دکتر بهروز عطارباشی مقدم

The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been developed to measure the health status of Congestive heart failure (CHF) patients. This study aimed to translate KCCQ into a Persian version and assess its validity and reliability. We used a forward-backward procedure to translate the questionnaire. In a cross-sectional study, 150 CHF patients and 50 healthy subjects over 30 years old were selected to assess the reliability and construct validity of the instrument. The face and content validity were used for the questionnaire's validity. The validity was examined on a population of patients with CHF using the Persian version of the Minnesota Living Heart Failure Questionnaire (MLHF) health survey. Calculation of the Intraclass correlation coefficient (ICC) and Cronbach's alpha was done to evaluate the questionnaire's reliability. Test-retest reliability was examined by re-administering the KCCQ after 2 weeks. Test-retest results demonstrated that the Persian version has excellent reliability (ICC for all domains was higher than 0.93, P≤0.000). Internal consistency was found by Cronbach's alpha to be 0.86 for the clinical summary and 0.87 for the overall summary, respectively. Also, the correlation between the components of KCCQ and MLHQ showed satisfactory construct validity. Good Pearson's Correlation Coefficient was seen between KCCQ and MLHF (r= -0.44, P≤0.000 for the clinical summary; r= -0.45, P≤0.000 for the overall summary). Analysing the data from 50 healthy persons and 150 patients were shown that the Persian version of KCCQ has acceptable discriminate validity for all domains except self-efficacy. The Persian version of the KCCQ had satisfactory reliability and validity for assessing health-related quality of life status for Iranian CHF patients.

Chronic neck pain (CNP) is of the most common symptoms of musculoskeletal disorder. Diaphragmatic exercises can reduce pain, and disability, improve proprioception, and correct forward head posture (FHP) in patients with CNP. The present study aims to determine the effect of combining diaphragmatic exercises with physiotherapy on pain, disability, and active range of motions of cervical and FHP in individuals with CNP.

Thirty women with CNP were randomly divided into two combined groups of diaphragmatic exercises and physiotherapy (DEPT) and PHYSIOTHERAPY ALONE (PT). Each person received ten sessions of treatment over two weeks. The results were assessed in the first and tenth sessions as well as two weeks later. Pain intensity was measured by visual analogue scale (VAS), disability by neck disability index (NDI), cervical active range of motions (CAROMs) by goniometry, and FHP by a lateral photograph.

The VAS, neck disability index (NDI), CAROMs, and FHP were improved after the tenth session and in a two-week follow-up (P<0.001). A significant difference was observed between the groups for average changes of VAS (P=0.04) and active extension (P<0.001) after the tenth session, while the average changes between the two groups of cervical active left lateral flexion (P=0.82) and left rotation (P=0.11) in the next two weeks was not significant.

Both groups showed improvement in neck pain, disability, CAROMs, and FHP. However, diaphragmatic exercises and physiotherapy (DEPT) seem to have more lasting effects. Therefore, it is recommended to evaluate and modify the breathing patterns in the first line of treatment programs for patients with CNP.

Codes of ethics are a set of moral standards based on a value system widely accepted by members of a profession. In order to choose the right course of action and resolve potential ethical challenges, these codes will need to be developed so that ethical values can be identified and prioritized. Medical ethics covers all areas of medicine, and surely, rehabilitation is not an exception. This study aims to codify the ethics of the rehabilitation profession while considering the cultural and religious issues in Iran. For this purpose, we used a qualitative research method, including literature review, questionnaire, targeted interviews, content analysis, group discussion, and code extraction. The results were categorized into seven sections: “respect and empathy”, “autonomy”, “offering responsible care and reducing suffering”, “doing the right thing”, “beneficence”, “privacy and confidentiality”, and “social responsibility”. The development of ethical codes for rehabilitation determines moral norms in order to protect the rights of people who need rehabilitation services. These codes can also be used as a guide to the ethical challenges of the profession.

The current study aimed to update prior systematic review and meta-analyses (SRMA) in order to determine the effects of supervised exercise-based cardiac rehabilitation (EBCR) and introduce a suitable exercise protocol for management of lipid profile abnormalities in patients with cardiovascular disease (CVD).

PubMed, Scopus, and Web of Science databases were searched from 1980 to December 2018. All published, randomized controlled trials (RCTs) reporting the efficacy of supervised EBCR in patients with CVD and measuring at least 1 component of lipid profile were included. The quality of articles was assessed based on the Physiotherapy Evidence Database (PEDro) scale. Random effect model was used to calculate the effect size of post-intervention data.

Initially 774 RCTs were reviewed, 14 of them were included in the study. In comparison with the control group, supervised EBCR was associated with higher serum levels of high-density lipoprotein (HDL) [weight mean difference (WMD): 1.297; 95% confidence interval (CI): -1.620, 4.214] and lower serum level of low-density lipoprotein (LDL) (WMD: -7.797; 95%CI: -14.005, -1.588), total cholesterol (TC) (WMD: -11.029; 95%CI: -20.716, -1.342), and triglyceride (TG) (WMD: -14.602; 95%CI: -28.992, -0.212).

It seems that EBCR is correlated with an insignificant increase in HDL serum level and a significant decrease in LDL, TC, and TG serum levels. Considering subgroup analysis results, it is suggested that long duration, moderate exercise volume (EV), and combination of aerobic exercise (AE) and resistance exercise (RE) be used to improve HDL and TG serum levels. Short duration, high EV, and AE+RE seem to significantly reduce LDL serum level. Moreover, moderate EV is associated with a significant reduction in TC level.

Using simulated patients (SPs) in clinical skills education is a common method of providing training to students to hone their skills for future client encounters. The aim of this systematic review is to provide an overview of the SP strategy in physical therapy (PT) education.

 PubMed, SCOPUS, and Web of Science databases were searched up to November 2019 with no language restriction. Different keywords related to the topic were selected using MeSh. Any types of quantitative study design which had used simulation-based learning in physical therapy student were eligible for inclusion. Two researchers reviewed studies and appraised them critically.

 A total of 1049 abstracts were retrieved and after reviewing the full-text paper, 11 full-text articles were included. These studies had used simulated patients for various aims including replicate different aspects of knowledge, self-perceived skills real, clinical practice, attitudes, and feasibility. Based on the result of studies, SP as an educational technique, can improve student’s clinical reasoning skills, communication, and motivation in a safe method.

The simulated patient is a useful modality to deliver learning activities in medical education and physical therapy curricula, facilitating feedback on students’ performance with opportunities to interact with realistic patients and environments.

Lumbar stiffness is a common complaint of patients with low back pain. The Muscle Energy Technique (MET) is a common intervention to treat the spine and sacroiliac joint dysfunctions and their resulting disability in daily activities. This research aimed to evaluate the effects of MET on pain, functional disability, and lumbar stiffness of patients with sacroiliac joint dysfunctions by considering the type of dysfunction and the orientation of the correcting maneuver.

Fifty women with ant innominate or post innominate dysfunctions were recruited for the research and randomly divided into two groups (n=25). One group received one session of MET, and the other group received the sham position. Visual Analogue Scale (VAS), lumbar Stiffness Disability Index (SDI) and Oswestry Disability Index (ODI) were used for the evaluation of the participants before, 24 hours after and one week after the intervention.

According to the results, MET significantly decreased the mean range of VAS and ODI, 24 hours, and a week after the intervention (P<0.01). We did not see any significant difference in SDI values before, 24 hours, and one week after MET in the patients (P>0.01).

Applying MET regarding the kind of dysfunction may reduce the patient’s pain and disability.

The Minnesota Living with Heart Failure Questionnaire (MLHFQ) has been developed to measure health-related quality of life (HRQoL) status of Heart Failure (HF) patients. The aim of this study was to translate MLHFQ into the Persian version and assess the validity and reliability of the translated version. We used a forward-backward procedure for translation. In a cross-sectional study, 105 HF patients and 50 healthy subjects were selected to assess the reliability and construct validity of the instrument. The face and content validity were used to assess the questionnaire validity. Validity was examined on the HF patients group, using the Persian version of the Short form-36 health survey (SF-36) Questionnaire. In order to assess the questionnaire’s reliability, the Intraclass correlation coefficient (ICC) and Cronbach’s alpha were calculated. Test-retest reliability was examined by re-administering the MLHFQ after 2 weeks. Test-retest results demonstrated that the Persian version has excellent reliability (ICC for all 2 domains were higher than 0.91, P≤0.000). Internal consistency for Physical domain (PD), emotional domain (ED) and total scores using Cronbach’s alpha were 0.90, 0.84 and 0.92, respectively. ICC for PD, ED and total scores were 0.95, 0.94, and 0.97, respectively. Good and very good Pearson's Correlation Coefficient was seen between MLHFQ and SF-36 (r= -0.47 to -0.775, P≤0.000 for PD; r= -0.47 to -0.65, P≤0.000 for ED). The Persian version of the MLHFQ had satisfactory reliability and validity for assessing HRQoL status of Iranian HF patients.

Previous studies showed that Whole Body Vibration (WBV) is an effective modality for strength and power. WBV has many usages in training and rehabilitation. Core muscles have the central role in the stability of the spine and our daily activity; so, strengthening core muscles is essential. This study aimed to investigate the immediate effect of WBV on strength, endurance, and performance of core muscles in young, healthy females.

This study was a quasi-experimental interventional study. Twelve young, healthy females (18-28 years old) participated in this study; they received WBV in semi-squat position 5 times in 60 seconds separated by 30-second rest. The parameters of WBV included the frequency of 30Hz and an amplitude of 4mm. The tests used for the evaluation of core stability included Vertical Jump (VJ), pressure biofeedback, front abdominal power, trunk extensor endurance, and trunk flexor endurance tests. The tests were performed before, immediately after, and 30 minutes after the intervention.

According to the results, the trunk extensor endurance test, front abdominal power test, and pressure biofeedback had a significant effect (P<0.05). However, no change was observed in the trunk flexor endurance test and VJ test (P>0.05).

This study indicated that WBV could be useful in core stability, specifically for trunk extensor endurance, lumbar strength, and front abdominal power. More studies are required to prove the effect of WBV on VJ and trunk flexor endurance.

Percutaneous Coronary Intervention (PCI) is a non-surgical procedure for the treatment of Coronary Artery Diseases (CADs). One of the most common disorders associated with these procedures is the occurrence of Cognitive Impairments (CIs). This study aimed to assess the Reaction Time (RT) and anticipatory skill of PCI patients and healthy subjects, using computer-based software as a safe and easy method.

Ten male PCI patients and ten healthy male individuals participated in this cross-sectional study. Auditory choice and complex choice RT, visual choice and complex choice RT, and anticipatory skill of the low and high speed of the ball of both groups were analyzed by Speed Anticipation Reaction Test (SART) software.

No significant difference was seen between two groups in terms of simple auditory RT (P=0.15), auditory complex choice of RT (P=0.19), and anticipatory skills of the low speed of the ball (P=0.16). However, the performance of PCI patients was significantly worse on the simple visual RT (P=0.01), visual complex choice RT (P=0.05), and anticipatory skill of the high speed of the ball (P=0.04) compared to those of the healthy controls.

The assessment of RT and anticipatory skill as neurocognitive tests is considered to be one of the useful methods for evaluating the cognition function of patients, who have cardiovascular diseases. Furthermore, the pilot study suggests that PCI patients had a similar or even poorer performance in cognitive function compared with healthy people.