فهرست مطالب fateme esfandiarpour

The evaluation of VTE risk using risk assessment scales for each hospitalized patient is recommended by the National Institute for Health and Care Excellence. The purpose of this study was to compare the predictive accuracy of two common assessment scales, the Autar and Padua deep vein thrombosis (DVT) risk assessment scales.  

This prospective cohort study was  conducted on 228 ICU hospitalized patients. The risk of VTE was estimated using the Autar and Padua scales during the first 48 hours after admission. The predictive accuracy of the above two risk assessment scales for VTE in ICU patients was compared based on the area under the receiver operating curve (ROC).   

Results of ROC analysis indicated the area under the curve (AUC) values for the Autar (0.61 ± 0.05) and Pauda (0.53 ± 0.06). Log-rank test showed no difference in AUCs (P = 0.19). Moreover, the accuracy of the Autar scale  and Padua obtained 24% and 14% respectively. Both scales had 100% sensitivity but their specificity was low (Autar 14% and Padua 3%). The positive likelihood ratios (LR+) were 1.17 for Autar and 1.03 for Padua. The negative likelihood ratios (LR-)  were 0 for Autar and 0.89 for Padua. Inter-rater agreement values obtained 0.99 and 0.95 respectively for the the Autar and Padua scales.   

The AUC, accuracy, and LR+ of the Autar risk assessment scale were higher than the Padua scale in predicting VTE. However, both scales had excellent reliability, high sensitivity and low specificity. It is recommended that the risk of VTE is recorded by the Autar scale for patients admitted to ICUs. It can help the healthcare team in the use of prophylaxis for those that are at high risk for VTE.

Research evidence indicates that maladaptive reorganization of the brain plays a critical role in amplifying pain experiences and pain chronification; however, no clear evidence of change exists in brain wave activity among patients with chronic low back pain (CLBP). The objective of this study was to assess brain wave activity in patients with CLBP, compared to healthy controls. 

Twenty-five patients with CLBP and twenty-four healthy controls participated in the study. A quantitative electroencephalography device was used to assess brain wave activity in eyes-open and eyes-closed (EO and EC) conditions. The regional absolute and relative power of brain waves were compared between the groups.

Our results showed a significant increase in the absolute power of theta (F=5.905, P=0.019), alpha (F=5.404, P=0.024) waves in patients with CLBP compared to healthy subjects in both EC and EO conditions. Patients with CLBP showed a reduced delta absolute power in the frontal region (F=5.852, P=0.019) and augmented delta absolute power in the central region (F=5.597, P=0.022) in the EO condition. An increased delta absolute power was observed in the frontal (F=7.563 P=0.008), central (F=10.430, P=0.002), and parietal (F=4.596, P=0.037) regions in patients with CLBP compared to the healthy subjects in the EC condition. In the EC condition, significant increases in theta relative power (F=4.680, P=0.036) in the parietal region were also found in patients with CLBP.

The increased absolute power of brain waves in people with CLBP may indicate cortical overactivity and changes in the pain processing mechanisms in these patients.

The stability and mobility function of dominant and non-dominant limbs are different. Considering the lack of any previous investigation in this regard, this study aimed to investigate the effect of limb dominancy on anticipatory postural adjustments and reaction time (RT) during gait initiation in healthy people.

Twenty healthy people with the right limb dominant participated in the study. The two stimuli of warning and response were used within a 2-second interstimulus interval. In addition, the participants were instructed to get ready to initiate walking as soon as they hear the warning stimulus and initiate gait immediately after hearing the response stimulus, followed by measuring the RT and duration of the anticipatory postural adjustment phase.

The RT was slower when a person initiated gait with the dominant limb as compared with the non-dominant limb and no significant differences were observed in anticipatory postural adjustment phase duration between the two limbs.

In general, our findings demonstrated that information processing capacity for perception, motor planning, and selection of proper motor responses for movement initiation is affected by limb dominance

Impaired lower extremity kinematics has beenconsidered as a contributing factor to patellofemoral pain (PFP). However, current knowledge about the correlation between lower extremity kinematics and muscle strength is very limited. This study investigated the correlation between lower extremity kinematics and muscle strength, pain, physical activity level, as well as functional status in females with PFP.

Seventy-five females with PFP participated in this analytical crosssectional study. Lower extremity kinematics, maximal isometric strength of muscles, pain severity, physical activity level, as well as subjective and objective function were assessed using a motion analysis system, a dynamometer, Visual Analog Scale, the International Physical Activity questionnaire, and the Kujala questionnaire and the step-down test, respectively. The hip and knee kinematics were determined during the initial contact and the initial phase of landing. Pearson’s correlation coefficients were calculated to establish the correlation between the variables.

The knee rotation at the initial contact was significantly correlated with quadriceps strength (r=-0.240, P=0.038) and pain severity (r=0.268, P=0.020). Pain was significantly correlated with hamstring (r= -0.310, P=0.007) and quadriceps strength (r=-0.253, P=0.029) and the Kujala score (r=-0.346, P=0.002).

Our findings do not indicate a strong correlation between muscle strength and joint kinematics in females with PFP. An explanation is the presence of various subgroups of people with PFP. Future studies should focus on evaluating the correlation between the risk factors of PFP in subgroups, classified based on biomechanical, psychosocial, and anatomical characteristics.

The amount of anterior tibial translation during rehabilitation exercises is a key factor in organizing exercise regimen after anterior cruciate ligament injury. Excessive anterior tibial translation could increase the magnitude of tension imposed on injured and reconstructed anterior cruciate ligament knees. Forward lunge and open-kinetic knee extension exercises are commonly used in anterior cruciate ligament rehabilitation. However, there is insufficient data about the amount of anterior tibial translation in the eccentric and concentric phases of these exercises. This study compared the amount of anterior tibial translation in the eccentric and concentric phase of the lunge and seated knee extension in anterior cruciate ligament deficient and intact knees.

Using a non-probability sampling method, 14 men with unilateral anterior cruciate ligament rupture were selected for participation in this cross-sectional study. Participants were recruited from the university’s physiotherapy clinics. A uni-plane fluoroscope was used to image the knee joint while participants performed the forward lunge and open-kinetic knee extension exercises with the intact and injured legs in random order. Fluoroscopy imaging was performed in the radiology center at Sina Hospital, Tehran, Iran, from September 2013 to February 2014. Two factorial mixed ANOVA was used to analyze the data.

There were no significant differences in the anterior tibial translation between the limbs and contraction phases during the lunge exercise. During open-kinetic knee extension, the anterior tibial translation in anterior cruciate ligament deficient knees was significantly more than that of healthy knees at 0⁰ (P=0.007). The anterior tibial translation in the eccentric phase of open-kinetic knee extension at flexion angles of 0⁰ (P=0.049) and 15⁰ (P=0.024) was significantly greater than that in the concentric phase.

In the lunge exercise, the amount of anterior tibial translation was similar between the eccentric and concentric phases and the intact and anterior cruciate ligament deficient knees, however, during open-kinetic knee extension exercise, in the eccentric phase was greater than that in concentric, and in the intact knees was greater than that in the intact knees, at 0-15⁰ angles.

Literatures indicate a strong association between biomechanical factors, i.e., increased knee adduction moment (KAM) and knee osteoarthritis. Laboratory studies showed that yoga exercises and medial thrust (MT) gait pattern could reduce the KAM. However, there is a lack of clinical evidence to support their efficacy compared to current exercise therapy regimens.

This randomized control trial will compare the effects of combined yoga and the MT gait training and conventional knee exercises on gait biomechanics, pain, and function in people with knee OA.

Forty patients with knee OA will be randomly allocated to two treatment groups: (1) the yoga and MT gait group (YogaMT), and (2) the conventional physiotherapy group. Exercise therapy for the YogaMT group includes the MT gait training, and the yoga exercises, and for the conventional physiotherapy group, conventional knee strengthening exercises. The amount of KAM during gait, pain severity, and the functional score will be assessed at baseline, two days and one month after 12 sessions of treatment.

Physiotherapists should explore etiology-based interventions targeting the contributing factors to the development and progression of OA. The results of this RCT may help suggest a more effective treatment for patients with knee OA.

Neuroscience studies suggest that Chronic Low Back Pain (CLBP) is associated with central sensitization, and maladaptive reorganization of the brain; this introduced a new target for LBP treatment. Studies revealed that cortical and peripheral electrical stimulation can be beneficial in regulating brain neuronal activity. However, there is a scarcity of evidence to support the effects of cortical and peripheral stimulation on brain function in patients with CLBP. This double-blind randomized controlled trial investigated the immediate and short-term effects of cortical and peripheral stimulation applied alone and combined on brain activity, pain, and function in patients with CLBP.

Twenty-seven patients with CLBP were randomly assigned into three intervention groups using covariate adaptive randomization. The intervention groups received 10 sessions of treatment for 5 days/week as follows: 1: Real Transcranial Direct Current Stimulation (tDCS) and real Transcutaneous Electrical Nerve Stimulation (TENS); group 2: Real tDCS and sham TENS; and group 3: Sham tDCS and real TENS. Brian waves activity, pain intensity, functional ability, and pain threshold were assessed before, immediately after the first session of treatment, as well as one day and 1 month after the interventions.

The findings of this study provide insight into the effects of cortical and peripheral stimulation applied alone or combined on brain function in patients with CLBP. It also improves our understanding about potential association between CLBP and cortical plasticity.

Reduced strength and flexibility of lower limb muscles have been proposed as contributing factors to Patellofemoral Pain (PFP). However, relationship of muscle strength and flexibility with pain and function in people with PFP is not well recognized, yet. The purpose of this study was to investigate the correlation of lower limb muscles strength and flexibility with pain and function in females with PFP.
In this cross-sectional study 35 females with PFP and 35 matched healthy females participated. Muscle strength, muscle flexibility, and pain were assessed using a dynamometer, an inclinometer, and visual analog scale, respectively. In this account,Kujalla questionnaire and step-down test were used to determine the function. The data were analyzed using an independent t -test, Pearson correlation test and stepwise regression.
There were significantly lower strength of the knee extensors, the knee flexors, the hip abductors and lateral rotators in the PFP group as compared to the healthy group (P lower limb muscles strength in females with PFP is significantly less than a healthy matched group. Qquadriceps muscle flexibility and the hip abductor muscles strength may predict Kujalla and step-down scores in females with PFP, respectively

Previous studies suggest that hip muscle weakness may contribute to patellofemoral pain (PFP). Accordingly, addition of hip strengthening exercises to conventional knee exercises was recommended for treatment of PFP. However, evidence to support superior efficacy of additional hip exercises in treatment of PFP is limited. This study compared the clinical efficacy of knee exercises versus combined knee and hip exercises in females with PFP.
In this randomized clinical trial 60 females with PFP were randomly assigned into two groups: “the knee exercises” and “the knee and hip exercises”. Participants performed progressive therapeutic exercises 3 times a week for 4 weeks. Pain, muscle strength (the knee extensors, the hip abductors and the hip external rotators) and physical function were evaluated before and after treatment interventions using Visual Analogue Scale (VAS), a dynamometer, and step-down test, respectively.
Both groups showed significant improvements in pain, function, and the knee extensor, hip abductor and hip external rotator muscles strength after the interventions (P0.05).
Four weeks of either knee exercises or combined knee and hip exercises significantly improve function and reduce pain in women with PFP. Addition of hip strengthening exercises to conventional knee exercises was not associated with superior treatment outcomes.

Functional ankle instability (FAI), characterized by feeling of “giving way” and instability of ankle, is the most prevalent problem following ankle sprains which causes deficits in balance and health status. However, little is known about the correlation between ankle instability measuring tools in individuals with FAI..
The present study aimed at evaluating the correlation between self-reported instability with balance and health status in individuals with FAI..
Twenty-three patients with unilateral FAI and 23 healthy individuals participated in the present study. Ankle instability index and SF-36 questionnaire were completed by the participants; then balance error scoring system (BESS) was used to measure static balance. To compare balance and health status between the 2 groups, independent sample and Mann-Whitney tests were used; moreover, Spearman correlation coefficient was used to determine the correlation between the main variables..
BESS scores in FAI group was significantly more than the control group (P 0.05). However, no significant correlation was found between the balance tests scores and the instability index..
The results of the present study suggest that the individuals with FAI had greater activity limitations and participation restrictions compared with the control group. There were deficits in balance status in FAI group. Moreover, a significant correlation was observed between the ankle instability index and the subjective measures of health status..

The aim of this study was to determine the type and priority needs of people with multiple sclerosis in Khuzestan using Persian version of the Southampton Needs Assessment Questionnaire (SNAQ) and their relationship to age, gender, and physical disability scale, respectively.
In this cross-sectional study, the priority needs of 100 patients with multiple sclerosis (aged below 18 years) were studied, whose diagnosis had crossed over a period of one year. This study was covered by the MS Society of Khuzestan Province. Out of 100 patients, 25 were men and 75 were women. The data were analyzed to calculate the dispersion index of the unmet needs after the determination of initial priority needs by using the chi-square statistics.
Based on the patients’ responses, around eight unmet needs were located. Treatment needs, rehabilitation, and financial assistance were the first priority, the need for affordable housing and optimizing environment were at the second place, and employment, information, and fun were at the third place. With the increasing scale of physical disability, the dependence of the individuals on basic needs like treatment, rehabilitation, financial service and, accessibility for an optimizing environmental increases, and people’s satisfaction with the quality of health services reduces (P In order to meet the needs of people with multiple sclerosis in Khuzestan province, attempts should be made by planners and authorities to fix the therapeutic, rehabilitation, and financial issues at first, followed by the issues of affordable housing. Appropriate measures should be implemented for the success of these programs, and proper assessments of its functionality should be done in a periodic manner.

Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information.

In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients.

For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur.

Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant.

Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise.

Human knee joints experience very large loads and motions during regular daily, occupational and sport activities. Consequently, they are at high risk of being exposed to injuries and degeneration. Osteoarthritis and ligament injuries often inflict knee joints causing considerable pain and loss of productivity involving thus significant human and economic costs. Hence, biomechanics of human knee joints has been the focus of many investigations with the primary aim to improve understanding of joint function in normal and perturbed conditions. The existing prevention and treatment programs have been based on such studies.

Due to inherent costs, limitations, difficulties and ethical concerns associated with in vivo and in vitro cadaveric studies, finite element model studies have been developed as effective, powerful and complementary tools to investigate knee joint biomechanics subject to internal and external mechanical conditions affecting its normal function.

The advantage of finite element method in study of joint biomechanics lies in its robustness to incorporate complex 3D joint geometry, intricate boundary and loading conditions and materials with nonhomogeneous and nonlinear properties.

This article reviews important model studies, presents their relevant results and discusses some of the promising future directions.