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Gabriel A, Ridge ST, Birth M, Horstmann T, Pohl T, Konrad A. Local and non-local effects (on the posterior chain) of four weeks of foot exercises: a randomized controlled trial. Sci Rep 2024; 14:22000. [PMID: 39317709 PMCID: PMC11422494 DOI: 10.1038/s41598-024-71585-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
This study investigated the local, remote, and contralateral effects of a four-week intrinsic foot muscle exercise intervention in recreationally active participants on foot parameters, flexibility, and performance of the posterior chain (PC). Twenty-eight healthy participants (12f, 16m) were randomly assigned to a control group or performed 2 × 6 min of foot exercises twice daily unilaterally at least five days/week for four weeks. At baseline (M1), after the intervention (M2), and after a four-week wash-out period (M3), we assessed bilateral Foot Posture Index-6, medial longitudinal arch mobility, single-leg stance balance, range of motion (ROM) (first metatarsophalangeal joint and ankle), and flexibility and performance of the PC. The FPI-6 score changes over time differed significantly between groups for both legs, improving by 26% in the trained- (p < .001) and 11% in the untrained leg (p = .02) in the intervention group from M1 to M2. Improvements were maintained at M3 for the trained leg (p = .02). Ankle range of motion and balance of the trained leg improved from M1 to M2, yet only became significant at M3 (ROM: p = .02; balance: p = .007). The other parameters did not change significantly. A four-week foot exercise intervention might have local but no remote effects in healthy young adults.German Clinical Trial Register (DRKS00027923) (24/08/2022).
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Affiliation(s)
- Anna Gabriel
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Sarah T Ridge
- Department of Rehabilitation Sciences, College of Education, Nursing and Health Professions, University of Hartford, West Hartford, CT, USA
| | - Michael Birth
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Thomas Horstmann
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Torsten Pohl
- Professorship for Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, Graz, Austria
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Erten AB, Tarakçı D, Çaçan MA. The Effectiveness of Video-Based Game Exercise Therapy Applications in Pes Planus Rehabilitation: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e51772. [PMID: 37695657 PMCID: PMC10520774 DOI: 10.2196/51772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Pes planus is one of the most common foot deformities. Although there are many studies on the effectiveness of various exercise methods in pes planus rehabilitation, the number of studies on video-based game exercise therapy applications is very limited. OBJECTIVE This study aims to evaluate the effectiveness of 2 video-based game exercise therapies and structured exercise practices in pes planus rehabilitation. METHODS This study is a 3-arm, parallel-group, single-blinded randomized controlled trial. The study will include 69 patients with flexible pes planus aged between 18 and 25 years who attend the orthopedics and traumatology clinic and meet the inclusion criteria. The primary outcomes are measures of navicular drop and pedobarographic analysis before and after the intervention, and the secondary outcomes include balance, femoral anteversion, and lower extremity muscle strength. Participants will be evaluated with a navicular drop test for medial longitudinal arch height, a pedobarographic analysis system for plantar pressure analysis, a Craig test for femoral anteversion, the Becure Balance System for balance measurement, and a myometer device for lower extremity muscle strength measurement. Participants will be randomly assigned to a structured exercise group, an exergame group, or a serious game group according to their order of arrival. The structured exercise group will use a short foot exercise, a towel-picking exercise, and various walking and balance exercises. Patients in the serious play group will play the lower extremity games in the Becure Balance System. Patients in the exergame group will play balance games on the Nintendo Wii game console. All participants will participate in 18 exercise sessions (3 days a week for 6 weeks). After the treatment, the initial measurements will be repeated. RESULTS The study started in January 2023. It is expected to be completed in June 2024. CONCLUSIONS This study will be the first randomized controlled study to evaluate the effectiveness of 2 different video-based game exercise therapy applications in pes planus rehabilitation. Through this study, the use of video-based game exercise therapy in pes planus rehabilitation, together with the developing technology, will be a guide. In addition, a new exercise protocol, including serious game exercises, will be added to the literature. In the future, it is expected that our study on the development of different game systems, especially for the ankle, will provide pioneering feedback. TRIAL REGISTRATION ClinicalTrials.gov NCT05679219; https://clinicaltrials.gov/study/NCT05679219. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/51772.
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Affiliation(s)
- Ayşe Büşra Erten
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
- Physiotherapy Programme, Department of Therapy and Rehabilitation, Istanbul Vocational School of Health and Social Sciences, Istanbul, Turkey
| | - Devrim Tarakçı
- Department of Ergotherapy, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Akif Çaçan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Medipol Mega Hospital Complex, Istanbul Medipol University, Istanbul, Turkey
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Markowicz M, Skrobot W, Łabuć A, Poszytek P, Orlikowska A, Perzanowska E, Krasowska K, Drewek K, Kaczor JJ. The Rehabilitation Program Improves Balance Control in Children with Excessive Body Weight and Flat Feet by Activating the Intrinsic Muscles of the Foot: A Preliminary Study. J Clin Med 2023; 12:jcm12103364. [PMID: 37240471 DOI: 10.3390/jcm12103364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND determining the appropriate rehabilitation protocol is essential to influence the correction of flat feet, e.g., by activating the intrinsic muscles of the foot. Therefore, this study aimed to determine the impact of the exercises activating the intrinsic foot muscles for postural control in children with flat feet, with normal and excessive body weight. METHODS Fifty-four children aged 7 to 12 were enrolled in the research. Forty-five children were qualified for the final evaluation. Each child in the experimental group was demonstrated an appropriate technique for performing a short foot exercise without compensation by extrinsic muscle. The participants then performed a supervised short foot training session once a week and on other days of the week under the supervision of caregivers for 6 weeks. Flat feet were scored on the foot posture index scale. A postural test was evaluated with a Biodex balance system SD. Statistical significance in the foot posture index scale and postural test were evaluated using an analysis of variance (ANOVA) with Tukey's post-hoc test. RESULTS according to the six indices of the foot posture index scale, five indicators showed statistically significant improvement after rehabilitation. At the 8-12 platform mobility level, it was revealed that the excessive body weight group had significant improvements in the overall stability index and medio-lateral stability index, with eyes closed. CONCLUSION our results indicate that a 6-week rehabilitation program based on the activation of the intrinsic muscles of the foot resulted in an improvement in the foot position. This, in turn, affected balance control, especially in children with excess body weight in conditions of closed eyes.
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Affiliation(s)
- Maria Markowicz
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Wojciech Skrobot
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Agnieszka Łabuć
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Paulina Poszytek
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Agnieszka Orlikowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Ewelina Perzanowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Katarzyna Krasowska
- Department of Health and Life Sciences, Department of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland
| | - Konrad Drewek
- Cathedral and Clinic for Orthopaedics and Traumatology, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jan J Kaczor
- Division of Bioenergetics and Physiology of Exercise, Medical University of Gdansk, 80-210 Gdansk, Poland
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Gheitasi M, Maleki M, Bayattork M. Corrective exercise for intrinsic foot muscles versus the extrinsic muscles to rehabilitate flat foot curving in adolescents: randomized-controlled trial. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-021-00808-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Golchini A, Rahnama N, Lotfi-Foroushani M. Effect of Systematic Corrective Exercises on the Static and Dynamic Balance of Patients with Pronation Distortion Syndrome: A Randomized Controlled Clinical Trial Study. Int J Prev Med 2021; 12:129. [PMID: 34912505 PMCID: PMC8631118 DOI: 10.4103/ijpvm.ijpvm_303_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background: The purpose of this study was to determine the effect of systematic corrective exercises on the static and dynamic balance of students with pronation distortion syndrome. Methods: In this randomized controlled clinical trial study, 30 volunteers were selected and randomly divided into the control and experimental groups (15 subjects per group). The experimental group performed systematic corrective exercises for 12 weeks, while the control group performed the routine exercise. Static and dynamic balance was evaluated before and after the interventions. The data were analyzed using independent and paired t-tests (P < 0.05). Results: The results showed significant improvement (P < 0.05) in the static and dynamic balance in the experimental group, but not in the control group. A significant difference was evident between the experimental and control groups in terms of static and dynamic balances, in static balance including Flamingo balance test (42.26 ± 5.35 vs. 10.13 ± 1.92) stabilometr (1.23 ± 0.48 vs. 3.71 ± 1.02), and in dynamic balance including star excursion balance test (anterior direction 82.4 ± 6.2 vs. 66.7 ± 6.9, Posterior-internal direction 87.8 ± 4.7 vs. 69.6 ± 6.3, posterior-external direction 86.06 ± 6.93 vs. 67.2 ± 6.2), stabilometr (3.8 ± 0.6 vs. 11.18 ± 1.8) (P < 0.05 for all variables). Conclusions: It can be concluded that systematic corrective exercises improve static and dynamic balance in students with pronation distortion syndrome and it could be recommended as modalities for these people.
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Affiliation(s)
- Ali Golchini
- Faculty of Sport Science, University of Isfahan, Isfahan, Iran
| | - Nader Rahnama
- Faculty of Sport Science, University of Isfahan, Isfahan, Iran
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Association between abductor hallucis abductory force and navicular drop index, a predictive correlational study. J Pediatr Orthop B 2021; 30:484-487. [PMID: 33315804 DOI: 10.1097/bpb.0000000000000840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The role of intrinsic muscles of the foot in the medial longitudinal arch mechanism was investigated in several recent studies. It is determined that the abductor hallucis muscle (AHM) has an important role in dynamic support of the arch. Objective of our preliminary study was to establish a relationship between the navicular drop index (NDI) and the AHM abduction force. A single group exploratory design was used. The participants were 127 athletes aged 8-16 years (m/f 74/53; 11.99 ± 2.11 years; 156.21 cm ± 15.51 cm; 47.61 kg ± 13.96 kg; 2-5 training h/week), examined at a regular sport medical checkup. Abductor hallucis force was measured by a digital Algometer FPX 25/220, which is a newly developed approach that should be properly assessed in further studies to establish standardization and qualification of the algometer for this specific use. Navicular drop test has been performed as originally developed by Brody. Data were analyzed using Student's t-test, Mann-Whitney U test, contingency coefficients and logistic regression. Average NDI was found to be significantly different comparing the group with positive abduction force and the group that cannot perform the active abduction. Logistic regression indicated that the variable representing impossible active abduction was significantly associated with NDI. Preliminary results showed that there was a strong relationship between the hallux active abduction force and NDI in young athletes: the higher abduction force correlates to lower NDI. To determine clinical relevance of our investigation, further study is planned in which hallux active abduction force and NDI would be compared and correlated pre- and postspecific strengthening program.
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Hip-Focused Neuromuscular Exercise Provides Immediate Benefits in Foot Pronation and Dynamic Balance: A Sham-Controlled Cross-Over Study. J Sport Rehabil 2021; 30:1088-1093. [PMID: 34303314 DOI: 10.1123/jsr.2020-0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/01/2021] [Accepted: 04/09/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Knowledge on how to utilize a kinetic chain approach in foot and ankle rehabilitation is important. OBJECTIVE The aim of this study was to investigate the immediate effects of hip-focused neuromuscular exercise on foot pronation and single-leg neuromuscular control. DESIGN Cross-over study. SETTING University laboratory. PARTICIPANTS This cross-over study included 44 asymptomatic volunteers with foot pronation. INTERVENTIONS All participants performed (1) a hip-focused neuromuscular exercise and (2) a sham exercise in randomized order. MAIN OUTCOME MEASURES Foot pronation was assessed by the navicular drop test, and lower-extremity neuromuscular control was assessed by the Modified Star Excursion Balance Test and frontal plane projection angle during single-leg squat before and after the experiments. RESULTS Navicular drop test scores were significantly lower after the hip-focused neuromuscular exercise than after the sham exercise (mean difference [95% CI] = 2.84 [-1.08 to 6.77], P = .003). Modified Star Excursion Balance Test scores in the anterior (P = .008), posteromedial (P = .04), and posterolateral (P < .001) directions were significantly increased after hip-focused neuromuscular exercise. No statistically significant condition × time interaction was found for the frontal plane projection angle (P > .05). However, a main effect of time (P = .003) indicated that less dynamic knee valgus occurred during single-leg squat after both experiments. CONCLUSIONS Hip-focused neuromuscular exercise produced immediate alterations in foot pronation and dynamic balance. Thus, the hip-focused neuromuscular exercise may be used to control foot posture in foot rehabilitation integrated with a kinetic chain approach and could be an effective prevention and treatment strategy.
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Kim JS, Moon DC. A comparison of selective muscle activity in the abductor hallucis between flat feet and normal feet during single mini-squat exercise. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-203202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The abductor hallucis (AbH) is a key muscle in the stability of the foot by supporting the medial longitudinal arch (MLA). Individuals with flat foot show a flattening of the MLA with a decreased selective AbH activity relative to the other foot extrinsic muscles during functional movement. OBJECTIVE: To examine the selective muscle activity of the abductor hallucis (AbH) during single-leg mini-squat (SMS) in subjects with flat foot and normal individuals. METHODS: Twenty-four healthy adults (13 men and 11 women) with flat or normal feet participated in this study. All subjects performed single minisquat (SMS), and data were collected using sEMG from the AbH, TA, and GCM during SMS. RESULTS: An inter-gender comparison of the EMG data revealed no difference. The EMG activity of the AbH in individuals with flat foot was significantly lower than that of individuals with normal feet. Moreover, the AbH/TA ratio in subjects with flat foot, , was significantly lower than that in subjects with normal feet. CONCLUSION: In a clinical setting, clinicians should focus on strengthening exercises of the AbH muscle due to reduced activation of the AbH muscle in individuals with flat foot. The selective muscle activity of the AbH muscle during SMS should be emphasized.
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Pabón-Carrasco M, Castro-Méndez A, Vilar-Palomo S, Jiménez-Cebrián AM, García-Paya I, Palomo-Toucedo IC. Randomized Clinical Trial: The Effect of Exercise of the Intrinsic Muscle on Foot Pronation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4882. [PMID: 32645830 PMCID: PMC7369729 DOI: 10.3390/ijerph17134882] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/18/2020] [Accepted: 06/26/2020] [Indexed: 12/11/2022]
Abstract
Background: There is little scientific evidence regarding the effectiveness of strengthening exercises on the foot's intrinsic musculature in improving the lower limb on the statics and dynamics in healthy individuals. Method: To evaluate the effect on foot posture with regard to the reinforcement of the short foot exercise (SFE) compared to another without a recognized biomechanical action, which we called the "non-biomechanical function" (NBF) exercise. A randomized clinical trial was carried out with 85 asymptomatic participants with a bilateral Foot Posture Index (FPI) greater than 6 points. An experimental group (n = 42) did SFE training and a control group (n = 43) carried out NBF exercises. The foot posture was evaluated twice via the navicular drop (ND) test, and the FPI was assessed on the day of inclusion in the study (pre-intervention) and after four weeks of training (post-intervention). Results: Statistically significant values were not found in foot posture between the experimental and the control groups when comparing before and after the training. However, the foot posture was modified in both groups with respect to its initial state, and the ND value decreased. Conclusions: SFE could be considered a useful tool to deal with pathologies whose etiology includes excessive pronation of the foot.
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Affiliation(s)
| | | | | | - Ana María Jiménez-Cebrián
- Nursing and Podiatry Department, University of Malaga, 29071 Malaga, Spain; (A.M.J.-C.); (I.G.-P.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain
| | - Irene García-Paya
- Nursing and Podiatry Department, University of Malaga, 29071 Malaga, Spain; (A.M.J.-C.); (I.G.-P.)
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Alam F, Raza S, Moiz JA, Bhati P, Anwer S, Alghadir A. Effects of selective strengthening of tibialis posterior and stretching of iliopsoas on navicular drop, dynamic balance, and lower limb muscle activity in pronated feet: A randomized clinical trial. PHYSICIAN SPORTSMED 2019; 47:301-311. [PMID: 30517043 DOI: 10.1080/00913847.2018.1553466] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Flexibility and strength are compromised in pronated feet, which could in turn lead to alteration of the dynamic balance and muscle activity in the lower extremities. This study aimed to analyze the effects of selective tibialis posterior strengthening and iliopsoas stretching on navicular drop, dynamic balance, and lower limb muscle activity in young adults with pronated feet. Methods: Twenty-eight participants with pronated feet were randomly assigned to either the stretching and strengthening group (n = 14) or the conventional exercise group (n = 14). The stretching and strengthening group performed tibialis posterior strengthening exercises and iliopsoas stretching three times a week for 6 weeks in addition to the conventional towel curl exercises. The conventional exercise group performed towel curl exercises only. Navicular drop, dynamic balance, and lower limb muscle activity were assessed at baseline and post-intervention. A mixed model analysis of variance was performed to test the study hypothesis. Results: Significant group effects for the activity of tibialis anterior (p = 0.003) and abductor hallucis muscle (p = 0.010), as well as for the posterolateral (p = 0.036) and composite reach scores (p = 0.018), were detected. Significant group × time interactions were observed for naviculardrop (p < 0.001), all dynamic balance components (p < 0.001), and the activity of tibialis anterior (p < 0.001) and abductor hallucis (p < 0.001). Conclusions: This study demonstrated that inclusion of selective tibialis posterior strengthening and iliopsoas stretching in addition to the conventional towel curl exercise program could improve important clinical outcomes, such as navicular drop, muscle activity, and dynamic balance in flatfeet.
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Affiliation(s)
- Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Shahid Raza
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Jamal Ali Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Pooja Bhati
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia , New Delhi , India
| | - Shahnawaz Anwer
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia
| | - Ahmad Alghadir
- Rehabilitation Research Chair, College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia
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