An information processing model for schizophrenia

A disorder of information processing must be present for a person to receive the diagnosis of schizophrenia, and is present when schizophrenic symptoms occur along with other diseases. We created a model for this disorder that resolves some paradoxic findings and suggests directions for future study. Basically, schizophrenics have a deficiency in information processing that can be characterized as conscious, serial, and limited in channel capacity. In contrast, those processes that seem automatic, unconscious, parallel, and almost unlimited in capacity seem to be normal or supernormal.

The interrater and intrarater reliability of the Modified Ashworth Scale in the assessment of muscle spasticity: limb and muscle group effect

The Modified Ashworth Scale (MAS) is a clinical scale used to assess muscle spasticity. While the evidence indicates that the reliability of the MAS is better in the upper limb and in certain distal muscle groups, no investigation has compared the effect of limbs and muscle groups on the MAS reliability. This study aimed to evaluate the effect of limb and muscle group on the reliability of the MAS in patients with spastic hemiplegia. Thirty subjects with upper and lower limb muscle spasticity were recruited for this trial. Two female experienced physiotherapists participated in this examination of reliability, and rated each patient in a randomized order in a single session. For the intrarater reliability, the second rater repeated the test 1 week later. Shoulder adductor, elbow flexor, wrist flexor, hip adductor, knee extensor, and ankle plantar flexor were tested on the hemiplegic side. Results demonstrated moderate inter (kappa=0.514, SE=0.046, p < 0.001) and intrarater (kappa=0.590, SE=0.051, p<0.001) reliability. For the inter and intrarater reliability, the agreement obtained for the upper and lower limb was similar. In the upper limb, the agreement between raters on the distal wrist flexor was significantly higher than the agreement on the proximal shoulder adductor. In the lower limb, there was a similar agreement between raters on the distal ankle plantar flexor and proximal hip adductor. For within rater, the agreement on the proximal and distal muscles of both limbs was not statistically significant. The Modified Ashworth Scale had moderate reliability. The limbs had no effect on the reliability. The agreement on distal wrist flexor in the upper limb was significantly higher between rater than in the proximal shoulder adductor. The agreement obtained with the MAS was not good, which questions the validity of the measurements.

Ashworth Scales are unreliable for the assessment of muscle spasticity

Ashworth Scales are the most widely used tests to assess the severity of muscle spasticity. These scales offer qualitative and subjective information; consequently, there are issues concerning validity and reliability. This article presents the results of a study comparing interrater reliability of the original and of the modified Ashworth Scales for measuring muscle spasticity in elbow flexors. Fifteen patients with hemiplegia (nine men and six women) with a median age of 52 years (interquartile range, 28-64) participated in this study. Two physiotherapists rated the muscle tone of elbow flexors according to ratings criteria of the Ashworth and the modified Ashworth Scales. Kappa values for the original Ashworth and the modified Ashworth Scales were 0.17 (SE 0.21; p = 0.41) and 0.21 (SE = 0.12; p = 0.08), respectively. The scales showed similar levels of reliability (chi2= 0.0285, df=1, p = 0.7). The Ashworth Scales are not reliable for the assessment of muscle spasticity. In the absence of interrater reliability, the validity of the measurements may also be questioned.

Validation of a Mini-Mental State Examination (MMSE) for the Persian population: a pilot study

The objective of the study was to develop and validate a translated and culturally adapted Mini-Mental State Examination (MMSE) for the Persian-speaking population. The MMSE was translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with Alzheimer's disease (n = 13) were studied. The difference between groups on the mean total scores of the Persian MMSE was statistically significant (control = 28.62 +/- 2.09; subjects with Alzheimer's disease = 11.77 +/- 5.66; p < .001). The cutoff score of 23 was the best cutoff score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was a significant correlation between the Persian MMSE score and the level of education (r = .46) and with age (r = -.77). There was no significant correlation between the Persian MMSE and gender. The Persian MMSE was found to be valid for discrimination of cognitive impairment in the Persian-speaking community.

A neurophysiological and clinical study of Brunnstrom recovery stages in the upper limb following stroke

PRIMARY OBJECTIVE

To determine the extent to which the Brunnstrom recovery stages of upper limb in hemiparetic stroke patients are correlated to neurophysiological measures and the spasticity measure of Modified Modified Ashworth Scale (MMAS).

RESEARCH DESIGN

A concurrent criterion-related validity study.

INTERVENTIONS

Not applicable.

METHODS AND PROCEDURES

Thirty patients (15 men and 15 women; mean ± SD = 58.8 ± 11.5 years) with upper limb spasticity after stroke were recruited. Wrist flexor spasticity was rated using the MMAS. The neurophysiological measures were Hslp/Mslp ratio, H(max)/M(max) ratio and Hslp.

MAIN OUTCOMES AND RESULTS

There was a significant moderate correlation between the Brunnstrom recovery stages and the neurophysiological measures. The Brunnstrom recovery stages were highly correlated to the MMAS scores (r = -0.81, p < 0.0001).

CONCLUSIONS

The Brunnstrom recovery stages are moderately correlated with neurophysiological measures and highly correlated with the MMAS regarding the evaluation of motor recovery in stroke patients. The Brunnstrom recovery stages can be used as a valid test for the assessment of patients with post-stroke hemiplegia.

Measurement of lower-limb muscle spasticity: intrarater reliability of Modified Modified Ashworth Scale

The Modified Modified Ashworth Scale (MMAS) is a clinical instrument for measuring spasticity. Few studies have been performed on the reliability of the MMAS. The aim of the present study was to investigate the intrarater reliability of the MMAS for the assessment of spasticity in the lower limb. We conducted a test-retest study on spasticity in the hip adductors, knee extensors, and ankle plantar flexors. Each patient was measured by a hospital-based clinical physiotherapist. Twenty-three patients with stroke or multiple sclerosis (fourteen women, nine men) and a mean +/- standard deviation age of 37.3 +/- 14.1 years participated. The weighted kappa was moderate for the hip adductors (weighted kappa = 0.45, standard error [SE] = 0.16, p = 0.007), good for the knee extensors (weighted kappa = 0.62, SE = 0.12, p < 0.001), and very good for the ankle plantar flexors (weighted kappa = 0.85, SE = 0.05, p < 0.001). The kappa value for overall agreement was very good (weighted kappa = 0.87, SE = 0.03, p < 0.001). The reliability for the ankle plantar flexors was significantly higher than that for the hip adductors. The intrarater reliability of the MMAS in patients with lower-limb muscle spasticity was very good, and it can be used as a measure of spasticity over time.

Dry needling for the treatment of poststroke muscle spasticity: a prospective case report

BACKGROUND

Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke.

OBJECTIVE

To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic.

METHODS

The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax/Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2).

RESULTS

The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax/Mmax ratio (0.39, 0. 29, and 0.32 at T0, T1, and T2, respectively). The patient was able to voluntarily extend the wrist and fingers slightly after DN. The upper limb Brunnstrom recovery stage (3 to 4) and hand function (2 to 3) improved and maintained. The passive supination increased at T1 (75°) and T2 (50°) compared to T0 (38°).

CONCLUSIONS

This prospective case report presents dry needling as a novel method in neurorehabilitation for the treatment of poststroke spasticity. Further research is recommended.

Inter-rater reliability of the Modified Modified Ashworth Scale in assessing lower limb muscle spasticity

PRIMARY OBJECTIVE

To assess the inter-rater reliability of the Modified Modified Ashworth Scale (MMAS) in lower limb muscle spasticity.

RESEARCH DESIGN

Cross-sectional observational study.

INTERVENTIONS

Not applicable.

METHODS AND PROCEDURES

Twenty-two adults with neurological conditions (17 women, five men, age range 21-82 years; mean +/- SD, 44 +/- 18 years) participated. Hip adductor, knee extensor and ankle plantarflexor were assessed in a random order.

MAIN OUTCOMES AND RESULTS

Inter-rater agreement for two raters was very good for the hip adductor and the knee extensor (weighted kappa = 0.82, p < 0.0001) and good for the ankle plantarflexor (weighted kappa = 0.74, p < 0.0001).

CONCLUSIONS

The Modified Modified Ashworth Scale produced reliable measurements between raters in the assessment of lower limb muscle spasticity.

The effect of continuous ultrasound on chronic non-specific low back pain: a single blind placebo-controlled randomized trial

BACKGROUND

Non-specific chronic low back pain (NSCLBP) is one of the most common musculoskeletal disorders around the world including Iran. One of the most widely used modalities in the field of physiotherapy is therapeutic ultrasound (US). Despite its common use, there is still inconclusive evidence to support its effectiveness in patients with NSCLBP. The objective of this study was to evaluate the effect of continuous US compared with placebo US additional to exercise therapy for patients with NSCLBP.

METHODS

In this single blind placebo controlled study, 50 patients with NSCLBP were randomized into two treatment groups: 1) continuous US (1 MHz &1.5 W/cm2) plus exercise 2) placebo US plus exercise. Patients received treatments for 4 weeks, 10 treatment sessions, 3 times per week, every other day. Treatment effects were assessed in terms of primary outcome measures: 1) functional disability, measured by Functional Rating Index, and 2) global pain, measured by a visual analog scale. Secondary outcome measures were lumbar flexion and extension range of motion (ROM), endurance time and rate of decline in median frequency of electromyography spectrum during a Biering Sorensen test. All outcome variables were measured before, after treatment, and after one-month follow-up. An intention to treat analysis was performed. Main effects of Time and Group as well as their interaction effect on outcome measures were investigated using repeated measure ANOVA.

RESULTS

Analysis showed that both groups had improved regarding function (FRI) and global pain (VAS) (P < .001). Lumbar ROM as well as holding time during the Sorensen test and median frequency slope of all measured paravertebral muscles did not change significantly in either group (P > .05). Improvement in function and lumbar ROM as well as endurance time were significantly greater in the group receiving continuous US (P < .05).

CONCLUSIONS

The study showed that adding continuous US to a semi supervised exercise program significantly improved function, lumbar ROM and endurance time. Further studies including a third group of only exercise and no US can establish the possible effects of placebo US.

TRIAL REGISTRATION

NTR2251.

Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity

The measurement of spasticity is part of the neurological examination of patients with disorders of the central nervous system. Recently, the Modified Modified Ashworth Scale (MMAS) was developed for the characterization of muscle spasticity. The purpose of this study was to determine the interrater reliability of the MMAS in the assessment of wrist flexor muscle spasticity in adult patients after upper motoneuron lesions resulted in hemiplegia. Thirty hemiplegic patients (17 males and 13 females) with a mean age of 55.6+/-7.8 years participated in this study. The wrist flexor spasticity was assessed according to MMAS by two female physiotherapists. The raters gave 23 patients the same spasticity score (weighted percentage agreement=97.4%). The most agreement occurred for scores 3 (46.7%) and 0 (16.7%), respectively. The agreement between raters was very good (weighted kappa=0.92, SE=0.03, p<0.0001). In conclusion, the MMAS has very good interrater reliability for the assessment of wrist flexor muscle spasticity.

The Modified Tardieu Scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia

PRIMARY OBJECTIVE

To investigate the inter-rater reliability of the Modified Tardieu Scale (MTS) in the measurement of elbow flexor muscle spasticity in patients with adult hemiplegia.

RESEARCH DESIGN

A cross-sectional study to examine the agreement between two raters on elbow flexor muscle spasticity using Modified Tardieu Scale.

INTERVENTIONS

Not applicable.

METHODS AND PROCEDURES

Thirty patients (21 men, nine women) with an age range of 21-79 years (mean = 54.9; SD = 15.7) were tested. Two inexperienced raters assessed the elbow flexor muscle spasticity in the affected side during the same session. The order of assessments by the two raters was randomized. The main outcome measure was dynamic component of spasticity (R2-R1). Reliability was also calculated for MTS scores, angle of muscle reaction (R1), and passive range of motion (R2).

MAIN OUTCOMES AND RESULTS

The ICC for R2-R1 was 0.72. The ICC for MTS scores, R1 and R2 were 0.74, 0.74 and 0.56, respectively.

CONCLUSIONS

The Modified Tardieu Scale did not provide acceptable high inter-rater reliability in the measurement of muscle spasticity in patients with hemiplegia when used by raters of limited experience.

Low back pain during pregnancy in Iranian women: Prevalence and risk factors

Low back pain (LBP) is a common and often disabling condition that deserves attention. Although LBP during pregnancy is a common clinical problem, only one study was found documenting prevalence of LBP during pregnancy in Iran. No investigation evaluated the diagnostic value of possible risk factors. The aims of the present, cross-sectional study were 1) to ascertain the prevalence of LBP of Iranian women during pregnancy and compare to other ethnic/cultural groups and 2) identify risk factors associated with LBP during pregnancy in Iranian women. One hundred three women were interviewed in the obstetric ward of a university hospital within 48 hours after giving birth. Possible risk factor associations were studied by using nonparametric tests, and sensitivity, specificity, positive and negative predictive, and likelihood ratio values were calculated for the interview questions about previous low back pain, LBP during menstruation, and trauma during pregnancy. The prevalence of LBP during pregnancy was found to be 57.3%, which is similar to most other countries. Pain onset was most frequently reported in the third trimester of pregnancy (40.7%) and was often reported to be in the low back area (71.2%). Almost half of the patients reported their pain as being moderate (44.1%). The logistic regression model demonstrated that the LBP during menstruation predicts a high risk for LBP during the current pregnancy. The study showed that LBP during menstruation and previous LBP may be useful tests for ruling out and ruling in LBP during pregnancy, respectively.

Comparison of acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache

OBJECTIVE

The purpose of this study was to compare the acute effects of superficial and deep dry needling into trigger points of suboccipital and upper trapezius muscles in patients with cervicogenic headache.

METHODS

Thirty participants (8 men, 22 women) aged 19-60 years (mean age ± SD, 39 ± 10 y) with a clinical diagnosis of cervicogenic headache were randomly divided into superficial and deep groups. Headache index, trigger points tenderness, cervical range of motion (CROM), functional rating index was assessed at baseline, immediate and 1 week after the treatment.

RESULTS

Two approaches of dry needling showed reduction in headache index and trigger points tenderness. Deep dry needling showed greater improvement of cervical range of motion (p < 0.001) and functional rating index (p < 0.01).

CONCLUSION

The application of dry needling into trigger points of suboccipital and upper trapezius muscles induces significant improvement of headache index, trigger points tenderness, functional rating index and range of motion in patients with cervicogenic headache. Deep dry needling had greater effects on CROM and function.

Intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of upper-limb muscle spasticity

The aim of this study was to investigate the intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the upper limb of patients with hemiparesis and to determine the effect of pain and contracture presence on the reliability of the MMAS. For this test-retest study 30 patients with hemiparesis were included. One physiotherapist using the MMAS, randomly rated the spasticity of shoulder adductors, elbow flexors, and wrist flexors in the affected upper limb of each patient with hemiparesis twice with at least a 1 week interval between testing sessions. The presence of pain and contracture during passive stretch was recorded. The magnitude of the contracture was measured by a goniometer. The quadratic weighted kappa statistics was very good for the upper limb spasticity (κw= 0.84). Intra-rater reliability was good for shoulder adductors (κw=0.75), and very good for elbow flexors and wrist flexors (κw 0.86 and 0.90, respectively). There were no differences between the weighted kappa values for muscle groups (p>0.05). The intra-rater reliability was also good in the presence of pain or contracture. The MMAS had very good intra-rater reliability in the assessment of upper limb spasticity in patients with hemiparesis. The presence of pain during shoulder abduction or contracture of the shoulder adductors had no influence on the reliability of the MMAS (κ w=0.75, 0.77, respectively).

A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke

BACKGROUND

Spasticity is a common complication after stroke. Dry needling (DN) is suggested as a novel method for treatment of muscle spasticity.

OBJECTIVE

To explore the effects of DN on wrist flexors spasticity poststroke.

METHODS

A single group, pretest-posttest clinical trial was used. Twenty nine patients with stroke (16 male; mean age 54.3 years) were tested at baseline (T0), immediately after DN (T1), and one hour after DN (T2). DN was applied for flexor carpi radialis (FCR) and flexor carpi ulnaris on the affected arm for single session, one minute per muscle. The Modified Modified Ashworth Scale (MMAS), passive resistance force, wrist active and passive range of motion, Box and Block Test, and FCR H-reflex were outcome measures.

RESULTS

Significant reductions in MMAS scores were seen both immediately after DN and at 1-hour follow-up (median 2 at T0 to 1 at T1 and T2). There were significant improvements in other measures between the baseline values at T0 and those recorded immediately after the DN at T1 or one hour later at T2.

CONCLUSIONS

This study suggests that DN reduced wrist flexors spasticity and alpha motor neuron excitability in patients with stroke, and improvements persisted for one hour after DN.

Inter- and intrarater reliability of the Modified Modified Ashworth Scale in patients with knee extensor poststroke spasticity

Muscle spasticity is a common motor disorder following upper motor neuron syndrome. A reliable and valid clinical tool is essential to document the effect of therapeutic interventions aimed to improve function by reducing spasticity. The Modified Ashworth Scale (MAS) is the most widely used and accepted clinical scale of spasticity. The MAS has been recently modified. The aim of this investigation was to determine the interrater and intrarater reliability of clinical test of knee extensor post-stroke spasticity graded on a Modified Modified Ashworth Scale (MMAS). Two raters scored the muscle spasticity of 15 patients with ischaemic stroke. For the inter- and intrarater reliability, two raters agreed on 80.1% and 86.6%, respectively. The Kappa values were good (kappa=0.72, SE=0.14, p<0.001) between raters and very good (kappa=0.82, SE=0.12, p<0.001) within one rater. The values of Kendall tau-b correlation were acceptable for clinical use with 0.87 (SE=0.06, p<0.001) between raters and 0.92 (SE=0.05, p<0.001) within one rater. The MMAS demonstrated reliable measurements for a single rater and between raters for measuring knee extensor post-stroke spasticity. The results encourage further study on the reliability and the validity of the scale.

Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia

The Modified Modified Ashworth Scale (MMAS) is a simple clinical outcome measure to assess muscle spasticity in people with brain injury. The objective of this cross-sectional study was to assess the interrater reliability of the MMAS in the upper limb of adult patients with hemiplegia. Participants were fifteen patients with a mean age of 57.3 +/- 14.4 years. They had brain injury on average 33.3 +/- 26.2 months earlier. Two common spastic muscle groups (elbow flexor and wrist flexor) on the hemiparetic side of the patients were rated by two physiotherapists according to a standardized protocol. The order of raters' assessment and the sequence of muscle testing was randomized. The weighted Kappa (kappaw) values were calculated for reliability. The kappaw was 0.61 for elbow flexor and 0.78 for wrist flexor. Results support the good interrater reliability of the MMAS for persons with upper limb spasticity.

Neurophysiological and clinical effects of dry needling in patients with upper trapezius myofascial trigger points

INTRODUCTION

Dry needling (DN) is a widely used in treatment of myofascial trigger points (MTrPs). The purpose of this pretest-posttest clinical trial was to investigate the neurophysiological and clinical effects of DN in patients with MTrPs.

METHODS

A sample of 20 patients (3 man, 17 women; mean age 31.7 ± 10.8) with upper trapezius MTrPs received one session of deep DN. The outcomes of neuromuscular junction response (NMJR), sympathetic skin response (SSR), pain intensity (PI) and pressure pain threshold (PPT) were measured at baseline and immediately after DN.

RESULTS

There were significant improvements in SSR latency and amplitude, pain, and PPT after DN. The NMJR decreased and returned to normal after DN.

CONCLUSIONS

A single session of DN to the active upper trapezius MTrP was effective in improving pain, PPT, NMJR, and SSR in patients with myofascial trigger points. Further studies are needed.

Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study

INTRODUCTION

Reliable and valid tools must be used to assess spasticity in clinical practise and research settings. There is a paucity of literature regarding the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS). No study, to date, has been performed to compare the validity of the MMAS and the MTS. This neurophysiological study protocol will compare the validity of the MMAS and the MTS in the assessment of poststroke wrist flexor spasticity.

METHODS AND ANALYSIS

Thirty-two patients with stroke from the University Rehabilitation clinics will be recruited to participate in this cross-sectional, non-interventional study. All measurements will be taken in the Physical Medicine and Rehabilitation Department of Shafa University Hospital in Tehran, Iran. First, wrist flexor spasticity will be assessed clinically using the MMAS and MTS. The tests will be applied randomly. For the MTS, the components of R1, R2, R2-R1 and quality of muscle reaction will be measured. Second, neurophysiological measures of H-reflex latency, H(max)/M(max) ratio, H(slp) and H(slp)/M(slp) ratio will be collected from the affected side. The results will be analysed using Spearman's ρ test or Pearson's correlation test to determine the validity of the MMAS and the MTS as well as to compare the validity between the MMAS and the MTS.

ETHICS AND DISSEMINATION

The Research Council, School of Rehabilitation and the Ethics Committee of Tehran University of Medical Sciences (TUMS) approved the study protocol.  The study results will be disseminated in peer-reviewed publications and presented at international congresses.

The functional rating index: reliability and validity of the Persian language version in patients with low back pain

STUDY DESIGN

Crosscultural adaptation and psychometric measurements of the Functional Rating Index (FRI).

OBJECTIVE

To develop and investigate the reliability and validity of the Persian version of the FRI when applied to patients with low back pain (LBP).

SUMMARY OF BACKGROUND DATA

The FRI is a self-report questionnaire designed to assess patient's perception of function and pain. Despite the use of this outcome measure in clinical trials in Iran, it was not translated and culturally adapted.

METHODS

The FRI was translated into Persian language and crossculturally adapted. The Persian FRI was administered to 100 patients with LBP (male patients/female patients = 22/78). A numerical rating scale, the Roland-Morris Disability Questionnaire, the Oswestry Disability Questionnaire, and the Quebec Back Pain Disability Scale were also recorded. The test-retest reliability (time interval = 7 days) was assessed in 50 patients.

RESULTS

There were no missing responses and floor or ceiling effects. The examination of discriminative validity showed that the questionnaire discriminated clearly between patients and healthy participants (P < 0.001). The concurrent criterion validity was confirmed by the Spearman rank correlation between the Persian FRI and the numerical rating scale (0.73, P < 0.0001 for test; and 0.77 for retest, P < 0.0001). Evidence for construct validity was found with a significant Pearson correlation between the FRI and the Roland-Morris Disability Questionnaire (r = 0.61; P < 0.0001), the Oswestry Disability Questionnaire (r = 0.75; P < 0.0001), or Quebec Back Pain Disability Scale (r = 0.76; P < 0.0001). Internal consistency reliability estimates (Cronbach α) for the Persian FRI were high, with 0.89 for test and 0.92 for retest. The test-retest reliability for the total score was excellent with an intraclass correlation coefficient (agreement) (ICCagreement) of 0.81 (P < 0.0001).

CONCLUSION

The Persian version of the FRI seems to have an excellent reliability and validity when applied to patients with LBP.

Development of the Persian version of the Modified Modified Ashworth Scale: translation, adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity

PURPOSE

Development of the Persian version of the Modified Modified Ashworth Scale (MMAS), and to investigate the interrater and intrarater reliability of the Persian MMAS when used to quantify elbow flexor spasticity in patients after stroke.

METHODS

The Persian MMAS was developed by the forward and backward translation procedure, a final review by an expert committee, and testing for acceptability and the clarity of item wording so that the scale could be used by Persian-speaking examiners. Psychometric testing included interrater and intrarater reliability. Elbow flexor spasticity was examined by two raters in 30 patients after stroke twice on two occasions using the Persian MMAS. The weighted κ was used for the statistical analysis.

RESULTS

The interrater and intrarater reliability was very good for the Persian MMAS (weighted κ: 0.81-0.91; 95% CI 0.68-0.98) with statistically significant agreement between raters and within raters (all p < 0.001).

CONCLUSIONS

The Persian version of the MMAS was successfully developed. The Persian MMAS showed very good interrater and intrarater reliability in patients with elbow flexor spasticity after stroke. The results support the use of the Persian version of the MMAS both in clinical and research settings.

Therapeutic effects of dry needling in patients with upper trapezius myofascial trigger points

BACKGROUND

Active myofascial trigger points (MTrPs) are major pain generators in myofascial pain syndrome. Dry needling (DN) is an effective method for the treatment of MTrPs.

OBJECTIVE

To assess the immediate neurophysiological and clinical effects of DN in patients with upper trapezius MTrPs.

METHODS

This was a prospective, clinical trial study of 20 patients with upper trapezius MTrPs and 20 healthy volunteers (matched for height, weight, body mass index and age), all of whom received one session of DN. Primary outcome measures were neuromuscular junction response (NMJR) and sympathetic skin response (SSR). Secondary outcomes were pain intensity (PI) and pressure pain threshold (PPT). Data were collected at baseline and immediately post-intervention.

RESULTS

At baseline, SSR amplitude was higher in patients versus healthy volunteers (p<0.003). With respect to NMJR, a clinically abnormal increment and normal reduction was observed in patients and healthy volunteers, respectively. Moreover, PPT of patients was less than healthy volunteers (p<0.0001). After DN, SSR amplitude decreased significantly in patients (p<0.01), but did not change in healthy volunteers. A clinically important reduction in the NMJR of patients and increment in healthy volunteers was demonstrated after DN. PPT increased after DN in patients, but decreased in healthy volunteers (p<0.0001). PI improved after DN in patients (p<0.001).

CONCLUSIONS

The results of this study showed that one session of DN targeting active MTrPs appears to reduce hyperactivity of the sympathetic nervous system and irritability of the motor endplate. DN seems effective at improving symptoms and deactivating active MTrPs, although further research is needed.

TRIAL REGISTRATION NUMBER

IRCT20130316128.

The functional rating index: reliability and validity of the Persian language version in patients with neck pain

STUDY DESIGN

Psychometric testing of the Persian Functional Rating Index (PFRI).

OBJECTIVE

To determine the reliability and validity of the PFRI in Persian-speaking subjects with neck pain (NP).

SUMMARY OF BACKGROUND DATA

The Functional Rating Index is a self-report questionnaire that can be used for patients with back pain or NP. The PFRI has been recently validated in patients with low back pain, whereas it is not validated in patients with NP.

METHODS

One hundred patients with NP, mean age of 42 years, participated in the study; 50 patients agreed to be tested on 2 occasions during a 7-day interval for the reliability phase of the study. A visual analogue scale, the Neck Disability Index, and the Neck Pain and Disability Scale were also completed to assess validity. Fifty healthy subjects completed the PFRI for discriminative validity.

RESULTS

Floor and ceiling effects were not observed. Independent t test showed a statistically significant difference in PFRI total scores between patients and healthy subjects supporting the discriminative validity of the PFRI (P < 0.001). PFRI and visual analogue scale demonstrated concurrent criterion validity, with Pearson correlation coefficients of 0.75 for test and 0.70 for retest. Construct validity was supported by a significant Pearson correlation between the PFRI and the Neck Disability Index (r = 0.72, P < 0.0001) and between the PFRI and the Neck Pain and Disability Scale (r = 0.63, P < 0.0001). Factor analysis revealed a 2-factor solution, which jointly accounted for 64.75% of the total variance. Additional factor analysis suggested 8-item PFRI as a unidimensional functional instrument for patients with NP. Internal consistency for the PFRI was high. (Cronbach α coefficients were 0.88 for test, 0.89 for retest, and 0.89 for 8-item PFRI.) Reproducibility assessed by test-retest reliability was excellent (intraclass correlation coefficient [ICC](agreement) of 0.96, P < 0.0001).

CONCLUSION

The PFRI is valid and reliable for use in a Persian-speaking population with NP.

A preliminary study into the effect of low-intensity pulsed ultrasound on chronic maxillary and frontal sinusitis

Sinusitis is a very common acute or chronic illness that affects a significant percentage of individuals. Recently, therapeutic ultrasound was reported as a treatment for chronic sinusitis. The purpose of this study was twofold: 1) to evaluate the effectiveness of low-intensity pulsed ultrasound (US) in chronic sinusitis using a pretest-posttest research design and 2) to determine the level of association between the independent variables of initial presence of symptoms, age, gender, and duration of disease and the dependent variable of improvement of symptoms. Patients with chronic sinusitis were treated with low-intensity pulsed US, 3 days per week for 15 sessions. Fifty-seven patients (18 females and 39 males; mean age, 35 years) were included in the study. The results of the McNemar test showed a significant change in proportions of post nasal drip and nasal obstruction, two common leading symptoms of patients with chronic sinusitis (p < 0.001). Most of the major and minor symptoms showed significant changes after US therapy (p < 0.05). The total improvement of symptoms was 81.3%. The greatest improvement in symptoms was observed in nasal discharge (100%), followed by facial pain (95.4%) and postnasal drip (82.7%), three major factors in sinusitis. There was a significant, low association between the initial presence of symptoms and the improvement of symptoms after US therapy (chi(2) = 30.352; df = 12; p = 0.002; phi value = 0.356). A significant, low association was also noted between the age and the improvement of symptoms after intervention (chi(2) = 17.548; df = 6; p = 0.007; phi value = 0.270). It may be concluded that low-intensity pulsed US has a significant effect on chronic sinusitis and improves patient symptoms in our study group.

Inter-rater reliability of the Modified Modified Ashworth Scale as a clinical tool in measurements of post-stroke elbow flexor spasticity

Patients with neurological conditions may be affected by spasticity. The Modified Modified Ashworth Scale (MMAS) is a clinical tool used to measure spasticity. The purpose of the present study was to investigate the inter-rater reliability of the MMAS during the assessment of elbow flexor spasticity in adult patients with post-stroke hemiplegia. Twenty-one adult patients with stroke (5 women, 16 men) with a median age of 60 years (interquartile range, 47-68) were tested. Elbow flexors on the affected side were examined. Inter-rater reliability for two inexperienced raters was very good. The weighted Kappa value was 0.81 (Standard Error = 0.097, 95% CI: 0.62-1.00, p = 0.0002). The weighted percentage agreement was 97.4%. The agreement between raters occurred mostly on score 1 (38.1%) followed by score 0 (23.8%). The MMAS yielded reliable measurements between raters when used on patients post-stroke with elbow flexor spasticity.