علیرضا اکبرزاده باغبان

This study aimed to investigate the relationship between psychological factors and clinical outcomes of therapeutic exercise after 3 months in individuals undergoing total knee arthroplasty (TKA). Another aim of this study was to evaluate the effect of 3 months of therapeutic exercise on the psychological factors of these patients.

This quasi-experimental study involved 29 patients with an average age of 62.76 years who had undergone TKA for their first knees. These patients performed therapeutic exercises for three months. Pain intensity and range of motion (ROM) of flexion and extension were assessed 3 times: before surgery, at the beginning of physiotherapy and 12 weeks after therapeutic exercises. Patients’ functional ability and psychological indicators were evaluated in two phases: Before surgery and at the end of the 12th week. Clinical outcomes, including pain, knee ROM, and functional ability, were assessed using the visual analog scale, goniometer and Oxford knee score, respectively. The depression index was assessed with the Beck depression inventory (BDI) second version, anxiety with the state-trait anxiety index, fear of movement with the tampa scale of kinesiophobia (TSK) questionnaire and pain catastrophizing with the pain catastrophizing scale questionnaire.

The results showed that two psychological indices, including trait anxiety and pain catastrophizing, had a significant negative correlation with the clinical outcomes of physiotherapy after TKA. The higher the trait anxiety before surgery was, the lower the pain reduction during the activity (r=-0.574, P=0.002) and the lower the improvement in functional abilities (r=-0.402, P=0.038). Also, the higher the index of preoperative pain catastrophizing, the lower the pain reduction during activity (r=-470, P=0.013) and the lower the improvement in functional abilities (r=-0.436, P=0.023). No significant correlation was found between other psychological indicators before surgery and the clinical outcomes of physiotherapy. On the other hand, among the psychological factors, trait anxiety (P=0.01) and fear of movement (P=0.01) were significantly improved after 3-month therapeutic exercise. 

Psychological factors can play an essential role in predicting the clinical outcomes of physiotherapy after TKA. In addition, the improvement of psychological factors after therapeutic exercises may indicate that these psychological problems can be improved by reducing pain and achieving better ROM during treatment, so psychological factors are not considered an obstacle to surgery.

Electromyography (EMG) biofeedback has been suggested as a relatively new approach to help resolve muscle disorders. This research aimed to evaluate the influence of 8 weeks of proximal pelvic muscle training and biofeedback on pain, muscle strength, and their EMG activity in individuals suffering from patellofemoral pain syndrome (PFPS).

This randomized clinical trial was performed on 30 young people aged 22 to 45 with PFPS. People in the intervention group (15 people) received EMG biofeedback of the abductor (gluteus medius) and external rotator (gluteus maximus) muscles along with routine physiotherapy treatments, including stretching exercises, isometric exercises of gluteal and quadriceps muscles, and conventional transcutaneous electrical nerve stimulation. In the control group (15 people), routine physiotherapy treatments were only performed on the patients. The participants of two groups were treated for 8 weeks, 3 sessions every week. Pain by a visual analog scale (VAS), maximal voluntary isometric strength (MVIC) of the abductor and external rotator muscles of the thigh with a dynamometer, and activity of these muscles, including maximum contraction, integrated EMG and onset EMG using EMG, were measured before and after the interventions.

MVIC and EMG of the gluteus medius muscle demonstrated that the intervention group had more maximum EMG activity (P=0.043) and MVIC (P=0.003) than the control group. MVIC and the maximum EMG activity of the gluteus maximus muscle showed no significant difference between the two groups. Still, the increase in the integrated EMG of this muscle in the intervention group indicated a greater increase than in the control group (P=0.0001). Moreover, people in the intervention group had significantly less pain than the group of routine exercises alone after 8 weeks of treatment (P=0.016). 

Adding 8 week biofeedback training of abductor and external rotator muscles to the routine therapeutic exercise in PFPS can lead to pain reduction, improvement of muscle strength and better performance of these muscles. This change could potentially slow down the degenerative process of the patellofemoral joint.

Tennis elbow involves the lateral part of the elbow that seriously impairs upper extremity function. Recently, radial shock wave therapy (RSWT) and dry needling (DN) have been proposed for the treatment of various tendinopathies. This study aims to compare the effects of DN and RSWT on the pain, disability and grip strength of patients with tennis elbow.

 In this pilot study, 12 patients with tennis elbow aged 30-50 years participated. They were randomly divided into two groups: RSWT (n= 6; three sessions per week; 1.5-Bar, 10-Hz, 2000 shock waves) and DN (n=6; five sessions). To assess the pain level, we used the visual analog scale (VAS) and pressure pain threshold (PPT). To assess functional disability, the quick disabilities of the arm, shoulder and hand (Quick DASH) questionnaire was used. We also measured the hand grip strength. All outcome measures were assessed before, immediately after and four weeks after the intervention.

In the RSWT group, the pain (VAS score) and disability (grip) in the follow-up phase showed a significant decrease compared to the pre-test phase (P<0.05), while the post-test scores showed no significant decrease compared to pre-test scores (P˃0.05). The score of quick DASH significantly decreased in the post-test and follow-up phases compared to the pre-test phase (P<0.05). In the DN group, the pain significantly decreased in the follow-up phase compared to the pre-test phase (P<0.05) and the disability significantly decreased in the post-test and follow-up phases compared to the pre-test phase (P<0.05). No significant difference in the quick DASH score was found among different time points (P>0.05). The mean PPT scores of the first and second trigger points and the PPT for the average of the first and second trigger points were not significantly different among different time points in any group (P>0.05). Moreover, none of the study variables were significantly different between the two treatment groups in the post-test and follow-up phases (P>0.05).

 Both DN and RSWT can reduce pain and improve the hand grip strength of patients with tennis elbow. Their effects on pain reduction were maintained four weeks after the intervention. The RSWT can reduce the Quick DASH score. There is no significant difference between their effects on pain, grip strength, and Quick DASH score. Therefore, both DN and RSWT have a therapeutic potential in treating tennis elbow.

Considering the few published population-based studies about vocational driver vision, this study conducted for determining prevalence of color vision deficiencies and refractive errors in vocational drivers applying for a health card in Shahrood.

Methods and Materials: 

In this cross-sectional study, among the vocational drivers of Semnan province who were registered to obtain/renew health card at the occupational health center, 2856 eligible person included in the study. In all candidates, refractive errors and visual acuity (with and without correction) measured, and color vision test evaluated with Ishihara pseudo-isochromatic plates.

Among 2856 participants with an average of 38.09 ± 7.2 years old (range of 23 to 61 years), 197 participants (6.89% of population) had color vision disorders. 108 participants (3.78%) had deuteranomaly, 33 person (1.15 %) had protanomaly, 31 person (1.1 %) had deuteranopia, and 23 person (0.8 %) had protanopia and 2 persons (0.07%) were total color blind. The average of visual acuity of the right eye without correction was 0.81 ± 0.18 decimal and the left eye was 0.78 ± 0.17 decimal. These are reported 0.99 ± 0.01 and 0.99 ± 0.02 for right and left eyes (respectively) with correction. The prevalence of myopia and hyperopia among color blinds 18 and 9.7 percent and in the entire studied population 21.7 and 10.8 percent (respectively) obtained.

Considering the importance of vision health in study group and considering that vocational drivers have reached these stages after obtaining all related driving licenses, however, their prevalence of CVD and refractive errors are considerable.

 Diabetes mellitus is one of the most prevalent metabolic conditions in the world. One of its consequences is overactive bladder (OAB), which is a syndrome whose symptoms appear during the urine storage phase in the form of increased urinary frequency or urinary urgency. The prevalence of this disorder is estimated to be 22.5-24.2 % in people with type 2 diabetes (T2D). Recently, a useful technique for the treatment of OAB, named transcutaneous tibial nerve stimulation (TTNS), has been introduced. This study aims to investigate the effect of TTNS in women with T2D and OAB.

 This randomized, double-blind clinical trial was conducted on 40 women with T2D and OAB symptoms, who were divided into two control and intervention groups. The control group performed pelvic floor muscle (PFM) training daily for one month, while the intervention group received 12 sessions of TTNS combined with PFM training. Before and after the intervention, the lower urinary tract symptoms were recorded using the Persian version of the International Consultation on Incontinence Modular Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). Independent t-test, paired t-test, Wilcoxon test, Mann-Whitney U test, and chi-square test were performed for data analysis using SPSS software, version 24.

 There was no significant difference between the two groups in the ICIQ-FLUTS score, incontinence quality of life, or PFM strength, and endurance (P>0.05). However, their scores were significantly different after treatment in each group compared to the pre-treatment phase (P≤0.05).

 The combination of TTNS and PFM training has no advantage over PFM training alone in managing OAB symptoms and improving PFM strength and quality of life in women with T2D.

Patients with knee osteoarthritis (KO) commonly show quadriceps muscle weakness. One of the important reasons for this weakness is arthrogenic muscle inhibition (AMI), a process in which neural inhibition causes the failure of quadriceps activation. The present study aims to evaluate the effect of cross-education on the AMI and the maximum extensor force of quadriceps in women with unilateral KO.

this study, 21 women with unilateral KO (grade 2) participated. The AMI and the maximum extensor force of the quadriceps in the affected knee were measured before, immediately after, and 15 minutes after cross-education. The cross-education included isometric training of the contralateral quadriceps in 5 sets of 8 repetitions in one session. For measuring the AMI and maximum extensor force of the quadriceps, a burst of electrical stimulation was superimposed on the maximal voluntary contractions in 6 seconds.

Immediately after one session of cross-education, the AMI of the affected knee significantly decreased and the maximum extensor force of quadriceps significantly increased compared to the pre-test phase (P=0.001). Fifteen minutes after cross-education, AMI significantly increased compared to the post-test phase (P=0.018), but was still lower than that in the pre-test phase (P=0.001)

One session of cross-education can reduce AMI and increase maximum extensor force of quadriceps in women with KO, and this effect remains for at least 15 minutes.

Autism spectrum disorder is one of the neurodevelopmental disorders. The main symptoms of this disorder are problems in communication and social interactions, and having repetitive and limited patterns of behaviors. Considering the importance of the theory of mind (TOM) and pretend play in cognitive and social development of children and the existence of mentioned problems in children with autism, this study aims to compare the effects of pretend play and the TOM between normal children and children with high-functioning autism (HFA).

In this analytical-comparative study, 45 normal children and 18 children with HFA were selected. They underwent TOM test and Child Initiated Pretend Play Assessment (CHIPPA). Then, the collected data were analyzed.

The mean total score of TOM test was 9.94 in autistic children and 28.96 in normal children. The mean percentages of elaborated pretend actions in total were 87.96 and 43.45 in normal children and children with HFA, respectively. The mean number of object substitutions was 16.47 in normal children and 2.81 in children with HFA. Also, the mean number of imitated actions in total was 2.02 in normal children and 3.06 in children with HFA.

Autistic children have poorer performance in the TOM test and pretend play compared to normal peers. They have poorer elaborated pretend actions and object substitutions; however, the number of imitated actions in the pretend play is low in both groups.

Due to the substantial prevalence of patellofemoral pain syndrome and the importance of quadriceps strengthening in knee rehabilitation, determining the best way to activate and strengthen the patella stabilizing muscles is considered as one of important keys of treatment. The aim of this study is to evaluate the effect of different hip rotations associated with ankle dorsiflexion during maximal straight leg raising (SLR) maneuver in the sitting position on thickness and fibers angle of vastus medialis oblique (VMO) and vastus lateralis (VL) muscles using ultrasonography.

This quasi-experimental study was performed on 40 individuals (healthy group: 20, patellofemoral pain syndrome [PFPS] group: 20). VMO and VL thickness and fiber angle were measured using ultrasonography during maximal SLR in 6 positions: hip internal, hip external, and neutral rotations with and without ankle dorsiflexion. 

In between-group comparison, no significant difference was found for all variables with different SLR maneuvers (P>0.05). In the within-group comparison, hip external rotation compared to other hip positions without ankle dorsiflexion resulted in a significant increase in VMO thickness and fiber angle in both groups (P<0.05). Also, adding ankle dorsiflexion to different hip rotations during SLR significantly increased the thickness and fiber angle of VMO and VL.

By changing hip rotations with or without ankle dorsiflexion during SLR, the trend of changes in VMO and VL thickness and fiber angle in the two groups followed the same pattern. Moreover, performing SLR in hip external rotation with ankle dorsiflexion can be recommendable for the rehabilitation of PFPS.

Balance disorder in patients with stroke can cause the loss of independence and increase possibility of falling. The olfactory stimuli can activate the brain areas involved in balance activities. This study aims to investigate the effect of balance exercises combined with olfactory stimuli on the balance of patients with stroke.

In this randomized clinical trial, 32 patients with stroke were randomly assigned into groups of balance+olfactory stimulation and balance. The first group performed the balance exercises while wearing a mask containing the lavender essential oil. The second group performed the balance exercises while wearing a mask containing distilled water. Both groups performed the exercises for 20 min at one session. The timed up & go (TUG) test, 10-m walk test with self-selected speed, and Mini-Balance Evaluation Systems Test (Mini-BEST) were used for assessments. The data were analyzed in SPSS software, version 22. P<0.05 was statistically significant.

The mean score of 10-m walk test before and after the intervention was significantly different (decreased) in the combined group (P=0.001) and balance group (P<0.001). The mean TUG score before and after the intervention was also significantly different (decreased) in the combined group (P= 0.008) and balance group (P=0.003). The mean score of mini-BEST before and after the intervention was also significantly different (increased) in the combined group (P=0.001) and balance group (P= 0.008). No significant difference was observed in the mean scores of 10-m walk test (P=0.386), TUG test (P=0.720) and mini-BEST (P=0.152) between the two groups before and after the intervention.

One session of balance exercise can improve the static and dynamic balances of patients with stroke. Including the olfactory stimulation by the lavender essential oil in the balance exercise program has no significant effect. It is recommended that the effects of long-term use of different olfactory stimuli on the balance of patients with stroke should be investigated in the future studies.

Domestic violence is one of the most common problems in the world, which has negative physical and psychological consequences and can be effective in women's cancer screenings. The aim of this study is to investigate the relationship between the experience of domestic violence and women's cancer screening

The current case-control study was conducted on 404 women aged 18-45 referring to medical centers covered by the Social Security Organization of Isfahan city and using easy sampling method during six months. The rate of screening in two groups of women with violence and without violence was investigated. SPSS version 20 software and chi-square, Fisher's exact, Mann-Whitney and logistic regression tests were used for data analysis.

The statistical results in the present study show a significant difference in screenings in both case and control groups. 22/8% and 35/6% in the violent group and 25/7% and 37/1% in the non-violent group and incompletely performed in the violence group 2 77/83 and 83/6 percent, and in the group of never seen violence, it is 74/3 and 62/9 percent.

Considering the inverse relationship between domestic violence and conducting screenings, life skills training, counseling and presentation Suitable solutions for couples to prevent violence can improve the barriers to screening and the resulting outcome.
Key words: Domestic Violence, Cervical Cancer, Breast cancer, Breast self-examination

 Work-life balance refers to a person’s ability to effectively manage multiple responsibilities at work. Quality of life (QOL) is a person’s satisfaction with values in which they live. This study aims to investigate the relationship between work-life balance and QOL in dormitory and non-dormitory students

 This cross-sectional study was conducted on 230 students (dormitory and non-dormitory) of Shahid Beheshti University of Medical Sciences, Tehran, Iran, who were selected by a simple random sampling method. They completed the Life Balance Inventory and short form health survey (SF-36) questionnaire. The collected data were analyzed in SPSS v.18 software.

 The work-life imbalance in dormitory students (34.2%) was higher than in non-dormitory students (20.4%). The mean scores of physical health and mental health summary measures in non-dormitory students were higher than in dormitory students. There was a significant correlation between some domains of work-life balance and QOL (P<0.05).

Work-life balance, physical health, and mental health of non-dormitory students are higher than dormitory students. Given the relationship between work-life balance and QOL, educational and welfare planning should be made in universities to help improve the QOL of students.

 Moral distress may occur when people are unable to follow professional standards and ethical values in their profession. It is a significant issue in the healthcare profession and has negative consequences. In addition, there is a concern that it may adversely affect clinical performance and, in some cases, patient outcomes. Based on the evidence, occupational therapists experience moral distress, Therefore, there is a need for a tool that enables researchers to identify the extent of moral distress in each individual and to measure the effectiveness of strategies designed to reduce distress and prevent employee burnout. The aim of this study was to develop and evaluate the face and content validity of the Moral Distress Questionnaire in occupational therapists.

 This psychometric study was performed in two stages. The first stage involved preparing a pool of questionnaire items, and the second stage examined the face and content validity of the questionnaire. First, texts and related studies were reviewed to extract the questionnaire items. Searching various databases was done to find any conditions that create moral distress in occupational therapy. Three qualitative studies conducted in the field of ethical issues of occupational therapists in the field of psychiatry, children and adults were fully studied. The codes extracted from these studies and the quotations of the interviewees were read. Then the questionnaire items were extracted from the codes, sentences and phrases of the studies. The items were read several times and edited in terms of content clarity, grammar and concept comprehension, and duplicate topics were removed. After preparing the pool of items for the preliminary questionnaire, the scientific stages of face and content validity of the questionnaire were completed. The face validity of the questionnaire was measured qualitatively and quantitatively by 30 occupational therapists who were selected by available sampling from clinics, hospitals and public and private centers. Inclusion criteria were at least one year of work experience in various fields of occupational therapy. Quantitative face validity was performed by determining the impact score of the item. In order to perform qualitative content validity, experts in the field of teaching ethics in occupational therapy and familiar with tool development were invited to review the questionnaire and exchange views in a face-to-face meeting. Seven people participated in the panel of experts. Participants were told that the tool would be an Evaluative tool designed to assess the extent of moral distress among occupational therapists working in clinical settings. After carefully studying the tool, they were asked to consider and comment on the four criteria of clarity, simplicity, transparency, and relevance of items to moral distress. To assess the quantitative content validity of the questionnaire, 20 occupational therapists with doctoral degrees were asked to complete the relevant forms for assessing Content Validity Ratio (CVR) and Content Validity Index (CVI).

After reviewing the texts and related studies and analyzing the findings and concepts, a preliminary questionnaire with 50 items was extracted. The items of the questionnaire reached 22 items after completing qualitative and quantitative face and content validity. The impact score of the item was between 2.85 to 4.83. The CVR was in the acceptable range of 0.5 to 1 with an average of 0.7. The CVI of the questionnaire was 0.93.

 The Moral Distress Questionnaire in Occupational Therapists with 22 items on a four-point scoring scale has appropriate content validity and can be used to measure moral distress in occupational therapists after completing the validity and reliability steps.Temodipi ciusant. Aquiatem quae pa isciduc iliberr oritatur

Pelvic Floor Muscle (PFM) training is the primary therapeutic intervention of PFM dysfunctions. In addition, strengthening some other muscles such as; Gluteus Maximus, Obturator Internus, Adductor Magnus, and D2 extension PNF pattern is suggested as complementary therapeutic methods. This study aimed to investigate the synergistic relationship between these muscles and PFM function using Transabdominal Ultrasonography and bladder base displacement.

Twenty-one healthy multiparous women, aged 20-40 years, participated in this cross-sectional and analytical study. Transabdominal Ultrasonography was used to measure the bladder base displacement. The following five different interventions were randomly performed, 1) PFM contraction, 2) Gluteus Maximus contraction, 3) Obturator Internus, 4) Adductor Magnus contraction, and 5) D2 extension PNF pattern. All participants did contractions three times with a 30 second rest period between each contraction. The mean of three measurements in each position was compared with the PFM contraction. Kolmogorov-Smirnov fitness test and Repeated Measures ANOVA were used to analyze the data. A level of P≤0.05 was considered significant.

The main effect of all interventions was significant compared to the contraction of the PFM (P=0.0001 and F=392.9). The amount of the bladder wall base displacement during Obturator Internus contraction and PNF D2 Extensor Pattern was more significant than the PFM contraction and in the same direction. With the Gluteus Maximus muscle contraction, the bladder base displacement was more significant than the contraction of the PFM. Still, in the opposite direction, and with the contraction of the Adductor Magnus muscle, it was approximately equal to the contraction of the PFM (P≤0.0001).

This study showed that the contraction of Adductor Magnus, Obturator, pelvic floor muscles, and also the PNF D2 Extensor Pattern could increase the bladder base displacement, which could confirm the synergistic relationship between these muscles and the PFM. However, this relationship was not observed in Gluteus Maximus muscle contraction.

Solar spectrum is composed of different wavelengths that some of them may lead to various ocular diseases. The aim of this study was to investigate the effectiveness of sunglasses in filtering harmful light.

In this cross-sectional study, 56 pairs (112 lenses) of branded sunglasses randomly collected from different importing companies. A spectrophotometer was used to measure blue light transmission. For statistical analysis, non-parametric Mann-Whitney and Kruskal-Wallis tests were used. A P ≤ 0.05 was considered statistically significant.

The mean UVA and UVB transmission of the sunglasses were 0.16±1.21% and 0.01±0.06 %, respectively. The mean blue light transmission of the sunglasses was 10.03 ± 3.91 %. The effect of different colors on the blue light transmission was significant (P≤0.001). Polarization and visible light transmission of the sunglasses had no significant effect on blue light transmission (P=0.3).

The effectiveness of available sunglasses to filter hazardous light was acceptable, and brown colored sunglasses was the best option to filter of the blue light.

One of the most important problems of old age is physical health and cognitive problems that have a significant effect on their quality of life. Balance training can improve motor and cognitive function in the elderly. Therefore, the aim of this study was to investigate the effect of balance training on cognitive and occupational performance of the elderly.

This quasi-experimental study (pretest-posttest design) was performed on 13 elderly people aged 60-75 years in Kahrizak Charity Center in Tehran. Elderly people with the ability to walk independently, with a score of at least 20 on the Mini-Mental State Exam (MMSE) and a score of 20-40 on the Berg Balance Scale (BBS) underwent the cognitive tests of the Tower of London, the N-back task, and Advanced Reaction Time in the first week, each of which measures the variables of problem-solving, working memory, reaction time (simple, diagnostic, and selective), respectively, while the Canadian Occupational Performance Measure (COPM) was used to assess performance and satisfaction. Then, balance training was performed in twenty sessions for ten weeks, two sessions per week for each elderly person, and in the last week of the intervention, cognitive tests and occupational performance were repeated and the results were compared before and after the experiment.

The mean score of working memory before and after the intervention increased significantly from 21.92±5.47 to 30.38±5.36 (p<0.001) and problem solving from 13.15±9.92 to 19.38±11.87 (p=0.003), respectively. The mean score of occupational performance increased significantly from 6.47±1.53 to 7.07±1.71 (p=0.002) and variable of satisfaction from 6.51±1.79 to 7.10±1.61 (p=0.02). However, no significant change was observed in the reaction time variable (simple, diagnostic, and selective).

The results of the study showed that participating in a balance training program can have positive effects on a number of cognitive functions such as problem solving, working memory and also occupational performance (performance, satisfaction) in the elderly.

Pelvic Organ Prolapse (POP) is one of the dysfunctions of the Pelvic Floor Muscles (PFM), with descending of pelvic viscera, vaginal wall, uterus, bladder and rectum. Regarding the role of PFM as part of the core muscles in body balance, it has been suggested that women with PFM dysfunctions may have a lower level of balance. Therefore, this study was performed with aim to compare the level of dynamic balance in non-postmenopausal women with and without POP in two positions of full and empty bladder.

This cross-sectional comparative study was performed in 2018 on 30 non-pregnant married women in the Rehabilitation School of Shahid Beheshti University of Medical Sciences. The subjects were divided in to three groups (n=10 in each group): with symptomatic POP, asymptomatic POP and without POP. After collecting demographic information, the pelvic inclination angle, and the dynamic balance in Antero-Posterior, Medio-Lateral planes as well as total balance index were assessed. Data were analyzed using SPSS statistical software (version 22) and Kolmogorov-Smirnov, one-way ANCOVA and Fisher's exact test. P<0.05 was considered statistically significant.

No significant differences were not found among three groups in terms of dynamic balance index with both full and empty bladder (p<0.05). Moreover, there were no significant differences among three groups regarding the pelvic inclination angle (p<0.05).

The association of POP as one of the dysfunctions of pelvic floor muscle is not confirmed by postural stability. Further studies using the motion analysis system and simultaneous recording of electrical muscle activity are recommended.

 Spasticity is one of the components of an Upper Motor Neuron (UMN) lesion that occurs usually after a period of flaccidity in the form of velocity-dependent resistance to passive stretch. Spasticity is a significant cause of limited mobility and disability in neurological diseases. There are several clinical approaches to control spasticity. Recently, Shock Wave Therapy (SWT) has been reported to be a new, safe, and effective method for reducing spasticity for people with upper motor neuron lesions. We conducted a meta-analysis of relevant clinical trials to assess the effect of applying SWT on spasticity in UMN lesions. 

An electronic search was performed in PubMed, ISI Web of Science, Scopus, Science Direct, MEDLINE, and Google scholar from January 2005 to January 2020. Studies were included if they measured spasticity with the Modified Ashworth Scale (MAS) or/and neurophysiological indices in patients with stroke, multiple sclerosis, and cerebral palsy. The keywords of muscle hypertonia or spasticity, extracorporeal shock wave therapy, stroke, multiple sclerosis, and cerebral palsy were used. Two independent researchers searched articles, screened eligible studies against the inclusion criteria, and assessed the methodological quality of included studies. The methodological quality of studies was evaluated using the Downs and Black tool. The difference between the means was considered as the effect size in the MAS and Hoffman reflex/motor response (H/M) ratio before and after the intervention with 95% CI in random-effects models. Analyzes were performed using STATA software version 11.

 The initial search led to the retrieval of 98 studies based on the inclusion and exclusion criteria, of which 24 full-text articles were reviewed and 14 articles were included in the meta-analysis process. All 14 articles had examined the effects of shockwave on the MAS. Four studies with 120 patients had examined the effects of shockwave therapy on the H/M ratio. Significant reduction in MAS grade was observed immediately [I2 = 100%, P<0.001, SMD=1.38 with 95%CI: (0.80, 1.87)] and three months after SWT [I2 = 100%, P<0.001, SMD=1.13 with 95%CI: (0.50, 1.76)] in comparison with the baseline values. ESWT had no significant effects on the H/M ratio [I2 = 97.5%, P<0.001, SMD=1.09 with 95%CI: (-0.54, 2.73)].

 SWT can improve spasticity based on the MAS. The lack of SWT effects on the neurophysiological parameter of spasticity supports this opinion that SWT acts on the non-neural component of spasticity. Differences observed in studies in terms of treatment sessions, intervals of treatment sessions, energy density, number of shocks, and follow-up duration need to be examined more closely. More randomized clinical trials are needed in the future to analyze the impact of these factors on the efficacy of SWT for spastic patients.

Quantitative and qualitative evaluation of facial asymmetry in patients with unilateral exotropia Duane retraction syndrome (DRS) with head turn in comparison with normal subjects.

The present cross-sectional study was performed on 22 samples, including 11 patients with unilateral exotropia DRS with a head turn and 11 normal subjects without torticollis as a control group. To evaluate the appearance of the face, from a distance of 40 cm, four photos of each sample were captured and analyzed, using Corel Draw X7 software. The presence of qualitative facial asymmetry parameters, including one-side compression of the nostrils, cheek and face, and columella deviation were recorded. Quantitative facial asymmetry parameters, including "relative face size" and "facial angle" were also measured.

The mean age of patients and normal subjects was 17±10 and 18±10, respectively. Two groups were matched by gender and age (P=0.885, P>0.99, respectively). All 11 (100%) exotropia DRS patients had facial asymmetry, but in the control group, facial asymmetry was observed in 6 (54.5%) subjects, and 5 (45.5%) subjects had perfectly symmetrical faces (P = 0.736). The mean facial angle in the patient group (1.7°±0.016°) was significantly higher than the control group (0.8°± 0.8°) (P= 0.012). Also, the mean relative face size in the patient group (1.022±0.016) was significantly higher than the control group (1.008±1.006) (P = 0.019). The frequency of all qualitative facial asymmetry parameters (one-side compression of the nostrils, cheek and face, and columella deviation) in the patient group was significantly higher than the normal control group (all, P <0.001).

All facial asymmetry parameters in exotropia DRS patients with head turns were significantly higher than the normal control group.

To evaluate the facial characteristics in patients with unilateral esotropic Duane retraction syndrome (DRS) with head turn and compare with orthotropic participants.

This cross-sectional descriptive-analytical study was performed on 42 esotropic DRS patients with head turn and 42 orthotropic participants. Four photos of each patient were taken from 40 cm and the pictures were analyzed with Corel Draw X7 software. "Facial angle" (the angle between the line connecting the two outer canthi with the line connecting the corners of lips) and "relative face size" (the ratio of the distance between the outer canthus and lip corner of both face sides) were measured. Qualitative variables of facial asymmetry (columella deviation, one-side compression of the face, nostrils, and cheek) were also recorded.

The mean age of patients and controls was 15 ± 9 and 17 ± 10 years, respectively (P = 0.268). In the DRS group, 35 patients (83.3%) had facial asymmetry, and only 7 patients (16.7%) had symmetrical faces (P <0.001), while in the control group, facial asymmetry was found in 21 participants (50%). The mean relative face size in the DRS group (1.018 ± 0.013) was significantly higher than orthotropic participants (1.010 ± 0.008) (P= .0030). Although the mean facial angle in the DRS group (1.06 ° ± 0.96 °) was higher than orthotropic participants (0.80 ° ± 0.64 °), no significant relationship was observed between them (P = 0.119). The frequency of presence of facial asymmetry, columella deviation, one-side compression of the face, nostrils, and cheek in DRS patients was significantly higher than orthotropic participants (all, P<0.001).

Facial asymmetry in esotropic DRS patients with head turn is significantly higher than in orthotropic participants.

Posturography is a method in which the postural stability of adults is evaluated by measuring the center of pressure sway. This study aims to evaluate the reproducibility of measuring the center of pressure oscillation in standing position with internal perturbation in healthy young women with and without hyperkyphosis.

Ten women with dorsal hyperkyphosis with the mean age of 23.5±2.65 years and 10 healthy women with the mean age of 21.9±1.3 years (October 2018 to February 2019) were recruited for the study. Subjects were asked to perform rapid bilateral arm elevation while standing on a force plate. Standard deviation of the amplitude and The standard deviation of the velocity of the center of pressure sway in anterior-posterior, Medio-lateral directions and the area of sway were used for statistical analysis. Measurements were carried out by one examiner with a 1-day interval in The Biomechanics laboratory of The School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences. The relative reproducibility of the measurements was calculated by Intra-class Correlation Coefficient (ICC), standard error of measurement (SEM) and minimal detectable changes (MDC).

The intra-rater reliability of standard deviation of the center of pressure sway velocity and amplitude of both directions in both groups were more than 0.75. The intra-rater reliability of the area of the center of pressure sway in the healthy and hyperkyphosis group were 0.42 and 0.38 respectively.

Standard deviation of the amplitude and standard deviation of the velocity of the center of pressure sway can be considered as reliable variables for assessing static balance in young women with and without dorsal hyperkyphosis in future studies. However, the inconsistency of sway area especially in women with hyperkyphosis suggests that the use of it for differentiation between subjects and the assessment of the outcome of any interventions on the postural stability should be considered with caution.

 Because of the significant prevalence of diabetes, disability of patients due to the complication of Diabeti Neuropathy (DN) has been increased. Physiotherapy is one of the methods for DN which can help control the symptoms through modalities such as infrared radiation, electrical stimulation and electromagnetic fields. Tecar therapy is a form of electromagnetic fields.This study investigated the effect of Capacitive Tecar therapy on pain and tactile sensation of the feet in type 2 diabetics with symptoms of peripheral neuropathy. 

This clinical trial was performed as pre-test and post-test with a control group. The samples consisted of 24 diabetics aged 17-78 years with symtoms of peripheral neuropathy allocated in the control and experimental group randomly. The patients of experimental groups participated in 10 sessions and received the Capasitive tecar therapy with 10%-30% intensity in addition to infrared radiatin; the controls received the same protocol with zero intensity of tecar. Pain and tactile sensation of the soles were evaluated before and after sessions. The collected data were analyzed by the Reapeted measure Analysis Of Variance (ANOVA). All statistical analyses were performed in SPSS V. 18. The significance level was set at P<0.05.

 The results of Rearetd Measure ANOVA showed that there was a significant difference in the mean scores of pain and tactile sensation of soles in the post-test compared to the pre-test of two groups.(P<0.001).There was also a significant difference in the means of post-test scores of variable pain (P=0.002) and tactile sensation (P<0.001) between the two groups. The improvement of variables in experimental group was more than control group.

 The results of this study revealed that Tecar Therapy with infrared radiation can be an appropriate therapeutic program for improving pain and tactile sensation of soles in diabetic patients with symptoms of peripheral neuropathy.

Ocular thyroid disease is a common complication associated with Graveschr('39') disease and hyperthyroidism, which in severe cases there is a risk of irreversible loss of vision. The aim of this study was to compare the visual acuity, refractive errors, proptosis and ocular deviation of these patients with healthy individuals.

In this historical cohort study, 65 patients with history of thyroid disease were compared with 65 healthy subjects. Patients in the age range of 24 to 60 years with a history of thyroid disease and healthy individuals were selected from those who referred to the eye clinic who did not have thyroid disease. The proptosis of the eyes was measured with Hertel exophthalmometer. Visual acuity of the patients was measured with Snellen chart and refractive error measurement was done with an auto-refractometer.

Of the patients, 53 (81.5%) were males and 12 (18.5%) were females. Sphere refractive error in patients and healthy individuals was -0.85±2.44 diopters and -0.46±1.26 diopters, respectively. The mean visual acuity in the patient and healthy groups was 0.91±0.13 and 0.96±0.08 in Snellen unit (p≤0.0001), respectively. The mean proptosis in patient and healthy individuals was 17.7±2.55 mm and 16.05±1.86 mm (p≤0.0001), respectively. The mean of total eye astigmatism in patient and healthy individuals was -1.11±1.19 diopters and -0.6±0.66 diopters, respectively (p≤0.0001).

Higher astigmatism and proptosis and decreased visual acuity in the patients, indicating thyroid disease has affected on the involved eye.

Diabetic neuropathy leads to a reduction in the balance due to peripheral nerves involvement. On the other hand, quantitative studies have shown changes in balance indicators after using the body's entire body vibration. The purpose of the present study was to evaluate the changes of equilibrium indices immediately after using the apparatus for whole body vibration in patients with type II diabetic neuropathy.

In the current single-session, single-blind clinical trial study, 32 patients with diabetic neuropathy were divided into two experimental and control groups. Patients in the intervention group, stood on the laser screen of the body's total vibration, with a frequency of 30HZ and an amplitude of 2 mm, knees bent to 30 degrees for six times with a one-minute rest. In the control group, there were patients with the same conditions, but they stood still on the device screen. Patients in both groups were evaluated before and after intervention using Biodex device. Regarding the normal distribution of data, Shapiro-Wilk test was used. Also, t-paired test and covariance analysis were run for further comparisons.

Based on t-paired sample test, general balance (p = 0.000), balance in the anterior-posterior direction (p = 0.000), and balance in side direction (p = 0.033), before and after intervention, revealed significant changes (P = 0.06); however, in the control group, general balance (p = 0.06), balance in the anterior-posterior direction (p = 0.33), and balance in side direction (p = 0.79) were not significantly different compared between pretest and posttest. Comparing the results of the two groups, using independent t-test, general equilibrium (p = 0.000), balance in the anterior-posterior direction (p = 0.000), and bilateral balance (p = 0.027) showed statistically significant differences.

According to the results, the whole body vibration can be effective in improving the balance in the short time.

The myofascial trigger points are very sensitive points in tight bundles of the skeletal muscle and contribute to pain and motor limitation and ultimately cause functional impairment. The myofascial trigger points are divided into two active and latent groups clinically. Latent trigger points are more common compared with active trigger points. Among the muscles of the body, the upper trapezius muscle, has the lowest pressure pain threshold against the allgometer, is the most common site of the trigger points in which the trigger points develop, and can cause the myofascial pain syndrome in the neck and shoulders. Methods and Materials: The current study was performed on 10 women with an upper trapezius latent trigger points. Upper trapezius muscle thickness and pennation angle at rest and then thickness and angle pennation of muscle in contraction were measured using a Honda ultrasound machine (2100) Japan – 7.5 MHz linear transducer) in a sitting position on an armchair. Measurements were repeated twice on the same day for half an hour. Intra-class correlation coefficients (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC) tests were used to measure the intrarater reliability and to estimate measurement errors.

The results for ICC, SEM, and MDC were used to examine the interrater reliability measuring the thickness of the upper trapezius muscle at rest (ICC = 0.962, SEM = 1.43, MDC = 3.97) and the  pennation angle of the upper trapezius at rest (ICC = 0.913 , SEM = 1.46, MDC = 4.06), the thickness of the upper trapezius muscle in contraction (ICC = 0.979, SEM = 1.95 MDC = 5.43), and pennation angle of the upper trapezius in contraction (ICC = 0.870, SEM = 1.46, MDC = 4.06).

It can be cloncluded that ultrasound, according to the method used in the present study, is a reliable method with small SEM and MDC values in the thickness and pennation angle measurements of upper trapezius muscle at rest and the thickness and pennation angle of the upper trapezius muscle in the contraction.