Journal of Modern Rehabilitation
Volume:17 Issue: 3, Summer 2023

Antiviral drugs have been extensively used as a potential treatment during the COVID-19 pandemic. Based on previous studies, there were concerns about some of these drugs’ ototoxic and vestibulotoxic effects. Still, these concerns were exacerbated by the widespread use of these drugs at the beginning of the COVID-19 pandemic. Therefore, this article was done to comprehensively review the effects of ototoxicity and vestibulotoxicity of chloroquine (CQ)/hydroxychloroquine (HCQ) and remdesivir with different administration models and compare with the COVID-19 treatment guidelines in the world and Iran.

This study collected the related published studies in PubMed, Scopus, Google Scholar, and Web of Science with the main keywords “chloroquine”, “hydroxychloroquine”, “remdesivir”, “ototoxicity”, “vestibulotoxicity”, and “COVID-19”.

The dose or duration of used HCQ/CQ drugs that caused ototoxic or vestibulotoxic effects in some diseases was reported mainly more than in COVID-19 guidelines, especially in Iran. These findings align with a recent study on slight HCQ-induced ototoxicity in patients with COVID-19 at low doses and short lengths of use. No evidence of possible cochlear damage after taking remdesivir is reported.

It seems that the concern about the ototoxic effects of some drugs used in the COVID-19 pandemic should be according to some factors that affect the pharmacological effects of drugs, such as dose, length of use, and co-administration of drugs. Therefore, lower dosage and length of use in some administration models in COVID-19 treatment, such as Iran, are associated with limited and reversible ototoxicity effects. However, further studies are needed.

High prevalence of knee osteoarthritis (OA) in Iran and the subsequent disability have resulted in representing multifarious non-aggressive interventions with distinct influences on the disease. The aim of this study was to review previous domestic studies about the effects of conservative therapeutic options on patients with knee OA.

Using search engines involving IranMedex, MedLib, ISC, Google Scholar, Magiran, SID, rehabilitation, and medical journals based on defined keywords, 98 Persian language articles were found, and 37 studies were finally included in our study after applying the exclusion criteria. The type of study, the pattern of choosing subjects, patient information, the measurements, interventions, and the results were exploited from each article, and the physiotherapy evidence database (PEDro) scale was administrated to evaluate the studies.

Based on analysis of PEDro scale results (Mean±SD for articles score: 5.89±1.29), the quality of most articles was as fair and good. The focus of conservative treatments was on exercise therapy methods, assistive devices, and physical therapy management. From a clinical perspective, the evidence indicates the appropriate effects of such treatment choices on alleviating pain, enhancing function, and improving quality of life in individuals with knee OA.

Most conservative methods can reduce pain, and improve quality of life and physical performance in patients with knee OA. However, further high-quality studies with larger sample sizes and long-term follow-ups are required to determine whether knee OA can be managed by conservative methods.

A few instruments are accessible for clinical estimation of the thoracic and lumbar curvatures. This methodical survey aims to identify the validity and reliability of noninvasive thoracic kyphosis and lumbar lordosis measurements.

This research is a literature review. The process was performed on articles in credible databases, such as Medline, Embase, AMED, CINAHL, PubMed, and Biomedical Reference Collection, Expanded, Sport Discus, Science Direct, Web of Science, searching for the terms thoracic kyphosis, lordosis, spinal curvature, lordosis and reliability, lordosis and validity, kyphosis and reliability, kyphosis and validity, test, measure, flexi curve, radiograph, spinal mouse, inclinometer, kyphometer, image processing, Cobb, during 1960 to 2020.

The result of the systematic search revealed that ten methods among all related papers have inclusion criteria, 3D ultrasound, Arco meter, DE Brunner’s kyphometer, digital inclinometer, electro goniometer, goniometer, flexi curve angle, image processing, pantograph, and spinal mouse.

The validity and reliability of non-invasive methods for estimating kyphosis and lordosis curvatures were indicated in 26 papers. Based on the current little evidence, noninvasive procedures have high to very high reliability and moderate to high validity.

The study was conducted to compare the immediate effect of high-power pain threshold ultrasound (HPPTUS) and deep transverse friction massage (DTFM) as a traditional technique on the treatment of upper trapezius active myofascial trigger points in male patients with mechanical neck pain.

In this parallel single-blind randomized clinical trial study, 60 men with mechanical neck pain (mean age: 30.57±6.19 years) who met the inclusion and exclusion criteria were randomly assigned to HPPTUS and DTFM as the control group. A visual analog scale (VAS), pain pressure threshold (PPT), and range of motion (ROM) of cervical lateral flexion (CLF) were assessed before and after treatment.

Analysis of pre- and post-treatment findings showed that the VAS (P<0.01), PPT (P<0.01), and ROM of CLF (P<0.01) improved significantly in both groups while ROM of CLF increased significantly more in the HPPTUS group. An indirect correlation was found between the pre-treatment ROM of CLF and ROM of CLF improvement in both groups. A significant indirect correlation was observed between pre-treatment VAS and ROM of CLF improvement in the HPPTUS group. In the DTFM group a significant indirect correlation was found between pre-treatment ROM of CLF and VAS improvement.

The results showed that HPPTUS can be used as an effective treatment for active trigger points (TP). It seems that this method is more effective than deep transverse friction massage.

Some accurate tools exist to assess fear-avoidance behavior, such as the Tampa scale for kinesiophobia (TSK) in individuals with musculoskeletal problems. The current research aims to compare the psychometric characteristics of the original 17-items TSK questionnaire and its 11-item brief version in chronic non-specific low-back pain (CNSLBP).

In this test development study, 295 patients with CNSLBP referred to the physiotherapy clinic of Milad Hospital in Tehran city, Iran were evaluated. Confirmatory factor analysis (CFA) and α Cronbach was conducted to assess the validity and reliability of the original and brief version of the TSK, respectively. For goodness-of-fit, the Χ2/df, root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), and comparative fit index (CFI) indices were used.

Internal consistency specified by Cronbach’s α was 0.949 for the original version of the questionnaire and 0.927 for the brief one. Based on the CFA findings, the goodness-of-fit indices for the brief version were GFI=0.921, RMSEA=0.078 (90% confidence interval (CI), 0.062%-0.094%), comparative fit index (CFI)=0.981, and Χ2/df=2.791. These indices for the original one were 0.882, 0.066 (90% CI, 0.055%-0.076%), 0.983, and 2.270, respectively. A significant correlation was found between these two versions (P<0.001). These findings confirm the adequacy of the brief version of the TSK.

The brief version of TSK can be considered a reliable and valid tool to evaluate somatic focus and activity avoidance in patients with CNSLBP.

The production of figurative expressions, particularly idioms, and proverbs, is negatively affected by damage to the left hemisphere and subcortical area of the brain. Alzheimer patients, thanks to the preservation of basal ganglia, can produce these expressions. In contrast, compared to Alzheimer’s patients, Parkinson’s patients cannot produce these expressions due to the malfunction of the basal ganglia. This study attempts to compare the linguistic and cognitive performance of Persian-speaking patients with Alzheimer’s disease, Parkinson’s disease, and healthy counterparts regarding the production and comprehension of these figurative expressions.

In doing so, by selecting a sample of participants composed of 10 Alzheimer’s patients, 10 Parkinson’s patients, and 10 healthy individuals matched with each other regarding age and education. Then, different tests, including Arizona battery for communication disorders of dementia, famous names, and face test, structured conversation, figurative expression completion, elicitation of response based on situational context, Northridge evaluation of idioms and proverbs in situational context, conventional and figurative expression evaluation were condcuted to analyze their performance.

The results of Arizona battery for communication disorders of dementia indicated that Alzheimer’s patients were in the middle stage of the disease while Parkinson’s participants were classified as non-dementia patients. Although the result of the Renown face and name recognition test demonstrated a significant difference between Alzheimer’s patients and the healthy group regarding cognition and confidence levels, the same result was not observed between healthy control and Alzheimer’s patients. Furthermore, in the test of structured conversation, the proportion of produced words by Alzheimer’s patients was more than that of Parkinson’s patients. However, the results of sentence and figurative expression completion tests corroborated the weaker performance of Alzheimer’s patients compared to their Parkinson and healthy counterparts. Furthermore, notwithstanding in the test of Elicitation of response based on Situational Context, Parkinson’s patients performed more poorly than their Alzheimer and healthy counterparts, in the tests of conventional and figurative expression evaluation, Alzheimer’s patients’ pattern of performance was different from that of other groups as they performed more weakly than Parkinson patients.

The observed dissociation in the performance of Alzheimer as well as Parkinson’s patients in the linguistic production and comprehension tests shed light on the significant role of the subcortical area of the brain in the production of idioms and proverbs.

Stroke is the primary cause of functional dependency in daily activities leading to disability of the individual. It becomes an economic burden for the person and society. Post-stroke management in rehabilitation gives more emphasis on improving functional performance. The improvement in functional activities of post-stroke survivors makes them independent in their daily activities at home but, still an impediment exists to participate in society and reintegrating into the community. The objective of the study is to find the association of community reintegration with the functional performance of one-year post-stroke survivors in eastern India and to compare their functional independence, community reintegration, and participation in instrumental daily living activities between stroke affection side and stroke subtype of the study group.

A cross-sectional observational study was carried out on post-stroke survivors between 30 and 60 years of age without sex barrier. Ninety-four patients (mean age 54.38±12.06) were recruited for the study. The outcome was measured by the community integration questionnaire (CIQ), Lawton instrumental activities of daily living (LIADL), and functional independence measure (FIM).

Spearman rank order correlation was used and found a significant positive correlation persists between FIM to CIQ as the r=0.565 (P=0.01, 95% CI, -0.40%-0.70%) and LIADL to CIQ r=0.687 (P=0.01, 95% CI, -0.55%-0.79%) FIM to LIADL r=0.532 (P=0.01, 95% CI, -0.36%-0.67%). Mann-Whitney U test was done to compare FIM, LIADL, and CIQ between stroke affection side (right vs left) and stroke sub-type (ischemic vs haemorrhagic), and no significant difference was found.

Functional independence, instrumental activities of daily living, and community reintegration are associated with each other. Hence, community reintegration should be incorporated into stroke rehabilitation to maintain a meaningful life as a part of society and family.

Diabetes mellitus (DM) is the most common metabolic disorder. The improvement of the quality of life (QoL) of people with DM is one of the goals in most health systems. This study was conducted to investigate the relationship between the QoL and social support in these individuals.

Forty people with diabetes with lower limb amputation participated in this descriptive cross-sectional study. For data collection, the multidimensional scale of perceived social support (MSPSS), medical outcome study-social support survey (MOS-SSS), the diabetes quality of life (DQoL), and demographic questionnaires were used.To examine the relationships between the variables, an independent t-test, Pearson correlation coefficient, Spearman’s correlation coefficient, and multivariate analysis were performed by SPSS software, version 22.

In this study, 56% of the participants (22 people) were male and the rest were female. The results of the linear regression analysis showed that there was a significant and direct relationship between QoL and social support resources (P=0.002, β=0.514) and dimensions (P=0.01, β=0.458). QoL was significantly correlated with marital status (P=0.015) and economic status (P=0.046).

Increased social support enhances QoL in people with diabetes with lower limb amputation. Therefore, planning to improve social support is highly important in improving the QoL in these people.

The knee is the most affected weight-bearing joint by osteoarthritis. The kinetics parameters are correlated with the progression of knee osteoarthritis (KOA). This study was done to investigate the relationship between kinetics parameters and functional tests with Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores in people with moderate KOA.

Twenty- three participants with moderate KOA participated in this study. Gait analysis involved the measurement of the external peak knee adduction moment (PKAM), peak knee flexion moment (PKFM), knee adduction moment impulse (KAM impulse), and knee flexion moment impulse (KFM impulse) during level walking. Functional tests included timed up and go (TUG) and figure of eight walkings (FO8W) tests. Pearson’s correlation coefficient was used to investigate the correlation between kinetics parameters and functional test scores with WOMAC total scores and sub-scores.

There was a significant inverse correlation between the first PKAM and WOMAC total score and pain sub-score (r=-0.43 P=0.03 and r=-0.6 P=0.002, respectively). Also, there was a significant inverse correlation between the second PKAM and pain sub-score (r=-0.46 P=0.02). There was no significant correlation between functional tests and WOMAC scores.

The low score of the WOMAC in the moderate KOA should not be attributed to the low level of joint knee moments.

In individuals with anterior cruciate ligament deficiency (ACLD), defective sensory and motor neuroplasticity occurs in the central nervous system (CNS) due to defects in sensory afferents. To successfully restore ACLD individuals to pre-injury conditions, it is necessary to modify the neuroplasticity created in the CNS by prescribing more appropriate training. For this aim, in this study, we used perturbation training differently.

Thirty athletes with unilateral anterior cruciate ligament (ACL) rupture were randomly assigned to the perturbation and standard training groups. The training program of two groups was performed in three intermittent sessions per week for one month. The relative power spectrum of alpha of quantitative electroencephalography (QEEG) was measured in three tasks: (1) the single-leg jump-landing, (2) the single-leg stance with opened eyes, and (3) the single-leg stance with closed eyes.

The perturbation training group only showed significant symmetry in the relative power spectrum of alpha between the two limbs in the single-leg jump-landing test (P=0.92, ES=0.04) in comparison pre-post test. Also, this group showed high symmetry in the alpha band in the single-leg stance test with closed eyes (P=0.53, ES=0.16).

The results of the present study showed that both mechanical perturbation and standard training are suitable for transporting ACLDs back to sports. It also seems that mechanical perturbation training had higher effectiveness in modifying the CNS alpha power.

We evaluated the effect of electromyography biofeedback on proprioception and functional balance in healthy young athletes.

In this clinical trial, 24 athletes were randomly divided into two study (n=12) and control (n=12) groups. The study group received rehabilitation exercises, including one-foot standing, squatted standing, and isometric contraction of quadriceps muscle at different knee angles, including 30, 45, and 90 degrees of knee flexion along with electromyography biofeedback. The control group received only rehabilitation exercises without electromyography biofeedback. Exercises were performed by both groups for a 4-week period in three sessions per week. Functional balance and proprioception before and after exercises were measured using the star excursion balance test and a system consisting of digital photography non-reflective markers, respectively. The data of the center of pressure and time of vertical ground reaction force using a force plate was also collected to evaluate static balance and dynamic balance, respectively.

The absolute error in knee joint reconstruction for 30° (P=0.005), 45° (P=0.001), and 90° (P=0.033) angles significantly decreased after the intervention in the study group compared to the control group. Star excursion balance test scores in all directions did not show any significant differences between the two groups (P>0.05), except for the anterior-lateral direction (P=0.03). Moreover, all variables related to static and dynamic balance did not show a significant difference between two the groups after the interventions (P>0.05).

The electromyography biofeedback intervention can probably be used as a rehabilitation protocol in recovering and healing proprioception injuries resulting from sports injuries.

Parkinson’s disease is a chronic progressive neurodegenerative disorder causing impaired motor function and various non-motor symptoms. One of the most common problems in Parkinson’s patients is occupational performance problems. The cognitive orientation to daily occupational performance (CO-OP) is one of the client-centered and problem-solving approaches in occupational therapy evaluations and interventions. This study aims to determine the effectiveness of the CO-OP approach on perceived satisfaction and occupational performance in a 62-year-old woman with Parkinson’s disease.

Case Description: 

The client was a 62-year-old woman with moderate cognitive impairment, stage 3 on the Hoehn and Yahr scale, and signs of depression. In our case study, the outcome measures were the Canadian occupational performance measure (COPM), functional independence measure (FIM), Montreal cognitive assessment (MOCA), and Beck depression inventory-II (BDI-II). We administered the CO-OP intervention for six weeks. Sessions were performed twice a week for one hour per session.

The results indicate that the CO-OP intervention improves the client’s satisfaction, occupational performance, and functional independence. Although the results from this single case cannot be generalized, the findings suggest that CO-OP intervention may help improve satisfaction and occupational performance in adults with Parkinson’s disease. Further investigation is necessary.

These results suggest that CO-OP can be a valuable occupational therapy interventions for individuals with Parkinson’s disease. We recommend that occupational therapists consider using this approach in their practice to improve the occupational performance of their patients with Parkinson’s disease.