javad sarrafzadeh

Upper limb motor disability, with a prevalence of approximately 77%, is the most common complication after stroke. Despite advancements in rehabilitation, many patients face persistent upper limb discrepancies. Adopting top-down and bottom-up interventions may enhance neuroplasticity and improve upper limb function. This study aims to determine the effect of motor cortical transcranial direct-current stimulation (tDCS) as a top-down approach combined with task-oriented training (TOT) as a bottom-up intervention on changes in electroencephalography (EEG) spectral power in chronic stroke patients.

Thirty chronic hemiparetic stroke survivors were randomly assigned to receive real or sham stimulation targeting the primary motor cortex (C3/C4) at 2 mA for 20 minutes and TOT daily over 15 sessions. EEG was conducted before and after the intervention, with a 3-month follow-up and the relative powers of delta to gamma frequency bands were recorded during the movement task with each hand (healthy and involved).

Significant differences in the theta (P=0.000), alpha (P=0.004), beta (P=0.000) and gamma (P=0.003) relative powers were observed between groups at follow-up. Additionally, the Friedman test revealed a significant decrease in alpha and beta bands’ relative powers in the healthy hand of the control group at follow-up (P=0.001). The experimental group displayed increased alpha and beta powers and decreased theta without statistical significance.

The increase in the relative power of low frequencies and the decrease in high frequencies in the sham group, which were more prominent than the increases in alpha and beta bands’ relative power and the decrease in theta in the experimental group, can indicate that the real-tDCS can prevent the recovery drop of relative powers. Due to the inconsistent effects of tDCS on the EEG power spectrum in stroke patients, conventional tDCS administration may require adjustments for optimal application to brain target points.

To review the educational program of physical therapy students at the basic level, it is necessary to understand the challenges and problems faced by physical therapy graduates when working with the elderly. This study aimed to explain the deficiencies of the basic level educational program of physical therapy students with a qualitative study of the content analysis type.
   In-depth and semi-structured face-to-face interviews were conducted in qualitative research with a content analysis approach, with 13 physical therapists with at least 1 year of experience in the specialized field of geriatrics. The obtained data were analyzed using Granheim and Loudman's content analysis method.
   A total of 29 codes of the physical therapy program defects in the field of geriatrics were obtained and placed in the 3 main categories as follows: The physical therapist’s knowledge, the physical therapist’s attitude, and the physical therapist’s skill.
   The findings indicated that revisions are necessary to the undergraduate physical therapy training curriculum. It is possible to provide a lesson unit with a holistic approach to the elderly in the form of a physical therapy unit for the elderly, as well as valid instructions and guidelines in the field of aging for physical therapists. This can be done through basic or master's level internships in elderly care centers.

 Quantitative electroencephalography (EEG) power spectra analysis was applied to assess brain activation during chronic pain. Although many studies have shown that there are some common characteristics among individuals suffering from various pain syndromes, the data remains inconclusive. The present study aimed to assess chronic low back pain (CLBP) based on functional brain changes with EEG in CLBP patients compared with healthy controls.

 Multichannel electroencephalogram data were recorded from 30 subjects with CLBP and 30 healthy controls under eye-open resting state conditions and active lumbar forward flexion, and their cortical oscillations were compared using electrode-level analysis. Data were analyzed using a pair t-test.  

 A total of 30 patients (19 men and 11 women in the case group (mean [SD] age, 35.23 [5.93] years) with 30 age and sex-match healthy controls participated in the study. A paired t-test was applied to identify whether there was any difference in the absolute and relative power of frequency spectra between CLBP patients and healthy controls. The results showed a significant increase in alpha relative power in CLBP patients compared with healthy controls in an open-eye resting state (P < 0.050) and active lumbar forward flexion (P < 0.050). 

 The enhanced alpha relative power in CLBP patients could be relevant to attenuating sensory information gating and excessive integration of pain-related information. Increased power at the EEG seems to be one of the clinical characteristics of individuals with CLBP. EEG can be a simple and objective tool for studying the mechanisms involved in chronic pain and identifying specific characteristics of CLBP patients.

Lumbar multifidus muscle provides stability to the spine. The present study aimed to evaluate the reliability of ultrasound findings in patients with lumbar multifidus myofascial pain syndrome (MPS). A total of 24 cases (7 females, 17 males, mean age: 40.13± 5.69, BMI: 26.48±4.96) with multifidus MPS were assessed. The variables were muscle thickness in rest and contraction, thickness changes, and cross-sectional area (CSA) in rest and contraction. Two examiners performed the test and retest sessions. The active trigger points of lumbar multifidus on the right and left side of the cases were 45.8 % and 54.2%, respectively. The intraclass correlation coefficient (ICC) values for muscle thickness and thickness changes showed moderate to very high reliability for both within and between intra-examiner measurements. (ICC, 1st examiner: 0.78-0.96; ICC, 2nd examiner: 0.86-0.95). In addition, the ICC values of within and between-session intra-examiner for CSA were high. (ICC, 1st examiner: 0.83-0.88; ICC, 2nd examiner: 0.84-0.89). The ICC and standard error of measurement (SEM) of inter-examiner reliability ranged between 0.75 to 0.93 and 0.19 to 0.88 for multifidus muscle thickness and thickness changes. The ICC and SEM of inter-examiner reliability ranged between 0.78 to 0.88 and 0.33 to 0.90 for CSA of the multifidus muscle.  The within and between-session reliability of multifidus thickness, thickness changes, and CSA was moderate to very high in patients with lumbar MPS when taken by two examiners. Furthermore, the inter-examiner reliability of these sonographic findings was high. Level of evidence: III

The muscle volume considerably changes with aging, pathologies, mechanical loading and exercise, and immobilization. It is recognized as an important parameter that can be measured by various methods to evaluate the effectiveness of interventions focusing on muscle strengthening and function. However, before the application of any measurement method, their reliability needs to be investigated and established.

This study aimed to evaluate the inter- and intra-rater reliability of the manual measurement method of the abductor hallucis muscle volume in feet with hallux valgus deformities using magnetic resonance imaging (MRI).

The MRI images of the feet of 15 samples with a hallux valgus deformity were selected in this study. The cross-sectional areas of the abductor hallucis muscle were measured in the cuts along the entire length of the foot and multiplied by slice thickness. Two trained raters performed the measurements. The second rater repeated the measurements after five days to eliminate the memory effect. The intra-rater reliability and inter-rater reliability were assessed based on the intraclass correlation coefficient [ICC (2, 1)] to evaluate the extent of agreement between the raters at a 95% confidence interval.

The between- and within-rater ICCs were 0.92 (0.79 - 0.97) and 0.99 (0.97 - 0.99), respectively. The standard error of measurements was also small in both inter-rater (6.2%) and intra-rater (2.1%) reliability analyses.

The manually outlined slice-by-slice volume measurement of the abductor hallucis muscle based on MRI images showed excellent inter- and intra-rater reliability. The excellent intra-rater reliability, besides the lower standard error percentage of measurements, indicates the superiority of measurements by a single person. However, further studies with a larger sample size are recommended.

Context:

 With a key role in normal shoulder function, scapular kinematics have been investigated in shoulder impingement syndrome (SIS).

This systematic review aimed at determining scapular kinematic patterns in patients with SIS compared to in asymptomatic individuals.

Data Sources: 

Databases such as PubMed, Scopus, Web of Science, Ovid, Embase and PEDRO were searched from January 1995 to June 2021. Study Selection: Articles in English published in peer-reviewed journals and using motion analysis systems to compare scapular kinematics between patients with SIS and asymptomatic subjects during arm elevation were included. Data Extraction: A modified Downs and Black checklist was used to assess the risk of bias of the included studies. A random-effects model was employed to perform a meta-analysis.

Nine out of 1650 screened abstracts were included for data extraction. Scapular upward rotation significantly decreased during arm elevation in SIS (SMD = -0.13, 95% CI = -0.23 to -0.02) with a low effect size (I2 = 46%). No differences were observed in scapular posterior tilt (SMD = -0.07, 95% CI = -0.18 to 0.03) and external rotation (SMD = 0.02, 95% CI = -0.06 to 0.09) between patients with SIS and asymptomatic subjects.

This review revealed that except for scapular upward rotation, scapular movement was generally insignificantly different between the subjects with and without SIS during arm elevation. Between-group differences might have been overlooked as a result of the high risk of bias in the included studies. The high-quality studies addressing confounders are required to provide a definitive conclusion on the relationship between SIS and scapular kinematics.

Obesity is known to be an important risk factor in the development of UI (urinary incontinence). Physiotherapy (exercise therapy and biofeedback) has been presented as a common treatment for the improvement of UI. Pelvic floor physiotherapy (PFPT) with weight loss (WL) may significantly improve UI in obese women. This study aimed to compare the effects of PFPT with and without WL on UI symptoms in obese women.

This non-randomized clinical trial was performed with 51 middle-aged obese women with UI. Twenty-nine women in the PFPT group received 12 sessions of PFPT, and 22 women in the PFPT+WL group received 12 sessions of PFPT and nutritionist recommendations for WL. The outcome measures included anthropometric measurements, strength and endurance of pelvic floor muscles, intravaginal pressure (IVP), international consultation on incontinence questionnaire (ICIQ-SF), visual analog scale (VAS), and quality of life (QOL). All measurements were taken at baseline and after the 12-session treatment.

The PFPT+WL group had a 4.95 kg weight loss (p <0.001). Strength and endurance of PFM, IVP, ICIQ UI-SF, VAS, and QOL showed significant improvement in both groups (p <0.001). The ICIQ UI-SF and total I-QOL in the PFPT+WL group were significantly different from those in the PFPT group (p=0.015, p=0.033, respectively), (95% CI: 2.23 - 5.10 vs. 2.85- 5.35 and 180.48 - 214.67 vs. 164.13 - 203.39, respectively).

The proposed protocol of applying PFPT with WL compared to PFPT alone led to more significant improvement in UI severity and QOL in middle-aged obese women with UI.

Recurrent low back pain (RLBP) affects different structures in the lumbar spine. Exercise therapy is highlyrecommended as one of the first-line treatments. One crucial variable introduced to enhance RLBP is the externalfocus. The present study aimed to investigate the effects of external focus training on pain, the thickness of transverseabdominis (TrA), internal oblique (IO), external oblique (EO), and lumbar multifidus (LM) muscles, kinesiophobia, fearavoidancebeliefs, and disability of people with RLBP. This randomized-controlled trial consisted of 38 RLBP patients. Patients were randomly divided into two groupsthe treatment group (n=19) that received external focus training in addition to motor control training and the control group(n=19) that received motor control training alone. The primary outcome was pain intensity, and secondary outcomes werethe thickness of TrA, IO, EO, LM muscles, kinesiophobia, fear-avoidance beliefs, and disability that were measured at thebaseline and after 16 sessions of interventions. The interventions were performed three sessions weekly. Reduction in pain intensity was more significant in the intervention group than in the control group (P<0.001, Cohen’sd=-1.47). The thickness of TrA muscle in the contraction condition of the intervention group was significantly more on the leftside (P<0.001, Cohen’s d=1.05) than on the right side (P=0.03, Cohen’s d=0.44). Other outcomes showed no significantdifferences. However, the Cohen’s d effect size for the left IO (Cohen’s d=0.57) and TKS (Cohen’s d=-0.53) were moderate. In RLBP patients, external focus and motor control training could effectively reduce the pain. Althoughthis intervention could increase the thickness of the TrA muscle of RLBP, it has no significant effect on the thicknessof IO, EO, and LM muscles. In addition, the obtained results indicated that this intervention has no significant effect onkinesiophobia, fear-avoidance beliefs, and disability..Level of evidence: I

Neck pain is a highly prevalent disorder in developed countries. A myofascial trigger point (MTrP) is distinguished under the name of the fundamental excessive menstruation for it and certain reason for musculoskeletal dysfunction. MTrP refers to a sensitive spot in a taut band whose stretch and compression can induce pain. Modifications in the motor cortex, sensory input, irritability, and integration are the adaptive mechanisms to pain. Accordingly, this study aimed to investigate the preparatory brain activity and anticipatory postural control in chronic neck pain.

The study participants included 25 women with an active MTrP in the upper trapezius muscle and 25 healthy women in the control group. We recorded the brain activities from Cz, Pz, and Fz regions and muscle activities of both sides of the upper trapezius, anterior deltoid, cervical and lumbar paraspinal, sternocleidomastoid, and medial head of the gastrocnemius. The participants had to flex their arms in reply to the second sound stimulus, followed by the first sound. Then, their reaction time and brain activity were evaluated.

Significant differences between the two groups were detected in brain activities’ measurements and the onset of muscle activation (P<0.001). The exception was the onset of gastrocnemius muscle activation (P>0.05).

The current study suggests that active MTrP induces latency and lengthens the muscle reaction time; thus, the production of suitable motion after the stimulus will be affected. Brain alteration after pain damages movement changes and postural control mechanism.

Bacterial involvement in chronic rhinosinusitis (CRS) condition made it difficult to treat using available antibiotic therapy. Therapeutic ultrasound was investigated here to evaluate bacterial diversity and quantity before and after continuous/pulsed ultrasound strategy compared to control patients.

Totally, 34 CRS patients were studied in three groups, including continuous ultrasound, pulsed ultrasound and control. Bacterial culture and identification were done before and after treatment. Computed tomography scan (CT scan) and questionnaire scores were recorded two times before and after intervention.

The most prevalent bacterial isolates were non-hemolytic Streptococci (34 patients), coagulase-negative Staphylococcus (33 patients), Gram-negative cocci (26 patients), Staphylococcus aureus (19 patients), Streptococcus pneumoniae (five patients) and Streptococcus pyogenes (five patients). Both continuous and pulsed ultrasound could significantly reduce the quantity of bacterial isolates after treatment. CT scan and questionnaire results support the effectiveness of therapeutic ultrasound.

The quantity of clinically important bacteria was significantly reduced using ultrasound treatment and recovery of patients was supported by CT scan and questionnaire scores. Alternative therapeutic ultrasound could be an effective procedure in CRS patients.

Knee osteoarthritis (KOA) may considerably change the gait parameters, including the gait variability patterns. Uncontrolled manifold (UCM) analysis has been used to evaluate the relationship between motor control and gait variability as a useful index for assessing the multi‑segmental movements’ coordination during walking. To our knowledge, no research has evaluated the alterations in the gait kinematic parameters during normal and narrow path walking in individuals with KOA as compared to asymptomatic people.

In this cross‑sectional study, individuals diagnosed with mild to moderate medial KOA and asymptomatic people will walk at their comfortable preferred speed on a treadmill. A motion capture system will be used to record at least 50 successful gait cycles. The kinematic variability of joints during gait will be analyzed using UCM, with the center of mass (COM) displacement considered as the performance variable. The primary outcome measure will be the lower limb synergy index. Variability of the COM displacement and changes in angles and angular velocities of lower extremity joints will be assessed as the secondary outcomes.

The results of this protocol study provide information on the lower limb kinematic synergy during gait on normal and narrow paths for individuals with KOA and asymptomatic controls.

This information will help the researchers and clinicians understand KOA patients’ gait variability characteristics more deeply. Moreover, it may lead to an enhanced evidence‑based approach for clinical decision‑making concerning improving gait stability and decreasing the falling risk in these people.

Tecar therapy as a modality has been considered due to its reported effects on reducing pain and swelling and finally increasing range of motion and improving function. The aim of this study was to evaluate the effects of tecar therapy on acute symptoms of athletes following lateral ankle ligament sprain in the treatment and control groups between pre-treatment periods, after 6 sessions, and after 12 sessions of treatment.

In this study, 23 patients in each group including athletes with an acute lateral ankle ligament sprain in the acute stage in Tehran. The participant of this study were divided into 2 groups of control with normal treatment and the second group with normal treatment + tecar treatment. Participants were homogenized in terms of age, height, weight, and level of exercise. To evaluate the pain intensity of patients in the two groups and to measure the swelling of the ankle joint, a tape measure (mm) was used. A goniometer was used to measure the degree of ankle motions. The Foot and Ankle Ability Measure (FAAM) questionnaire was also used to collect data.

Statistical analyzes showed that the mean numerical visual criterion of pain in both groups was significantly lower after 6 and 12 sessions of treatment (P<0.001). The results of the analysis of variance showed that the mean swelling in the treatment group and in the control group after 6 and 12 sessions of treatment (P<0.001) was significantly lower than the mean swelling before treatment. Also, the mean swelling after 12 sessions of treatment was significantly lower than after 6 sessions of treatment (P<0.001). Regarding daily life activities and the percentage of athlete satisfaction in performing the activity, the test results showed that the athlete’s scores after 6 and 12 sessions of treatment (P<0.001) were significantly higher than before treatment. Also, their scores after 12 sessions of treatment were significantly higher than 6 sessions (P<0.001). The performance scores in both groups after 6 and 12 sessions of treatment (P<0.001) were significantly higher than performance scores before treatment. Also, the performance scores after 12 sessions of treatment were significantly higher than 6 sessions of treatment (P<0.001).

The results of the present study showed that tecar therapy in patients with lateral ligament sprain of the ankle joint improves the condition of symptoms after an injury, including swelling, pain, daily life activities, percentage of athlete satisfaction with daily activities, and finally his performance and it can be used as a complementary treatment along with common therapies.

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. Various treatments have been suggested for CTS and there is no consensus on their superiority and the order of their use. Laser therapy is a non-invasive treatment method for many musculoskeletal diseases, including CTS. This study aimed to determine and compare the effect of high-power lasers (HPLs) and low-power lasers (LPLs) on pain severity, function, pinch strength, and nerve conduction study findings in patients aged 30-50 years with mild or moderate CTS.

This is a prospective, randomized, single-blind clinical trial. The study population included 45 patients aged 30-50 years who came to the physical medicine and rehabilitation clinic of Shohada-e-Tajrish hospital and mild or moderate CTS was confirmed for them. Patients were randomly assigned to control, LPL therapy, and HPL therapy groups. Pain, function, pinch strength, and nerve conduction study findings were recorded in all groups before, immediately and 12 weeks after the treatment. All data were compared using SPSS version 21.

All groups showed improvement regarding pain, function, and pinch strength. Laser therapy showed significantly better results compared to a wrist splint, but no significant difference was seen between high-power and LPL therapy groups. Nerve conduction evaluation findings did not reveal any significant difference.

Both the wrist splint and laser therapy can improve the symptoms of carpal tunnel syndrome. HPL therapy showed better results, although not significantly different from LPL therapy

 One of the most common poor postures in the head and neck region is the forward head posture (FHP). It seems that improper posture for a long period of time causes abnormal physiological load on the neck. Thus, the result can be neck pain (NP). The aim of this study was to compare the relationship between intensity of FHP and a history as well as intensity of NP plus disability in the cervical region. 

 A total of 32 female students with FHP and history of mild NP participated in this study. The craniovertebral angle (CVA) was measured by taking photos via a digital camera in standing and sitting positions. Intensity of pain was investigated using the Visual Analog Scale (VAS) and the severity of disability was tested with Neck Disability Index (NDI). 

 The Pearson's correlation coefficient was used to investigate the association between the CVA, VAS, NDI, and duration of neck pain. There was a significant positive relationship between the CVA in standing and sitting positions along with a negative correlation between CVA in both standing and sitting positions and the intensity as well as history of NP and severity of disability. 

 Proper postural habits can contribute to prevention of NP. Also, postural correction training in subjects with FHP and NP, in addition to pain decrement methods, can help to reduce pain and disability in these subjects.

 Plantar fasciitis is the most prevalent cause of pain in heels and widely treated using the shockwave therapy. 

 Thirty patients (12 males and 18 females) randomly participated in this single blind clinical trial study that aimed to evaluate the effects of low energy extracorporeal shockwave therapy on pain in patients with chronic plantar fasciitis. Group 1 patients were treated with low energy shockwave and stretch, and group 2 control patients were treated by stretch and a placebo shockwave. The groups were demographically similar with respect to age, gender, and BMI. The patients were assessed for pain using the visual analog scale (VAS). 

 After 2 weeks of treatment, a significant difference in pain was observed between the two groups. The VAS results showed 76% reduction of pain in group 1 and 46% in group 2. 

 The use of low energy radial shockwave has significant short-term effects on pain relief in chronic plantar fasciitis and is, thus, recommended as a relatively painless and safe therapy prior to surgery.

Muscles that are attacked by neuromuscular disorders are integral parts of the musculoskeletal system, so the evaluation of this system is very important for therapists. Measurement of muscle morphology with rehabilitative ultrasound imaging has attracted much attention in recent years and researcher have demonstrated that it is a practical tool for physical therapists; however, far too little attention has been paid by therapists to it. This paper has tried to provide some relevant information about this method.

Myofascial Trigger Point (MTrP) is one of the most common musculoskeletal disorders. The MTrP includes highly sensitive points within a taut band, is painful to palpation, and causes pain in a specific pattern. The MTrP is more prevalent in the upper trapezius muscle because this muscle plays an important role in maintaining the posture of the head and neck. 
This study aimed to compare the effects of dry needling and high-intensity laser therapy on the clinical signs of females with active trigger points in the upper trapezius muscle.

Thirty females with the active MTrP of the upper trapezius muscle were randomly assigned into two groups: high-intensity laser therapy group (n=15) and dry needling group (n=15); they received the interventions in five sessions for three weeks. The outcome measures included pain intensity and pain pressure threshold, which were assessed before and two days after the interventions. 

In both study groups, the scores of the visual analogue scale of pain were significantly decreased, also, the pain pressure threshold was significantly increased (P=0.001), after the treatment. However, the two groups did not significantly differ in any of the outcome measures (P>0.05).

Both high-intensity laser therapy and dry needling can be employed to treat the MTrP of the upper trapezius muscle. Considering the effectiveness of the two treatments, each of the methods can be alternatively selected for these patients.

Psoas major (PM) is a challenging muscle from the functional and anatomical point of view. The dysfunction of this muscle can result in low back pain (LBP). This study aimed to assess the intrarater reliability of ultrasound imaging (USI) of PM muscle thickness in subacute LBP patients and healthy participants without LBP in rest and during muscle contraction conditions.

PM thickness was measured in all lumbar segments (L1-L5) using a USI device in 10 healthy and 10 subacute LBP participants. The intrarater data were assessed on the same day with 1- hour interval and after 7 days. Intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change (MDC), and independent t test were used for analyses. Significant level was set at 0.05.  

PM thickness in all lumbar levels had excellent reliability (ICC range 80-98) for both groups and conditions. SEM (0.42-2.29) and MDC (1.16-6.34) were low, and PM thickness was greater than rest in contraction condition. There were no significant differences between the 2 groups in PM thickness. 

The USI demonstrated good intrarater reliability for assessing PM thickness in patients with subacute LBP. The thickness of PM in patients with subacute LBP was similar with that in healthy participants.

Chronic functional constipation is a prevalent and symptom-based disorder of the gastrointestinal tract. Constipation takes several different forms among patients. The Wexner Constipation Scoring System (WCSS) was developed to present a uniform tool for the assessment of chronic functional constipation. The purpose of this study was to provide the Persian version of WCSS and assess its validity and reliability.

WCSS was translated into Farsi. After being linguistically validated, the Persian version of the WCSS was administered to a sample of 76 patients with chronic functional constipation. Reliability tests were used to evaluate the internal consistency (the Cronbach alpha) and reproducibility (Intraclass Coefficient Correlation [ICC]) of the tool. The validation studies were conducted to assess the convergent validity (Correlated with the Patient Assessment of Constipation Symptom [PAC-SYM]) and Concurrent Validity (Correlated with Patient Assessment of Constipation Quality of Life [PAC-QOL]) of the tool, too.

The Cronbach alpha for total scores was 0.66 and the ICC was 0.85 (0.77-0.90, 95% CI). The total score of WCSS was significantly correlated with the total scores of PAC-SYM (r=0.67) and PAC-QOL (r=0.61). 

The linguistic and psychometric evaluation demonstrated good validity and reproducibility of the Persian version of WCSS.

The back extensor muscles are the main spinal supportive factors which function establishes spinal stability and erect posture of the spine. Spine deviation from the ideal alignment, like abnormal increase in the forward curvature of the thoracic spine may cause changes in the trunk muscle activity which can lead to a change in the spinal proprioception. It seems that the corrected spinal alignment as a result of an orthotic treatment course facilitates the back muscles activity and improve proprioception. The present study aimed to investigate the changes occurring in thoracic kyphosis, trunk extensor muscle strength and trunk extensor force sense after using the Spinomed orthosis in elderly people with hyperkyphosis. Twenty-six elderly people with hyperkyphosis who met the eligibility criteria participated in this preliminary study at School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran, from August to November of 2017. Subjects were randomly allocated to the experimental (wearing the orthosis with maintaining the daily physical activities) and control (maintaining daily physical activities) groups. Degree of kyphosis, absolute error of force sense and trunk extensor muscle strength were measured in all participants before and after intervention for 9 weeks. Thirteen elderly people with 63.85±4.63 years old in the experimental group and thirteen elderly people with 66.92±3.25 years old were participated in data analysis. The results showed significant reduction in degree of kyphosis (P<0.001) and absolute error of force sense (P=0.001), and improvement of trunk extensor muscle strength (P=0.021) in the experimental group. Independent t-test results showed a significant difference between experimental and control groups with better outcomes in terms of posture correction (P<0.001) strength (P=0.002) and force sense (P=0.035) in the orthosis group. Using Spinomed orthosis for 2 months (2 hours per day) appears to have some benefit in terms of back extensor muscle strength and muscle force control. Also, Spinomed orthosis can be prescribed to improve spinal posture.

One of the most common inappropriate postures is forward head posture (FHP), which the head is placed in front of the trunk in sagittal plane. Due to head and neck joints and muscles’ impairments, it seems this postural disorder might affect neck proprioception. The purpose of the present study was to evaluate cervical proprioception in FHP subjects with and without neck pain and healthy subjects.

31 subjects with FHP, 31 subjects with FHP and 31 healthy subjects were participated in this study. Craniovertebral (CV) angle was determined by photography. Cervical range of motion (CROM) device was used to measure active range of motion (AROM), joint reposition error of target angle (50 percent of the total AROM) and neutral angle in neck flexion, extension, left and right rotation and lateral flexion.

The results of ANOVA test showed there was a significant difference between AROM of extension, right rotation, and left lateral flexion between groups (p<0.05). Furthermore, there was a significant difference between target and neutral angle reposition error in all directions in FHP groups and healthy group (p<0.05). Also, the result of Pearson correlation test showed a significant and inverse correlation between CV angle and repositioning error (p<0.05).

The results of our study showed that FHP, regardless of pain, increases the amount of joint reposition error. As a result, mechanical stability and normal kinematics are reduced.

Balance disorder is one of the most-studied fields in low-back pain patients (LBP). However, there is insufficient information regarding the effect of LBP subgrouping on postural control. The purpose of the present study was to compare postural control between subgroups of chronic nonspecific LBP and healthy subjects during lifting. A total of 35 men with chronic LBP (19 active extension pattern [AEP] and 16 flexion pattern [FP]) and 15 healthy controls were enrolled in this cross-sectional study. Pooled LBP was subdivided based on the O’Sullivan’s classification system (OCS). The participants were asked to lift a box from the ground to the waist level and hold it for 20 seconds. The load was 10% of the subject’s weight. Force plate system was used to record balance parameters, including standard deviations (SDs) of center of pressure (COP) amplitude and COP velocity in anterior-posterior and medial-lateral directions and mean total velocity. The test was divided into two static and dynamic phases. Data were analyzed using one-way analysis of variance and independent t-test. There were no significant differences between pooled LBP and control groups in any of the variables, except for the SD of the anterior-posterior direction velocity in the X-plane in the static phase (P=0.017). After classifying LBP, the results showed that the healthy and AEP groups were significantly different in SD of COP velocity in the frontal plane (P=0.021), mean total velocity (P=0.010), and SD of COP velocity in the sagittal plane (P=0.039). The present study showed that postural control was not different between the pooled LBP and normal groups. After classifying pooled LBP based on OCS, we found that the AEP showed different postural control as compared to healthy controls in the dynamic phase. The FP and AEP exhibited different postural control relative to the healthy controls in the static phase, and COP velocity was lower in those groups compared to the control group. The results of this study support the concept of LBP classification.

Bacterial pathogens, in particular drug resistant strains, involved in chronic rhinosinusitis may result in treatment failure. Ultrasound waves are able to destroy bacterial population in sinus cavities and can recover patients. Twelve patients with chronic sinusitis and 10 healthy controls were treated by continuous ultrasound waves. Clinical specimens were collected before and after treatment. Serial diluted specimens were cultured on blood agar, chocolate and MacConkey agar plates for bacterial isolation. Bacterial DNA was extracted and used for Staphylococcus aureus detection using quantitative PCR. S. aureus was the most isolated bacterium (10 patients), which was eradicated from 8 patients after treatment. Using phenotypic methods at the beginning, 3 out of 10 healthy individuals were found to be positive. From 11 positive patients for S. aureus identified by real time qPCR, 9 showed significant reduction after treatment. In the healthy group, S. aureus was detected in 4 samples using qPCR, but they were clean at the second sampling. According to our phenotypic and molecular experiments, continuous ultrasound treatment effectively reduced the bacterial population in studied patients (p < 0.01). This was a hopeful basis for doing more studies with ultrasound therapy as a treatment option.

Static and dynamic postures of lumbopelvic in low back pain (LBP) are considered as two important aspects of clinical assessment and management of LBP. Thus, the focus of the current study was to compare the posture and compensatory strategy of hip and lumbar region during trunk flexion between LBP subgroupsand health subjects. LBP cases are subdivided into active extension pattern (AEP) and flexion pattern (FP) based on O’Sullivan’s classification system (OCS). This work was a cross-sectional study involving 72 men, 21 low back pain patients with FP and 31 low back pain patients with AEP and 20 healthy groups. Lumbar and hip angles during trunk flexion were measured by a 3D motion analysis system in neutral standing posture and end-range of trunk flexion. The participants were asked to full bend without any flexion of the knees. The bending speed was preferential. Hip and lumbar ranges of motion were divided into four quartiles (Q). The quartiles were compared between groups. Data analysis was performed using oneway analysis of variance (ANOVA) and independent t-test. There was no statistically significant difference in lumbar lordosis in standing and full trunk flexion positions between the healthy groups and heterogeneous LBP groups. In addition, there was not any statistically significant difference between the healthy group and the homogenous LBP group (FP and AEP). Moreover, no statistically significant difference was observed in hip angles during standing between the healthy group and the heterogeneous LBP group, and between the healthy group and the homogenous LBP group (FP and AEP). In full trunk flexion position, there was statistically significant difference in hip angles between the healthy group and the heterogeneous LBP group (P=0.026). In this position, the difference in hip angles between the healthy group and FP group was statistically significant (P<0.05). In the second Q, there was no significant difference between the healthy group and the heterogeneous LBP group (P=0.062), however, there was a significant difference between FP group and the healthy group in the fourth Q of the total hip range of motion. There was no statistically significant difference between the healthy group and the heterogeneous LBP group (P=0.054) but there was a difference between FP group and the healthy group. Lumbar/hip motion ratio (L/H ratio) was different between and within the subgroups in the second Q. This study supported the subgrouping of LBP and showed that the difference between subgroups could be determined effectively through subdividing the total range of lumbar and hip motions into smaller portions. It is possible that the neuromuscular system selects different strategies to compensate and prevent further injury of the chain components (muscle, joint, nerve and etc.).
Level of evidence: IV

Few studies have compared superficial and deep dry needling techniques in treatment of trigger points in patients with Myofascial Pain Syndrome (MPS). To compare the effects of Superficial Dry Needling (SDN) and Deep Dry Needling (DDN) on Range of Motion (ROM) and functional ability in subjects with upper trapezius MPS. This is a quasi-experimental study conducted on 50 patients with MPS of upper trapezius muscle. They were randomly divided into two groups of 25 treated with SDN and DDN. They were examined in Physiotherapy Clinic of Iran University of Medical Sciences during 2016-2017. Neck disability and cervical ROM were measured using Neck Disability Index (NDI) instrument a goniometer, respectively. The subjects were evaluated before the treatment, after the treatment, and 7-and 15-day follow-up periods. The Independent t-test and ANOVA were used to compare the two groups at different times of evaluation. There was no significant difference between SDN and DDN groups in terms of age (P=0.41), weight (P=0.99), and height (P=0.51). Interaction effect between group and time on the lateral cervical ROM over the unaffected side and NDI were significant (P<0.001). The simple main effect of time and group on NDI and ROM were also significant (P<0.001). The changes in the ROM and NDI were observed over time when SDN and DDN techniques were used, but these changes were more significant in patients treated with DDN, especially in the follow-up periods.