Comparison of a 30-year trend of incidence, prevalence, and DALY due to low back pain in Iran with Low- and High-SDI countries; Based on GBD study 2019 Data

Introduction

Low back pain (LBP) represents the leading cause of disability worldwide and is a major economic and welfare problem. This study aimed to report incidence, prevalence, and disability-adjusted life years (DALY) rates of LBP in Iran by gender and different sociodemographic index (SDI) countries from 1990 to 2019.

Methods

The age-standardized LBP and incidence, prevalence, and DALY were extracted based on the Global Burden of Disease (GBD) 2019 in Iran for males and females, and low- and high-SDI countries during 1990- 2019.

Results

GBD 2019 data for LBP in Iran indicate a significant downward trend of incidence and prevalence from 1993 to 2019 in males, females, and both, except during the 1999-2002 period for females. A sharp reduction is seen in LBP incidence and prevalence from 1996 to 1999. Gender is not a determining factor in the LBP prevalence in Iran. Regarding the SDI categories, Iran had the highest incidence rate compared to countries with low- and high SDIs. High-SDI countries had the highest prevalence and DALY compared with Iran and low-SDI countries.

Conclusion

The age-standardized incidence and prevalence of LBP in Iran showed a downward trend, from 1993 to 2019, especially from 1996 to 1999. Comparing Iran with low- and high-SDI countries, a heavier incidence of LBP was observed in Iran and heavier prevalence and DALY were seen in high-SDI countries. Therefore, more therapeutic healthcare interventions are required to reduce the LBP burden more effectively.

Effects of foot orthoses on running kinetics and kinematics: A systematic review and meta-analysis

BACKGROUND

Foot orthoses (FOs) are often prescribed by clinicians to treat foot and ankle conditions, prevent running injuries, and enhance performance. However, the lack of higher-order synthesis of clinical trials makes it challenging for clinicians to adopt an evidence-based approach to FOs' prescriptions.

RESEARCH QUESTION

Do FOs with different modifications alter lower extremity running kinematics and kinetics?

METHODS

A systematic search of seven databases was conducted from inception to February 2023. The analysis was restricted to healthy adults without foot musculoskeletal impairments and studies that compared the FOs effects with the controls. The methodological quality of the 35 studies that met the eligibility criteria was evaluated using the modified Downs and Black checklist. The random effects model estimated the standardized mean difference (SMD) with 95% confidence intervals and effect sizes. Sub-group analyses based on FOs type were performed to assess the potential effects of the intervention.

RESULTS

Our findings indicated that both custom and off-the-shelf arch-support FOs reduced peak plantar pressure at the medial heel (SMD=-0.35, and SMD=-1.03), lateral heel (SMD=-0.50, and SMD=-0.53), and medial forefoot (SMD=-0.20, and SMD=-0.27), but increased plantar pressure at the mid-foot (SMD=0.30, and SMD=0.56). Compared with the controls, significant increases (SMD=0.36) in perceived comfort were found with custom FOs. A reduction (SMD=-0.58) in initial ankle inversion was found when a raised heel cup was integrated with arch-support FOs. A medial post integrated with arch support exhibited a reduced ankle (SMD=-1.66) and tibial (SMD=-0.63) range of motion. Custom FOs, however, unfavorably affected the running economy (SMD=-0.25) and perceived exertion (SMD=0.20).

SIGNIFICANCE

Although FOs have been reported to have some positive biomechanical effects in healthy populations without musculoskeletal impairments or running-related issues, they need to be optimized and generalized to achieve better running performance and prevent injury.

Biomechanical effects of foot orthoses on jump landing performance: A systematic review

Jumping is involved in a wide range of sports and activities, and foot orthoses (FO) are suggested to enhance performance and prevent injury. The aim of this systematic review was to investigate whether using FO with different modifications affects jump landing biomechanics and improves performance in healthy individuals. The search strategy included 7 databases that identified 19 studies. The study quality was evaluated using a modified Downs and Black index. The primary outcome measures were joint kinematics, kinetics, muscle activity, vertical jump height, and horizontal jump distance. Our findings indicated that incorporating arch support with a rearfoot post and softer forefoot region into FO may improve several biomechanical variables during jump landing activities. Improvements in vertical ground reaction force loading rates, knee and ankle kinematics, and muscle cocontraction during jumping with FO could enhance jumping performance. In addition, improvements in hip, knee, ankle, and tibial kinematics and vertical ground reaction force loading rates during landing could reduce impact forces and related injuries. Although a limited number of studies have addressed the effects of FO on vertical jump height and horizontal jump distance, inserting such FO inside shoes with optimum bending stiffness could facilitate jumping performance. A rigorous exploration of the effect and mechanism of FO designs on jumping performance could benefit jumping-related activities and prevent ankle and knee injuries.

Effects of ankle-foot orthoses on step activities in the community: a systematic review

PURPOSE

To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders.

METHODS

Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale.

RESULTS

Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life.

CONCLUSIONS

Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.

The effect of Tecar therapy on neurological disorders and nerve conduction velocity of lower limbs in peripheral neuropathy of type 2 diabetic patients: A six-week follow-up study

Objectives

This study aimed to investigate the effect of Tecar therapy on neuropathy symptoms and tibial nerve conduction velocity in individuals with diabetes.

Patients and methods

The single-blind, randomized, sham-controlled clinical trial was conducted between January 2019 and October 2019. Twenty-four type 2 diabetics (8 males, 16 females; mean age: 60.4±8.9 years; range, 40 to 78 years) with peripheral neuropathy were randomly allocated to control (n=12) and study (n=12) groups. The study group received the capacitive Tecar therapy with 10 to 30% intensity and infrared radiation in 10 sessions. The controls received the same protocol with zero intensity. The neuropathy symptoms and nerve conduction velocity were evaluated at baseline, after 10 sessions, and six weeks after the end of sessions.

Results

There were no significant differences in variables (p>0.05). In this way, the homogeneity of the data variables was confirmed. Moreover, the results of two-way mixed analysis of variance showed that improvement of neuropathy symptoms in the study group was significantly more than controls in all stages (p<0.001). After 10 sessions, the results of post hoc analysis showed that the neuropathy symptoms and tibial nerve conduction velocity were significantly improved in both groups (p<0.05). However, there was no change in these outcomes after six weeks in the control group (p>0.05).

Conclusion

Tecar therapy could improve neuropathy symptoms and tibial nerve conduction velocity in diabetic individuals with peripheral neuropathy. Therefore, the use of this method to control the symptoms of diabetic patients can be recommended.

Effect of Dynamic Neuromuscular Stabilization and Vojta Therapy on Respiratory Complications in Neuromuscular Diseases: A Literature Review

Objective

The purpose of this study was to review the literature on the effect of dynamic neuromuscular stabilization (DNS)/Vojta on respiratory complications of neuromuscular diseases.

Methods

The search strategy was conducted, based on the population, intervention, comparison, and outcome method, in the PubMed, Embase, ISI Web of Knowledge, ProQuest, and Scopus databases from inception to August 2021. The quality assessment of included papers was performed through the Physiotherapy Evidence Database scale. A narrative analysis was performed since a meta-analysis could not be conducted.

Results

A total of 7 papers were chosen for the final assessment. All studies, except 1, evaluated individuals with neurological disease. Three studies evaluated Vojta therapy effects, and 4 studies evaluated DNS effects on respiratory parameters. Although the studies had limitations in their methodology according to the Physiotherapy Evidence Database scale, 4 were identified as level 1 evidence. None of the studies reported any adverse effects of Vojta therapy or DNS on respiratory parameters. However, not enough clinical trials were found to examine the effect of DNS on respiratory disease.

Conclusion

Although the studies were weak in internal and external validity, this review suggests that Vojta therapy and DNS may influence respiratory parameters, such as blood gases, diaphragm movements, and functional respiratory parameters, in patients with neuromuscular diseases.

Comparison of 4 weeks of cupping and Kinesio-taping on clinical and ultrasound outcomes of carpal tunnel syndrome during pregnancy

OBJECTIVE

To explore effect of cupping and Kinesio-taping techniques on clinical and ultrasound outcomes of carpal tunnel syndrome (CTS) during pregnancy.

METHODS

Thirty pregnant women suffering from CTS were randomly assigned into Kinesio-taping (n = 15) and cupping (n = 15) groups. In Kinesio-taping group, individuals underwent Kinesio-taping for three days, one day with no treatment, and three days with Kinesio-taping, continuing this procedure for four weeks. In cupping group, cupping was moved for 5 min with pressure of 50 mm-Hg on the carpal tunnel area. This procedure continued longitudinally in forearm area for 2 min. The therapeutic intervention of cupping group continued with eight sessions, two days a week for 4 weeks. Ultrasound outcomes including median nerve cross-sectional area through ultrasonography, and clinical outcomes including pain through visual analog scale and severity of symptoms and functional status through Boston questionnaire were measured in both groups before and after therapeutic program.

RESULTS

In both groups, a significant reduction was observed in all variables after treatment compared to pre-treatment (P < 0.001). In inter-group comparison, a significant improvement was found in outcomes of Boston questionnaire and ultrasound results about median nerve cross-sectional area at pisiform and hook of hamate in cupping group compared to Kinesio-taping at end of four weeks (P < 0.001).

CONCLUSION

Both cupping and Kinesio-taping improved clinical and ultrasound outcomes of CTS. However, efficacy of cupping compared to Kinesio-taping was better in improvement of median nerve cross-sectional area at hamate hook and pisiform levels, symptoms severity scale, and functional status scale, which makes the results clinically more applicable.

Design and Development of Kardex and Nursing Reports in the Rehabilitation Hospital

Introduction

A nursing rehabilitation Kardex and reports could act as a framework to facilitate and organize rehabilitation programs.

Objectives

This study aimed to design a special Kardex and a structure to rehabilitation nursing reports.

Methods

This study was carried out in two phases consisting of literature review and Delphi method in Rofideh Rehabilitation Hospital, Tehran, Iran. In the first phase, a diverse literature review was done. PubMed, Elsevier, Web of Science, and Google Scholar as a search engine were searched using the keywords of Kardex, "nursing report," "nursing note," "nursing rehabilitation," "nursing Kardex" from 2010 to 2020. After a literature review, the first draft of the Kardex was made. In the next step, using the Delphi method, the initial Kardex was sent to rehabilitation nursing experts in four rounds, and their comments were applied on that.

Results

The rehabilitation nursing Kardex was prepared after four rounds. The Kardex content included "Evaluation of nutritional needs," "Requirements for daily living," "Patients' education," "Examination of bedsores," "Fall prevention," and "communication with rehabilitation departments (physiotherapy, occupational therapy, and speech therapy)."

Conclusion

Rehabilitation Kardex and nursing report sample can be used as a suitable tool to promote patients' independence in rehabilitation centers.

Comparing the immediate effect of pneumatic and conventional knee braces on gait, satisfaction and pain in patients with knee medial osteoarthritis

Background/aims

Knee braces can change loading direction on knees in people with osteoarthritis, thereby reducing symptoms and progression of the disease. The aims of this study were to explore the immediate effect of two types of braces, a pneumatic knee brace with air pressure embedded in a sandal cuff (sandal cuff pressure) and a conventional knee brace on gait, pain and satisfaction during walking in patients with knee medial osteoarthritis.

Methods

A total of 28 patients with knee medial osteoarthritis were assigned to two groups, 14 patients used a conventional brace and 14 used a prototype brace with a pneumatic system, which was designed and fabricated by the authors, and followed the mechanism of variable pressures in the stance and swing phases of a gait cycle in a patient's knee. The gait parameters (walking self-selected speed, cadence, step length, knee range of motion, and maximum knee adduction moment, walking speed, cadence and step length) were measured with a Kistler force plate and Vicon motion analysis under two conditions: with and without brace for the conventional brace group, and under three conditions of no brace, brace with sandal cuff pressure, and brace without sandal cuff pressure for the pneumatic brace group. Patients' pain and satisfaction were also measured using a visual analogue scale and Likert scale respectively.

Results

Both groups showed a significant reduction in maximum knee adduction moment and pain wearing braces in comparison to no brace during walking (P<0.05). The knee range of motion was significantly decreased in the pneumatic brace group with and without sandal cuff pressure compared with no brace (P<0.001). No significant difference was found for any of the variables when using the pneumatic brace with and without sandal cuff pressure (P>0.05). In the between-group comparison, only patients' satisfaction was significantly reduced when using the pneumatic brace in both walking with (P=0.041) and without (P=0.02) sandal cuff pressure compared to those using the conventional brace.

Conclusions

Both conventional and pneumatic braces led to reduced knee adduction moment and pain in patients with knee osteoarthritis. However, using a pneumatic brace reduced the knee range of motion and satisfaction of patients, which could be because the brace was a prototype.

Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis

PURPOSE

To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments.

METHODS

PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible.

RESULTS

Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19-0.88), timed-up and go test (SMD: -0.45, CI: -0.67 to -0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25-2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53-1.28), Timed Up-Stairs (SMD: -0.35, CI: -0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38-0.92). Heterogeneity was non-significant for all outcomes (I² < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others.

CONCLUSIONS

An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.IMPLICATIONS FOR REHABILITATIONAn AFO can improve functional performance and ambulation in survivors of strokes.Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured.There was no evidence as to the effectiveness of specific AFO designs over others.

The impact of anodal transcranial direct current stimulation of primary motor cortex on motor learning in older adults with low levels of activity

Background/aims

Older adults with different physical activity levels have often demonstrated individual differences in motor performance and learning. Serial reaction time task training and anodal transcranial direct current stimulation of the primary motor cortex were used in this study to evaluate how these interventions affected motor learning in older adults with low activity levels.

Methods

In this randomised controlled trial, 28 healthy, right-handed, older adults with low activity levels, with a mean age of 69.92 years, were randomly allocated to an anodal transcranial direct current stimulation group (n=14) or sham transcranial direct current stimulation group (n=14), based on a simple non-probability sampling method. The experimental group was exposed to 20 minutes of anodal transcranial direct current stimulation of the motor cortex, using a tDCS device, alongside eight sequenced or randomised blocks of serial reaction time task activities, for 5 consecutive days. In the control group, the tDCS device was automatically switched off after 1 minute. To assess implicit motor learning, the response time and error rate of two sequenced blocks of serial reaction time task activities were collected before, immediately following, 1 day and 1 week after the completion of the intervention.

Results

Immediately following the end of the intervention, at day 5, the mean response time and error rate were 925.09 and 2.55 in the experimental group, and 1016.52 and 4.10 in the control group. At 1 day after the completion of the intervention, the mean response time and error rates were 927.40 and 3.03 in the experimental group and 1021.91 and 4.34 in the control group. At 1 week after the completion of the intervention, the mean response time and error rates were 942.26 and 3.63 in the experimental group and 1050.08 and 5.11 in the control group. These findings indicate that response time and error rate were significantly decreased in both stimulation groups at different time points (P<0.001). At the same time, there were no significant differences in the response time and error rate between the two groups at different time points: immediately (P=0.07, P=0.31), 1 day (P=0.06, P=0.41) and 1 week (P=0.04, P=0.35) after the completion of the intervention respectively.

Conclusions

Serial reaction time task training, with or without applying anodal transcranial direct current stimulation, can improve motor learning in low-activity older adults. Therefore, it appears that anodal transcranial direct current stimulation did not affect or improve motor learning in older adults with low motor activity. Motor learning training can be used alone as a practical and helpful intervention to improve performance and implicit motor skill learning with long-lasting effects in older adults with low levels of activity.

Effect of 3D printed insoles for people with flatfeet: a systematic review

This systematic review aimed to evaluate custom-made 3D printed insoles for people with flatfeet. PubMed, Embase, ISI web of knowledge, ProQuest, Scopus, and Cochrane databases, were searched from inception until January 2022. The quality assessment of included studies was performed through the Downs and Black checklist. A narrative analysis was performed since a meta-analysis could not be conducted. Ten studies including 225 subjects with flexible flatfeet were chosen for final evaluation. Although the evidence from selected literature was generally weak, using insoles with 3D printing technology may positively affect pain (comfort score) and foot function, with no significant change in vertical loading rate during walking or running. There were discrepancies among studies for plantar pressures, center of pressure trajectories, 3D ankle joint kinematics and kinetics of gait while wearing these insoles. Dose-response effects of medial posting on 3D printed insoles suggested beneficial effects on lower limb gait biomechanics in people with flatfeet. There was insufficient evidence to conclude the comparison between 3D printed insoles and other types of insoles. In conclusion, using a 3D printed insole may improve comfort score and foot function in people with flatfeet.

Ankle-foot orthosis with an oil damper versus nonarticulated ankle-foot orthosis in the gait of patients with subacute stroke: a randomized controlled trial

BACKGROUND

Gait improvement in patients with stroke has been examined in terms of use or non-use of an ankle-foot orthosis (AFO), but the effects of different kinds of AFOs remain unclear. In this study, the effect on gait of using an AFO with an oil damper (AFO-OD), which has plantarflexion stiffness without dorsiflexion resistance, was compared with a nonarticulated AFO, which has both dorsiflexion and plantarflexion stiffness, in a randomized controlled trial.

METHODS

Forty-one patients (31 men, 10 women; mean age 58.4 ± 11.3 years) in the subacute phase of stroke were randomly allocated to two groups to undergo gait training for 1 h daily over 2 weeks by physiotherapists while wearing an AFO-OD or a nonarticulated AFO. A motion capture system was utilized to measure shod gait without orthosis at baseline and after training with the allocated AFO. Data analysis focused on the joint kinematics and kinetics, spatial and temporal parameters, ground reaction force, and shank-to-vertical angle. Unpaired t-test or Mann-Whitney U test was performed to clarify the difference in gait with an AFO between the two AFO groups after training, with a significance level of p = 0.05.

RESULTS

Thirty-six patients completed the study (17 in the AFO-OD group and 19 in the nonarticulated AFO group). The ankle joint was more dorsiflexed in single stance (p = 0.008, effect size r = 0.46) and peak ankle power absorption was larger in stance (p = 0.007, r = 0.55) in the AFO-OD group compared with the nonarticulated AFO group. Peak power absorption varied among patients in the AFO-OD group. Increased dorsiflexion angles were also found at initial contact (p = 0.008, r = 1.51), pre-swing (p = 0.045, r = 0.91), and the swing phase (p = 0.045, r = 0.91) in the AFO-OD group. There was no difference in peak plantarflexion moment, ankle power generation, spatial or temporal parameters, ground reaction force, or shank-to-vertical angle between the two groups.

CONCLUSIONS

The results of this study showed that an AFO with plantarflexion stiffness but without dorsiflexion resistance produced greater improvement in ankle joint kinematics and kinetics compared with the nonarticulated AFO, but the results of peak power absorption varied greatly among patients. Trial registration UMIN000028126, Registered 1 August 2017, https://upload.umin.ac.jp/cgi-bin/icdr/ctr_menu_form_reg.cgi?recptno=R000032197.

Translation and cultural adaptation of the Sensory Profile 2 to the Persian language

Introduction

The purpose of this study was to translate and cross-culturally adapt the original Sensory Profile 2 questionnaires to Persian and access the psychometric properties of the adapted questionnaires.

Method

The translation and cultural adaptation of the original questionnaires were carried out under the published guidelines. Furthermore, we employed the multiple methods to establish the validity and reliability of the Sensory Profile 2 questionnaires. We calculated the content validity, internal consistency, and test–retest, along with the standard error of measurement. The study included 1272 children, between 0 and 14 years old, without any disabilities. They were selected from child developmental centers and elementary and middle schools of Tehran, the capital of the Islamic Republic of Iran.

Results

The item-level content validity index and the scale-level were satisfactory for all the items, quadrant, section, and factor of the Sensory Profile 2. The values of alpha for all questionnaires were ranged from 0.67 to 0.91. Furthermore, the test–retest reliability values for all questionnaires ranged from 0.72 to 0.95.

Conclusions

The Sensory Profile 2-Persian version can considered as a valid and reliable tool for utilization in Persian-speaking children between 0 and 14 years old.

Effect of knee braces and insoles on clinical outcomes of individuals with medial knee osteoarthritis: A systematic review and meta-analysis

Knee osteoarthritis is a disabling disease, causing pain and reduced function.Orthoses are used to manage this problem, including knee braces and lateral wedge insoles. However, there is still controversy on which type of intervention is more effective. This systematic review and meta-analysis aimed toevaluate the effect of knee braces and lateral wedge insoles and compare their clinical outcomes onindividuals with medial knee osteoarthritis. We conducted the search strategy based on the population, intervention, comparison, andoutcome (PICO) method. We searched with PubMed, EMBASE, Web of Science, and Scopus databases for the related studies. The articles quality assessment was done based on the modified Downs and Black checklist. Totally, we chose 32 controlled trials, including 1.849 participants, for the final evaluation. Almosttwo-thirds of the studies had a moderate quality. The overall outcome suggested that both interventionshad improved pain and function. The difference between both interventions on pain reduction was not significant (standardized mean difference = 0.12, 95% confidence interval = 0.34 to 0.1) based on meta-analysis. Both knee brace and lateral wedge insole can improve pain and function in people with knee osteoarthritis. Using either separately or both of them together are effective.

Efficacy of Corrective Surgery for Gait and Energy Expenditure in Patients with Scoliosis: A Literature Review

The aim of this literature review was to evaluate selected original papers that measured gait parameters and energy expenditure in idiopathic scoliosis (IS) treated with surgical intervention. IS is a progressive growth disease that affects spinal anatomy, mobility, and left–right trunk symmetry. Consequently, IS can modify human gait. Spinal fusions remain the primary approach to correcting scoliosis deformities, thereby halting progression. Using the population intervention comparison outcome measure framework and selected keywords, 15 studies that met the inclusion criteria were selected. Alteration of spatial and temporal variables in patients with IS was contradictory among the selected studies. Ankle and foot kinematics did not change after surgery; however, pelvic and hip frontal motions increased and pelvic rotation decreased following surgery. Patients with IS continued to show excessive energy expenditure following surgery in the absence of a physical rehabilitation protocol. Spinal surgery may be considered for gait improvement and IS treatment. There were inadequate data regarding the effect of corrective surgery on the kinetics, energy expenditure, and muscle activity parameters.

Effect of different designs of ankle-foot orthoses on gait in patients with stroke: A systematic review

BACKGROUND

Ankle foot orthoses (AFOs) are used to improve the gait of patients with stroke.

RESEARCH QUESTION

The current review aimed at evaluating the efficacy of different designs of AFOs and comparison between them on the gait parameters of individuals with hemiplegic stroke.

METHODS

The search strategy was based on the population intervention comparison outcome (PICO) method. A search was performed in PubMed, ISI Web of Knowledge, Scopus, Science Direct, and Google Scholar databases.

RESULTS

A total of 27 articles were found for the final evaluation. All types of AFOs had positive effects on ankle kinematic in the first rocker and swing phases, but not on knee kinematics in the swing phase, hip kinematics or the third rocker function. All trials, except two, assessed immediate or short-term effects only. The articulated passive AFO compared with the non-articulated passive AFO had better effects on some aspects of the gait of patients with hemiplegia following stroke, more investigations are needed in this regard though.

SIGNIFICANCE

An ankle-foot orthosis can immediately improve the dropped foot in the stance and swing phases. The effects of long-term usage and comparison among the different types of AFOs need to be evaluated.

Influence of heel design in an orthopedic shoe on ground reaction forces during walking

BACKGROUND

One of the treatments prescribed for musculoskeletal patients is orthopedic shoe. The use of an orthopedic shoe is thought to produce a more typical ground reactive force pattern.

OBJECTIVES

This study was designed to determine the influence of three heel designs of an orthopedic shoe on the ground reaction forces during walking in healthy subjects.

STUDY DESIGN

Quasi-experimental.

METHOD

In total, 30 healthy adults (12 males, 18 females) walked at a self-selected pace for six trials in each of the three shoe conditions having three different heels which included the following: standard heel, beveled heel, and positive posterior heel flare. For each trial, ground reaction force parameters were recorded using a force plate.

RESULTS

Repeated measures analysis of variance indicated that the impact force was significantly reduced for the positive posterior heel flare condition by 8% and 13% compared with standard and beveled heels, respectively (p < 0.001). The first peak of vertical force showed a significant reduction in the beveled heel by 5% and 4% compared with the standard heel and the positive posterior heel flare, respectively (p < 0.001). Loading rate was significantly reduced in the beveled heel and the positive posterior heel flare conditions (p < 0.05).

CONCLUSION

Positive posterior heel flare reduced impact force due to its geometry flexibility, while a beveled heel reduced first peak of vertical force. The findings of this study show that the shape of the heel therefore has the potential to modify impact loads during walking.

CLINICAL RELEVANCE

This study provides new evidence that by changing shape in the heel of orthopedic shoe impact loads are reduced during walking. Thus, these findings indicate that use of heel design may be beneficial for various musculoskeletal disorders, including key public health problems.