilibrium stress-strain curve and the dynamic (dyn) elastic modulus was determined from the dynamic test4. Poisson's ratios were 0.1 and 0.5 for calculation of the equilibrium and dynamic modulus, respectively.
POLARIZED MICROSCOPY: Polarized microscopy (PLM) (Leitz Ortholux II POL -polarized microscope, Leitz, Wetzlar, Germany) was used to analyze collagen orientation angles5. The transversally averaged depth-wise profiles of all samples were interpolated to 100 points, where the collagen fibers parallel to the cartilage surface indicated an angle of 0° (superficial zone).
STATISTICAL TESTS: A linear mixed model (ver. 19, SPSS Inc., Chicago, IL) was chosen for statistical comparisons between groups. Sample type (FG, FC, TP) was set as a fixed variable and elastic moduli and collagen orientation within the animal were coded as a random variable. Restricted maximum likelihood (REML) estimation was used. Furthermore, estimated means for the different groups (ACLT, C-L, CTRL) were obtained from the fitted model, and the main effects between the groups were compared. 95% confidence intervals for differences with Bonferroni corrected adjustment are presented.
Results
ELASTIC MODULI: Eq and dyn moduli varied as function of location (Tables 1&2). The eq modulus was significantly lower in ACLT than C-L for FC and was lower in ACLT compared to CTRL group knees for med. FC. The dyn moduli in the lateral and medial FCs of the ACLT and C-L groups were significantly lower than those in the CTRL group. Moreover, in the medial FC the ACLT group cartilage exhibited significantly lower dyn moduli than the C-L group cartilage. In TPs, the only significant difference was observed in the lateral side with the eq modulus being significantly lower in the ACLT than in the CTRL group. No significant differences in the moduli were observed in the FG.
COLLAGEN ORIENTATION: As a result of the ACLT, significant changes in the collagen orientation angles were noticed in lateral FC, medial TP and FG (Fig. 1). Alterations in the collagen orientation angles were concentrated in the superficial and middle zones. Specifically, the collagen fibrils were more disorganized, i.e., less parallel to the surface in the ACLT and C-L groups than in the CTRL group. In the lateral FC, the ACLT cartilage also showed more disorganized collagen fibrils than the C-L group cartilage.
Discussion
Site dependent variations in the eq and dyn elastic modulus and in the collagen orientation angle were observed in normal and ACL transected rabbit knee joints. Specifically, FCs were significantly affected by the transection, as noticed both in the moduli and fibril orientation, while the effect in TP was smaller. Only the collagen orientation was altered in FG cartilage. Interestingly, the dynamic modulus and collagen orientation angle of lateral FC cartilage in the C-L group differed significantly from those in the CTRL group. These results suggest that the increased instability in the knee joint caused by ACLT may have a larger effect on the FC cartilage compared to the FG.
As a result of ACLT, the most severe changes in the tissue moduli were detected in FCs. Specifically in the lateral FC, the dynamic modulus was reduced simultaneously with the superficial collagen fibrillation. This is consistent with earlier findings suggesting that the collagen fibril network primarily controls the dynamic and tensile properties of cartilage6. The result also suggests that the lateral FC of rabbits is prone to alterations in joint loading. However, the dynamic modulus and collagen orientation angle of cartilage were unaffected in the lateral TP, suggesting that this site can withstand abnormal loading easily. It may be that 4 weeks is still such a short time that some sites in the knee can withstand altered loading after ACL transection, while some sites begin to deteriorate more rapidly.
Significance
The present study provides novel information on the site-dependent mechanical and structural changes in cartilage properties in early experimental OA. These findings may help to optimize strategies for the prevention of OA and provide new ways for predicting the time course of OA progression.
Acknowledgements
Finnish Cultural Foundation, Academy of Finland, Kuopio University Hospital, European Research Council, Sigrid Juselius Foundation. AIHS, CIHR
References
1. Vignon E et. al., J.Rheumatol. 1984;11:202-7; 2. Stoop R et. al., Osteoarthritis Cartilage 2001;9:308-15; 3. Sah RL et. al., J.Orthop.Res. 1997;15:197-203. 4. Hayes WC et.al., J.Biomech. 1972;5:541-51; 5. Rieppo J et. al., Microsc.Res.Tech. 2008;71:279-87; 6. Korhonen RK et. al., J.Biomech. 2003;36:1373-9"
19th Annual Meeting of European Orthopedics Research Society
"Introduction: The anterior cruciate ligament (ACL) is one of the four major knee ligaments. This... more "Introduction: The anterior cruciate ligament (ACL) is one of the four major knee ligaments. This ligament is very strong although ACL injuries are very common specially in young and highly active
people. Injuries range from mild, like a partial even unvisible tear to severe complete rupture of the ligament or avulsion fracture of the ligament insertion site on the bone. The injured ACL can not control knee movement specially tibial anterior glide therefore, knee bones rub against each other in an abnormal way. The induced abnormal bone sliding can damage the cartilage, menisci and even other ligaments around the knee and definitely results in osteoarthritis in long term. Present study focused on the short term effect of partial ACL injury on the cartilage structure and function and knee joint friction coefficient in rabbit model.
Methods: Total of 30 male white skeletally mature dutch rabbits
weighting 1.5 to 2 kg devided in 2 accurately matched group. The
anterior bundle of ACL were cut in left knee of 15 rabbits to simulate ACL injury. Before and following the operation, the rabbits housed seperatedly in cages where they can move easily and have free access to food and water. At the same time control group undergo no intervention. Each of these groups devided into 3 subgroups of 5 rabbits according to the duration of observation (Control group consisted of Control, 62 control and 85 control - Surgery group consisted of 42 surgery, 62 surgery and 85 surgery).
Friction coefficient of whole knee complex measured in vitro by the Friction Tester that was designed and created in the university
biomechanic lab. Skin, muscle and all soft tissues around the knee joint were removed. Joint capsul with it’s tendon and ligament attachments saved intact. After friction test, joint capsul, menisci and all soft tissue around the knee joint were removed. Tibia and femor seperated and prepared for stress-relaxation test by Zwick Universal Testing Machine; Zwick / Roell GmbH & Co., Ulm, Germany. Following biomechanical test, samples were fixed in formalin 10% for further histological analysis. Kruskal wallis test used to detect any difference between 6 subgroups with alpha=0.05 and Beta=0.8. To determine which 2 groups are significantly different Mann-Withney test was used. Results: Coefficient of friction of the knee joint was not significantly different in any surgery subgroup according to different control groups with no significant difference between 2 knees of the same animal. On the other hand significant differences between young modulus (P=0.047) and maximal force (P=0.027) of cartilage were recorded between different groups as shown in
Discussion: ACLT induces an acute inflammatory response. Right after inflammation submission and during subacute phase, changesin frictional properties of the knee joint are neglectable although change in articular surface loading pattern following ACLT affects cartilage biomechanical properties rapidly. It seems that articular cartilage is highly sensitive to articular loading pattern and significantly affected even when change in biorheology of joint because of ACLT induced inflammation is undetectable. These alterations can gradually lead to osteoarthritis. Cartilage detoriation soon after the intervention implies that rehabilitation intervention following ACL injury should be started as soon as possible to reduce the rate and extend of induced degeneration process.
Conclusion: These results affirmate the higher sensitivity of
cartilage biomechanical parameters rather than friction coeffitient for detection of deterioration process in joint following ACL transection."
Purpose: Articular cartilage is a specialized connective tissue covering articular surface in syn... more Purpose: Articular cartilage is a specialized connective tissue covering articular surface in synovial joints. According to the position of cartilage in these joints, any motion results in different compressive and shear loading on cartilage; cartilage healing is too slow. In abnormal situations, cartilage wear and tear can precede regeneration resulting in cartilage degeneration phenomenon known as oseteoarthritis (OA).
Variety of researches is running to identify OA characteristics and
compare the quality and duration of the effects of therapeutic strategies. On the other hand, experimental models using laboratory animals are especially There are different animal models to study OA however anterior cruciate ligament transaction (ACLT) is more common.
Low Power Laser Therapy (LPLT) is one of the common physical
modalities to relief pain. OA results in structural and functional changes in cartilage. The question is wheater LPLT can affect cartilage function or not? Present study focused on the short-term effects of LPLT on the bimoechanical properties of articular cartilage as an index of cartilage function in rabbit ACLT model.
Methods: Total of 15 male white skeletally mature Dutch rabbits
weighting 1.5 to 2 kg devided into 3 groups (85 Control, 85 Surgery and Laser). The anterior cruciate ligament (ACL) was cut in the left knee of rabbits in 85 Surgery and Laser groups. The rabbits were housed seperatedly in cages where they can move easily and have free access to food and water. 85 days (3 months) following the surgery theses rabbit were sacrificed. 85 Control group underwent no intervention during the same period.
LPLT started at the 62th day after surgery for 10 sessions, 3 days a week using Ga-Al-As pulse 810nm Laser (Physiolaser, RJ Laser, Germany). For biomechanical test, tibia and femur seperated and prepared for thickness measurement and stress-relaxation test by Zwick Universal Testing Machine; Zwick/Roell GmbH & Co., Ulm, Germany. Kruskal Wallis test used to detect any difference between groups with alpha = 0.05 and Beta = 0.95. To determine which two groups were significantly different the Mann-Withney test was used.
Results: Cartilage thickness of tibia and femur was not different while comparing groups (Table 1). On the other hand, significant differences between tibial cartilages were observed in different groups as shown in Figure 1. Maximal force in 85 control group was significantly less than 85 surgery and laser groups (P = 0.014 and P = 0.043 respectively). Same differences were detected in Young modulus (P = 0.014, P = 0.043 respectively).
The ACL is one of the four major knee ligaments. The injured ACL cannot control knee movement especially tibial anterior glide therefore, knee bones rub against each other in an abnormal way. The induced abnormal sliding can damage the cartilage, menisci and even other ligaments around the knee and eventually results in OA. ACLT changes the biomechanical properties of articular cartilage more than cartilage thickness although it seems that three months after ACLT, cartilage thickness is less than control group. On the other hand, in both femur and tibia cartilage seems to become thicker following LPLT; however, none of these changes is statictically significant. Apparently, destructive effects of ACLT are more pronounced on tibial cartilage. 12 weeks after ACLT, tibial cartilage strength and young modulus decreased significantly, although 10 seassions of LPT reversed
this process completely. Same trend was observed in femural cartilage but these changes were not statistically significant.
Conclusions: Following ACLT articular cartilage softens and its strength decreases. It seems that therapeutic laser can help cartilage to resume its original characteristics.
Uploads
Papers by Zahra Sadat Rezaeian
Methods. Search will be done in Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, the MOH Thesis, MOH Articles, Magiran, and SID. Google Scholar search engine will also be used. All types of Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation in English and Persian published prior
to September 2019 will be included. The articles recruiting 18 to 60 years old will be included. Considering PICO, the finally retrieved articles will be assessed qualitatively by CONSORT, STROBE, PEDro, NIH and CASP checklists. Changes in pain and function will be favorable.
Dissemination. The protocol presented in present paper will be used to summarize and qualify present literatures on conservative therapy for chronic non-specific low back pain with sacroiliac joint origin.
KEY WORDS: Rehabilitation; Physical Therapy; Pain; Function; Non-specific Chronic Low Back Pain; Sacroiliac Joint Dysfunction.
Hypothesis/purpose. The aim of present study was to compare the effect of facilitatory gastrocnemius taping on dynamic balance and muscle activity during Y-balance test in healthy middle-age men.
Study design. Double-blinded (participant, assessor) randomized control trial.
Methods. 30 healthy middle-age men who were not routinely involved in exercise program were randomly assigned in Kinesio Taping® and sham group. They took part in Y-balance test before, immediately, 20 minutes and 24 hours after taping. Y-balance records and medial and lateral gastrocnemius activity were reported for each test. Between group and within group changes were analyzed using independent T test and
repeated measures. Correlation between Y-balance record and gastrocnemius activity were be analyzed using pearson correlation test.
KEY WORDS: Dynamic balance; Gastrocnemius; kinesiotaping; middle-age.
Methods. Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, and also the MOH Thesis, MOH Articles, Magiran, and SID as the national databases will be searched. Also, Google Scholar search engine will be used. All study types except Qualitative Studies, and
Narrative Reviews, i.e. Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation, in English and Persian will be retrieved. The publication date should
not be after August 2019. To ensure all the publication has been reached, search will be extended to three years before the publication date of first article found for each type of electrical stimulation currents. The search will be limited to human studies of subjects between 18-65, regardless of gender and race. The search strategy will cover PICO. The
quality of studies will be determined using Consort, STROBE, NHLBI, PEDro and CASP checklists in expert consensus.
Dissemination. The results of this plan will clarify which electrical stimulation current will improve pain and function in chronic non-specific low back pain. This is valuable in clinical practice to optimize therapeutic planning.
KEY WORDS: Electrical stimulation; current; pain; function; nonspecific chronic low back pain; physical therapy
It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI).
Research Question
Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects?
Methods
A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions.
Results
The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05).
Significance
Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.
Keywords
Chronic ankle instability; Postural control; Cognitive task; Sprain; Dual task; Stroop
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https://www.sciencedirect.com/science/article/pii/S0966636220300953?dgcid=coauthor
Materials and Methods: This designed study will involve 60 patients with PFP syndrome. Eligible subjects will be divided randomly into control (physical therapy), physical therapy plus active LLL, and physical therapy plus placebo laser. The physical therapy program will be exactly the same for all groups including exercise and education for ten sessions, every other day. The LLL group will receive 808 nm, 200 mW, 4 J Ga-Al-As laser over 5 points for
20 seconds per point. The laser will be deactivated in placebo group, and for the control group, the laser will not be used. The outcomes include pain and function, which will be measured using visual analogue scale (VAS), the Persian version of the Kujala patellofemoral questionnaire, and the step down test. Following Shapiro-Wilk test, the paired t and one-way ANOVA tests, if data distribution followed normal distribution, or the Kruskal-Wallis and Mann Whitney tests, if data distribution did not follow normal distribution, will be administered at the significance level of less than 0.05.
Conclusion: Therapeutic exercises is the treatment of choice for PFP syndrome. LLL is a commonly favorable modality prescribed as a part of physical therapy program for musculoskeletal disorders. However, the effect of laser in subjects with PFPS has not been thoroughly investigated. In designed study, it will be examined whether adding
LLL to standard physical therapy has a clinical benefit in subjects with PFPS.
Keywords: Low-level laser therapy, Patellofemoral pain syndrome, Pain, Function
Methods: Sixteen non-athlete healthy young men aged 20 to 30 without any familial history of cardiovascular problems were studied. Ten participants were randomly selected and involved in an aerobic training program on ergometer cycle, 3 times a week, for a period of two months. Each session continued for 30 minutes; consisting of 1 minute warm up, 15 minutes aerobic exercise, 8 minutes active recovery and 5 minutes passive recovery. The other 6 volunteers form the control group did not take part in any exercise during these 8 weeks. Cardiovascular response of all participants was evaluated before and after the training period by means of Bruce test.
Results: Before starting the program, there was no significant difference between experiment and control groups based on Bruce test parameters including speed, slope and energy expenditure (METS). After 8 weeks aerobic training, there were significant increases in Bruce parameters of the experiment group in comparison to pre training data and to the control group. Similar changes were observed in ergometer workload which was necessary for achieving and maintaining threshold heart rate for 10 minutes, the distance (Km) and the energy (Kcal).
Conclusion: Aerobic training improves people’s performance due to its effects on cardiovascular system. These effects were evaluated with Bruce test as an index of VO2MAX.
Key words: Cardiovascular function; Bruce test; Aerobic training, Cycle ergometer.
Materials and Methods: This randomized clinical trial study included 20 patients with moderate knee osteoarthritis randomly assigned into continuous and intermittent physiotherapy groups. The intervention was exactly the same for both groups including 10 sessions of conventional physical therapy. The treatment frequency was 6 and 3 sessions per week for continuous and intermittent groups, respectively. Using Knee injury and Osteoarthritis Outcome Score (KOOS) and Intermittent and Constant Osteoarthritis Pain (ICOAP) questioners, 6-minute-walking test, timed get up and go test, pain based on visual analogue scale (VAS), and function were assessed before, after 10 sessions, and after one month of follow up. The outcome was analyzed using independent t-test and, repeated measures ANOVA.
Results: Prior to the study, there was no significant difference between groups (P > 0.05). At the end of the 10th treatment session (P = 0.048), and after 1 month of follow up (P = 0.030), only the daily activity subscale of the KOOS questionnaire was significantly less in the continuous group. The records of 6-minute-walk test (P = 0.046), timed get up and go test (P = 0.040), continuous pain (P = 0.006), symptoms (P = 0.020), pain (P = 0.003), and quality of life (P = 0.010) subclasses of KOOS improved significantly in continuous group. After one month of follow up, daily activity subclass and pain based on VAS score were significantly better than baseline records (P = 0.002). In intermittent group, pain based on VAS score (P = 0.002) and continuous pain (P = 0.030) improved significantly after 10th session and follow up period).
Conclusion: It seems that the frequency of the treatment sessions has no significant effect on the treatment results in short term. Thus, the physiotherapist may take the subject's preference and their time limitations for scheduling the sessions. Continuous intervention may probably be the better choice to reach better results while intermittent protocol may result in more lasting effects
Keywords: Osteoarthritis of knee; Pain; Functional performance; Physiotherapy (Techniques)
Materials and Methods: This cross-sectional study was carried out on 32 non-athletic men aged 19-40 years who were assigned into two groups of 16 participants purposefully, ACL reconstruction and healthy. Using a Biodex machine 3.0, maximum voluntary isometric contraction of hamstring muscles was measured in 30°, 60°, and 90° angles in a random order. Then, 20% and 60% of maximum muscle contraction were calculated for each subject. The participants were requested to produce 20% and 60% contraction force randomly in aforementioned angles with and without visual feedback. This way the difference between subject’ performance with and without visual feedback was calculated. The average of static force sense and the maximum voluntary isometric contraction (MVIC) were compared between the groups using Mann-Whitney U test. Using the Kendall's tau-b Correlation Coefficient, the correlation between MIVC and mean error of static force sense was determined.
Results: There was no statistically significant difference between the groups in the term of average error of knee flexor static force sense in 30°, 60°, and 90° angles with target forces of 20% and 60% (P < 0.05). Moreover, the average error of flexor static force sense in 30°, 60°, and 90° angles and the maximum voluntary isometric contraction of knee flexor were not significantly correlated in either group (r ≤ 0.82, P > 0.05)
Conclusion: It seems that the static force sense of knee flexor muscles of the knee will be similar to healthy subjects, 6 months after ACL reconstruction surgery.
Keywords: Static force sense; Flexor muscles of knee; Anterior cruciate ligament reconstruction
Methods: After gaining permission from the International Consultation on Incontinence Modular Questionnaire (ICIQ) advisory board, the English Female Lower Urinary Tract Symptoms (FLUTS) questionnaire was translated into Persian and then translated back into English. One hundred fourteen women with pelvic floor dysfunction were asked to complete the Persian FLUTS and International Consultation on Incontinence Modular Questionnaire Overactive Bladder Questionnaire (ICIQ-OAB). The Persian FLUTS questionnaire was also readministered to 20 patients 2 weeks after their initial visit. Study data were analyzed using SPSS V16.0. To validate the translated questionnaire, we assayed content/face validity, internal consistency/reliability, and construct validity. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and the intraclass correlation coefficient (ICC) respectively.
Results: The mean age of the patients was 48.8 years old, 84% were married, and 59% had at least one Caesarean. Except for very few missing data, there is no any ambiguity in the Persian version of the FLUTS questionnaire. The Cronbach’s alpha
was 0.83, indicating a high internal consistency. Concerning criterion validity, correlation between the Persian FLUTS and the OAB was 0.77 (p<0.001).
Conclusion: The initial testing of the Persian version of the
FLUTS questionnaire demonstrates good internal consistency,
content validity, and reliability.
Keywords: Female Lower Urinary Tracts Symptoms; Validation; Persian; Questionnaire; Linguistics; Quality of life.
Methods: This study was a double-blind randomized clinical trial (RCT). In this study, 20 participants were randomly assigned to 2 groups. The intervention started the first day after surgery. One of the groups (n = 10) received therapeutic exercise program, and the other group (n = 10) received therapeutic exercise program as well as lymphatic correction with fan-shaped KT over a four-week period. KT was attached to the upper limb of the surgical side, the effects of the interventions were examined from two aspects of shoulder pain and function (based on the SPADI questionnaire).
Results: The findings of the study indicated that both groups had significant improvements in pain and function after the four-week period of intervention. The improvement in shoulder function was significantly greater in the exercise + KT group (p < 0.05), although there was no significant difference between the two groups in shoulder pain (p > 0.05).
Conclusion: The use of fan-shaped KT with therapeutic exercises is recommended for improving the shoulder function after a modified radical mastectomy.
and chin tuck exercise has been traditionally prescribed to manage this condition. On the other hand, turtle is one of the common exercises in tai chi. Although, recently the physiotherapists are more interested in including tai chi in exercise therapy, there is no study comparing the effect of chin tuck and turtle exercise.
Aim: The aim of this study was comparison of chin tuck and turtle exercise effects on FHP.
Material and methods: 46 asymptomatic FHP subjects aged 22.45 ± 1.70
years were randomly assigned into two groups of chin tuck and turtle exercise. Cervical curve was measured before and after a 6-week intervention. The measures were compared by Mann-Whitney U test, paired sample T test and Wilcoxon.
Results: 40 subjects completed the study. Within group analysis showed significant cervical curve increase. Interestingly, between group analysis showed equal cervical curve improvement.
Conclusions: Both chin tuck and turtle exercises improved the cervical curve in subjects with FHP. However, the effects of these two approaches seemed to be the same.
Keywords: Forward head posture; Chin tuck; Turtle exercise
Materials and Methods: 48 women aged between 40-70 years were purposefully divided into mild, moderate and sever osteoarthritis and healthy control group according to simple X-ray features of their knee joints. The participants walked at their convenient self-selected speed to collect five clean trials. The data were recorded using a motion analysis system and a 3-dimentional model of lower extremity segments was developed from motion capture data using visual 3-D software. Mechanical energy of lower extremity was calculated using this model.
Results: The study groups were significantly different in age (P ≤ 0.001) and walking speed (P ≤ 0.001). One-way analysis of variances (ANOVA) and post-hoc Tukey test revealed that there was significant difference between the study groups regarding mechanical energy. However, univariate general linear models with adjustments to age and to walking speed were developed; in addition, a bivariate general linear model was adjusted to age and walking speed. All the models confirmed that the differences were not imposed by the severity of knee osteoarthritis.
Conclusion: It seems that increase in mechanical energy of lower extremity in subjects with knee osteoarthritis intensifies with the progression of the disease; this is not a direct effect of the level of joint deterioration but is an indirect effect of older age and lower walking speed in subjects suffering from more advanced knee osteoarthritis.
Keywords: Knee osteoarthritis; Severity; Gait analysis; Mechanical energy
Methods: 43 volunteers with acute nonspecific low back pain were randomly assigned into experimental group (spinal manipulation plus active exercise, n=21) and control group (spinal manipulation n = 22).After signing formal consent, demographic information was obtained. Immediate analgesic effect was reported measuring pain intensity (VAS) before and immediately after the manipulation in either group. Pain intensity and disability score according to Oswestry Disability Index were reported at the beginning, after the 10th therapeutic session, and at one month follow-up.
Results: Forty subjects completed the study. Pain and functional disability score decreases significantly over time in both groups (P<0.001), although intergroup difference were not significant for pain severity (P=0.24) and functional disability score (P=0.42). Also, in this study, the results showed that the pain after a session of manipulation (P <0.001) was significantly lower than before treatment.
Conclusion: It seems that in spite of immediate significant improvement in pain and functional disability following supplementary exercise therapy protocol, it is not significantly different from manipulation. More studies are recommended to investigate the effect of various exercise protocols in different types of low back pain.
Keywords: Acute low back pain; spinal manipulation; active exercise; pain; functional disability.
Key Words: Low Back Pain, Discogenic, Dry needling.
Objective: The present study aimed to translate and evaluate the reliability and validity of the Persian version of the 11-item Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in Iranian subjects with Knee Osteoarthritis (KOA). Materials and Methods: The ICOAP questionnaire was translated according to the Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. The procedure consisted of forward and backward translation, as well as the assessment of the psychometric properties of the Persian version of the questionnaire. A sample of 230 subjects with KOA was asked to complete the Persian versions of ICOAP and Knee injury and Osteoarthritis Outcome Score (KOOS). The ICOAP was readministered to forty subjects five days after the first visit. Test–retest reliability was assessed using Intraclass Correlation Coefficient (ICC), and internal consistency was assessed by Cronbach's alpha and item-total correlation. The correlation between ICOAP and KOOS was determined using Spearman's correlation coefficient. Result: Subjects found the Persian-version of the ICOAP to be clear, simple, and unambiguous, confirming its face validity. Spearman correlations between ICOAP total and subscale scores with KOOS scores were between 0.5 and 0.7, confirming construct validity. Cronbach's alpha, used to assess internal consistency, was 0.89, 0.93, and 0.92 for constant pain, intermittent pain, and total pain scores, respectively. The ICC was 0.90 for constant pain and 0.91 for the intermittent pain and total pain score. Conclusion: The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA.
Keywords: Intermittent and constant osteoarthritis pain measure, knee osteoarthritis, pain, pain questionnaire, Persian, reliability, validity
DOI: 10.4103/1735-9066.185595
Methods. Search will be done in Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, the MOH Thesis, MOH Articles, Magiran, and SID. Google Scholar search engine will also be used. All types of Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation in English and Persian published prior
to September 2019 will be included. The articles recruiting 18 to 60 years old will be included. Considering PICO, the finally retrieved articles will be assessed qualitatively by CONSORT, STROBE, PEDro, NIH and CASP checklists. Changes in pain and function will be favorable.
Dissemination. The protocol presented in present paper will be used to summarize and qualify present literatures on conservative therapy for chronic non-specific low back pain with sacroiliac joint origin.
KEY WORDS: Rehabilitation; Physical Therapy; Pain; Function; Non-specific Chronic Low Back Pain; Sacroiliac Joint Dysfunction.
Hypothesis/purpose. The aim of present study was to compare the effect of facilitatory gastrocnemius taping on dynamic balance and muscle activity during Y-balance test in healthy middle-age men.
Study design. Double-blinded (participant, assessor) randomized control trial.
Methods. 30 healthy middle-age men who were not routinely involved in exercise program were randomly assigned in Kinesio Taping® and sham group. They took part in Y-balance test before, immediately, 20 minutes and 24 hours after taping. Y-balance records and medial and lateral gastrocnemius activity were reported for each test. Between group and within group changes were analyzed using independent T test and
repeated measures. Correlation between Y-balance record and gastrocnemius activity were be analyzed using pearson correlation test.
KEY WORDS: Dynamic balance; Gastrocnemius; kinesiotaping; middle-age.
Methods. Pubmed, ISI Web of Science, Scopus, Clinical Key, Science Direct, Medline, Embase, PEDro, ProQuest, the Cochrane Library, PROSPERO, and also the MOH Thesis, MOH Articles, Magiran, and SID as the national databases will be searched. Also, Google Scholar search engine will be used. All study types except Qualitative Studies, and
Narrative Reviews, i.e. Clinical Trials, Cohort, Case-controls, Cross-sectionals, Observational Descriptive, Case Report, Case Series, Ecological Studies, Systematic Reviews, thesis and dissertation, in English and Persian will be retrieved. The publication date should
not be after August 2019. To ensure all the publication has been reached, search will be extended to three years before the publication date of first article found for each type of electrical stimulation currents. The search will be limited to human studies of subjects between 18-65, regardless of gender and race. The search strategy will cover PICO. The
quality of studies will be determined using Consort, STROBE, NHLBI, PEDro and CASP checklists in expert consensus.
Dissemination. The results of this plan will clarify which electrical stimulation current will improve pain and function in chronic non-specific low back pain. This is valuable in clinical practice to optimize therapeutic planning.
KEY WORDS: Electrical stimulation; current; pain; function; nonspecific chronic low back pain; physical therapy
It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI).
Research Question
Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects?
Methods
A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions.
Results
The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05).
Significance
Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.
Keywords
Chronic ankle instability; Postural control; Cognitive task; Sprain; Dual task; Stroop
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Materials and Methods: This designed study will involve 60 patients with PFP syndrome. Eligible subjects will be divided randomly into control (physical therapy), physical therapy plus active LLL, and physical therapy plus placebo laser. The physical therapy program will be exactly the same for all groups including exercise and education for ten sessions, every other day. The LLL group will receive 808 nm, 200 mW, 4 J Ga-Al-As laser over 5 points for
20 seconds per point. The laser will be deactivated in placebo group, and for the control group, the laser will not be used. The outcomes include pain and function, which will be measured using visual analogue scale (VAS), the Persian version of the Kujala patellofemoral questionnaire, and the step down test. Following Shapiro-Wilk test, the paired t and one-way ANOVA tests, if data distribution followed normal distribution, or the Kruskal-Wallis and Mann Whitney tests, if data distribution did not follow normal distribution, will be administered at the significance level of less than 0.05.
Conclusion: Therapeutic exercises is the treatment of choice for PFP syndrome. LLL is a commonly favorable modality prescribed as a part of physical therapy program for musculoskeletal disorders. However, the effect of laser in subjects with PFPS has not been thoroughly investigated. In designed study, it will be examined whether adding
LLL to standard physical therapy has a clinical benefit in subjects with PFPS.
Keywords: Low-level laser therapy, Patellofemoral pain syndrome, Pain, Function
Methods: Sixteen non-athlete healthy young men aged 20 to 30 without any familial history of cardiovascular problems were studied. Ten participants were randomly selected and involved in an aerobic training program on ergometer cycle, 3 times a week, for a period of two months. Each session continued for 30 minutes; consisting of 1 minute warm up, 15 minutes aerobic exercise, 8 minutes active recovery and 5 minutes passive recovery. The other 6 volunteers form the control group did not take part in any exercise during these 8 weeks. Cardiovascular response of all participants was evaluated before and after the training period by means of Bruce test.
Results: Before starting the program, there was no significant difference between experiment and control groups based on Bruce test parameters including speed, slope and energy expenditure (METS). After 8 weeks aerobic training, there were significant increases in Bruce parameters of the experiment group in comparison to pre training data and to the control group. Similar changes were observed in ergometer workload which was necessary for achieving and maintaining threshold heart rate for 10 minutes, the distance (Km) and the energy (Kcal).
Conclusion: Aerobic training improves people’s performance due to its effects on cardiovascular system. These effects were evaluated with Bruce test as an index of VO2MAX.
Key words: Cardiovascular function; Bruce test; Aerobic training, Cycle ergometer.
Materials and Methods: This randomized clinical trial study included 20 patients with moderate knee osteoarthritis randomly assigned into continuous and intermittent physiotherapy groups. The intervention was exactly the same for both groups including 10 sessions of conventional physical therapy. The treatment frequency was 6 and 3 sessions per week for continuous and intermittent groups, respectively. Using Knee injury and Osteoarthritis Outcome Score (KOOS) and Intermittent and Constant Osteoarthritis Pain (ICOAP) questioners, 6-minute-walking test, timed get up and go test, pain based on visual analogue scale (VAS), and function were assessed before, after 10 sessions, and after one month of follow up. The outcome was analyzed using independent t-test and, repeated measures ANOVA.
Results: Prior to the study, there was no significant difference between groups (P > 0.05). At the end of the 10th treatment session (P = 0.048), and after 1 month of follow up (P = 0.030), only the daily activity subscale of the KOOS questionnaire was significantly less in the continuous group. The records of 6-minute-walk test (P = 0.046), timed get up and go test (P = 0.040), continuous pain (P = 0.006), symptoms (P = 0.020), pain (P = 0.003), and quality of life (P = 0.010) subclasses of KOOS improved significantly in continuous group. After one month of follow up, daily activity subclass and pain based on VAS score were significantly better than baseline records (P = 0.002). In intermittent group, pain based on VAS score (P = 0.002) and continuous pain (P = 0.030) improved significantly after 10th session and follow up period).
Conclusion: It seems that the frequency of the treatment sessions has no significant effect on the treatment results in short term. Thus, the physiotherapist may take the subject's preference and their time limitations for scheduling the sessions. Continuous intervention may probably be the better choice to reach better results while intermittent protocol may result in more lasting effects
Keywords: Osteoarthritis of knee; Pain; Functional performance; Physiotherapy (Techniques)
Materials and Methods: This cross-sectional study was carried out on 32 non-athletic men aged 19-40 years who were assigned into two groups of 16 participants purposefully, ACL reconstruction and healthy. Using a Biodex machine 3.0, maximum voluntary isometric contraction of hamstring muscles was measured in 30°, 60°, and 90° angles in a random order. Then, 20% and 60% of maximum muscle contraction were calculated for each subject. The participants were requested to produce 20% and 60% contraction force randomly in aforementioned angles with and without visual feedback. This way the difference between subject’ performance with and without visual feedback was calculated. The average of static force sense and the maximum voluntary isometric contraction (MVIC) were compared between the groups using Mann-Whitney U test. Using the Kendall's tau-b Correlation Coefficient, the correlation between MIVC and mean error of static force sense was determined.
Results: There was no statistically significant difference between the groups in the term of average error of knee flexor static force sense in 30°, 60°, and 90° angles with target forces of 20% and 60% (P < 0.05). Moreover, the average error of flexor static force sense in 30°, 60°, and 90° angles and the maximum voluntary isometric contraction of knee flexor were not significantly correlated in either group (r ≤ 0.82, P > 0.05)
Conclusion: It seems that the static force sense of knee flexor muscles of the knee will be similar to healthy subjects, 6 months after ACL reconstruction surgery.
Keywords: Static force sense; Flexor muscles of knee; Anterior cruciate ligament reconstruction
Methods: After gaining permission from the International Consultation on Incontinence Modular Questionnaire (ICIQ) advisory board, the English Female Lower Urinary Tract Symptoms (FLUTS) questionnaire was translated into Persian and then translated back into English. One hundred fourteen women with pelvic floor dysfunction were asked to complete the Persian FLUTS and International Consultation on Incontinence Modular Questionnaire Overactive Bladder Questionnaire (ICIQ-OAB). The Persian FLUTS questionnaire was also readministered to 20 patients 2 weeks after their initial visit. Study data were analyzed using SPSS V16.0. To validate the translated questionnaire, we assayed content/face validity, internal consistency/reliability, and construct validity. Internal consistency and test–retest reliability were assessed using Cronbach’s alpha and the intraclass correlation coefficient (ICC) respectively.
Results: The mean age of the patients was 48.8 years old, 84% were married, and 59% had at least one Caesarean. Except for very few missing data, there is no any ambiguity in the Persian version of the FLUTS questionnaire. The Cronbach’s alpha
was 0.83, indicating a high internal consistency. Concerning criterion validity, correlation between the Persian FLUTS and the OAB was 0.77 (p<0.001).
Conclusion: The initial testing of the Persian version of the
FLUTS questionnaire demonstrates good internal consistency,
content validity, and reliability.
Keywords: Female Lower Urinary Tracts Symptoms; Validation; Persian; Questionnaire; Linguistics; Quality of life.
Methods: This study was a double-blind randomized clinical trial (RCT). In this study, 20 participants were randomly assigned to 2 groups. The intervention started the first day after surgery. One of the groups (n = 10) received therapeutic exercise program, and the other group (n = 10) received therapeutic exercise program as well as lymphatic correction with fan-shaped KT over a four-week period. KT was attached to the upper limb of the surgical side, the effects of the interventions were examined from two aspects of shoulder pain and function (based on the SPADI questionnaire).
Results: The findings of the study indicated that both groups had significant improvements in pain and function after the four-week period of intervention. The improvement in shoulder function was significantly greater in the exercise + KT group (p < 0.05), although there was no significant difference between the two groups in shoulder pain (p > 0.05).
Conclusion: The use of fan-shaped KT with therapeutic exercises is recommended for improving the shoulder function after a modified radical mastectomy.
and chin tuck exercise has been traditionally prescribed to manage this condition. On the other hand, turtle is one of the common exercises in tai chi. Although, recently the physiotherapists are more interested in including tai chi in exercise therapy, there is no study comparing the effect of chin tuck and turtle exercise.
Aim: The aim of this study was comparison of chin tuck and turtle exercise effects on FHP.
Material and methods: 46 asymptomatic FHP subjects aged 22.45 ± 1.70
years were randomly assigned into two groups of chin tuck and turtle exercise. Cervical curve was measured before and after a 6-week intervention. The measures were compared by Mann-Whitney U test, paired sample T test and Wilcoxon.
Results: 40 subjects completed the study. Within group analysis showed significant cervical curve increase. Interestingly, between group analysis showed equal cervical curve improvement.
Conclusions: Both chin tuck and turtle exercises improved the cervical curve in subjects with FHP. However, the effects of these two approaches seemed to be the same.
Keywords: Forward head posture; Chin tuck; Turtle exercise
Materials and Methods: 48 women aged between 40-70 years were purposefully divided into mild, moderate and sever osteoarthritis and healthy control group according to simple X-ray features of their knee joints. The participants walked at their convenient self-selected speed to collect five clean trials. The data were recorded using a motion analysis system and a 3-dimentional model of lower extremity segments was developed from motion capture data using visual 3-D software. Mechanical energy of lower extremity was calculated using this model.
Results: The study groups were significantly different in age (P ≤ 0.001) and walking speed (P ≤ 0.001). One-way analysis of variances (ANOVA) and post-hoc Tukey test revealed that there was significant difference between the study groups regarding mechanical energy. However, univariate general linear models with adjustments to age and to walking speed were developed; in addition, a bivariate general linear model was adjusted to age and walking speed. All the models confirmed that the differences were not imposed by the severity of knee osteoarthritis.
Conclusion: It seems that increase in mechanical energy of lower extremity in subjects with knee osteoarthritis intensifies with the progression of the disease; this is not a direct effect of the level of joint deterioration but is an indirect effect of older age and lower walking speed in subjects suffering from more advanced knee osteoarthritis.
Keywords: Knee osteoarthritis; Severity; Gait analysis; Mechanical energy
Methods: 43 volunteers with acute nonspecific low back pain were randomly assigned into experimental group (spinal manipulation plus active exercise, n=21) and control group (spinal manipulation n = 22).After signing formal consent, demographic information was obtained. Immediate analgesic effect was reported measuring pain intensity (VAS) before and immediately after the manipulation in either group. Pain intensity and disability score according to Oswestry Disability Index were reported at the beginning, after the 10th therapeutic session, and at one month follow-up.
Results: Forty subjects completed the study. Pain and functional disability score decreases significantly over time in both groups (P<0.001), although intergroup difference were not significant for pain severity (P=0.24) and functional disability score (P=0.42). Also, in this study, the results showed that the pain after a session of manipulation (P <0.001) was significantly lower than before treatment.
Conclusion: It seems that in spite of immediate significant improvement in pain and functional disability following supplementary exercise therapy protocol, it is not significantly different from manipulation. More studies are recommended to investigate the effect of various exercise protocols in different types of low back pain.
Keywords: Acute low back pain; spinal manipulation; active exercise; pain; functional disability.
Key Words: Low Back Pain, Discogenic, Dry needling.
Objective: The present study aimed to translate and evaluate the reliability and validity of the Persian version of the 11-item Intermittent and Constant Osteoarthritis Pain (ICOAP) measure in Iranian subjects with Knee Osteoarthritis (KOA). Materials and Methods: The ICOAP questionnaire was translated according to the Manufacturers Alliance for Productivity and Innovation (MAPI) protocol. The procedure consisted of forward and backward translation, as well as the assessment of the psychometric properties of the Persian version of the questionnaire. A sample of 230 subjects with KOA was asked to complete the Persian versions of ICOAP and Knee injury and Osteoarthritis Outcome Score (KOOS). The ICOAP was readministered to forty subjects five days after the first visit. Test–retest reliability was assessed using Intraclass Correlation Coefficient (ICC), and internal consistency was assessed by Cronbach's alpha and item-total correlation. The correlation between ICOAP and KOOS was determined using Spearman's correlation coefficient. Result: Subjects found the Persian-version of the ICOAP to be clear, simple, and unambiguous, confirming its face validity. Spearman correlations between ICOAP total and subscale scores with KOOS scores were between 0.5 and 0.7, confirming construct validity. Cronbach's alpha, used to assess internal consistency, was 0.89, 0.93, and 0.92 for constant pain, intermittent pain, and total pain scores, respectively. The ICC was 0.90 for constant pain and 0.91 for the intermittent pain and total pain score. Conclusion: The Persian version of the ICOAP is a reliable and valid outcome measure that can be used in Iranian subjects with KOA.
Keywords: Intermittent and constant osteoarthritis pain measure, knee osteoarthritis, pain, pain questionnaire, Persian, reliability, validity
DOI: 10.4103/1735-9066.185595
The biomechanical factors regulate and propel growth, development, survival, degeneration, healing and repair of the tissues significantly. Advancements in understanding cell and tissue conscious and their adaptations with mechanical environment has been recently immixed with in vivo regenerative strategies adopted by injured or degenerated tissues and in vitro production of live tissue replacements.
Undoubtedly, precise understanding of that various aspects of tissue biomechanical behavior is essential to improve clinical therapeutics based on principals of tissue engineering and regenerative medicine in a variety of tissues including musculoskeletal, cardiovascular, craniofascial, urinary tract, skin and nervous systems.
On the other hand, biomechanical models are the keystone of producing regenerated tissue of high strength and endurance although there are many unsolved problems especially concerning function of tissues with complicated high demand mechanical environment.
The cases which full replacement approaches (such as joint replacement, prosthesis, etc.) afford unfavorable clinical outcome heighten the value of Regenerative Medicine approaches. In this context, the main challenge is to select the right combination of scafolds, cells, soluble environmental regulators and amplifiers of cell performance, growth and differentiation in each specific disease and disability.
In various musculoskeletal connective tissues, in vivo tissue regeneration (facilitating tissue healing) is more practical than replacing the engineered tissue. Many physical modalities and exercise interventions commonly administered in physical therapy are naturally capable of enhancing tissue resistance against destructive forces and may even expedite the process of tissue repair. The effect of these interventions may be measured by studying tissue and cell biomechanical models to upgrade the evidence bases of their administration.
Some clinical interventions change the function or titer of the regulatory proteins such as growth factors; others directly alter the function and survival of the specialized cells of the body. Understanding these effects help the therapists to arrange a logical and realistic management protocol to achieve the intended purpose. For this purpose the researchers analyze the biomechanical behavior of cells and tissues by means of a variety of biomechanical models from computer simulations to cadaver models and even in situ artificially produced tissues.
Keywords: biomechanics, survival, stress
reduction of gait stride length (2-5) and cadence (6, 7) in KOA patients in comparison to control normal groups. But there is controversy about them. The present study will discuss the
effect of KOA severity on gait spatiotemporal parameters.
Aim: To determine how KOA severity will affect stride length, walking speed and cadence.
Materials and Methods: Thirty four women aged between 40-70 years diagnosed with medial KOA were systematically divided in to three groups of mild, moderate and severe OA and a group of normal subjects. KOA severity was classified according to the (K–L scale) using atlas of the Osteoarthritis Research Society International (OARSI). Data collected using the motion analysis system in the Musculoskeletal Research Center of Faculty of
Rehabilitation Sciences, Isfahan University of Medical Sciences. The subjects were asked to walk with a comfortable self-selected speed along the 10-meter walking path to collect five successful trials and sampled at frequency of 120 Hz. The normality of all parameters was evaluated by Shapiro Wilk test and parametric test used for statistical evaluation to determined difference between the mean values of the parameters between groups by SPSS software (SPSS, version 16, SPSS Inc. Chicago, IL, USA)
Results: The ANOVA results of spatiotemporal parameters and post hoc analysis shown "stride length" is the only parameter that is significantly different in normal groups with all of the OA subjects (P<0.05). Walking speed in healthy people was significantly more than moderate and severe KOA groups (P=0.003, P= 0.00 respectively) however, difference to
mild KOA was not significant (P=0.81). Speed was not different between mild and moderate KOA groups (P=.41), but there was a significant difference in mild and severe OA subjects (P=0.007). The cadence was significantly different only between healthy persons and severe osteoarthritis subjects (P=.005).
Conclusions and clinical implication: It seems that "stride-length" is the key parameter to distinguish normal subjects from KOA client even in early stages. We recommend practitioners to observe patient’s apparent gait pattern with more focus on their stride length in clinics
References:
1. Zhang. et al. Clinics in geriatric medicine (2010).
2. Al-Zahrani. et al. Disability and rehabilitation (2002)
3. Esrafilian. et al. Rheumatology international (2013).
4. Gok. et al. Acta orthopaedica Scandinavica (2002).
5. Miller. et al. Journal of biomechanical engineering (2013).
6. Chen CP. et al. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists (2003).
7. Mills. et al. Arthritis care & research(2013).
Aim: The purpose of this study is to review the gait differences between osteoarthritic patients and healthy individuals.
Materials and Methods: In this study we have searched from April 2012 in Pub Med data base for relevant studies published in two recent decades from 1990 until now. The key words used in this article include "knee osteoarthritis" AND "gait" in combination with "severity" and "knee adduction moment". Abstracts articles that analyzed Kallgren and Lawrence progression in examination of KOA and evaluated the kinetic and kinematic parameters from 3D gait analysis, were eligible for inclusion.
Results: More than 100 articles are published about KOA severity and changes of knee adduction moment in osteoarthritic patients' gait. The major differences in kinetic and kinematic parameters between osteoarthritis patients and healthy subjects are in coronal plane (4). Most of the researchers believe that External knee adduction moment is a valid index for medial knee osteoarthritis(5) and increasing of this parameter has a correlation to disease progression(6) but some of them have shown that this correlation is only in severe degrees not in low grades. It seems that knee adduction angular impulse is more sensitive in mild osteoarthritis (7, 8).
Conclusion: Gait changes are the most common variation of knee osteoarthritis. The changes that most of the researches agreed with them are increase of KAM. There is no consensus about which factors have the greatest impact on disease progression yet and there is need for further studies.
References:
1. Sims EL. et al. Journal of women & aging (2009).
2. Zhang Y. et al. Clinics in geriatric medicine (2010).
3. Broström EW. et al. Best Practice & Research Clinical Rheumatology (2012).
4. Mundermann A. et al. Arthritis and rheumatism (2005).
5. Birmingham TB. et al. Arthritis and rheumatism (2007).
6. Barrios JA. et al. Clinical biomechanics (Bristol, Avon) (2009).
7. Kean CO. et al. Clinical biomechanics (Bristol, Avon) (2012).
8. Thorp LE. et al. Arthritis and rheumatism (2006).
Any articular motion results in different compressive and shear loads on cartilage; cartilage is an avascular and anervous tissue therefore, cartilage wear and tear proceeds regeneration and results in cartilage degeneration phenomenon known as oseteoarthritis (OA).
The question is that can therapeutic pulsed ultrasound improve tibial cartilage strength if LIPUS is applied according to guidelines for physiotherapy clinical practice? The importance of tibial articular cartilage is that degenerative process in the knee joint is mor sever in load bearing surfaces of tibial plateaues
Methods
Total of 15 male white skeletally mature dutch rabbits weighting 1.5 to 2 kg divided into 3 accurately matched group. The ACL were cut in left knee and the rabbits were housed for 9 weeks afterward. On 9th week following surgery, the Control group was scarified, the LIPUS group received LIPUS every other day for 10 sessions according to clinical guidelines for LIUPS application in rehabilitation of OA patients and NonLIUPS group undergo no intervention for the same period. Biomechanical test protocol was accurately adopted from a previous study on experimental knee joint hemarthrosis[10]. the ex vivo biphasic viscoelastic unconfined stress–relaxation test was performed at the central point of the medial plateau of the tibia using a 100N load cell and impervious plane-ended indenter of 1.46 mm in diameter (Zwick Universal Testing Machine; Zwick 2.5/ Roell GmbH & Co., Ulm, Germany)[4,11,12].
To ensure perfect contact between cartilage and indenter, 0.01N preload applied. The main test conducted applying 0.1 mm displacement at constant rate of 0.5 mm/min. This strain sustained for 1000 seconds to obtain equilibrium status of cartilage. Then another stress-strain test was done up to maximum stress of 6 MPa [5-7]. All the data were processed in MATLAB (R2009a; the Math-Works, Inc., Natick, MA, USA). Maximal force as maximal load in the requested displacement point (0.1 mm) and equilibrium force as recorded load after equilibrium status (after 1000 s) were extracted from these data
Cartilage thickness measured after indentation test using needle probing compression test with a 0.12 mm needle that compressed cartilage at constant rate of 0.5 mm/min[10]. Reliability of the thickness measurements was evaluated for the each sample by measuring thickness in 2-3 points away from the indentation contact. During the tests the sample was kept moist by spraying normal saline [11].
Using SPSS 17.0 (SPSS Inc., Chicago, IL, USA) Kruskal wallis test used with alpha=0.05. To determine which 2 groups are significantly different Mann-Withney test was used.
Results
The animals’ weight at the start day of study was not significantly different showing the groups were similar in basic characteristics.
The macroscopic & histological findings in control group confirmed successful induction of OA like changes in left knee of samples 9 weeks following ACLT. Following 10 sessions of LIPUS therapy, there was significantly more synovial fluid inside the joint and the synovial membrane was extremely hypertrophic. In addition, the histological sections showed improvement in OA characteristics toward normal cartilage.
Cronbach's alpha for thickness in each group was ≥ 0.7 that is a good reliability. LIUPS prevented further deterioration of cartilage thickness however no significant differences were recorded in either biomechanical parameters. Elastic Modulus in LIPUS group was significantly more than NounLIPUS group (P=0.043)
Conclusion
It seems that 10 sessions of LIPUS with the clinical characteristics suggested for OA patients in clinical guidelines can effectively save cartilage thickness from further deteriorations but it is not enough for improving biomechanical characteristics of the articular cartilage. Insignificant improvement of all biomechanical properties of articular cartilage can be of clinical value especially with regard to maximal force and elastic modulus and can imply that may be continuing suggested therapeutic procedure for further duration can improve functional properties of cartilage along with saving its material volume. This can be because of facilitation of cellular repair due to mechanical stress induced by ultrasound[1-3,8,9]
Objective: Myocardial Infarction (MI) is the major cause of death in the industrial countries. In addition to the clinical and economic burden, MI affects health related quality of life. Original version of the SAQ was developed cross-sectionally and may be used for measuring clinically important dimensions of coronary artery disease. However, the Persian version has not been validated for patients with Myocardial Infarction patients.
Materials and Methods: After multi-stage translating based on Manufacturers Alliance for Productivity and Innovation protocol, the reliability examined on 130 patients with MI. The SF-36 was used to assess the validity of the SAQ. To assess test-retest reliability, the patients refilled the SAQ after 5 days. Reliability of the SAQ was assessed by Cronbach’s Alpha and the Intra-class Correlation Coefficient. Validity was determined using Pearson correlation matrix for the subclasses and the total scores (ρ).
Results: Internal consistency was between 0/58 and 0/89 ICC over a 5-day period exceeded 0.6 in all domains. The weighted kappa ranged from 0.492 to 0.853.
Conclusion: Reliability and validity of the Persian version of the SAQ is acceptable and it seems that this questionnaire is a useful tool in assessing health related quality of life in Persian speaking patients with myocardial infarction suffering from angina.
Keywords: Seattle Angina Questionnaire (SAQ), myocardial infarction, health related quality of life, reliability, validity."
Health Related Quality of Life (HRQL) instruments include subjective and objective assessments therefore; they are more proficient measures to determine the efficiency of prevention and treatment strategies in CHD. In our country, researches in quality of Life (QoL) are restricted as a result of the lack of sensitive tools in Persian language. There are a variety of outcome measure to study the quality of life in cardiac and angina patients.
Short Form-36 and Sickness Impact Profile are two generic instruments commonly used for HRQL assessment in MI patients. There are also disease specific questionnaires for this group of patients including MacNew, Rose Angina and Seattle Angina Questionnaires (SAQ). SAQ is a 19 item self-administered commonly used measure of HRQL for patients suffering angina in Europe and USA. It measures physical activity, angina stability and frequency, treatment satisfaction and disease perception. In addition to brevity, SAQ measures a range of functional status directly resulted from CAD. SAQ is more responsiveness than MacNew 12 months following coronary artery disease in terms of angina frequency and disease perception. In 2010, the Patient-Reported Outcome Measures Group admitted SAQ assesses more physical symptoms and less emotional and cognitive changes. The Persian translation of this valuable outcome measure has been recently validated by our research group at Isfahan University of Medical Sciences.
debated. Many studies have examined gait analysis to compare knee joint torque during activities of daily
living.
Methods: We performed a systematic review of the literature for published papers that reported saggital
plane knee joint kinetics and kinematics in ACL deficient individuals. Our objective was to explore the gait
adaptations in subjects with Anterior Cruciate Ligament Deficiency (ACLD)
Results: we found 35 articles with the following keywords: ACL, ACL Deficiency, ACL Injury, Moment,
Torque, Quadriceps and Quadriceps Avoidance Gait, 18 of which were excluded because of scarcity of
relevance.
Discussion: Literature suggests that ACLD patients tend to adopt different strategies after ACL injury,
such as Quadriceps Avoidance Gait, Hamstring Facilitation and Muscle co-contraction
Anterior cruciate ligament transection (ACLT) is a recognized method to induce osteoarthritis (OA) in animal models1-3. ACLT changes the loading patterns of the knee joint, leading to changes in the material properties of articular cartilage. However, it is not known how the biomechanical properties and orientation of the collagen fibers of cartilage change at different sites of the knee joint in early OA. The aim of this study was to investigate the equilibrium and dynamic mechanical properties and the collagen matrix organization of articular cartilage in the lapine knee joint at a very early stage of OA, created experimentally by ACLT.
Methods
SAMPLES: Thirteen skeletally mature New Zealand white rabbits were used. Unilateral ACLT was performed in 10 rabbits. Contralateral (C-L) joints were also prepared for the analysis and the non-transected joints were used as a control group (CTRL). Animals were sacrificed at four weeks after ACLT. Femoral groove (FG), medial and lateral femoral condyles (FC) and tibial plateaus (TP) were harvested and used for analysis. All procedures were approved by the Animal Ethics committee at the University of Calgary.
BIOMECHANICAL TESTING: Loading was applied using indentation testing (indenter dia. 1 mm). Pre-conditioning was done using a 2 % cyclic strain and stress-relaxation protocol using a ramp rate of 100 %/s (3 x 5 % step, 15 min relaxation time). Then, a sinusoidal load was applied (1 Hz, 4 cycles). The equilibrium (eq) elastic modulus was calculated from the slope of the equilibrium stress-strain curve and the dynamic (dyn) elastic modulus was determined from the dynamic test4. Poisson's ratios were 0.1 and 0.5 for calculation of the equilibrium and dynamic modulus, respectively.
POLARIZED MICROSCOPY: Polarized microscopy (PLM) (Leitz Ortholux II POL -polarized microscope, Leitz, Wetzlar, Germany) was used to analyze collagen orientation angles5. The transversally averaged depth-wise profiles of all samples were interpolated to 100 points, where the collagen fibers parallel to the cartilage surface indicated an angle of 0° (superficial zone).
STATISTICAL TESTS: A linear mixed model (ver. 19, SPSS Inc., Chicago, IL) was chosen for statistical comparisons between groups. Sample type (FG, FC, TP) was set as a fixed variable and elastic moduli and collagen orientation within the animal were coded as a random variable. Restricted maximum likelihood (REML) estimation was used. Furthermore, estimated means for the different groups (ACLT, C-L, CTRL) were obtained from the fitted model, and the main effects between the groups were compared. 95% confidence intervals for differences with Bonferroni corrected adjustment are presented.
Results
ELASTIC MODULI: Eq and dyn moduli varied as function of location (Tables 1&2). The eq modulus was significantly lower in ACLT than C-L for FC and was lower in ACLT compared to CTRL group knees for med. FC. The dyn moduli in the lateral and medial FCs of the ACLT and C-L groups were significantly lower than those in the CTRL group. Moreover, in the medial FC the ACLT group cartilage exhibited significantly lower dyn moduli than the C-L group cartilage. In TPs, the only significant difference was observed in the lateral side with the eq modulus being significantly lower in the ACLT than in the CTRL group. No significant differences in the moduli were observed in the FG.
COLLAGEN ORIENTATION: As a result of the ACLT, significant changes in the collagen orientation angles were noticed in lateral FC, medial TP and FG (Fig. 1). Alterations in the collagen orientation angles were concentrated in the superficial and middle zones. Specifically, the collagen fibrils were more disorganized, i.e., less parallel to the surface in the ACLT and C-L groups than in the CTRL group. In the lateral FC, the ACLT cartilage also showed more disorganized collagen fibrils than the C-L group cartilage.
Discussion
Site dependent variations in the eq and dyn elastic modulus and in the collagen orientation angle were observed in normal and ACL transected rabbit knee joints. Specifically, FCs were significantly affected by the transection, as noticed both in the moduli and fibril orientation, while the effect in TP was smaller. Only the collagen orientation was altered in FG cartilage. Interestingly, the dynamic modulus and collagen orientation angle of lateral FC cartilage in the C-L group differed significantly from those in the CTRL group. These results suggest that the increased instability in the knee joint caused by ACLT may have a larger effect on the FC cartilage compared to the FG.
As a result of ACLT, the most severe changes in the tissue moduli were detected in FCs. Specifically in the lateral FC, the dynamic modulus was reduced simultaneously with the superficial collagen fibrillation. This is consistent with earlier findings suggesting that the collagen fibril network primarily controls the dynamic and tensile properties of cartilage6. The result also suggests that the lateral FC of rabbits is prone to alterations in joint loading. However, the dynamic modulus and collagen orientation angle of cartilage were unaffected in the lateral TP, suggesting that this site can withstand abnormal loading easily. It may be that 4 weeks is still such a short time that some sites in the knee can withstand altered loading after ACL transection, while some sites begin to deteriorate more rapidly.
Significance
The present study provides novel information on the site-dependent mechanical and structural changes in cartilage properties in early experimental OA. These findings may help to optimize strategies for the prevention of OA and provide new ways for predicting the time course of OA progression.
Acknowledgements
Finnish Cultural Foundation, Academy of Finland, Kuopio University Hospital, European Research Council, Sigrid Juselius Foundation. AIHS, CIHR
References
1. Vignon E et. al., J.Rheumatol. 1984;11:202-7; 2. Stoop R et. al., Osteoarthritis Cartilage 2001;9:308-15; 3. Sah RL et. al., J.Orthop.Res. 1997;15:197-203. 4. Hayes WC et.al., J.Biomech. 1972;5:541-51; 5. Rieppo J et. al., Microsc.Res.Tech. 2008;71:279-87; 6. Korhonen RK et. al., J.Biomech. 2003;36:1373-9"
people. Injuries range from mild, like a partial even unvisible tear to severe complete rupture of the ligament or avulsion fracture of the ligament insertion site on the bone. The injured ACL can not control knee movement specially tibial anterior glide therefore, knee bones rub against each other in an abnormal way. The induced abnormal bone sliding can damage the cartilage, menisci and even other ligaments around the knee and definitely results in osteoarthritis in long term. Present study focused on the short term effect of partial ACL injury on the cartilage structure and function and knee joint friction coefficient in rabbit model.
Methods: Total of 30 male white skeletally mature dutch rabbits
weighting 1.5 to 2 kg devided in 2 accurately matched group. The
anterior bundle of ACL were cut in left knee of 15 rabbits to simulate ACL injury. Before and following the operation, the rabbits housed seperatedly in cages where they can move easily and have free access to food and water. At the same time control group undergo no intervention. Each of these groups devided into 3 subgroups of 5 rabbits according to the duration of observation (Control group consisted of Control, 62 control and 85 control - Surgery group consisted of 42 surgery, 62 surgery and 85 surgery).
Friction coefficient of whole knee complex measured in vitro by the Friction Tester that was designed and created in the university
biomechanic lab. Skin, muscle and all soft tissues around the knee joint were removed. Joint capsul with it’s tendon and ligament attachments saved intact. After friction test, joint capsul, menisci and all soft tissue around the knee joint were removed. Tibia and femor seperated and prepared for stress-relaxation test by Zwick Universal Testing Machine; Zwick / Roell GmbH & Co., Ulm, Germany. Following biomechanical test, samples were fixed in formalin 10% for further histological analysis. Kruskal wallis test used to detect any difference between 6 subgroups with alpha=0.05 and Beta=0.8. To determine which 2 groups are significantly different Mann-Withney test was used. Results: Coefficient of friction of the knee joint was not significantly different in any surgery subgroup according to different control groups with no significant difference between 2 knees of the same animal. On the other hand significant differences between young modulus (P=0.047) and maximal force (P=0.027) of cartilage were recorded between different groups as shown in
Discussion: ACLT induces an acute inflammatory response. Right after inflammation submission and during subacute phase, changesin frictional properties of the knee joint are neglectable although change in articular surface loading pattern following ACLT affects cartilage biomechanical properties rapidly. It seems that articular cartilage is highly sensitive to articular loading pattern and significantly affected even when change in biorheology of joint because of ACLT induced inflammation is undetectable. These alterations can gradually lead to osteoarthritis. Cartilage detoriation soon after the intervention implies that rehabilitation intervention following ACL injury should be started as soon as possible to reduce the rate and extend of induced degeneration process.
Conclusion: These results affirmate the higher sensitivity of
cartilage biomechanical parameters rather than friction coeffitient for detection of deterioration process in joint following ACL transection."
Variety of researches is running to identify OA characteristics and
compare the quality and duration of the effects of therapeutic strategies. On the other hand, experimental models using laboratory animals are especially There are different animal models to study OA however anterior cruciate ligament transaction (ACLT) is more common.
Low Power Laser Therapy (LPLT) is one of the common physical
modalities to relief pain. OA results in structural and functional changes in cartilage. The question is wheater LPLT can affect cartilage function or not? Present study focused on the short-term effects of LPLT on the bimoechanical properties of articular cartilage as an index of cartilage function in rabbit ACLT model.
Methods: Total of 15 male white skeletally mature Dutch rabbits
weighting 1.5 to 2 kg devided into 3 groups (85 Control, 85 Surgery and Laser). The anterior cruciate ligament (ACL) was cut in the left knee of rabbits in 85 Surgery and Laser groups. The rabbits were housed seperatedly in cages where they can move easily and have free access to food and water. 85 days (3 months) following the surgery theses rabbit were sacrificed. 85 Control group underwent no intervention during the same period.
LPLT started at the 62th day after surgery for 10 sessions, 3 days a week using Ga-Al-As pulse 810nm Laser (Physiolaser, RJ Laser, Germany). For biomechanical test, tibia and femur seperated and prepared for thickness measurement and stress-relaxation test by Zwick Universal Testing Machine; Zwick/Roell GmbH & Co., Ulm, Germany. Kruskal Wallis test used to detect any difference between groups with alpha = 0.05 and Beta = 0.95. To determine which two groups were significantly different the Mann-Withney test was used.
Results: Cartilage thickness of tibia and femur was not different while comparing groups (Table 1). On the other hand, significant differences between tibial cartilages were observed in different groups as shown in Figure 1. Maximal force in 85 control group was significantly less than 85 surgery and laser groups (P = 0.014 and P = 0.043 respectively). Same differences were detected in Young modulus (P = 0.014, P = 0.043 respectively).
The ACL is one of the four major knee ligaments. The injured ACL cannot control knee movement especially tibial anterior glide therefore, knee bones rub against each other in an abnormal way. The induced abnormal sliding can damage the cartilage, menisci and even other ligaments around the knee and eventually results in OA. ACLT changes the biomechanical properties of articular cartilage more than cartilage thickness although it seems that three months after ACLT, cartilage thickness is less than control group. On the other hand, in both femur and tibia cartilage seems to become thicker following LPLT; however, none of these changes is statictically significant. Apparently, destructive effects of ACLT are more pronounced on tibial cartilage. 12 weeks after ACLT, tibial cartilage strength and young modulus decreased significantly, although 10 seassions of LPT reversed
this process completely. Same trend was observed in femural cartilage but these changes were not statistically significant.
Conclusions: Following ACLT articular cartilage softens and its strength decreases. It seems that therapeutic laser can help cartilage to resume its original characteristics.