ghadamali talebi

Musculoskeletal pain syndrome (MPS) is one of the main causes of functional disability. Although the symptoms and complaints of patients with MPS are often related to their musculoskeletal structures, repeated microtraumas and overuse (the main causes of musculoskeletal pain) may also lead to abnormal neurodynamics. Abnormal neurodynamics refers to mechanical dysfunction in the movement of nerve structures related to the surrounding tissues or disruption in the normal elongation of the nerve. Some recent studies have suggested the possibility of abnormal neurodynamics in patients with MPS. Therefore, this study aims to determine the frequency of abnormal neural tension and its association with functional disability in patients with MPS of the upper extremity.

A hundred participants with MPS (78 women and 22 men) participated in this study. Median, radial and ulnar nerve neurodynamic tests were performed according to Butler & Shacklock’s approach. There was a five-minute rest between each test to avoid the therapeutic effects of neurodynamic maneuvering. To quantitatively measure the intensity of the abnormal tension in the peripheral nerves in case of a positive neurodynamic test, the angle of the elbow joint in extension (for the median and radial nerves) and the angle of the shoulder joint in abduction (for the ulnar nerve) were measured using a standard goniometer. The association between abnormal neural tension and functional disability was investigated using Pearson's correlation test. The statistical significance level was set a t 0.05.

Regardless of the type of disorder, 112 patients had abnormal neural tension (some participants had more than one disorder) and underwent the neurodynamic test. Based on the results, 50 patients (50%) had at least one median, radial, or ulnar nerve tension dysfunction. There was no significant association between the degree of functional disability and the severity of abnormal neural tension according to the joint angle.

In many patients with MPS of the upper extremity with no obvious symptoms of neurological dysfunction, the nerve neurodynamic test is positive. Therefore, it is recommended that in all patients diagnosed with MPS, nerve neurodynamic test and, if necessary, neurodynamic therapy should be included in the routine physiotherapy.

The kinesiopathology model is a new rehabilitation model classifying, evaluating, and treating patients with non-specific back pain. Sahrmann proposed this model based on movement disorder syndromes. The present cross-sectional study aimed to evaluate the radiograph of the linear and angular displacement of the lumbar spine in patients with lumbar flexion impairment syndrome (LFIS) and lumbar extension impairment syndrome (LEIS). In this study, 50 adults aged 18-46 years were enrolled, including 25 patients with LFIS and 25 with LEIS. The eligible participants were referred to the radiology department for radiography in the common position of neutral, full extension, and full flexion position while standing. The White and Panjabi’s method was used to measure the linear and angular displacements. Moreover, pain intensity was assessed using the visual analogue scale, and functional disability was investigated using a modified Oswestry Disability Questionnaire. The parameter of the linear displacement at the L3-L4 level was significantly different between the two groups (P=0.02). The mean duration of low back pain was longer in the LEIS, compared to the LFIS group (P=0.01). In patients with LEIS, compensatory responses occur that cause less linear displacement at the L3-L4 level, compared to the patients with LFIS. Therefore, it is important to design appropriate exercises to better control the linear displacement at the L3-L4 level during the full range of motion in patients with LFIS. Level of evidence: III

This study aimed to assess the satisfaction of physiotherapy students with the general structure of objective structured clinical examination (OSCE).

A researcher-made questionnaire consisting of eight items was distributed to 43 graduate and undergraduate physiotherapy students to evaluate the general structure of OSCE. Data analysis was done through SPSS software v. 20, considering a significance level of P<0.05.

Among 43 participants with a mean age of 23.7±2.4 years old, the percentage of desirable attitude toward attractiveness of the OSCE was 46.6%, being fair was 21%, identifying strengths and weaknesses was 53.5%, the ability to assess knowledge and information was 11.7%, good assessment of practical skills was 30.3%, good assessment of clinical diagnosis skills was 34.9%, and appropriateness was 34.9%. In total, 88.4% of the participants believed that OSCE increases students’ stress. The total satisfaction of all the participants with the OSCE was 2.7±0.8, with last year’s students significantly less than graduate ones (2.6±0.9 vs 2.9±0.3).

The findings showed that the satisfaction of physiotherapy students regarding the general structure of the OSCE was not desirable, and OSCE was considered stressful. Therefore, due to the importance of OSCE in assessing clinical skills, it is better to improve the quality of holding the OSCE by fixing existent shortcomings, including shortness of time at each OSCE station and establishing training sessions.

Objective :

Upper limb neurodynamic tests are used to evaluate the mechanical sensitivity of the peripheral nerves. However, very little is known about the reliability of upper limb neurodynamic tests, especially for the radial and ulnar nerves. This study aimed to evaluate the reliability of neurodynamic tests of the upper extremities to test median, radial, and ulnar nerves. 

Materials & Methods:

 In this observational cross-sectional study, 25 asymptomatic subjects aged 19-45 years participated. They were selected using simple non-random sampling. Then two examiners performed the neurodynamic tests on them on two successive days. The goal was to assess the reliability of median, radial, and ulnar neurodynamic tests. During the neurodynamic tests, the participants reported the initial stretching pain and the moment of submaximal pain (substantially obvious pain) in related areas of the nerve distribution, including the anterior side of the elbow and forearm for the median nerve, posterolateral aspect of the elbow and forearm for radial nerve, and medial side of elbow and forearm for the ulnar nerve. At the starting point of painful stretching and the submaximal pain, the angle of elbow extension (for median and radial nerve tests) and shoulder abduction angle (for ulnar nerve test) were measured using a mechanical goniometer. The range between these two points was used to analyze the reliability. The intraclass correlation coefficient (ICC) and the standard error of measurement (SEM) were calculated to examine the relative and absolute reliability, respectively. Using t-test, the difference in the mean of the measurements was calculated.

Results:

 No significant difference was found between the mean measurements of the two testers in intra-session and inter-session reliability. For examiners 1 and 2, was obtained 0.94 (SEM:2ο) and 0.89 (SEM:2.85ο) for the median nerve, 0.56 (SEM:6.36˚ ) and 0.93 (SEM:1.82ο) for radial nerve, and 0.42 (SEM:3.27ο) and 0.79 (SEM:1.42ο) for the ulnar nerve. Inter-tester intra-session reliability was obtained at 0.84 (SEM: 3.44ο), 0.54 (SEM: 6.1ο), and 0.55 (SEM: 2.75ο), respectively, for median, radial, and ulnar nerves. Inter-tester inter-session reliability was obtained at 0.97 (SEM:1.43ο), 0.69 (SEM:5.06ο), and 0.51 (SEM: 2.8˚ο), respectively, for median, radial, and ulnar nerves.

Conclusion:

 The upper limb neurodynamic tests and measurement of the range between the onset of stretching pain and the point of submaximal pain have moderate to excellent reliability. Therefore, these clinical tests can be used in diagnostic evaluations and treatment interventions. Also, the median nerve neurodynamic test has higher relative reliability than radial and ulnar nerve neurodynamic tests.

Manual therapy techniques are part of physiotherapy treatment of carpal tunnel syndrome (CTS) which are classified into two groups including nerve mobilization and mechanical interface mobilization. The aim of the study was to find which manual therapy method-technique directed to mechanical interface and nerve mobilization–has superior beneficial effects on clinical and electrophysiological findings in conservative management of patients with CTS.

Thirty patients with CTS participated into two groups namely: mechanical interface and nerve mobilization in this randomized clinical trial. The intervention was performed three times weekly for 4 weeks. Mechanical interface mobilization was directed to structures around the median nerve at the forearm and wrist. Techniques of median nerve gliding and tension were used in the nerve mobilization group. The outcome measures included visual analogue scale (VAS), symptom severity scale (SSS), hand functional status scale (FSS) and motor and sensory distal latencies of median nerve. Paired t-test and ANCOVA were used for statistical analysis.

At the end of the 4th week of the treatment, the mean of VAS, SSS and FSS significantly improved in both groups (p<0.05), but the difference was not significant between the two groups (P>0.05). Although the mean of motor and sensory distal latencies of median nerve at the end of the treatment period only improved in the nerve mobilization group (p<0.05), the difference was not significant between the two groups (P>0.05).

Mechanical interface mobilization and nerve mobilization techniques are not superior to each other in reducing pain and improving hand symptoms and functional status.

Generally, conservative interventions including physiotherapy modalities and manual therapy have been recommended in the management of carpal tunnel syndrome (CTS), but this subject has not been studied in diabetic patients with CTS. Therefore the aim of this study was to investigate the effects of manual therapy on diabetic patients with CTS.
Thirty diabetic patients with CTS were randomly divided into two equal groups: modality group and manual therapy group. Participants in the modality group received transcutaneous electrical nerve stimulation (TENS) and therapeutic ultrasound (US) and patients in the manual therapy group received manual techniques for the median nerve and its surrounding structures. Interventions were applied 3 times weekly for 4 weeks in both groups. Visual analogue scale (VAS), symptom severity scale (SSS), functional status scale (FSS) and median neurodynamic test (MNT) were evaluated before and after the interventions in both groups. Paired t-test and independent t-test were used for statistical analysis.
Paired t-test revealed that all of the outcome measures had a significant change in the manual therapy group, whereas only the VAS and SSS changed significantly in the modality group at the end of 4 weeks. Independent t-test showed that the variables of SSS, FSS and MNT in the manual therapy group improved significantly greater than the modality group.
Manual therapy techniques applied to mechanical interface of the median nerve and nerve mobilization possess more appropriate and valuable effects on hand difficulties than modalities in diabetic patients with CTS.

Attitude Students towards the field of study and the future career should always be considered by health authorities of education and welfare system in each country. Positive attitudes can lead to increase student's satisfaction with the field of study and thereby foster the more effective and interested of human capital. The aim of this study was to determine the attitude of first-year students of physiotherapy towards their field of study and future career in Babol University of Medical Sciences.
This applied resaerch, in a descriptive-analytical method, was conducted in three years sequentially. The sample size of study was 61 of the first year of physiotherapy students. Data were collected by a questionnaire including demographic information and 25 five-choice questions. Finally, Data were analyzed by descriptive tests, T-test and Pearson tests using SPSS V-16 software.
FINDINGS: The mean of student's attitude score was obtained 77.62±9.66, respectively, indicates positive attitude of students to their field of study and future career. Individual interest score (self-concept) was obtained 7.76±1.47 for the field of study, which indicates a relatively good interest of the students. Also, There was a significant correlation between these two variables.
The attitude of physiotherapy students towards their field of study and future career is relatively positive. According to activate performance in the human resources in the field of health system, Planning accurately for promote clinical-professional increase job opportunities should be taken to strengthen attitude.

Indentifying the factors affecting on educational progress and or academic degradation is very impotent in education fields. Some researchers have been reported a direct relation between the self-esteem and educational progress, while another authors have doubted such direct relation. This study was aimed to determining the relationship between self-esteem and educational progress in physiotherapy students at Babol University of medical sciences.
In this correlation study, initially 52 physiotherapy students, undergraduate level, interred; but finally 45 subjects completed the questionnaire with the consent and consciously. The questionnaire included two parts: demographic information’s and cooper-smith valid test with 58 questions. The cooper-smith questionnair was used to measuring the student’s self-esteem. Also, the correlation between self-esteem and average score and other demographic data was surveyed. Data analyzed using pearson's test and t-test via SPSS.
FINDINGS: The mean of student’s self-esteem and their average score determined 34.10±6.34 and 16.866±1.059 respectively. There was not a significant correlation between the student’s self-esteem and average score (p=0.255). The mean of student’s self-esteem was significantly lower in boy students (32.00±5.394) with respect to girl students (36.42±6.628) (p=0.028). A significant correlation was found between student’s self-esteem and marital status (p=0.020); the mean of self-esteem in married students and unmarried students were 41.00±1.414 and 33.33±6.211. Additionally, there was not found any significant correlation between Paternal education level and student’s iterance rank and between age and self-esteem (p>0.05).
The student’s self-esteem is a Complex issue and somewhat independent of educational progress and Paternal education level. Interestingly, self-esteem was higher in girl's students and married individuals with respect to boy's students and unmarried individuals respectively.

Nerve mobilization is a relatively new approach in manual therapy whose efficacy and the most effective method of use are not clear. The aim of the present study was to investigate the effectiveness of manual therapy on severity of hand symptoms and median nerve tension in patiens with Carpal Tunnel Syndrome (CTS).
In the current RCT study, 32 patients with CTS were assigned into two groups of treatment and control. In both groups, the patients received the routine physiotherapy including the rest splint, TENS, and therapeutic ultrasound for four weeks. In addition to the routine physiotherapy, the patients in the treatment group received the manual therapy for both nerve mobilization and mechanical interface structures. The severity of hand symptoms (pain and tingling) and median nerve tension were assessed at the baseline and after four weeks using visual analogue scale and, median neurodynamic test, respectively. Paired and independent t-tests were run to compare data within and between the two groups. The significance level was set at p There was a significant improvement in the severity of hand symptoms and median nerve tension in both groups at the end of the study compared to baseline values (p Using manual therapy for nerve mobilization and mechanical interface structures, accompanied by physiotherapy modalities, leads to more improvement in hand sensory discomfort and median nerve tension in patients with carpal tunnel syndromes.

Excessive lumbar vertebrae translation and rotation in sagittal plane has been attributed as an associated factor of lumbar segmental instability (LSI) and low back pain (LBP). Reduction of these abnormalities improves back pain. The aim of this study was to investigate the effect of core stability exercise on the translation and rotation of lumbar vertebrae in sagittal plane in patients with nonspecific chronic LBP (NSCLBP). In this randomized clinical trial, 30 patients with NSCLBP due to LSI were included. The participants were randomly divided into two groups of treatment and control. The treatment group received general exercises plus core stability exercise for 8 weeks whereas; the control group received only general exercises. The magnitude of translation (mm) and rotation (deg) of lumbar vertebrae in the sagittal plane was determined by radiography in flexion and extension at baseline and after intervention. The primary outcome measures were to determine the mean changes from baseline in translation and rotation of the lumbar vertebrae in the sagittal plane after 8 weeks of intervention in each group. The secondary outcome was to compare the two groups in regard to translation and rotation of the lumbar vertebrae at the end of the study period. Data were analyzed using paired t-test and independent t-test. Thirty patients aged 18-40 years old with clinical diagnosis of NSCLBP entered the study. Compared with baseline values, mean value of translation and rotation of the lumbar vertebra reduced significantly in both groups (P<0.05), except L3 translation in the control group. At the endpoint, mean translation value of L4 (P=0.04) and L5 (P=0.001) and rotation of the L5 (P=0.01) in the treatment group was significantly lower than the control group. These findings indicate that in patients presented with NSCLBP due to lumbar segmental instability, core stability exercises plus general exercises are more efficient than general exercises alone in the improvement of excessive lumbar vertebrae translation and rotation.

Background and Urinary incontinence is one of the most common problems in women. The aim of this study was to investigate the frequency of different types of urinary incontinence in women who referred to pelvic floor disorders clinic. In a descriptive cross-sectional study 200 women with symptoms of urinary incontinence were evaluated from all patients who were referred to pelvic floor disorders clinic in Roohani Teaching Hospital, 2013-2014. The research parameters were age, height, weight, para, type and number of delivery, urge incontinence, stress incontinence, and mixed incontinence. The patients mean age, mean weight, and mean BMI were 48.24± 9.95, 75.82±13.33kg and 29.95± 5.32 kg/m2, respectively. Stress incontinence was observed in 90 (45%) urge incontinence was found in 45 patients (22.5%), and mixed incontinence was seen in 65 participants (32%). Among the subjects 145 (72.5%) had vaginal delivery of whom 23.4% had urge incontinence, 40% had stress incontinence, and 36.6% had mixed incontinence. In patients with cesarean section, urge incontinence was observed in 31.2%, stress incontinence in 56.2% and mixed incontinence was seen in 12.5%. According to high frequency of stress incontinence, health care providers should consider early detection and treatment of these patients.

Patients with anterior cruciate ligament (ACL) deficiency are divided to coper and noncoper groups. The purpose of this study was to compare the efficacy of perturbation training with traditional rehabilitation on functional tests of lower extremity and knee muscles isokinetic peak torque ratio in two groups of patients with ACL-deficient: coper and noncoper In this clinical trial study، 24 patients with ACL-deficient were divided to two groups: coper and noncoper. They participated in a management plan for 4 weeks، three times a week، including perturbation exercises and traditional rehabilitation (stretching، strengthening، and endurance exercises). Lower extremity functional tests through hop tests and knee muscles isokinetic peak torque ratio were evaluated. After 4 weeks، all the functional tests improved significantly in both groups; and timed 6-meter hop test showed significant improvement in coper group with respect to noncoper grouop (p< 0. 05). There was no significant difference between two groups in knee flexors to extensors isokinetic peak torque ratio; but this ratio was lower and close to normal values in coper group. Perturbation training with traditional rehabilitation improves functional abilities of lower extremity in both groups of coper and noncoper of the patients with ACL-deficient. Probably، the patients of noncoper ACL-deficient have chance to return in some daily activities too.

Item analysis is an integrate component of course assessment which helps observe the item characteristics and improve the quality of the course exam. It also provides a guide for improving the teaching method to enhance the students’ learning outcomes. However, item analysis results may not be applied to adjust the way teachers teach and improve the items characteristics. The purpose of this study was to determine the effect of item analysis in improving assessment and teaching quality. The Item characteristics of the final exam for kinesiology course for physiotherapy students in 2 semesters were studied. Improved and good multiple choice questions (MCQs) were then conducted for another semester, followed by application of both good MCQs and improved teaching for the other semester. The item characteristics were compared to observe any effect of good MCQs and teaching on educational performance. The good MCQs along with the improved teaching were associated with the greater mean score and the students who passed the exam rather than those with only good MCQs. The percentage of easy questions (42.5%) in students who received good MCQs and improved teaching compared with those (15%) who only received good MCQs indicated that the improved pool of questions were shifted from medium to easier questions. We concluded that the item analysis should be followed by revised and improved teaching method. It appears that improved item characteristics are associated with improved teaching method and possibly with an improvement in students’ learning.

Neuromobilization techniques have been recently put forward in physiotherapy of carpal tunnel syndrome. The aim of this study was to assess the effect of neuromobilization on different aspects of evaluation including subjective، physical، and electrophysiological findings in CTS. In this randomized clinical trial study، 20 patients with carpal tunnel syndrome (32 hands) were assigned into two groups; treatment and control group. In both groups، the patients received the physiotherapy modalities including the rest splint، TENS، and therapeutic ultrasound for 4 weeks. In addition to the physiotherapy modalities، the patients in treatment group received the neuromobilization techniques. The symptoms severity scale، visual analogue scale، functional status scale، Phalen''s sign، median nerve tension test، and median nerve sensory and motor distal latency were assessed. Data were analyzed by Kolmogrolf-Sminolf، Paired T and Independent T and Mc nemar tests. There was a significant improvement in symptoms severity scale، visual analogue scale، median nerve tension test، and Phalen''s sing in both groups (P<0. 05). However، the functional status scale (P<0. 001) and median nerve motor distal latency (P=0. 015) were significantly improved only in the treatment group who received the neuromobilization. There was no significant difference between two groups in any other parameters (P>0. 05)، except that the median nerve tension test (P<0. 001) and functional status scale (P=0. 004) was improved in the treatment group (P=0. 023). Physiotherapy modalities and neuromobilization itself have positive effects on hand symptoms and the finding of physical examination. Thus، we suggest adding the neuromobilization techniques into the physiotherapy modalities in patients with carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in upper extremity in which the median nerve is compressed in the wrist and assessed based on subjective، physical، and electrophysiological findings. The objective of this study was to determine the correlation among subjective، physical examination، and electrophysiological studies. Twenty five patients with CTS (totally 40 hands) from mild to moderate severity were recruited. Subjective (symptom severity scale، functional status scale، and visual analog scale)، physical examination (Phalen’s test and median nerve tension test)، and electrophysiological (median nerve distal sensory and motor latency) studies were performed for all subjects. Higher intra-correlation was found among subjective findings than electrophysiological parameters. The inter-correlation between subjective and median nerve tension test ranged from low to moderate. Also، a low intra-correlation was found between electrophysiological findings. Furthermore، there was no significant correlation between the subjective and electrophysiological studies. Similar result was found between the median nerve tension test and the electrophysiological studies. Each aspect of the examination of the patients with CTS provides specific information of the diseases and cannot be replaced by one another. Therefore، it appears that any improvement in subjective and/or physical findings does not necessarily lead to an improvement in electrophysiological studies in median nerve in patients with CTS.

In this study 22 male Guinea Pigs, 4-6 months old, weighting 400-450 g were used. A computer controlled indentor system was used to apply a controlled pressure. The applied pressure was 291 mmHg for 3 hours over the trochanter region of animal hind limb. The animals were divided in three groups; in group 1, pressure was applied 3 hours continuously, in group 2, pressure was applied 90 minutes at two days and in group 3, Pressure was applied in two cycles of 90 minutes with 15 minutes rest between them. To study the biomechanical and histological changes, tissue was removed 7 days after pressure application. Uniaxial tensile test was performed at a deformation rate of 20 mm/min. In this test, the contralateral site on the experimental animal served as intra-animal control. Tissue biopsy was taken and stained with H&E and Trichorome for histological examination. Continuous pressure induced muscle necrosis. Also ultimate stress, stiffness, ultimate strain and area under the load-deformation curve decreased significantly. These results suggest that application of continuous pressure is the major cause of ischemia and necrosis of soft tissue.