The Intra-Rater Reliability of Ultrasonography for the Measurement of Lumbar Multifidus and Erector Spinae Thickness in Different Positions in People with and without Active Extension-Related Non-Specific Low Back Pain

Background

The paraspinal muscles, including multifidus (MF) and erector spinae (ES) play key roles in the stability and movement of the lumbar spine. This study aimed to determine the intra-rater reliability of the ES and MF muscle thickness measures of the rehabilitative ultrasound imaging (RUSI) in people with active extension pattern (AEP) non-specific chronic low back pain and controls.

Methods

Fifteen females with AEP and 19 controls participated in this test-retest intra-rater reliability study, including two different testing sessions performed in four to seven days apart. The primary (raw) and derived (normalized) measures of the L4 MF and ES muscles`thickness were examined in three different positions (prone, sitting, and standing) on both days. A two-way mixed average of intra-class correlation coefficient (ICC3, K) with confidence interval (CI = 95%) was used to determine the relative reliability. The standard error of measurement (SEM) and minimal detectable change (MDC) values at a CI of 95% were computed to examine the absolute reliability.

Results

The ICC values for the primary thickness of the L4 ES and MF muscles were from 0.85 to 0.91, except for MF muscle thickness in standing (ICC = 0.67) and sitting (ICC = 0.66) positions . The ICC values for derived data were lower in both groups. The SEM and MDC values were small enough to confirm the absolute reliability of the primary data.

Conclusion

This study supports the use of RUSI for examining the primary measures of the L4 MF and ES muscles in asymptomatic and AEP participants, but it should be used cautiously for assessing the derived measures.

The Effect of Leg Dominance and Group Difference in Star Excursion Balance Test between Individuals with Chronic Ankle Instability, Ankle Sprain Copers and Healthy Controls

Objectives

To evaluate patients with chronic ankle instability (CAI), copers who had a sprain without instability, and healthy controls using the Star Excursion Balance Test (SEBT). In addition, the reach distance was assessed between the both legs in terms of dominant and non-dominant in all groups.

Methods

A total of 75 subjects (25 healthy, 25 CAI, and 25 Coper) participated. The maximum reach distance in SEBT was assessed in anterior (ANT), postero-medial (PM), and postero-lateral (PL) directions in both legs for each subject. All data were analyzed by SPSS version 21. Tukey post hoc test was used to compare all groups. Paired T-test was used to compare dominant and non-dominant legs in each group.

Results

In 75 subjects have participated in the data collection, no significant differences were reported among all groups for age and BMI measurements. Significant lower reach distance in scores of ANT in the dominant leg of the CAI was demonstrated when compared with the control and the coper groups (P=0.008). No statistical significant difference was determined between the dominant and non-dominant legs in each group (P>0.05).

Conclusion

It seems that relevant strategies for postural control should be taken into account in the rehabilitation setup of individuals with CAI.

Psychometric properties of the Persian version of the pain anxiety symptom scale (PASS-20) in chronic non-specific neck pain patients

OBJECTIVES

Pain-related anxiety has been linked to avoidance behaviour, maintenance of pain and disability. A valid and reliable tool is required to evaluate pain-related anxiety among Persian speaking adults with chronic non-specific neck pain (CNSNP). This study aimed to evaluate psychometric properties of the Persian pain anxiety symptom scale-20 (PASS-20) according to the consensus-based standards for the selection of health measurement instruments (COSMIN) checklist in Iranian adults with CNSNP.

METHODS

198 individuals with CNSNP completed the PASS-20. The factorial structure (confirmatory factor analysis (CFA), exploratory factor analysis (EFA)), test-retest reliability (intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC)), internal consistency (Cronbach's alpha), and construct validity (convergent and known-group validity) were assessed. The correlation between PASS-20 with pain catastrophizing scale (PCS), Tampa Scale for Kinesiophobia (TSK), neck disability index (NDI), Beck Depression Inventory (BDI), visual analog scale (VAS) (Spearman's rank correlation) were examined. Known-group validity of PASS-20 was evaluated by comparing the difference between the PASS-20 scores of the known groups based on level of disability, pain intensity and gender using non-parametric tests.

RESULTS

The CFA showed almost the best fit with the original version. The subscales and total score demonstrated good internal consistency (Cronbach's α: 0.70-0.92) and high test-retest reliability (ICC: 0.94-0.97). PASS-20 had significant moderate correlations with PCS, TSK, NDI, VAS and a significant low correlation with BDI. Regarding known-group validity, the total score of Persian PASS-20 was higher in CNSNP with higher levels of pain and disability and in the female gender.

CONCLUSIONS

The Persian PASS-20 has acceptable psychometric properties in adults with CNSNP. The results of the factor analysis supported the four-factor structure comparable to the original version.

ETHICAL COMMITTEE NUMBER

921672004.

Altered muscle strength and flexibility among a subgroup of women with chronic nonspecific low back pain: Cross-sectional case-control study

OBJECTIVE

To compare muscle strength and flexibility among a subgroup of women with extension-related chronic nonspecific low back pain (CNLBP) with healthy controls.

METHODS

In this case-control study, 32 subjects with and without extension-related CNLBP were tested (n = 16 in each group). Gluteal, abdominal, paravertebral, and hamstring strength, along with hip flexor flexibility and hamstring flexibility were compared between groups. Data were analyzed using the Mann-Whitney test (p < .007).

RESULTS

The CNLBP subgroup displayed significantly lower strength of all muscles analyzed (p < .007), with the exception of gluteus medius. The flexibility of the hip flexors and hamstrings were not significantly reduced among the women with CNLBP (p > .007).

DISCUSSION

The present study showed that alterations in muscle strength, but not flexibility, partly consistent with those previously hypothesized but not objectively reported, were present among a subgroup of women with extension-related CNLBP. These results may have implications for the selection of therapeutic exercises among this subgroup of people with CNLBP.

Reliability of Center of Pressure measures of Postural Stability in Anterior Cruciate Ligament Reconstructed Athletes: Effect of Vibration and Cognitive Load

BACKGROUND

To evaluate intra and intersession reliability of the Center of Pressure (COP) parameters in Anterior Cruciate Ligament Reconstructed (ACLR) athletes with and without ankle vibration using a dual-task paradigm.

METHODS

Postural sway of 14 ACLR individuals was assessed during a single-leg stance on a force platform. COP parameters were assessed with manipulating sensory inputs via vision and ankle vibration under single and dual-task conditions. The outcome variables included COP displacement in medial-lateral (ML) and anterior-posterior (AP) range, mean velocity (mV), and area. During dual-task conditions, the auditory Stroop Task was applied. Intraclass correlation coefficient (ICC) values and standard error of measurement (SEM) were assessed for relative and absolute reliability.

RESULTS

The COP measures had moderate to very high intrasession reliability (ICC range: 0.51-0.93) for conditions with vibration and cognitive task, with the highest ICCs for mV and the lowest for area, regardless of eyes being open or closed. The intersession reliability was moderate to high for mV (ICC range: 0.60-0.82) and little to very high (ICC range: 0.21-0.97) for the range of ML and AP, as well as an area in conditions with vibration and cognitive task.

CONCLUSION

The mV is the most reliable COP parameter for assessing postural control under ankle vibration and dual-task conditions for both operated and non-operated sides. During closed-eye conditions, the application of vibration affected the intersession reliability with decreased ICCs on the operated side and increased ICCs on the non-operated side.

Analysis of Connected Speech in Persian Aphasic Patients and its Relationship With Type and Severity of Aphasia

Background and Objectives: There are several tests to determine the type and severity of aphasia, but they take a long time to administer when assessing aphasic patients. In recent years, the analysis of spontaneous speech has gained great attention because it is important to diagnose and follow post-treatment improvement in aphasic patients. This study was done to assess some parameters of connected speech in aphasic patients. In addition, the correlation between connected speech parameters and the type and severity of aphasia was measured. Methods: We compared the connected speech parameters of 27 aphasics (10 fluent and 17 non-fluent), Persian speakers, compared with the control group. There were two groups matched by age, sex, and education. Nest’s bird story pictures were used to elicit a speech sample. In the next step, the connected speech was analyzed to define speech parameters, including speech rate, mean length of utterance, number of utterances, total words, content words, function words, nouns, and verbs. Moreover, the severity of aphasia was measured using a Persian Western Aphasia Battery (WAB). Results: The findings showed significant differences between groups in all parameters of the connected speech (P<0.01). The correlation coefficient between speech parameters and severity of aphasia demonstrated that all parameters were highly correlated (r >0.71) with the severity of aphasia (P<0.01) except for speech rate and the number of function words. There were some typical differences between linguistics grammatical and pragmatical characters of different types of aphasia. Conclusion: Connected speech is one of the most sensitive parts of language in all types of aphasic patients. There are some clinical signs for differential diagnosis of aphasia based on speech measures. According to the findings, the type and severity of aphasia and connected speech were highly correlated. Thus, the use of the connected speech analysis is necessary as an assessment tool for the diagnosis of aphasia.

Variables related to the quality of life of families that have a child with severe to profound intellectual disabilities: A systematic review

Background

Family quality of life (FQoL) of families that have a child with severe to profound intellectual disabilities (SPID) is an important and emerging concept, however, related variables are inconclusive.

Aim

To gain a better understanding of variables related to the FQoL of families that have a child with SPID, variables related to the FQoL of families that have a child with intellectual disabilities (ID) were systematically reviewed.

Methods and procedures

A search strategy was performed in five databases. Critical appraisal tools were employed to evaluate the quality of both quantitative and qualitative studies. Data extraction and synthesis occurred to establish general study characteristics, variables, and theoretical concepts. Variables were categorised into four key concepts of the FQoL: systemic concepts, performance concepts, family-unit concepts and individual-member concepts.

Outcomes and results

A total of 40 studies were retrieved with 98 variables. Quality scores ranged from 7 to 13 (quantitative) and 5 to 13 (qualitative) out of 13 and 14 points, respectively. Five out of the 40 studies (13%) focused on individuals with SPID. Variables related positively or negatively to the FQoL, and were categorised within systemic concepts (n = 3); performance concepts (n = 11); family-unit concepts (n = 26); and individual-member concepts (n = 58).

Conclusions and implications

Several variables were found to be (inter)related to the FQoL of families that have a child with ID. A contrasting picture emerged regarding the impact of a disability in relation to transitional phases. However, studies which include families of children with SPID were minimal, therefore, it remained ambiguous to what extent the identified variables apply to these families.

Comparison of the reliance of the postural control system on the visual, vestibular and proprioceptive inputs in chronic low back pain patients and asymptomatic participants

BACKGROUND

Although proprioception deficits have been documented in chronic low back pain (CLBP) patients, little is known about adaptive strategies to provide postural control in these patients. Substitution of unreliable proprioceptive information with other afferents might be considered plausible.

RESEARCH QUESTION

Is the response of the postural control system dependent on the source of sensory afferents being manipulated in persons with and without CLBP?

METHODS

Sixty persons with and without CLBP participated in this cross-sectional study. Center of pressure (COP) displacement range, velocity, path length and area were calculated under four sensory conditions: 1) normal upright standing; 2) upright standing on a foam with eyes open and head in neutral position; 3) upright standing with eyes open and 60° cervical extension and 4) upright standing with eyes closed and 60° cervical extension. A two-way repeated measures analysis of variance was used to compare COP masseurs under different conditions and between the groups.

RESULTS

CLBP patients demonstrated fewer alterations to manipulation of both visual and vestibular afferents in terms of number of COP variables significantly altered. ML range and velocity in both groups and path length in the CLBP group were significantly different between conditions 2 and 4. In both groups, all COP variables except AP range increased significantly in condition 2 compared to conditions 1and 3 (p < 0.001). AP velocity was the only variable to be different between conditions 1 and 3 in both CLBP (p = 0.025) and control (p < 0.001) groups. Between group differences were significant on AP velocity (p = 0.019).

SIGNIFICANCE

No overweighting was observed in the vestibular or visual afferents in CLBP patients. Compensatory strategies seem to lie within proprioceptive system by reweighting afferents from different body segments. The postural control system behaved more robustly in CLBP patients while AP COP velocity was found as the most sensitive and discriminating parameter.

Relationships between metabolic profiles and gene expression in liver and leukocytes of dairy cows in early lactation

Homeorhetic mechanisms assist dairy cows in the transition from pregnancy to lactation. Less successful cows develop severe negative energy balance (NEB), placing them at risk of metabolic and infectious diseases and reduced fertility. We have previously placed multiparous Holstein Friesian cows from 4 herds into metabolic clusters, using as biomarkers measurements of plasma nonesterified fatty acids, β-hydroxybutyrate, glucose and IGF-1 collected at 14 and 35 d in milk (DIM). This study characterized the global transcriptomic profiles of liver and circulating leukocytes from the same animals to determine underlying mechanisms associated with their metabolic and immune function. Liver biopsy and whole-blood samples were collected around 14 DIM for RNA sequencing. All cows with available RNA sequencing data were placed into balanced (BAL, n = 44), intermediate (n = 44), or imbalanced (IMBAL, n = 19) metabolic cluster groups. Differential gene expression was compared between the 3 groups using ANOVA, but only the comparison between BAL and IMBAL cows is reported. Pathway analysis was undertaken using DAVID Bioinformatic Resources (https://david.ncifcrf.gov/). Milk yields did not differ between BAL and IMBAL cows but dry matter intake was less in IMBAL cows and they were in greater energy deficit at 14 DIM (-4.48 v -11.70 MJ/d for BAL and IMBAL cows). Significantly differentially expressed pathways in hepatic tissue included AMPK signaling, glucagon signaling, adipocytokine signaling, and insulin resistance. Genes involved in lipid metabolism and cholesterol transport were more highly expressed in IMBAL cows but IGF1 and IGFALS were downregulated. Leukocytes from BAL cows had greater expression of histones and genes involved in nucleosomes and cell division. Leukocyte expression of heat shock proteins increased in IMBAL cows, suggesting an unfolded protein response, and several key genes involved in immune responses to pathogens were upregulated (e.g., DEFB13, HP, OAS1Z, PTX3, and TLR4). Differentially expressed genes upregulated in IMBAL cows in both tissues included CD36, CPT1, KFL11, and PDK4, all central regulators of energy metabolism. The IMBAL cows therefore had greater difficulty maintaining glucose homeostasis and had dysregulated hepatic lipid metabolism. Their energy deficit was associated with a reduced capacity for cell division and greater evidence of stress responses in the leukocyte population, likely contributing to an increased risk of infectious disease.

Persian version of the LANSS and S-LANSS questionnaires: A study for cultural adaptation and validation

The aim of this study was to culturally adapt and validate Leeds assessment of neuropathic symptoms and signs (LANSS) and self-report LANSS (S-LANSS) tools. Patients with chronic pain (n = 206) were categorized into neuropathic pain (NeP) (n = 101) or non-NeP (n = 105). After the translation process, both questionnaires and the Persian Douleur Neuropathique 4 (P-DN4) were administered to patients to assess the clinometric properties. The mean overall score of both tools was significantly higher in the NeP group (p < 0.01). Test-retest reliability analysis of the overall score of the Persian (P)-LANSS and PS-LANSS were 0.99 and 0.98, respectively. α-Cronbach value for P-LANSS and PS-LANSS were 0.64 and 0.61, respectively. Factor analysis of both questionnaires yielded two components explaining most of the observable variance. The P-LANSS was significantly correlated with PS-LANSS and P-DN4 (ρ = 0.92, p = 0.01, for both). PS-LANSS was also significantly correlated with P-DN4 (ρ = 0.79, p = 0.01). Both tools successfully diagnosed NeP patients at the cutoff point of ≥12 with 88.12% sensitivity and 76.19% specificity for P-LANSS and 83.17% sensitivity and 95.24% specificity for PS-LANSS. P-LANSS and PS-LANSS are reliable and valid tools to identify NeP component in chronic pain patients. PS-LANSS was found to be an acceptable alternative for P-LANSS.

Eligibility of the movement-based classification systems in the diagnosis of patients with low back pain: A systematic review

OBJECTIVE

To evaluate the eligibility of the movement-based classification systems in the diagnosis of patients with low back pain.

METHODS

The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta -Analysis guidelines. Different databases including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest and Google Scholar were searched from January 1990 to December 2017. All studies assessed the reliability and validity of the movement-based classification systems to diagnose patients with low back pain were included. The keywords used to search the studies were: "reliability", "validity", "classification", "movement impairment" and "low back pain". Study selection and data extraction were performed by two independent reviewers.

RESULTS

Sixteen articles were met the inclusion criteria. Of these articles, 13 studies assessed the reliability and validity of movement-based classification systems to categorize patients with low back pain. Two out of 16 articles compared patients with low back pain and healthy subjects and one article had no control group.

CONCLUSIONS

The results of the reviewed studies demonstrated that movement-based classification systems are valid and reliable enough to categorize patients with low back pain.

Underlying pathway of factors leading to mental health in Iranian young adolescents: A structural equation modeling

Background:

The present study aimed to provide a field-tested model of constituting factors affecting mental health in young Iranian adolescents.

Materials and Methods:

In this cross-sectional study, a conceptual model was proposed based on an extensive literature review. A total of 254 young adolescents aged 11–14 years were recruited from north, south, east, and west regions of Tehran megacity by a random cluster sampling procedure, of whom 244 adolescents participated. The adolescents and their mothers altogether completed eight questionnaires pertaining to the proposed conceptual model: (1) Strengths and Difficulties Questionnaire (SDQ), (2) Childhood Experience of Care and Abuse Questionnaire, (3) Child Exposure to Domestic Violence Scale, (4) Drug Abuse Screening Test-10, (5) Baumrind Parenting Style Questionnaire, (6) Conflict Behavior Questionnaire, (7) General Health Questionnaire-28, and (8) Garmaroodi Socioeconomic Status Questionnaire. The statistical analysis was performed using structural equation modeling.

Results:

This study demonstrated that parent mental health (b = −0.111), experience of father's care (b = −1.112), conflict with mother (b = 0.309), conflict with father (b = 0.135), and exposure to domestic violence (b = 0.217), as well as age (b = 0.93) and gender (b = 0.139), had direct effect on adolescent mental health (all P < 0.05). Further, the results showed that exposure to domestic violence and conflict with mother had the greatest direct impact on adolescent mental health among all other family-related factors, followed by conflict with father and parent mental health. Conflict with mother and conflict with father also affected adolescent mental health indirectly through experience of domestic violence and had a mediating effect for the influence of several other factors on adolescent mental health, thus playing an important role in the pathway leading to young adolescent mental health status in the Iranian population.

Conclusion:

Overall, the final model proved to be fit and the factors constituting the final model were able to predict 88% of the variations in the mental health of Iranian adolescents. This model can guide clinical psychologists, psychiatrists, and other mental health workers in a more realistic and effective prevention or treatment planning for their young clients. Moreover, it may help in arriving at a comprehensive preventive policymaking for mental health policymakers.

The inter- and intra-rater reliability of Modified Tardieu Scale in assessing spasticity of knee extensors in patients with multiple sclerosis

INTRODUCTION

Spasticity is one of the most common and disabling symptoms in Multiple sclerosis (MS). The is a clinical tool for assessing spasticity. This study aimed to investigate the inter- and intra-rater reliability of the modified Tardieu scale for assessing knee extensors spasticity in MS patients.

METHODS

Twenty-six patients with MS (12 females and 14 males) with a mean age of 40 ± 11.39 years participated in this study. The extensor muscles of both knees were evaluated using the MTS in two sessions. At first session, two examiners randomly assessed the knee extensor spasticity to study the inter-rater reliability and 3-4 days later the first examiner assessed the patients again, to determine intra-rater reliability. Intra-class Correlation Coefficient (ICC) analysis, two-way random effect model was used to determine the reliability of various components of the modified Tardieu scale.

RESULTS

The inter-rater reliability for quality of muscle reaction of knee extensor muscles was very good (ICC = 0.89) and for the difference between the angle of muscle response (R1) and full range(R2) of movement (R2- R1), as spasticity intensity criterion, was good (ICC = 0.73). ICC values for R2-R1 and muscle response quality assessments by one rater were 0.73 and 0.82, respectively.

CONCLUSION

The findings of the current study showed that the MTS has good to very good inter- and intra-rater reliability for assessing knee extensors spasticity in MS patients.

Reliability of postural control during double-leg standing in subjects with nonspecific chronic low back pain: Dual-task paradigm and manipulated visual and somatosensory inputs

BACKGROUND

The aim of this study is to evaluate the test-retest reliability of the Center of Pressure (COP) parameters in quiet double-leg standing in subjects with Non-Specific Chronic Low Back Pain (NSCLBP) during dual taking associated with manipulated visual and somatosensory inputs.

MATERIALS AND METHODS

In this observational cross-sectional study, the static balance of thirty NSCLBP patients were assessed during a double-leg stance by using the force platform. Subjects were accosted by manipulated somatosensory and visual inputs during dual taking in eight different conditions (with and without vibration, eyes-open and eyes-closed, and with and without auditory Stroop test). The COP parameters were recorded as follows: range sideways and range fore-aft as well as mean velocity and area variables. The cognitive task parameters included the reaction time and error ratio. The intra-class correlation coefficient (ICC) was computed to assess the intersession reliability of COP parameters.

RESULTS

in intersession, range sideways, range fore-aft, and mean velocity measures possessed moderate to high ICC, but area owned high ICC only in one condition (double-leg stance, eyes-close, with vibration, and with auditory Stroop test). Notably, other conditions had low ICC, and moderate to high and low to very high ICC were reported for reaction time and error ratio.

CONCLUSION

Among the parameters studied in the present study, the mean velocity measure seems to be the most reliable variable of postural control in the subjects with NSLBP especially in more challenging conditions, i.e., quiet double-leg standing with eyes closed and adding vibratory inputs during dual-tasking.

Magnitude, symmetry and attenuation of upper body accelerations during walking in women: The role of age, fall history and walking surface

OBJECTIVES

The present experiment examined the role of age and fall history in upper body accelerations when walking on an even and on an uneven surface.

STUDY DESIGN

An observational cross-sectional study.

MAIN OUTCOME MEASURES

The magnitude (root mean square [RMS]), symmetry (harmonic ratio) and attenuation (attenuation coefficient) of upper body accelerations were quantified as primary outcomes; gait spatiotemporal parameters were measured as secondary outcomes.

METHODS

Twenty young adults (mean ± SD age: 29.00 ± 4.51 yrs), 20 older non-fallers (66.60 ± 5.43 yrs) and 20 older fallers (68.55 ± 4.86 yrs) walked on an even and on an uneven surface, while wearing four accelerometers attached to the forehead, pelvis, right and left shanks.

RESULTS

Older fallers exhibited increased RMS acceleration in the mediolateral direction at the pelvis level compared with young adults when walking on the even surface (0.18 ± 0.04 vs. 0.14 ± 0.02, respectively), whereas walking on an uneven surface was associated with reduced magnitude of acceleration in older fallers (0.19 ± 0.04) compared with non-fallers (0.23 ± 0.04) and young adults (0.22 ± 0.03). Among other changes, walking on the uneven surface diminished pelvis-to-head attenuation in the mediolateral direction in older fallers (38.07 ± 14.51) compared with non-fallers (50.96 ± 11.03) and young adults (62.62 ± 8.21; all ps<0.05).

CONCLUSIONS

Reduced mediolateral accelerations in older fallers when walking on the uneven surface can be interpreted as a compensatory mechanism to preserve stability through increased body stiffness. Reduced postural flexibility in the frontal plane compromises the central role of the trunk in minimizing the impact of gait-related oscillations to the head, as evidenced by reduced mediolateral attenuation in older fallers.

Translation, reliability, and validity of the avoidance endurance questionnaire in Iranian subjects with chronic non-specific neck pain

Background:

To cross-cultural adaptation, test-retest reliability, construct validity of the Persian version of avoidance endurance questionnaire (AEQ) in Iranian subjects with chronic nonspecific neck pain (CNSNP).

Objective:

The AEQ differentiates endurance responses [ER; positive mood scale (PMS), thought suppression scale (TSS), pain persistence behavior scale (PPS), humor/distraction scale (HDS), and behavioral endurance scale (BES) from fear-avoidance responses (FARs; anxiety/depression scale (ADS), catastrophizing scale (CTS), helplessness/hopelessness scale (HHS), avoidance of social activities scale (ASAS), and avoidance of physical activities scale (APAS)].

Methods:

One hundred and thirty persons with CNSNP took part in this psychometric study. The translation process was done by Beaton guideline. Test–retest reliability and internal consistency were presented by intraclass coefficient (ICC) and Cronbach's alpha, respectively. The construct validity was measured by the correlation between AEQ subscales and the Short-form health survey (SF-12), visual analog scale (VAS), fear-avoidance beliefs questionnaire (FABQ), pain catastrophizing scale (PCS), Tampa scale for kinesiophobia (TSK), and neck disability index (NDI).

Results:

The Cronbach's alpha of all FAR and ER subscales was more than 0.7, and ICCs of all FAR subscales were more than 0.8 and ICCs of ER subscales were reported between 0.59 and 0.86. The correlation between FAR subscales and TKS, FABQ, FABQ.PA, FABQ.W, NDI, PCS, and VAS were the limit between -0.239 and 0.199, and the association between ER subscales and the abovementioned questionnaires was the limit between 0.179 and 0.644.

Conclusions:

The Persian version of AEQ showed acceptable reliability (test–retest, internal consistency) for FAR and ER, and also the construct validity was acceptable. The Persian version of AEQ had acceptable psychometric properties, thus it is a good instrument to identify fear avoidance and ERs of the pain.

The Psychometric Properties of the Drug Abuse Screening Test

Background

Substance abuse is a critical problem in most countries, especially in developing ones. Early detection is the pre-requisite of early control, for which reliable and valid tools are required. In the present study, we aimed at measuring the psychometric properties of the 10-item Drug Abuse Screening Test (DAST-10) in Iranian individuals.

Methods

After translation and back-translation of the questionnaire, 244 adults were recruited from Tehran Megacity, Iran, and completed the questionnaires. Participants were recruited by a multistage randomized cluster sampling method. Reliability was determined by Cronbach’s alpha. Also, construct validity was evaluated using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA).

Findings

The internal consistency using Cronbach's alpha coefficients for the total score of the Persian version of DAST-10 was 0.93. EFA evoked only one factor for DAST-10. The CFA for 1-factor models for DAST-10 indicated an acceptable fit for the proposed models.

Conclusion

The results prove desirable reliability and validity of the Persian version of the DAST which can be utilized as a screening instrument for drug abuse among Iranian adults.

The Psychometric Properties of the Persian Version of Childhood Experience of Care and Abuse Questionnaire (CECA)

Background

The present study aimed to determine the psychometric properties of the Persian version of the Childhood Experience of Care and Abuse Questionnaire (CECA.Q), a tool based on a retrospective interview with the child.

Materials and Methods

To this aim, 251 adolescents from four regions of Tehran megacity completed the questionnaire. The reliability of the questionnaire was examined, along with the face and content validity. In addition, the construct validity was evaluated by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Results

EFA and CFA supported a 4-factor solution including mother's role scale items, father's role scale items, maternal behavior scale items, and paternal behavior scale items. The total variance extracted in EFA ranged from 33.9 to 60.7. The internal consistency for mother's role, father's role, maternal behavior, and paternal behavior was 0.61, 0.65, 0.86, and 0.9 respectively. Thus, the questionnaire had a suitable fit, as well as reasonable reliability and validity.

Conclusion

The Persian version of the CECA.Q had adequate reliability and validity as a self-report measurement for childhood experience of care and abuse.

Attentional Demands of Postural Control in Chronic Ankle Instability, Copers and Healthy Controls: A Controlled Cross-sectional Study

BACKGROUND

It has been shown that cognitive loading affects postural control in different populations. However, there is limited and conflicting information about dual task challenges on postural control in chronic ankle instability (CAI).

RESEARCH QUESTION

Does cognitive task performance change standing postural control in individuals with CAI, copers and healthy subjects?

METHODS

A descriptive, analytic, and controlled cross-sectional study was conducted on 75 individuals. They were assigned into three matched groups, including CAI, copers, and healthy controls. Postural control variables were collected during single leg standing on a force plate with and without vision and cognition. Parameters of center of pressure (COP), including mean COP area, range, sway index and velocity, were measured. Additionally, cognitive task performance by auditory stroop was assessed by calculating the reaction time and error ratio. Mixed model ANOVAs were used to determine the effects of group and testing conditions.

RESULTS

The CAI group demonstrated greater COP sway parameters compared to other groups under all testing conditions. The main significant effect of vision was observed for all COP parameters with greater COP sway during eyes closed compared to eyes open (P < 0.05). The main effect of a cognitive task was significant with reduced COP sway while performing the secondary cognitive compared to a single task in all three groups (P < 0.05). The cognitive task results revealed significantly longer reaction times in the CAI group compared to copers and healthy individuals (p < 0.05).

SIGNIFICANCE

Considering postural control deficits in CAI, especially in eye-closed condition and effects of cognitive loading, may guide us to improve postural control in those with CAI with neurocognitive training. Furthermore, no difference between coper and healthy groups may imply a successful compensatory postural control mechanism in copers.

Genome-wide association for metabolic clusters in early-lactation Holstein dairy cows

The aim of this study was to detect the genomic region or regions associated with metabolic clusters in early-lactation Holstein cows. This study was carried out in 2 experiments. In experiment I, which was carried out on 105 multiparous Holstein cows, animals were classified through k-means clustering on log-transformed and standardized concentrations of blood glucose, insulin-like growth factor I, free fatty acids, and β-hydroxybutyrate at 14 and 35 d in milk (DIM), into metabolic clusters, either balanced (BAL) or other (OTR). Forty percent of the animals were categorized in the BAL group, and the remainder were categorized as OTR. The cows were genotyped for a total of 777,962 SNP. A genome-wide association study was performed, using a case-control approach through the GEMMA software, accounting for population structure. We found 8 SNP (BTA11, BTA23, and BTAX) associated with the predicted metabolic clusters. In experiment II, carried out on 4,267 second-parity Holstein cows, milk samples collected starting from the first week until 50 DIM were used to determine Fourier-transform mid-infrared (FT-MIR) spectra and subsequently to classify the animals into the same metabolic clusters (BAL vs. OTR). Twenty-eight percent of the animals were categorized in the BAL group, and the remainder were classified in the OTR category. Although daily milk yield was lower in BAL cows, we found no difference in daily fat- and protein-corrected milk yield in cows from the BAL metabolic cluster compared with those in the OTR metabolic cluster. In the next step, a single-step genomic BLUP was used to identify the genomic region(s) associated with the predicted metabolic clusters. The results revealed that prediction of metabolic clusters is a highly polygenic trait regulated by many small-sized effects. The region of 36,258 to 36,295 kb on BTA27 was the highly associated region for the predicted metabolic clusters, with the closest genes to this region (ANK1 and miR-486) being related to hematopoiesis, erythropoiesis, and mammary gland development. The heritability for metabolic clustering was 0.17 (SD 0.03), indicating that the use of FT-MIR spectra in milk to predict metabolic clusters in early-lactation across a large number of cows has satisfactory potential to be included in genetic selection programs for modern dairy cows.

Potential of milk mid-infrared spectra to predict nitrogen use efficiency of individual dairy cows in early lactation

Improving nitrogen use efficiency (NUE) at both the individual cow and the herd level has become a key target in dairy production systems, for both environmental and economic reasons. Cost-effective and large-scale phenotyping methods are required to improve NUE through genetic selection and by feeding and management strategies. The aim of this study was to evaluate the possibility of using mid-infrared (MIR) spectra of milk to predict individual dairy cow NUE during early lactation. Data were collected from 129 Holstein cows, from calving until 50 d in milk, in 3 research herds (Denmark, Ireland, and the UK). In 2 of the herds, diets were designed to challenge cows metabolically, whereas a diet reflecting local management practices was offered in the third herd. Nitrogen intake (kg/d) and nitrogen excreted in milk (kg/d) were calculated daily. Nitrogen use efficiency was calculated as the ratio between nitrogen in milk and nitrogen intake, and expressed as a percentage. Individual daily values for NUE ranged from 9.7 to 81.7%, with an average of 36.9% and standard deviation of 10.4%. Milk MIR spectra were recorded twice weekly and were standardized into a common format to avoid bias between apparatus or sampling periods. Regression models predicting NUE using milk MIR spectra were developed on 1,034 observations using partial least squares or support vector machines regression methods. The models were then evaluated through (1) a cross-validation using 10 subsets, (2) a cow validation excluding 25% of the cows to be used as a validation set, and (3) a diet validation excluding each of the diets one by one to be used as validation sets. The best statistical performances were obtained when using the support vector machines method. Inclusion of milk yield and lactation number as predictors, in combination with the spectra, also improved the calibration. In cross-validation, the best model predicted NUE with a coefficient of determination of cross-validation of 0.74 and a relative error of 14%, which is suitable to discriminate between low- and high-NUE cows. When performing the cow validation, the relative error remained at 14%, and during the diet validation the relative error ranged from 12 to 34%. In the diet validation, the models showed a lack of robustness, demonstrating difficulties in predicting NUE for diets and for samples that were not represented in the calibration data set. Hence, a need exists to integrate more data in the models to cover a maximum of variability regarding breeds, diets, lactation stages, management practices, seasons, MIR instruments, and geographic regions. Although the model needs to be validated and improved for use in routine conditions, these preliminary results showed that it was possible to obtain information on NUE through milk MIR spectra. This could potentially allow large-scale predictions to aid both further genetic and genomic studies, and the development of farm management tools.

Prediction of metabolic clusters in early-lactation dairy cows using models based on milk biomarkers

The aim of this study was to describe metabolism of early-lactation dairy cows by clustering cows based on glucose, insulin-like growth factor I (IGF-I), free fatty acid, and β-hydroxybutyrate (BHB) using the k-means method. Predictive models for metabolic clusters were created and validated using 3 sets of milk biomarkers (milk metabolites and enzymes, glycans on the immunogamma globulin fraction of milk, and Fourier-transform mid-infrared spectra of milk). Metabolic clusters are used to identify dairy cows with a balanced or imbalanced metabolic profile. Around 14 and 35 d in milk, serum or plasma concentrations of BHB, free fatty acids, glucose, and IGF-I were determined. Cows with a favorable metabolic profile were grouped together in what was referred to as the "balanced" group (n = 43) and were compared with cows in what was referred to as the "other balanced" group (n = 64). Cows with an unfavorable metabolic profile were grouped in what was referred to as the "imbalanced" group (n = 19) and compared with cows in what was referred to as the "other imbalanced" group (n = 88). Glucose and IGF-I were higher in balanced compared with other balanced cows. Free fatty acids and BHB were lower in balanced compared with other balanced cows. Glucose and IGF-I were lower in imbalanced compared with other imbalanced cows. Free fatty acids and BHB were higher in imbalanced cows. Metabolic clusters were related to production parameters. There was a trend for a higher daily increase in fat- and protein-corrected milk yield in balanced cows, whereas that of imbalanced cows was higher. Dry matter intake and the daily increase in dry matter intake were higher in balanced cows and lower in imbalanced cows. Energy balance was continuously higher in balanced cows and lower in imbalanced cows. Weekly or twice-weekly milk samples were taken and milk metabolites and enzymes (milk glucose, glucose-6-phosphate, BHB, lactate dehydrogenase, N-acetyl-β-d-glucosaminidase, isocitrate), immunogamma globulin glycans (19 peaks), and Fourier-transform mid-infrared spectra (1,060 wavelengths reduced to 15 principal components) were determined. Milk biomarkers with or without additional cow information (days in milk, parity, milk yield features) were used to create predictive models for the metabolic clusters. Accuracy for prediction of balanced (80%) and imbalanced (88%) cows was highest using milk metabolites and enzymes combined with days in milk and parity. The results and models of the present study are part of the GplusE project and identify novel milk-based phenotypes that may be used as predictors for metabolic and performance traits in early-lactation dairy cows.

Comparing Levels of Mastery Motivation in Children with Cerebral Palsy (CP) and Typically Developing Children

Introduction

The present study aimed to compare motivation in school-age children with CP and typically developing children.

Material and Methods

229 parents of children with cerebral palsy and 212 parents of typically developing children participated in the present cross sectional study and completed demographic and DMQ18 forms. The rest of information was measured by an occupational therapist. Average age was equal to 127.12±24.56 months for children with cerebral palsy (CP) and 128.08±15.90 for typically developing children. Independent t-test used to compare two groups; and Pearson correlation coefficient by SPSS software applied to study correlation with other factors.

Results

There were differences between DMQ subscales of CP and typically developing groups in terms of all subscales (P<0.05). The lowest motivation scores of subscales obtained in gross motor persistence (2.4870±.81047) and cognitive-oriented persistence (2.8529±.84223) in children with CP. Motivation was correlated with Gross Motor function Classification System (r= -0.831, P<0.001), Manual ability classification system (r=-0.782, P<0.001) and cognitive impairment (r=-0.161, P<0.05).

Conclusion

Children with CP had lower mastery motivation than typically developing children. Rehabilitation efforts should take to enhance motivation, so that children felt empowered to do tasks or practices.

Mastery Motivation in Children with Cerebral Palsy (CP) Based on Parental Report: Validity and Reliability of Dimensions of Mastery Questionnaire in Persian

Introduction:

The present study aimed to investigate validity and reliability of Persian Dimensions of Mastery Questionnaire (DMQ18) in children with cerebral palsy.

Material and Methods:

The original version was carried out through back translation into Persian, and then the construct validity was assessed by confirmatory factor analysis; and reliability was evaluated through Cronbach’s alpha (n=230). Intra-class correlation coefficient (ICC) was used for test retest reliability (n=32).

Results:

230 parents (155 (67.4%) mothers and 75 (32.6%) fathers) of children and adolescents with CP with an average age of 126.99±24.59 months participated in the present research. Non-questions excluded from the confirmatory factor analysis, and thus all questions remained. Internal consistency reliability and total score were acceptable in all domains (higher than 0.70) except for negative reactions, sadness/shame (Cronbach’s alpha of 0.414). Intra-class correlation coefficient of all domains and total score were significant (p<0.001).

Conclusion:

DMQ18 (parental report) was valid and reliable for children with cerebral palsy. It also provided valuable information about different aspects of motivation in CP children according to their parents’ opinion, and thus it can be used in clinical interventions.

Attention demands of postural control in non-specific chronic low back pain subjects with low and high pain-related anxiety

Impaired postural control in chronic low back pain (CLBP) has been attributed to deficits in sensory and motor functions. However, it is not known if pain-related anxiety affects motor and cognitive function of postural control. The aim of this study was to compare the interactive effects of postural and cognitive function in CLBP patients with high and low pain-related anxiety and healthy subjects. Thirty-eight patients with nonspecific CLBP (19 with low and 19 with high pain-related anxiety levels) and 20 asymptomatic subjects participated. Postural control was assessed by center of pressure (COP) parameters including mean total sway velocity, area, anterior-posterior (A-P), and medial-lateral (Med-Lat) range. Postural task was assessed during four conditions (eyes open with and without ankle vibration-eyes closed with and without ankle vibrations). Participants performed the postural task with or without auditory Stroop task. Average reaction time and error ratio of auditory Stroop test were calculated as measures of the cognitive task performance. Significantly reduced sway area was observed in CLBP patients with high pain-related anxiety and control subjects during the dual-task condition as compared with the single task. In addition, A-P range was significantly reduced in CLBP patients with high pain-related anxiety during dual tasking when eyes were closed with ankle vibration. In addition, only the CLBP subjects with high pain-related anxiety showed significantly longer reaction times by increasing the difficulty of standing postural task. Pain-related anxiety may influence the postural cognitive interactions in CLBP patients. Furthermore, it may be considered as a contributing factor for postural strategies adopted by CLBP patients.

Reliability and Validity of the European Child Environment Questionnaire (ECEQ) in Children and Adolescents with Cerebral Palsy: Persian Version

The aim of this study was to assess the reliability and validity of the Persian version of the European Child Environment Questionnaire (ECEQ) in the Iranian context. In total, 332 parents (20.2% fathers and 79.8% mothers) of children and adolescents with cerebral palsy (CP) with an average age of 12.33 years (min 7.08 to max 18.08) from three provinces in Iran participated in the study. The original version of the questionnaire was translated and back-translated. Confirmatory construct validity was assessed by factor analysis and reliability was evaluated by Cronbach’s alpha (N = 332) and after two weeks’ test–retest reliability (n = 51) using an intraclass correlation coefficient (ICC). Eleven questions were dropped as they did not fit well into domains in the Persian version (p > 0.05). Cronbach’s alpha and intraclass correlation coefficient in all domains and overall were acceptable (higher than 0.70) and significant (p > 0.05). The Persian version of the ECEQ is suitable for assessing the needs and availability of environmental factors and is reliable and valid for children with CP, as reported by their parents.

Normal values of abdominal muscles thickness in healthy children using ultrasonography

Abdominal muscles are one of the important elements to support the lumbar spine. Evaluation of muscle thickness using ultrasonography (US) is considered to be a source of information from muscles characteristics. The purpose of this study was to demonstrate normal reference data of abdominal muscles thickness and subcutaneous fat in adolescents using US. A random sample of 160 healthy adolescents (80 boys and 80 girls) at the age range of 15-18 years was recruited. Three abdominal muscles including Transversus Abdominis (TA), Internal Oblique (IO), External Oblique (EO) and subcutaneous fat (SF) were bilaterally measured using US. The range of normal values for TA muscle thickness was between 2.31 and 2.57 mm, for IO muscle thickness was between 4.02 and 5.15 mm and for EO muscle thickness was between 2.81 and 3.17 mm. The normal patterns of abdominal muscles were found as IO > EO > TA at both sides. Boys were taller, heavier with greater body mass index (BMI) and had larger abdominal muscles thickness than girls. A weak negative correlation was found between age and muscles size [r = (-0.06) - (-0.23), p < .05], but a significant positive correlation was found between BMI and muscle size (r = 0.21-0.68, p < .05). It seems that abdominal muscles thickness in adolescents followed the same pattern of muscle size in adults. BMI appeared to be the best predictor of muscle thickness. However, further studies are recommended to support the findings of the present study.

Comparative Study of Abdominal Muscle Thickness on Ultrasonography in Healthy Adolescents and Patients With Low Back Pain

OBJECTIVES

Low back pain (LBP) is a common musculoskeletal disorder among different age groups, including adolescents. The purpose of this study was to compare the abdominal muscle thickness between healthy adolescents and those with LBP.

METHODS

One hundred sixty healthy high school adolescents and 80 high school adolescents with LBP participated in the study. All participants were asked to complete a demographic questionnaire and also a visual analog scale and the Oswestry Disability Questionnaire to evaluate the pain intensity and functional disability. Then abdominal muscle thickness was examined with ultrasonography.

RESULTS

The healthy high adolescents included 80 boys and 80 girls, and the adolescents with LBP included 40 boys and 40 girls. The results showed a significant difference between healthy adolescents and those with LBP in terms of abdominal muscle thickness (P < .05). Patients with LBP had smaller abdominal muscles compared with healthy adolescents. No significant difference was found between the groups in terms of the subcutaneous fat dimension (P > .05).

CONCLUSIONS

The thickness of abdominal muscles was lower in adolescents with LBP. Future studies with a larger sample and a wider age range are recommended to support the results of this study.

Ultrasound imaging transducer motion during standing postural tasks with and without using transducer fixator

BACKGROUND

Changes in the orientation of ultrasound (US) transducer relative to the body surface during dynamic standing tests can affect US measurements.

OBJECTIVE

The purpose of the study was to evaluate ultrasound imaging transducer motion while measuring the lateral abdominal muscle thickness during standing tasks with and without using transducer fixator (TF).

DESIGN

Cross-sectional experimental study.

METHODS

A digital optical motion analysis system was used to assess the motions of US transducer during double-leg stance in different levels of platform stability of Biodex Balance System (BBS) (static, levels 6 and 3) with and without using TF in 45 healthy individuals. In addition, lateral abdominal muscle thickness was evaluated by US imaging.

RESULTS

The results indicated that the amount of angular and linear transducer motions during static and dynamic standing tasks significantly decreased by the use of TF as compared to the conditions without TF (P < 0.001, effect size> 0.84).

CONCLUSION

TF can significantly control US transducer motions within acceptable threshold limits during standing postural task. This may improve the clinical application of US imaging.

Effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome

OBJECTIVE

To compare the effects of vision and cognitive load on static postural control in subjects with and without patellofemoral pain syndrome (PFPS).

METHODS

Twenty-eight PFPS patients and 28 controls participated in the study. Postural control was assessed in isolation as well as with visual manipulation and cognitive loading on symptomatic limb. The outcome measures of postural control were quantified in terms of area, anterior-posterior (AP), medial-lateral (ML), and mean velocity (MV) of the displacements of center of pressure (COP). In addition, cognitive performance (auditory Stroop task) was measured in the forms of average reaction time and error ratio in baseline (sitting) and different postural conditions.

RESULTS

PFPS subjects showed greater increases in area (p = 0.01), AP (p = 0.01), and ML (p = 0.05) displacements of COP in the blindfolded tasks as compared to control group. However, cognitive load did not differently affect postural control in the two groups. Although PFPS and control group had similar reaction times in the sitting position (p = 0.29), PFPS subjects had longer reaction times than healthy subjects in dual task conditions (p = 0.04).

CONCLUSION

Visual inputs seem to be essential for discriminating postural control between PFPS and healthy individuals. PFPS patients biased toward decreasing cognitive performance more than healthy subjects when they perform the single leg stance and cognitive task concurrently.

Reliability of the Upper Trapezius Muscle and Fascia Thickness and Strain Ratio Measures by Ultrasonography and Sonoelastography in Participants With Myofascial Pain Syndrome

Objective

The purpose of this study was to assess the intra- and interexaminer reliability of the upper trapezius muscle and fascia thickness measured by ultrasonography imaging and strain ratio by sonoelastography in participants with myofascial pain syndrome.

Methods

Thirty-two upper trapezius muscles were assessed. Two examiners measured the upper trapezius thickness and strain ratio 3 times by ultrasonography and sonoelastography independently in the test session. The retest session was completed 6 to 8 days later.

Results

A total of 87.5% of participants had trigger points on the right side, and 22.5% had trigger points on the left side. For the test session, the average upper trapezius thickness, fascia thickness, and strain ratio measured by first and second examiners were 11.86 mm and 11.56 mm, 1.23 mm and 1.25 mm, and 0.94 and 0.99, respectively. For the retest session, the previously mentioned parameters obtained by first and second examiners were 11.76 mm and 11.39 mm, 1.27 mm and 1.29 mm, and 0.96 and 0.99, respectively. The intraclass correlation coefficients indicated good to excellent reliability for both within-intraexaminer (0.78-0.96) and between-intraexaminer (0.75-0.98) measurements. Also, the intraclass correlation coefficients and standard errors of measurement of interexaminer reliability ranged between 0.88 to 0.93 and 0.05 to 0.44 for both muscle and fascia thickness and 0.70 to 0.75 and 0.04 to 0.20 for strain ratio of upper trapezius, respectively.

Conclusion

Upper trapezius thickness measurements by ultrasonography and strain ratio by sonoelastography are reliable methods in participants with myofascial pain syndrome.

Translation, cross-cultural adaptation and validation of the Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis

PURPOSE

Translation, cross-culturally adaptation and validation of a Persian version of COOP/WONCA charts in Persian-speaking Iranians with multiple sclerosis (MS).

METHOD

The Persian version of COOP/WONCA charts was developed after a standard forward translation, synthesis and backward translation. A total of 197 subjects with MS participated in this study. They were asked to complete the COOP/WONCA charts and Short-Form 36 Health Survey (SF-36). The COOP/WONCA charts were re-administered to 50 patients, 4 weeks after the first session. Expanded Disability Status Scale (EDSS) was also scored for each subject by the referring physician. Construct validity was assessed by testing linear relationship between corresponding domains of the COOP/WONCA charts, the SF-36 and the EDSS. Test-retest reliability was examined using interclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) values.

RESULTS

Related domains of COOP/WONCA charts and SF-36 demonstrated strong linear relationships with Spearman's coefficients ranging from -0.51 to -0.75 (p< 0.05). Physical fitness and daily activity charts also demonstrated strong relationships with the EDSS by Spearman's coefficients of 0.65 and 0.50, respectively (p< 0.05). The ICC values for most of COOP/WONCA charts domains were acceptable (>0.70) except for feelings and quality-of-life domains that were 0.50 and 0.51, respectively.

CONCLUSIONS

The Persian version of the COOP/WONCA charts was shown to be psychometrically appropriate to evaluate the functional level and quality of life in Persian-speaking Iranians with MS. Implications for rehabilitation COOP/WONCA charts are now available in Persian and demonstrate good psychometric properties. COOP/WONCA charts demonstrate excellent reliability and construct validity in a Persian-speaking Iranian population with MS. Minimal detectable change in COOP/WONCA is now available in MS to guide within and between group analyses. Knowledge on a wide variety of physical, mental and emotional parameters as well as the status of patients' symptoms, daily activities and quality of life helps rehabilitation clinicians and service providers plan preventive and remedial interventions more effectively.

A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people

BACKGROUND AND AIM

Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling.

METHODS

Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit.

RESULTS

The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001).

CONCLUSION

Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.

Development and face validity of a cerebral visual impairment motor questionnaire for children with cerebral palsy

AIM

The objectives of this study were (i) to develop two cerebral visual impairment motor questionnaires (CVI-MQ's) for children with cerebral palsy (CP): one for children with Gross Motor Function Classification System (GMFCS) levels I, II and III and one for children with GMFCS levels IV and V; (ii) to describe their face validity and usability; and (iii) to determine their sensitivity and specificity.

BACKGROUNDS

The initial versions of the two CVI-MQ's were developed based on literature. Subsequently, the Delphi method was used in two groups of experts, one familiar with CVI and one not familiar with CVI, in order to gain consensus about face validity and usability. The sensitivity and specificity of the CVI-MQ's were subsequently assessed in 82 children with CP with (n = 39) and without CVI (n = 43). With the receiver operating curve the cut-off scores were determined to detect possible presence or absence of CVI in children with CP.

RESULTS

Both questionnaires showed very good face validity (percentage agreement above 96%) and good usability (percentage agreement 95%) for practical use. The CVI-MQ version for GMFCS levels I, II and III had a sensitivity of 1.00 and specificity of 0.96, with a cut-off score of 12 points or higher, and the version for GMFCS levels IV and V had a sensitivity of 0.97 and a specificity of 0.98, with a cut-off score of eight points or higher.

CONCLUSION

The CVI-MQ is able to identify at-risk children with CP for the probability of having CVI.

Gross motor function in children with spastic Cerebral Palsy and Cerebral Visual Impairment: A comparison between outcomes of the original and the Cerebral Visual Impairment adapted Gross Motor Function Measure-88 (GMFM-88-CVI)

PURPOSE

To investigate whether the adapted version of the Gross Motor Function Measure-88 (GMFM-88) for children with Cerebral Palsy (CP) and Cerebral Visual Impairment (CVI) results in higher scores. This is most likely to be a reflection of their gross motor function, however it may be the result of a better comprehension of the instruction of the adapted version.

METHOD

The scores of the original and adapted GMFM-88 were compared in the same group of children (n=21 boys and n=16 girls), mean (SD) age 113 (30) months with CP and CVI, within a time span of two weeks. A paediatric physical therapist familiar with the child assessed both tests in random order. The GMFCS level, mental development and age at testing were also collected. The Wilcoxon signed-rank test was used to compare two different measurements (the original and adapted GMFM-88) on a single sample, (the same child with CP and CVI; p<0.05).

RESULTS

The comparison between scores on the original and adapted GMFM-88 in all children with CP and CVI showed a positive difference in percentage score on at least one of the five dimensions and positive percentage scores for the two versions differed on all five dimensions for fourteen children. For six children a difference was seen in four dimensions and in 10 children difference was present in three dimensions (GMFM dimension A, B& C or C, D & E) (p<0.001).

CONCLUSION

The adapted GMFM-88 provides a better estimate of gross motor function per se in children with CP and CVI that is not adversely impacted bytheir visual problems. On the basis of these findings, we recommend using the adapted GMFM-88 to measure gross motor functioning in children with CP and CVI.

Intratester and intertester reliability of the movement system impairment-based classification for patients with knee pain

BACKGROUND

The methods to standardize the test items used for classification of patients with knee pain based on the movement system impairment (MSI) approach have been established. To our knowledge, no study has concentrated on establishing reliability for proposed classification for knee pain problems.

OBJECTIVE

The aim of the study was to assess intra- and intertester reliability of the knee MSI classification in patients with knee pain.

DESIGN

A cross-sectional methodological study.

SETTING

Rasul Akram Hospital.

PARTICIPANTS

Ninety-six subjects with knee pain aged 18-65 years.

METHODS

In order to examine intertester reliability, all three testers assessed the symptoms, signs and the MSI diagnosis of subjects with knee pain simultaneously. In order to assess intratester reliability, the procedure was exactly repeated after a one-week intersession period. Kappa values and percentages of agreement were calculated to analyze the reliability level.

RESULTS

The kappa values for intra- and intertester reliability of the symptom items ranged from 0.83 to 1.00 and 0.00 to 0.83, respectively. For the sign items, the kappa values ranged from 0.18 to 1.00 and 0.00 to 0.82, respectively. Finally, the kappa values of intra- and intertester reliability for patients' classification judgments ranged from 0.66 to 0.71, and 0.48 to 0.58, respectively.

CONCLUSION

The results of the present study indicate that intertester reliability for the symptoms, signs and classification judgments of patients with knee pain based on the MSI approach seemed generally acceptable. However, for intratester reliability, lower levels of the system were observed, probably due to different pain levels or pain behavior between test and retest sessions.

Construct validity of center of rotation in differentiating of lumbar segmental instability patients

PURPOSE

Lumbar Segmental Instability (LSI) is a subgroup of nonspecific Low Back Pain (NSLBP) without any accepted diagnostic tool as a gold standard. Some authors emphasize on quality measure such as centre of rotation (COR) but construct validity of this measure had not been approved. Therefore the purpose of the present study was to evaluate Concurrent and Convergent validity of COR in differentiating LSI.

METHODS

A total of 66 volunteered males participated in three groups named control, NSLBP and LSI groups based on clinical examination. Patients were diagnosed as LSI according to screening criteria adopted by Hicks et al. Study variables included CORs of lumbar segments in sagittal plane. Three x-rays were taken in neutral, flexion and extension positions. The variables were calculated using CARA software. The ANOVA and Tukey test were utilized in statistic analysis.

RESULTS

ANOVA results demonstrated mean differences between three groups for COR of L4 motion segment in y axis (p= 0/008) and L5 motion segment in y axis (p= 0/005) were significant. Tukey test showed significant difference for COR of L4 motion segment in y axis between LSI and healthy groups (p= 0/038) and between LSI and NSLBP groups (p= 0/009). For COR of L5 motion segment in y axis, tukey test demonstrated mean difference between LSI and healthy groups (p= 0/028) and between LSI and NSLBP groups (p= 0/007) were significant. Tukey test did't show any significant difference between NSLBP and healthy groups for COR of L4 (p= 0/852) and L5 (p= 0/871) motion segments in y-axis.

CONCLUSIONS

The COR has ability to differentiate patients with signs and symptoms of LSI from other NSLBP and healthy subjects based on the present study results. However, more researches are needed to develop and support results of this study.

Adaptation, reliability and validity testing of a Persian version of the Health Assessment Questionnaire-Disability Index in Iranian patients with rheumatoid arthritis

OBJECTIVE

The aim of the present study was to culturally adapt and evaluate reliability and validity of Health Assessment Questionnaire-Disability Index (HAQ-DI) in Iranian patients with rheumatoid arthritis (RA).

SUBJECTS

234 patients with RA for validation study, Eighty-six participants for reliability study.

METHODS

Test-retest relative reliability and internal consistency of Persian version of HAQ-DI were examined by intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. Additionally, HAQ-DI construct validity (Spearman's correlation) was examined using Persian version of Short-Form 36 Health survey (SF-36), activity and severity parameters.

RESULTS

Persian version of HAQ-DI total score showed excellent test-retest reliability (ICC = 0.98) and internal consistency (Cronbach's alpha = 0.95). Spearman's correlations between the total PHAQ-DI score and activity and severity parameters were above 0.55. Correlation between PHAQ-DI and SF-36 Physical Health were higher as compared with SF-36 Mental Health.

CONCLUSION

Persian version of HAQ-DI is a reliable and valid culturally-adapted instrument in order to measure functional limitations in Iranian people with RA.

Validation of the movement system impairment-based classification in patients with knee pain

BACKGROUND

Categorizing patients with knee pain problems based on pathoanatomical sources has not proved to be the most effective method for directing physical therapy interventions. Movement system impairment (MSI) classification system may be an alternative in the assessment, diagnosis, and management of patients with knee pain. No previous study has been conducted to validate the proposed system in these patients.

OBJECTIVE

To assess construct validity of the MSI classification system in patients with knee pain.

DESIGN

A cross-sectional methodological study.

SETTING

Rasul Akram Hospital.

PARTICIPANTS

One hundred eighty subjects with knee pain aged 18-65 years.

METHODS

The MSI classification recognizes seven categories of knee pain problems based on the findings from the symptoms and signs assessment. Three physical therapists examined subjects with knee pain. A principal component analysis (PCA) was used to derive proposed categories. Eigenvalues and a scree plot were also used to determine the factor retention.

RESULTS

Four factors related to three proposed categories were extracted from the PCA. Two factors were related to tibiofemoral rotation (TFR) category. The other two factors were related to proposed categories patellar lateral glide (PLG) and tibiofemoral hypomobility (TFHypo).

CONCLUSION

The results provided evidence for the construct validity of three (TFR, PLG, and TFHypo) of the seven categories proposed by MSI classification. In addition TFR was subcategorized into two groups which were named as tibial lateral rotation (TLR) and femoral adduction/medial rotation (FAdd/MR) in the present study.