Iranian Rehabilitation Journal
Volume:19 Issue: 49, Dec 2021

To compare the efficacy of balance exercises in the aquatic and Non-aquatic environments compared with control in patients with grade 2 or 3 knee Osteoarthritis (OA).

For this single-blind, randomized control trial study, 43 women with mild to moderate knee OA were recruited through a simple non-probability sampling method. They were randomly assigned to the aquatic balance exercise group (n=15), Non-aquatic balance exercise group (n=15), and a control group (n=13). The intervention programs comprised aquatic and Non-aquatic balance training. Fall risk, the primary outcome, was measured by the Biodex balance system before and after the intervention. One-way ANOVA and paired sample t-test were used for analyzing data.

After 4 weeks training, the Mean±SD fall risk score significantly decreased from 3.49±1.14 to 2.59±1.22 (P<0.001) in the aquatic balance training group, from 3.21±0.62 to 2.19±0.62 (P<0.001) in the Non-aquatic balance training group, and from 3.77±1.13 to 3.17±1.22 (P<0.001) in the control group. Regarding between-group comparisons, we found significant differences between the Non-aquatic balance training group and the control group (P=0.03).

Despite the environment, the balance exercise program significantly improved fall risk scores among patients with grade 2 or 3 knee osteoarthritis.

Thoracic hyperkyphosis is one of the most common conditions in the elderly. The use of orthosis and exercise is one of the most effective treatments suggested, but unfortunately, there is little evidence to support this treatment. The study aimed to compare the effect of Spinomed® orthosis and elderly spinal orthosis with exercise and exercise alone on the angle of kyphosis, quality of life, and pain in the elderly with thoracic hyperkyphosis.

In this study, 40 older adults aged 60 years and older with a kyphosis angle of more than 50 degrees were recruited. The participants were allocated into three groups: Spinomed® orthosis and exercise (n=14), elderly spinal orthosis and exercise (n=15), and exercise only (n=11). The groups were treated for three months.

There was a significant decrease in the kyphosis angle of participants in the Spinomed® orthosis and exercise groups (P=0.005). Pain score was significantly decreased in the Spinomed® orthosis and exercise group (P=0.023). There was only a significant increase in the physical component summary in the Spinomed® orthosis and exercise group (P=0.03) and the elderly spinal orthosis and exercise group (P=0.04) .

The combination of Spinomed® orthosis with exercise is the best choice to correct the kyphosis angle, reduce pain, and increase the quality of life. Elderly spinal orthosis and exercise can also improve the quality of life scores.

This study aimed to examine Musculoskeletal Pains (MPs) among newly admitted university students and investigate the effect of gender differences on the prevalence of MPs.

This cross-sectional descriptive study was conducted on 2641 university students (1303 men, 1338 women). The study data were collected from the Health Center of the University of Tehran in the fall of 2019. Musculoskeletal pains in students were examined using the Nordic questionnaire. The data were analyzed by descriptive statistics and the Chi-squared test.

The highest prevalence rates of MPs in the past 12 months, past 7 days, and problems that inhibited routine activities in the past 12 months were reported in the neck area (13.4%, 5.8%, and 10.5%, respectively), and the lowest rates in the elbow (1.5%, 0.6%, and 1%, respectively). Findings also indicated a significant difference between men and women regarding MPs in the neck and shoulders in all three items of the Nordic questionnaire (P<0.05).

Based on these results, it is necessary to prevent musculoskeletal pains, especially in the neck and back, among the newly admitted students to the university.

This study aims to determine the association of ambulatory and social performance status of transfemoral prosthetic users with their age, gender, and marital status.

A cross-sectional study was conducted on 400 transfemoral prosthesis users. A sample was recruited from both genders aged 10-60 years using the prosthesis for at least one year. They were selected using the non-probability convenience sampling method from the Pakistan Institute of Prosthetic and Orthotic Sciences from July 2019 to December 2019. Lower extremity functional scale and short form-36 health survey questionnaire (SF-36) were used for data collection, followed by statistical analysis.

Ambulatory status (as measured by the total lower extremity functional scale) revealed significant association (P<0.001) with age. The highest score belonged to the 10-30 years age group. Also, there was a significant association (P=0.003) with marital status with the highest scores for unmarried ones. However, no significant (P=0.705) gender association was noted though scores were higher for the male gender. As regards, the social performance was measured by SF-36. The findings revealed a significant association (P<0.05) of most domains of SF-36 with age groups, with the highest scores for the age group of 10-30 years. Also, a significant association with the gender with higher scores in females was noted in most domains. In contrast, no significant association with marital status was reported in most domains.

Ambulatory status has a significant association with age and marital status with no significant gender association. While social performance has a significant association with gender, most domains had significant associations with age groups. However, no association with marital status was present.

Since there is no reliable and valid tool to assess all features of children’s phonological skills whose first language is Azeri, speech-language pathologists usually use informal or Persian instruments. So, it is essential to develop a tool in Azeri language for assessing articulation and phonological skills. For this reason, this study aimed to develop an Azeri Phonological Test (APT) and then determine the validity and reliability of this test in 4-6 years old children whose first language is Azeri.

Participants were 77 (41 boys and 36 girls; 4-6 years old) typically-developing children. They were selected by cluster sampling method. Firstly, Tabriz City in Iran was geographically divided into three sections, namely south, north, and center. Then, the kindergartens of each area were randomly selected for sampling. The participants were assigned into 2 groups: 48-60 months (n=38) and 61-72 months (n=39) old. To assess the phonological skills, nine stories were designed. An expert panel with 15 speech-language pathologists investigated the content validity of the stories. Then the psychometric characteristics of the APT, including reliability (test-retest reliability, inter-rater, and internal consistency) and validity (construct –known group validity), were assessed. The statistical tests used were intraclass correlation coefficient (intra-rater reliability and test-retest), Kuder-Richardson 21 (internal consistency), and the independent samples t-test (known-groups validity).

The content validity of the whole test was 0.91. Construct validity evaluation showed that age affects the test scores but not gender. There was a significant correlation between the results of test-retest and inter-rater reliability, and also, the test had a high internal consistency. 

Based on the findings, APT is a reliable and valid test for assessing the abilities of 4-6 years old children in terms of the production of sounds in the context of retelling stories.

Phonemic and semantic fluency tasks are used for verbal fluency (VF) evaluation. The present study aimed to select the most appropriate semantic categories and the most frequent phonemes of Persian as items for the VF test. Then, we determine the test results in differentiation between cognitively intact people and those with Mild Cognitive Impairment (MCI) and Alzheimer Disease (AD).

A cross-sectional study was conducted on 120 people (60 cognitively intact, 30 with AD, and 30 with MCI) in two phases. In phase one, linguists determine the most frequent phonemes at the beginning of Persian words and the most frequent semantic categories based on a survey. In phase two, the verbal fluency test was administered to cognitively intact people and those with cognitive impairment (patients with AD and MCI). One-way ANOVA and multiple linear regression were used for statistical analysis.

The normal subjects scored significantly higher in all phonemic and semantic fluency tasks than the patients with AD and people with MCI (P<0.05). Regarding the phonemic VF task, the phonemes /sh/, /s/, and then /a/ were better in differentiating the MCI and AD groups from the normal group. Regarding the semantic VF task, the animals’ category was better differentiated the MCI and AD groups from the normal group.

Comparing frequent phonemes and semantic categories of Persian across three groups of normal, AD, and MCI showed that some phonemes and semantic categories can be more differentiating in the VF task. However, it is a preliminary validation study, and this topic needs more investigation in the future.

COVID-19 pandemic and its consequences highlighted the importance of using telerehabilitation systems and affected the professional’s attitude toward it. This study aimed to investigate the feasibility, satisfaction, and attitude of rehabilitation professionals toward telerehabilitation during the COVID-19 pandemic in Iran. 

A web-based cross-sectional study was conducted to assess the feasibility, satisfaction, and attitude of rehabilitation professionals toward virtual training and telerehabilitation during the COVID-19 pandemic. A total of 118 occupational therapists, speech therapists, audiologists, psychologists, and educators completed the study questionnaires.

The findings indicate that the correlations among satisfaction, feasibility, advantages, and compatibility were significant (r ranging from 0.418 to 0.717). There were significant but weak positive correlations between years of working experience and scores of feasibility and advantages. In addition, the mean scores of feasibility, advantages, compatibility, and complexity in participants who provided telerehabilitation before the COVID-19 pandemic were higher than other respondents.

Because of the positive role of telerehabilitation in a situation such as the COVID-19 pandemic, health care systems should create mechanisms for its optimal use, protocol preparation, health professionals training, and infrastructure acquisition.

This study aims to compare, from a patient’s perspective, the cost-effectiveness between a self-managed program and usual physiotherapy care in treating knee osteoarthritis.

The study participants were assigned into two groups: group I received a weekly physiotherapy treatment plus instructions on self-management skills in goal setting, pain management, exercise, healthy eating, and dealing with fatigue (self-managed group); group II had a physiotherapy session three times a week (usual care group). The osteoarthritis cost and consequence and European quality of life-5 dimension (EQ-5D) were used to generate utility scores. The health effects measure of quality-adjusted life year (QALY) was obtained, and an incremental cost-effective ratio was calculated. Cost-effectiveness was determined by plotting a cost-effectiveness plane of incremental cost against QALY obtained.

After 8 weeks of intervention, the self-managed group recorded more significant improvements in pain level, function, and health-related quality of life than the usual care group. Clinical consultation costs (Mean±SD NGN [Nigerian naira]=1800±979), physiotherapy treatment costs (Mean±SD NGN=4000±00), and transportation costs (Mean±SD NGN=1,940±1,150) were less for the self-managed group than the usual care group. Imaging (x-ray) and drug costs did not differ significantly between groups. The QALYs gained over the 8-week intervention period was 0.13 for the self-management group compared to 0.11 for the usual care group. 

From the patient’s perspective, a self-managed program was cost-effective and cheaper for healthcare resource use. Physiotherapists may adopt the program to reduce out-of-pocket expenses for patients with knee osteoarthritis.

Locomotive syndrome refers to reduced mobility due to impairment of locomotive organs. Because of the importance of screening locomotive syndrome among older people, this article is focused on psychometric characteristics of Geriatric Locomotive Function Scale (GLFS)-5 and comparing it with GLFS-25 in Iranian older adults

This research was conducted on 320 older Iranian people. Validity and reliability of the GLFS-5 were examined and confirmed using Content Validity Index (CVI), factor analysis, correlation coefficient with the European Quality of Life Scale-5 Dimension (EQ-5D) questionnaire, the Cronbach α value for internal consistency, and intraclass correlation and Receiver Operating Characteristic (ROC) technique to determine the cutoff score for the locomotive syndrome.

In phase 1 of the study, 250 Iranian older people ≥60 years were analyzed. The factor analysis showed that the GLFS-25 is a multi-dimensional scale (Activities of Daily Livings [ADLs] and Quality of Life [QoL], pain, social relationship, and psychological status), and GLFS-5 is a one-dimensional scale (the ability to perform daily activities). The Cronbach α values for GLFS-25 and GLFS-5 were 0.93 and 0.84, respectively. As for association between the GLFS-25 and GLFS-5 with EQ-5D and Visual Analogue Scale (VAS) (health self-perceived), the Pearson correlation coefficients were 0.85 and -0.72 for GLFS-25 (P=0.01) and 0.82 and -0.67 for GLFS-5 (P=0.01), respectively. The cutoff scores to identify locomotive syndrome for the GLFS-25 and GLFS-5 were 16 and 4, respectively. 

Considering the good validity and reliability properties of the GLFS-5 compared to GLFS-25 and the more convenient use of this short version of the GLFS, its application is highly recommended for community-based screening of locomotive syndrome in Iranian older people.

This study evaluates the relationship between plasma high sensitive c-reactive protein (HSCRP) in patients with Major Depressive Disorder (MDD) under therapy.

This cross-sectional study included 90 patients with MDD that had been diagnosed previously to confirm their matching «DSM-5 criteria for MDD version 7.0.2,» employing the «mini-international neuropsychiatric interview.» Also, they were on antidepressants prescriptions for at least 4 months. The criteria of MDD were based on the self-administered inquiry forms for evaluating depression severity, comprising the 9-item Patient Health Questionnaire (PHQ-9) depression module. A venous blood sample was collected from all participants for White Blood Cells (WBCs) counts and HSCRP assays. Besides their BMI calculations, SPSS v. 23, was used for all statistical tests.

HSCRP mean serum levels were within normal ranges among MDD patients. The Mean±SD age of the MDD patients was 39.5±0.9 years, and most of them were obese; their Mean±SD BMI was 32.9±15.8 kg/m2. The mean WBCs count of the participants was within the normal ranges. The ratio of male/female participants in this study was 1.64:1. There was a non-significant difference between the sexes in all study parameters: no significant variations in the distribution of HSCRP levels according to the scores of depression severity. There was no significant variation in the distribution of WBCs counts according to the severity of depressive thoughts. A receiver operating characteristic curve (when tested for the diagnostic ability of HSCRP) revealed poor predictability to distinguish those with severe MDD from those with no or mild depressive thoughts: area under the curve=0.484, sensitivity=0.52, specificity=0.46, and P>0.05. 

The outcomes of our study highlighted the importance of low-grade inflammation as a risk factor of the onset or even worsening of depression in patients with MDD. This finding is reflected by a significant difference in the mean levels of serum HSCRP between those having mild and severe PHQ-9 scores. However, the mean serum levels of HSCRP were not correlated with the severity of depressive symptoms.

The current study aimed to identify the mothers’ traditional practice in caring for newborns with jaundice; we want to determine the association between mothers’ practices and their demographic characteristics. 

This cross-sectional study was conducted on 100 mothers from inpatient pediatric wards of Babylon Teaching Hospital for maternal and pediatric care. They were selected by non-probability, purposive sampling method. The study data were collected by a three-part tool: demographic data sheet related to mothers and children, mothers’ knowledge concerning neonatal jaundice, and the mother’s knowledge and home practices concerning neonatal jaundice. The obtained data were analyzed using the SPSS version 22.

Most mothers (67%) were younger than 30 years, and 10% had college or institute educational level. Also, 87% of mothers knew that jaundice is a common problem for neonates; 25% did not know that jaundice is abnormal if it occurs within the first 36 hours. About 17% of mothers did not agree that maternal and fetal blood group differences lead to jaundice. Besides, 47% of mothers were uncertain that severe jaundice could lead to deafness, and 78% knew that phototherapy is the treatment for jaundice.

The majority of respondents in the study were aged 29 years or less. Most of them adopted breast and formula as the type of feeding. The most recognizable outcome of this study was the adequate knowledge and practices of mothers concerning traditional caring for neonates with jaundice.

The prelinguistic skills which pave the way for language development have always been an area of research in the Speech Therapy field. Although studying these skills is important, there is a study gap among Persian children. Therefore, this study explored prelinguistic skills among a sample of Persian-speaking children aged 6 to 24 months and made a comparison between different age groups. We also studied the effects of gender and family history of speech-language disorders on children’s prelinguistic abilities. 

In the present study, 277 mothers of Iranian Persian-speaking children aged 6 to 24 months were asked to fill a research-made checklist that evaluated the prelinguistic skills of their children. This study was cross-sectional and was conducted in Tehran City, Iran, in 2021. Children’s abilities in different age groups were compared using the analysis of variance (ANOVA), Scheffe test, the Kruskal-Wallis test, and the post-hoc test. The differences between the total scores of the two genders were also determined using the Mann-Whitney U test.

Comparing the prelinguistic skills in different age groups indicated a statistically significant increase in the scores as children grow up. Children with a positive family history of speech-language disorders scored lower on the checklist than the others (91.03±17.37). Furthermore, there were statistically significant differences between the two genders in developing gesture, vocalization, first words, social interaction, imitation, and play; girls had higher scores. 

Based on the studies conducted in different countries, prelinguistic skills develop as children grow up; these skills facilitate language acquisition and other social skills. The present study also demonstrated the development of these skills alongside children’s development. This similarity between Persian-speaking children and other children from different cultures and languages, as well as better performance in children with a negative family history of speech-language impairments, confirm the role of genetic factors in children’s development. Moreover, the differences in the development of some prelinguistic skills between girls and boys reveal the impact of various factors, such as social factors, on prelinguistic skills development.

This study aimed to elucidate the outcome of an Inspiratory Muscle Training (IMT) rehabilitation intervention on the lung function, functional mobilization, balance, and peripheral muscle strength of the paretic side in patients with subacute stroke.

This double-blind, randomized controlled trial study was conducted on patients with stable subacute stroke. For 8 weeks, the intervention group (n=16) received 40% intensity IMT while the control group (n=16) received 10% intensity IMT. We assessed the patients’ lung function (spirometer) before and after the intervention, as well as their pulmonary muscle strength (micro-respiratory pressure meter [RPM]), quadriceps strength (handheld dynamometer), grip strength (Jamar), walking speed (10-m walk test), balance (Berg Balance Scale [BBS]), and functional mobilization (sit-to-stand test). 

There were significant differences between the intervention group and the control group after IMT for forced vital capacity (FVC)% (P<0.01; d=3.20), forced expiratory volume in the first second (FEV1)/FVC (P<0.001; d=2.55), FEV1% (P<0.001; d=5.10), walking speed (P<0.05; d=1.62), hand grip (P<0.001; d=2.45), quadriceps strength (P<0.001; d=4.18), functional mobilization (P<0.01; d=2.41), and maximal inspiratory mouth pressure (P<0.001; d=1.62), but no significant changes were seen in balance (P=0.304; d=0.57).

IMT improved lung function, functional mobilization, handgrip strength, and quadriceps strength on the paretic side of subacute stroke patients and is expected to improve functional status and allow the patient to participate in social activities. IMT exercise can be included in the rehabilitation program for subacute stroke patients.

Shin pain is a broad term used to describe lower leg pain. It is commonly seen in the athletic/sports population. Various conditions have been claimed to produce leg pain, and muscle herniation is one of these conditions. Muscle herniation is the protrusion of muscle through a defect in the overlying fascia. Although such herniation is common, it is often an underdiagnosed condition in the lower extremity. It usually occurs in athletes, especially in the anterior compartment of the leg, as a result of trauma or due to muscle hypertrophy secondary to strenuous exercise. Herniation diagnosis depends on its clinical presentation as it appears as a palpable soft tissue bulge through a fascia defect; radiological findings are used to confirm the diagnosis. Conservative treatment should be the initial approach, and surgery can be performed if conservative treatment fails.

We present a case of symptomatic anterior lower leg pain, initially diagnosed as a psychosomatic disorder by two orthopedic physicians. However, tibialis anterior hernia in this patient was confirmed after physical examination by a physiotherapist and subsequent referral for ultrasonographic evaluation to a radiologist. The patient underwent an 8-week course of conservative treatment under the supervision of a physiotherapist. This treatment significantly improved the patient’s pain and function.

After eight weeks of conservative treatment using Minhaj protocol for Tibialis Anterior hernia, the patient has reported improvement in pain (reduction of score from eight to two on the NPRS scale) and function. The patient returned to his previous level of physical activity following eight weeks of rehabilitation.

Tibialis anterior hernia should be considered a differential diagnosis in chronic leg pain with palpable soft tissue protrusion. Conservative treatment can be chosen as the primary approach.