Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial

BACKGROUND

The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain.

OBJECTIVE

To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke.

METHODS

Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment.

RESULTS

A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point.

CONCLUSION

The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Translation, Adaptation, and Determining the Intra-Rater Reliability of the Balance Evaluation Systems Test (BESTest) for Persian Patients with Chronic Stroke

This study aimed to translate and culturally adapt the BESTest to the Persian language and evaluate its intra-rater reliability in Iranian patients with stroke. A forward-backward translation and expert panel review method was followed. Eighteen patients post-stroke (15 men, 3 female) were included which were assessed by a physiotherapist two times with a one-week interval. The mean total score for the test and retest were 83.66 (SD = 11.98) and 82 (SD = 13.23), respectively. There were no floor and ceiling effects. The intra-rater ICC for the total score was 0.88 (95% CI = 0.73-0.95). The ICC for the BESTest sections ranged from 0.55 (95% CI = 0.12-0.80) to 0.89 (95% CI = 0.55-0.96). The standard error of measurement and the smallest detectable change of the BESTest total score were 8.33 and 22.82, respectively. Our findings confirm the intra-rater reliability of the Persian BESTest for balance assessment of patients with chronic stroke.

Dry Needling for Arthrogenic Muscle Inhibition of Quadriceps Femoris in Patients after Reconstruction of Anterior Cruciate Ligament: a Protocol for a Randomized Controlled Trial

Background

: Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR.

Methods

: A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit.

Discussion

: The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

Comparison of the immediate effects of plantar vibration of both feet with the plantar vibration of the affected foot on balance in patients with stroke: Preliminary findings

OBJECTIVE

Plantar vibration is one of the strategies to enhance balance in stroke patients. This study compared the effects of the plantar vibration of both feet and the plantar vibration of the most affected side in patients with stroke.

METHODS

This study was a single-blind clinical trial. Post-stroke patients with balance impairment were enrolled in the study and underwent two treatment sessions with a one-week interval. They received both feet's plantar vibration in one session and plantar vibration of the most affected side in the other session (frequency 100 Hz, 5 min). Mini-BESTest, Modified Modified Ashworth Scale (MMAS), and Semmes-Weinstein monofilament examination (SWME) were used to evaluate balance, spasticity, and plantar sensation, before and after the treatment sessions.

RESULTS

Ten patients with a mean age of 52.9 (SD = 5.48) years were enrolled in the study. Mini-BESTest scores of balance and plantar flexor muscle spasticity were significantly improved after both feet plantar vibration and plantar vibration of the more affected side. There was no significant difference between the effectiveness of both sides plantar vibration and the most affected side plantar vibration. There were no significant improvements in SWME sensory scores after plantar vibration of either both sides or the most affected side.

CONCLUSION

Plantar vibration of both sides had no additional benefits in this group of patients with chronic stroke. Plantar vibration of more affected side can be used for improving balance and plantar flexor spasticity post-stroke. The Plantar vibration had no effects on the affected foot sensibility.

Effects of dry needling session frequency on wrist flexor spasticity and motor recovery after stroke: a single-blind randomized clinical trial

BACKGROUND

Determining the optimal number of dry needling (DN) sessions to satisfactorily treat a stroke patient with spasticity is important from both clinical and economic perspective.

OBJECTIVE

To explore the effects of one versus three sessions of DN on spasticity of the wrist flexors and motor recovery after stroke.

METHODS

In this single-blind randomized clinical trial, 24 patients were randomly and equally divided into two groups: one group received one session of DN, while the other group received three sessions of DN in one week. Both groups received one minute of DN of the flexor carpi radialis and flexor carpi ulnaris. The outcome measures were the Modified Modified Ashworth Scale (MMAS), passive resistance torque (PRT), wrist active and passive extension range of motion (ROM), and the Brunnstrom Stages of Stroke Recovery (BSSR) measured before, immediately after, and one week after the last DN session.

RESULTS

Both groups demonstrated a significant improvement in all outcomes (p < .05). The MMAS scores in both groups meaningfully improved (p < .001). No significant differences were found between the two groups; however, a significant time-by-group interaction was observed for the PRT (p = .02; Cohen's d = 0.23-0.73), wrist active extension ROM (p = .001; Cohen's d = 0.37-0.67), and wrist passive extension ROM (p = .02; Cohen's d = 0.32-1.30). The BSSR significantly improved from 3 to 4 in both groups (p < .001).

CONCLUSION

Administering three sessions of DN can effectively improve spasticity and motor function after stroke.

The Effect of Uni-Hemispheric Dual-Site Anodal tDCS on Brain Metabolic Changes in Stroke Patients: A Randomized Clinical Trial

Uni-hemispheric concurrent dual-site anodal transcranial direct current stimulation (UHCDS a-tDCS) of the primary motor cortex (M₁) and the dorsolateral prefrontal cortex (DLPFC) may enhance the efficacy of a-tDCS after stroke. However, the cellular and molecular mechanisms underlying its beneficial effects have not been defined. We aimed to investigate the effect of a-tDCS_M1-DLPFC on brain metabolite concentrations (N-acetyl aspartate (NAA), choline (Cho)) in stroke patients using magnetic resonance spectroscopy (MRS). In this double-blind, sham-controlled, randomized clinical trial (RCT), 18 patients with a first chronic stroke in the territory of the middle cerebral artery trunk were recruited. Patients were allocated to one of the following two groups: (1) Experimental 1, who received five consecutive sessions of a-tDCS_M1-DLPFC M₁ (active)-DLPFC (active). (2) Experimental 2, who received five consecutive sessions of a-tDCS_M1-DLPFC M1 (active)-DLPFC (sham). MRS assessments were performed before and 24 h after the last intervention. Results showed that after five sessions of a-tDCS_M1-DLPFC, there were no significant changes in NAA and Cho levels between groups (Cohen's d = 1.4, Cohen's d = 0.93). Thus, dual site a-tDCS_M1-DLPFC did not affect brain metabolites compared to single site a-tDCS M₁.

Responsiveness of Persian 12-Item multiple sclerosis walking scale: a replication study

OBJECTIVE

To re-explore the responsiveness of the Persian version of Multiple Sclerosis Walking Scale-12 (MSWS-12p) to physiotherapy intervention and determine the minimally clinically important change (MCIC). This study followed a prospective cohort design. Patients with MS (PwMS) underwent physiotherapy treatment for 10 sessions. The outcome measures were the MSWS-12p and Timed 25-Foot Walk test (T25-FW). Data was collected before and after ten sessions of physiotherapy. The effect sizes and the area under receiver operating characteristics curve (AUC) and MCIC were calculated.

RESULTS

Thirty PwMS (16 female, mean age 43.07 years) participated in the study. The effect sizes for MSWS-12p were moderate (0.52, 0.64). The change scores of MSWS-12p showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (Eta coefficient test = 0.84). There was no correlation between the MSWS-12p total change scores and the T25-FW (r = - 0.14, p = 0.45). The AUC was perfect and the MCIC for the MSWS-12p was calculated 10.0 points. The MSWS-12p is responsive and demonstrates changes after physiotherapy. Changes > 10.0 points on MSWS-12p total score should be considered as true improvement after physiotherapy.

The effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy: a pilot study

OBJECTIVES

This study aimed to evaluate the effects of local calf vibration on balance, blood flow, and nerve conductivity in patients with diabetic peripheral neuropathy (DPN).

METHODS

An open-label controlled trial was designed. Patients with confirmed diagnoses of type 2 diabetes and DPN were enrolled in the study and underwent ten sessions of local calf vibration therapy for the dominant leg. The other leg was considered the control. Balance evaluation, nerve conduction studies, and color Doppler ultrasound were performed before and after the treatment course. The Wilcoxon signed rank test and the Mann-Whitney test were used to evaluate the differences between the test results before and after the intervention and between the intervention and control legs.

RESULTS

Seventeen patients with a mean age of 60.3 ± 5.6 years (11 males) participated in the study. Mean Brief BESTest total scores were significantly improved (14.06 vs. 17.35; P = .01, Cohen's d = 0.743). There were no significant differences between the treated and control legs regarding the nerve conduction and color Doppler ultrasound parameters before and after the intervention (P ≥ .054). Changes in the parameters were also not significantly different between legs (P ≥ .078), except for common peroneal nerve conduction velocity, for which there was a higher increase in its value in the treated legs compared to the control legs (4.17 vs. 0.9, P = .002).

CONCLUSION

Local calf vibration may positively affect balance and lower extremities nerve conduction in patients with DPN, and the findings of this study can be a basis for studies evaluating the efficacy of local calf vibration for treating DPN.

Use of low-level laser therapy for patients with chronic rhinosinusitis: a single-blind, sham-controlled clinical trial

Chronic rhinosinusitis (CRS) is one of the most common conditions all over the world. The purpose of this study was to investigate the effects of low-level laser therapy (LLLT) in patients with CRS. Fourteen adult patients with CRS participated in this single-blind, sham-controlled clinical trial (12 male, mean age 40 years). Patients received five successive sessions of sham laser followed by five successive sessions of real laser after 2 days. Ga-Al-As laser of 830 nm in a continuous mode at a power output of 30 mW and energy dose of 1 J was applied on the cheeks and the forehead for the maxillary and frontal sinuses, respectively. Laser was delivered on six points over each sinus, each point for 33 s. Four measurements were taken. The total symptom score (TSS) was calculated as the primary outcome measure. The effects of LLLT on TSS were evaluated by using repeated measure ANOVA. The percentage improvement of real laser and sham laser was compared by Wilcoxon signed ranked test. Cohen's d was used to calculate the effect size. Total symptom score significantly improved after real laser (p = 0.015, Cohen's d = 0.69). The percentage improvement for real laser (34.12 ± 46.43) was significantly better than the sham laser (5.02 ± 37.34, Z =  - 2.23, p = 0.026). No significant improvements were observed after sham laser. This study indicates that five-session active LLLT when compared with sham is effective in the treatment of CRS symptoms.

Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: a case report

BACKGROUND

Spasticity is a common cause of disability in multiple sclerosis (MS), which can negatively affect the patient's walking and balance.

OBJECTIVE

To evaluate the immediate effect of dry needling (DN) on spasticity and mobility in a female with MS.

CASE DESCRIPTION

In this case, a 38-year-old female with a 4-year history of MS was treated. The hamstring muscles (biceps femoris and semitendinosus) were needled for 1 minute in a single session. The main outcome measures were the Modified Modified Ashworth Scale (MMAS) to evaluate spasticity, the Timed 25-Foot Walk (T25FW) for the assessment of mobility and leg function performance, and stiffness as a biomechanical index of spasticity measured by a dynamometer. The assessments were done before and immediately after DN.

OUTCOMES

The MMAS scores decreased in the hamstrings (1 to 0) and quadriceps (2 to 1). The mobility improved as the time for T25FW decreased from 16.30 to 9.29 seconds. The stiffness of hamstring decreased after treatment (0.451 to 0.312).

CONCLUSION

One session of DN for the hamstring muscle decreased spasticity and improved mobility in this patient with MS. Further studies are suggested.

Reliability and validity of Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease

BACKGROUND

Mini-BESTest and Brief-BESTest are used to assess balance in patients with a wide range of balance disorders. While there are Persian versions of Mini-BESTest and Brief-BESTest, the psychometric properties have not been thoroughly evaluated. This study aimed to assess the reliability and validity of the Persian versions of Mini-BESTest and Brief-BESTest in persons with Parkinson's disease (PD).

METHODS

Three medical students rated videotaped performances of 49 individuals with PD on the Persian Mini-BESTest, Persian Brief-BESTest, and Berg balance scale (BBS). Healthy adults were matched with persons having PD in terms of age and gender.

RESULTS

There were no floor and ceiling effects. Inter- and intra-rater reliability was excellent (ICC = 0.965-0.973). The minimal detectable changes were 2.37 and 3.47 for Persian versions of Mini-BESTest and Brief-BESTest, respectively. The Persian versions of Mini-BESTest and Brief-BESTest had very good correlations with BBS (r > 0.7) confirming construct validity. There was a very good correlation between the Mini-BESTest and the Brief-BESTest total scores (r = 0.78). There were significant differences between the persons with PD and healthy adults on both tests supporting discriminant validity. Significant differences in balance performances across Hoehn and Yahr stages were found which supported known-groups validity.

CONCLUSION

The Persian versions of Mini-BESTest and Brief-BESTest are reliable and valid instruments for balance evaluation in persons with PD. Further study to determine the reliability and validity of both tests when examining patients in real-time in the clinic is warranted.

Normative values of functional reach test, single-leg stance test, and timed “UP and GO” with and without dual-task in healthy Iranian adults: A cross-sectional study

Background

Balance impairment is a common problem in all age groups. There are several tools to assess balance. Functional reach test (FRT), single-leg stance (SLS) test, timed up and go (TUG) test, and TUG with the cognitive dual-task (TUGcog) are commonly employed balance tests. The current study aimed to determine the normative values of FRT, SLST, TUG, and TUGcog across age groups and genders in healthy Iranian adults.

Methods

We designed a cross-sectional study, and 240 healthy adults (120 males and 120 females) in six age groups (18–29, 30–39, 40–49, 50–59, 60–69, ≥70 years) completed FRT, SLST, TUG, and TUGcog based on the Persian version of BESTest instructions.

Results

There were significant age-specific declines in balance performances. Gender had effects on 18–29 years and older adults (≥60 years), and males performed better than females. Male and females had similar performance on the TUG and TUGcog tests in 60–69 years (p > 0.05).

Conclusions

The normative values of FRT, SLS, TUG, and TUGcog provided for healthy Iranian adults increase the clinical utility of tests, and serve as a reference to estimating the individuals’ balance performance across age and gender groups.

•

This study provided reference values of four balance tests for Iranian adults.

•

Performance in balance tests declines with age among Iranian adults.

•

In most age groups, there is no significant difference between males and females regarding their balance.

Effects of dry needling and exercise therapy on post-stroke spasticity and motor function- protocol of randomized clinical trial

BACKGROUND

Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke.

METHODS

We will use a single-blind randomized controlled trial (RCT) in accordance with the CONSORT guidelines. A total of 24 patients with stroke will be included from the University Rehabilitation Clinics. The outcome measures will include Modified Modified Ashworth Scale, H_max/M_max ratio, H-reflex latency, Action Research Arm Test, Fugl-Meyer Assessment, and wrist extension active and passive range of motion. Patients in the DN and exercise therapy group will undergo 4 sessions of deep DN in flexor carpi radialis and flexor carpi ulnaris muscles on the affected upper limb and exercise therapy. Participants in the DN group will only receive DN for target muscles. Clinical and neurophysiological tests will be performed at baseline, after four therapy sessions, and at three weeks' follow-up.

DISCUSSION

This study will provide evidence for additional effects of exercise therapy to DN in comparison to DN alone on wrist flexors spasticity, motor neuron excitability, upper-limb motor function, and ROM in patients with chronic stroke.

Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report

BACKGROUND AND PURPOSE

The use of dry needling (DN) with other treatments may be more beneficial in managing post-stroke spasticity. We report the effects of DN plus exercise therapy (ET) on wrist flexor spasticity.

PATIENT PRESENTATION

The patient was a 45-year-old man with an 8-year history of stroke. The outcome measures included the Modified Modified Ashworth Scale (MMAS), H_max/M_max ratio, H-reflex latency, Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), and range of motion (ROM) which were assessed before (T1), after (T2), and after 3-week follow-up (T3).

CONCLUSION

The MMAS was improved at T2 from "3" to "2". The H_max/M_max decreased from 0.77 to 0.53 at T3. The H-reflex latency increased from 15.4 ms to 18.5 ms at T3. The wrist active and passive ROM increased ∼30° and ∼20° at T2, respectively. A 4-session DN plus ET may improve spasticity and ROM. No meaningful improvement was observed in function.

The MedRisk instrument for measuring patient satisfaction with physical therapy care: A validation of the Persian-language version

Background: Valid and reliable tools are required to measure patient satisfaction with physical therapy care. The aim of this study was to translate the MedRisk instrument for measuring patient satisfaction with physical therapy care (MRPS) into Persian language and to evaluate its measurement properties.Methods: A cross-sectional and prospective validation study design was adopted. The development of the Persian MRPS (MRPSp) followed the standard guidelines with "forward"-"backward" translation, consensus agreement of expert panel, and pilot testing. The final MRPSp was evaluated for reliability and validity.Results: A total of 114 patients (mean age 52.14 years, 72 females) participated in this study. The patients' satisfaction was high as reflected in the ceiling effect (25.4%). The overall Cronbach's α was 0.91. Corrected item-total correlations ranged from 0.22 to 0.88. Principal component analysis suggested a 7-item "internal" factor (alpha = 0.95) and a 3-item "external" factor (alpha = 0.74). The correlations of factors with two global measures of satisfaction were significant ranging from 0.247 to 0.789. Individual items of MRPSp had significant positive correlations with two global measures (r = 0.233-0.736). The standard error of measurement was between 0.97 and 2.14. The smallest detectable change was between 2.7 and 5.93.Conclusion: The Persian version of the MRPS is a two-factor reliable and valid instrument for measuring patient satisfaction with physical therapy care.

Inter- and intra-rater reliability of the modified modified ashworth scale in the assessment of muscle spasticity in cerebral palsy: A preliminary study

PURPOSE

The aim of the study was to investigate the inter- and intra-rater reliability of the Modified Modified Ashworth Scale (MMAS) in the assessment of lower extremity spasticity in children with spastic cerebral palsy (CP).

METHODS

Fifteen children (10 boys) with a mean age of 8.7±3.4 years participated. Two physiotherapists rated the spasticity of the hip adductors, knee extensors, and ankle plantar flexors for inter-rater reliability. Each child was examined again by one of the physiotherapists (same physiotherapist for all of the children) for intra-rater reliability (mean interval = 7 days). A random sequence of raters and muscles tested was applied.

RESULTS

The reliability of the intraclass correlation coefficients (ICC) for individual muscle groups ranged between good to excellent (ICCagreement of 0.60-0.83). The ICC values for overall inter-rater (ICCagreement = 0.82) and intra-rater reliability (ICCagreement  = 0.85) were excellent.

CONCLUSION

The MMAS showed excellent reliability for the assessment of lower extremity muscle spasticity in children with cerebral palsy. However, an interpretation should be made with caution due to the small sample size and wide range of confidence interval values.

Local plantar vibration for the treatment of diabetic neuropathy: a case report

PURPOSE

One of the most common and debilitating complications of diabetes is peripheral neuropathy. Physical modalities such as whole-body vibration are used to treat diabetic peripheral neuropathy (DPN), but there are limted studies on the effectiveness of local vibration for the treatment of PDN. In this study, we aimed to evaluate the effectiveness of local vibration in treating a patient with DPN.

METHODS

The local vibration was applied on the plantar side of both feet. The patient received 10 min of local vibration with 62.5 Hz frequency for five sessions. We used brief BESTest for balance evaluation, Numerical Pain Rating Scale (NPRS) for pain assessment, monofilament examination score for protective sensation evaluation, vibration threshold, and skin temperature to evaluate the effects of local vibration, which were measured before the treatment, after one session  of treatment, and after 5th session of treatment.

RESULTS

There was a 62.5% reduction in pain severity after five sessions of treatment. Vibration threshold of both patient's feet and protective sensation of right foot returned to normal after treatment. Skin temperature was increased in all evaluated points of both patient's feet, brief BESTest score increased by six points after five treatment sessions, indicating improvements in the blood flow of feet and balance, respectively.

CONCLUSIONS

Local plantar vibration was effective in improving the symptoms of DPN.

Effects of pulsed ultrasound on olfactory dysfunction in patients with chronic rhinosinusitis: A pilot study

BACKGROUND

and purpose. Olfactory dysfunction is a common symptom of chronic rhinosinusitis (CRS). This study aimed to evaluate the effects of therapeutic pulsed ultrasound (PUS) on olfactory dysfunction in patients with CRS.

MATERIALS AND METHODS

Patients with CRS underwent treatment with PUS for 10 sessions, three days a week. The outcome measures were the Smell Identification Test (SIT) and 20-item Sino-Nasal Outcome Test (SNOT-20).

RESULTS

Fifteen patients (9 male, mean age 48.9 ± 9.7 years) with disease duration of 55.13 ± 65.4 months participated. Analyses showed olfactory dysfunction was completely resolved (Cohen's d = 5.62). The SNOT-20 scores showed significant improvement of CRS symptoms after treatment (Cohen's d = 1.55). Effects remained at one-month follow-up.

CONCLUSION

Therapeutic PUS improved the olfactory dysfunction and sino-nasal symptoms in patients with CRS. The PUS can be considered as a promising strategy to target chronic rhinosinusitis.

Acute and Short-Term Effects of Dry Needling in Patients with Chronic Nonspecific Low Back Pain and Hamstring Tightness: A Pilot Study

BACKGROUND

Chronic nonspecific low back pain (LBP) is one of the common health issues. Hamstring tightness contributes to the development of LBP. This study aimed to investigate the acute and short-term effects of deep dry needling (DN) in patients with chronic nonspecific LBP and hamstring muscle tightness.

METHODS

A single-group pretest-posttest clinical study design was followed. The outcome measures were the visual analog scale (VAS), passive knee extension (PKE) test, finger-floor distance (FFD) test, and functional rating index (FRI). Patients underwent one session of deep DN of three points on both hamstring muscles, each point for one minute. Patients were assessed before (T0), immediately after (T1), and one week after DN (T2). The FRI was assessed at T0 and T2.

RESULTS

Ten women with a mean age of 21.1 years (SD = 1.6) participated in the study. Significant large effect sizes in VAS pain reduction (d = 1.25) and PKE hamstring tightness were obtained (hamstring: right, d = 0.82; left, d = 0.88) at T2. Medium effect sizes were obtained for FFD (d = 0.45) and FRI (d = 0.72) at T2.

CONCLUSION

A single session of deep DN improved pain and function and increased hamstring flexibility. This pilot study supports the use of DN in patients with LBP and hamstring tightness; however, future research with a rigorous study design of randomized controlled trial is required to confirm the findings. This trial is registered with IRCT20180511039612N1.

Role of Spasticity Severity in the Balance of Post-stroke Patients

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life. Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence. Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured. Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence. Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

Reliability and Validity of the Persian Version of the Mini-Balance Evaluation Systems Test in Patients with Stroke

BACKGROUND

Stroke can cause balance disorders, which often lead to falls and fall-related injuries. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a balance test that has been recently translated into Persian. The reliability and validity of the Persian version of Mini-BESTest have not been assessed in patients with stroke.

OBJECTIVES

To assess the reliability and validity of the Persian version of the Mini-BESTest in patients with stroke.

METHODS

A cross-sectional study was designed. Thirty patients with stroke participated in this study. Patients were tested using the Mini-BESTest according to the Persian instructions, and two raters independently rated each patient's performance. Each patient was matched with a healthy adult in the terms of age and gender. Healthy subjects were also tested for discriminative validity.

RESULTS

There was excellent correlation between two raters on the Persian version of the Mini-BESTest total scores (r_Pearson = 0.98, P < 0.001) and its sections (r_Pearson > 0.9). There was a significant difference between stroke patients and healthy subjects confirming the discriminative validity of the Persian version of the Mini-BESTest (19.4 ± 5.4 vs. 24.8 ± 2.3, P < 0.001).

LIMITATIONS

We only assessed stroke patients, and the results may not be generalized to other patients with balance deficits.

CONCLUSIONS

The Persian version of the Mini-BESTest is a reliable and valid tool for balance evaluation of stroke patients.

Dry Needling for Hamstring Flexibility: A Single-Blind Randomized Controlled Trial

CONTEXT

Hamstring muscle tightness is one of the most common problems in athletic and healthy people. Dry needling (DN) was found to be an effective approach for improving muscle flexibility, but there is no study to compare this approach with static stretching (SS) as a common technique for the increase of muscle length.

OBJECTIVE

To compare the immediate effects of DN and SS on hamstring flexibility in healthy subjects with hamstring tightness.

STUDY DESIGN

A single-blind randomized controlled trial.

SETTING

A musculoskeletal physiotherapy clinic at Tehran University of Medical Sciences.

SUBJECTS

Forty healthy subjects (female: 32, age range: 18-40 y) with hamstring tightness were randomly assigned into 2 groups of DN and SS.

INTERVENTION

The DN group received a single session of DN on 3 points of the hamstring muscles, each for 1 minute. The SS group received a single session of SS of the hamstrings, consisting of 3 sets of 30-second SS with a 10-second rest between sets in the active knee extension test (AKET) position.

MAIN OUTCOME MEASURES

The AKET, muscle compliance, passive peak torque, and stretch tolerance were measured at the baseline, immediately, and 15 minutes after the interventions.

RESULTS

Improvements in all outcomes was better for the DN group than for the SS group. DN increased muscle compliance significantly 15 minutes after the intervention, but it did not improve in the SS group.

CONCLUSION

DN is effective in improving hamstring flexibility compared with SS. One session of DN can be an effective treatment for hamstring tightness and increase hamstring flexibility. The improvements suggest that DN is a novel treatment for hamstring flexibility.

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.

Effect of Ankle Plantar Flexor Spasticity Level on Balance in Patients With Stroke: Protocol for a Cross-Sectional Study

BACKGROUND

The lower limb spasticity after stroke can affect the balance and gait of patients with stroke.

OBJECTIVE

The aim of this study is to assess the effects of ankle plantar flexor spasticity level on balance in patients with stroke.

METHODS

Patients with stroke were recruited from neurology and physiotherapy clinics in Tehran, Iran. Based on the level of ankle plantar flexor spasticity according to the Modified Modified Ashworth Scale (MMAS), the eligible patients with stroke were divided into 2 groups: high spasticity (MMAS score≥2) and low spasticity (MMAS score<2). The primary outcome measures were the MMAS scores, Activities-Specific Balance Confidence questionnaire scores, eyes-open and eyes-closed posturography measures, and Timed Up and Go test results. The secondary outcome measures were the ankle passive range of motion and ankle joint proprioception. The t test, mixed model univariate analysis of variance, and Spearman rank correlation were used for statistical analysis.

RESULTS

Data collection and statistical analysis are complete. The interpretation of results is underway. We expect the results to be published in winter 2020.

CONCLUSIONS

We believe that patients with high ankle plantar flexor spasticity after stroke will demonstrate greater balance dysfunction, which will worsen with impaired proprioception, passive range of motion, and eyes closed.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/16045.

Responsiveness and longitudinal validity of the Persian version of COMI to physiotherapy in patients with non-specific chronic low back pain

Background and aims The Core Outcome Measures Index (COMI) is a short, self-reported questionnaire for assessing important outcomes in patients with low back pain (LBP). The present study was conducted to explore the responsiveness and longitudinal validity of the Persian COMI (COMI-P) in patients with non-specific chronic LBP. Methods In this prospective cohort study of patients with non-specific chronic LBP receiving physiotherapy, patients completed a booklet containing the COMI-P, Persian Functional Rating Index (FRI-P), and a visual analogue scale (VAS) for pain before and after the end of ten-sessions of physiotherapy. Patients also completed a global rating of change scale (GRCS) at the end of the physiotherapy. Responsiveness was examined by means of internal responsiveness methods [t-test, standard effect size (SES); standardized response mean (SRM), and Guyatt responsiveness index (GRI)] and external responsiveness methods [correlation with external criteria and receiver operating characteristics (ROC) curve]. Results Fifty patients with a mean age of 50.62 ± 13.8 years participated. The paired t-test showed significant changes in COMI-P scores (p < 0.001). The effect sizes for COMI-P were large (range 0.96-1.23). The score changes for the COMI-P revealed significant correlations with FRI-P (r = 0.67, p < 0.001), the VAS (r = 0.65, p < 0.001), and the GRCS (r = 0.34, p = 0.02). The COMI-P change scores showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (r = 0.83, p < 0.001). The ROC area under the curve for the COMI-P based on the dichotomized SDC criterion was perfect. The minimal clinically important change was estimated 2.15 points (sensitivity 94% and specificity 100%). Conclusions The COMI-P appears to have responsiveness and longitudinal validity in detecting changes after physiotherapy for non-specific chronic LBP. An improvement of 2.15 points in COMI-P total score is required to be interpreted as minimally clinically important change in individual patients.

A pilot study on the short-term effects of myofascial release and core stability exercises on balance in chronic low back pain

Background and Aim: Balance disorders are among common complications of chronic low back pain (LBP). Since the tissue and echo­genicity of thoracolumbar fascia changes in chro­nic LBP, the independent motion of fascia layers would negatively alter, and it may affect the con­trol of spine movements. It has been shown that myofascial release (MFR) improves the function of transversus abdominis as a core muscle in LBP. So, MFR may affect the balance and pos­tural control in these patients. The aim of this study was to evaluate the immediate effects of MFR and core stability (CS) exercises on dyna­mic balance and pain in women with chronic non-specific LBP. Methods: In this pilot study, with a pretest-posttest design, 10 females aged 30 ± 9.04 parti­cipated. The participants received one session of MFR on thoracolumbar fascia and CS exercises. The outcome measures were dynamic balance by Y balance test (YBT) and pain with visual ana­logue scale (VAS), which were assessed before and immediately after the intervention. Results: Dynamic balance improved signifi­cantly (p < 0.02) after intervention. The VAS as an indicator of pain intensity showed significant improvement (p = 0.005). Conclusion: The application of MFR plus CS exercises for a single session is effective in improving dynamic balance and pain in women with chronic non-specific LBP. Keywords: Dynamic balance; core stability; low back pain; myofascial release

Statistical validity and reliability of the Persian version of the Western Ontario Meniscal Evaluation Tool (WOMET) according to the COSMIN checklist

BACKGROUND

The Western Ontario Meniscal Evaluation Tool (WOMET) is the only questionnaire available to assess quality of life in patients with isolated meniscal injuries. The aims of this study were to prepare the Persian version of the WOMET (PWOMET) and validate it in Iranian patients with isolated meniscal tears.

METHODS

In the first stage, the English version of WOMET was translated into Persian. Content validity, and qualitative and quantitative (impact score) face validity were tested by specialists and in a sample of 30 patients. In the second stage, PWOMET was assessed for the evaluation of psychometric properties in 100 patients with isolated meniscal injury and 50 healthy people based on the COSMIN checklist. Construct validity was tested based on structural validity (factor analysis) and hypothesis testing. Correlation with the total scores on the SF-36, IKDC and KOOS were used for concurrent criterion validity. Test-retest reliability and internal consistency were calculated using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. In addition the standard error of measurement (SEM) and smallest detectable change were calculated. Interpretability was investigated as the ceiling and floor effects and minimal important difference.

RESULTS

The PWOMET had acceptable qualitative face validity and content validity. The impact score (quantitative face validity) was more than 1.5 for all items. For construct validity, structural validity (factor analysis) and hypothesis testing ability were confirmed. Correlations between the PWOMET total score and IKDC, SF-36, KOOS scores were 0.61, 0.54 and 0.63, respectively (p < 0.001), thus confirming concurrent criterion validity. The intraclass correlation coefficient, Cronbach's alpha, SEM and smallest detectable change for the PWOMET were 0.73, 0.89, 9.43 and 26.13, respectively. The PWOMET had no ceiling or floor effects, and minimal important difference was 9.07.

CONCLUSION

The PWOMET provides valid and reliable scores for assessment of the quality of life in patients with isolated meniscal injury.

The short term-effects of both feet plantar vibration in post stroke patients balance

Background and Aim: Balance disorder is a common problem in post stroke patients. Vibration therapy is one of the interventions that is used to treat this impairment in physiotherapy. There are several studies on the effects of more affected foot plantar vibration on balance, however according to the researchers this cerebral lesion causes bilateral side effects in the body. So the aim of this study was to investigate the shortterm effects of both feet plantar vibration on the balance of post stroke patients. Methods: This pretest-posttest clinical study included 12 post stroke patients (8 male and 4 female, mean age 52.41 ± 9.03 years). The participants received one session of 5-min vibration stimuli (frequency, 100 Hz) to the plantar region on both feet. Mini-Balance Evaluation Systems Test (Mini-BESTest) score and plantar cutaneous sensation by Semmes Weinstein monofilament examination (SWME) were assessed before and immediately after the intervention. Results: Mini-BESTest mean total score improved significantly (p ≤ 0.001) after both feet vibration and these results were supported by a large effect size (Cohen d = 2.83). Mean number of detected points by SWME decreased after vibration therapy (p = 0.06) but it was not statistically significant. Conclusion: The findings suggest that local vibration applied directly to the plantar region of both feet in post-stroke patients could be an appropriate physiotherapy intervention to improve their balance. Keywords: Vibration; balance; stroke 

Immediate Effects of Dry Needling as a Novel Strategy for Hamstring Flexibility: A Single-Blinded Clinical Pilot Study

CONTEXT

There are numerous studies on the benefits of dry needling (DN) for pain relief. No studies exist examining the effects of DN on hamstring flexibility.

OBJECTIVE

To determine the immediate effects of DN on hamstring flexibility in healthy subjects with shortened hamstrings.

DESIGN

A single-blinded, pretest-posttest clinical pilot study.

SETTING

A university physiotherapy clinic.

SUBJECTS

A total of 15 healthy subjects (female = 11; age = 23.26 [4.3] y) with shortened hamstrings participated in this study.

INTERVENTION

Subjects received a single session of DN. Three locations on the hamstring muscle group were needled, each for 1 minute.

MAIN OUTCOME MEASURES

The active knee extension test, muscle compliance, passive peak torque, and stretch tolerance were measured at baseline, immediately, and 15 minutes after DN.

RESULTS

There were statistically significant improvements in all outcome measures immediately after DN and at the 15-minute follow-up. The effect sizes for all outcome measures were large (Cohen's d ≥ 0.8). No serious adverse events were observed with DN.

CONCLUSIONS

This is the first study that demonstrates the beneficial effects of DN on hamstring flexibility, muscle compliance, and stretch tolerance without added stretching. The beneficial effects of DN should encourage clinicians to use DN as a novel strategy for increasing muscle flexibility.

Comparison of Therapeutic Ultrasound and Radial Shock Wave Therapy in the Treatment of Plantar Flexor Spasticity After Stroke: A Prospective, Single-blind, Randomized Clinical Trial

BACKGROUND

This study aimed to compare the effects of therapeutic ultrasound (US) and radial extracorporeal shock wave therapy (rESWT) in the treatment of plantar flexor spasticity after stroke.

MATERIALS AND METHODS

In this prospective, single-blind, randomized clinical trial, 32 patients (age range 42-78 years; male 19) with stroke were randomly divided into two groups: The US group (n = 16) received the continuous ultrasound, intensity 1.5 w/cm², frequency 1 MHz, and duration 10 minutes. The rESWT group (n = 16) was treated with rESWT, 0.340 mJ/mm², 2000 shots. Both groups received the treatments for 1 session. The H-reflex tests of H_max/M_max ratio and H-reflex latency, the Modified Modified Ashworth Scale (MMAS), active range of motion (AROM), passive range of motion (PROM), passive plantar flexor torque (PPFT), and the timed "up and go" test (TUG) were blinded assessed at baseline (T0), immediately post-treatment (T1), and one hour follow-up (T2).

RESULTS

The H-reflex tests did not improve across the groups. However, the MMAS spasticity scores, AROM and PROM, PPFT, and TUG improved significantly within groups. The results found no significant differences between groups for all outcome measures.

CONCLUSIONS

The US and rESWT had similar effects, and the rESWT was not more effective than the US in improving ankle plantar flexor spasticity after stroke.

Responsiveness of Minimal Clinically Important Change for the Persian Functional Rating Index in Patients with Chronic Low Back Pain

STUDY DESIGN

A prospective, within-group cohort study of 46 patients with chronic low-back pain (CLBP).

PURPOSE

To assess the responsiveness of the Persian Functional Rating Index (PFRI) and to determine the minimal clinically important change (MCIC) of the PFRI in a cohort of patients with CLBP.

OVERVIEW OF LITERATURE

The FRI is an instrument for assessing pain and disability in patients with low-back pain. No study so far has examined the responsiveness of the PFRI.

METHODS

Forty-six patients with CLBP with a mean age of 50.33±14.28 completed the PFRI, the Persian Roland-Morris Disability Questionnaire (PRMDQ), and a Visual Analog Scale (VAS) before and after 10 physiotherapy sessions. A Global Rating of Change Scale (GRCS) was completed after treatment.

RESULTS

The changes in PFRI scores were statistically significant using the paired t-test (p<0.001). The PFRI revealed high effect sizes (range, 0.93-1.82). The PFRI showed significant correlations with the VAS (0.86), the PRMDQ (0.66), and the GRCS (0.45). The area under the receiver operator characteristic curve for the PFRI was good (0.76; 95% confidence interval, 0.56-0.95). The MCIC for PFRI was 10.63 points.

CONCLUSIONS

The results supported the responsiveness of the PFRI in patients with CLBP and showed the amount of change in PFRI scores perceived as worthwhile by the patients.

The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: A systematic review with meta-analysis

BACKGROUND

One of the leading causes of disability in the world with enormous economic burden is stroke.

OBJECTIVE

To quantify the effectiveness of different protocols of cycling with/without functional electrical stimulation on functional mobility after stroke.

METHODS

Multiple databases were searched till 2018. Data extraction was performed using a pre-determined data collection form. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation.

RESULTS

A total of 14 trials satisfied eligibility criteria and were included. Cycling had a positive effect on the 6-meter walking test performance (SMD, 0.41; 95% CI, 0.11 -0.71; I2 = 0% ) compared with no or placebo intervention (control). Compared with control, cycling had a positive effect on 10-meter walking speed (SMD, 0.30; 95% CI, 0.05 -0.55; I2 = 0% ), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 -0.57; I2 = 49% ). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 -1.97; I2 = 91% ) compared with cycling alone.

CONCLUSIONS

It appears that cycling has a positive effect on walking speed, walking ability and balance. Functional electrical stimulation combined with cycling has positive effects on balance beyond cycling alone.

A clinical single blind study to investigate the immediate effects of plantar vibration on balance in patients after stroke

Balance disorder is a very common cause of disability in patients after a stroke. Vibration therapy is one of the physiotherapeutic modalities used to improve balance.

OBJECTIVE

To investigate the immediate effects of plantar vibration on balance in patients with stroke.

METHODS

In this single blind comparative study, 22 patients with stroke (8 females, 14 males; age 55.82 ± 11.87 years old) participated. Patients underwent treatment, first with the placebo vibration and 1 week later with active vibration (frequency 100 HZ, 5 min). Mini-BESTest score, Modified Modified Ashworth Scale for plantar flexor spasticity, and ankle dorsiflexion passive range of motion (PROM) were evaluated before and immediately after the placebo or active vibration.

RESULTS

A significant clinical improvement in balance, ankle plantar flexor spasticity, and the ankle dorsiflexion PROM was observed following either placebo or active vibration. The improvements after active vibration were significantly greater for all outcome measures compared with placebo vibration. There was a large effect size (Cohen's d = 0.85) for balance after active vibration.

CONCLUSION

The vibration applied to the sole of the affected foot of patients after stroke was effective for improving balance, reducing ankle plantar flexor spasticity, and increasing ankle dorsiflexion PROM.

A study on the immediate effects of plantar vibration on balance dysfunction in patients with stroke

The aim of this study was to estimate the immediate effects of plantar vibration, applied to the more affected foot, on balance impairment in patients post-stroke. This pretest-posttest clinical study included 18 patients (13 men) poststroke; mean age 56.0±8.9 years (range, 41-71 years). One session of 5-min vibratory stimuli (frequency, 100 Hz) was applied to the plantar region of the more affected foot of all participants. The plantar vibration significantly improved the Timed UP and Go test (P=0.03, Cohen d=0.15), ankle plantar flexor muscle spasticity (P=0.008), and ankle passive range of motion (P<0.001, Cohen d=0.74). The posturography measures and Functional Reach Test did not improve significantly (P>0.05). Vibration stimuli applied to the plantar region of the more affected foot had significant effects on spasticity, ankle passive range of motion and dynamic balance as evaluated by the Timed Up and Go test in patients poststroke. There was no effect on static balance performance. Based on the results, the focal vibratory stimuli applied directly to the plantar region of the more affected foot may be recommended to improve the functional mobility and dynamic balance in patients with stroke.

Persian translation and validation of the Back Pain Functional Scale

BACKGROUND

Patient-reported questionnaires provide important tools that can be utilized for the assessment of treatment efficacy in clinic and research. This study aimed to translate, cross-culturally adapt, and validate the Back Pain Functional Scale into Persian (BPFSp).

METHODS

In this cross-sectional and prospective cohort of adult patients with low back pain (LBP), the translation and adaptation was performed according to standardized guidelines and pretested (n = 30). Psychometric testing was conducted with 100 patients with LBP and 50 healthy subjects. Fifty patients with LBP recompleted the BPFSp at least 7 days later for test-retest reliability.

RESULTS

The Persian adapted version of the BPFS was produced and validated. No floor and ceiling effects were revealed. The Cronbach'α coefficient for internal consistency was 0.895. The test-retest reliability was excellent (ICC_agreement = 0.88, CI 95%: 0.80-0.93). The standard error of measurement and smallest detectable change were 9.9% and 27.5%, respectively. Construct convergent validity was demonstrated with the Persian Functional Rating Index (r = -0.77). Criterion validity was established with the Numerical Pain Rating Scale (r = -0.67). Total BPFSp scores discriminated between patients with LBP and healthy subjects. Factor structure showed two latent factors explaining a total variance of 60.1%.

CONCLUSION

The BPFSp presented excellent reliability and validity for assessing the functional status in Persian speaking patients with LBP.

Biomechanical investigation of the modified Tardieu Scale in assessing knee extensor spasticity poststroke

OBJECTIVE

The modified Tardieu Scale (MTS) is a clinical tool for the measurement of muscle spasticity. The present study aimed to investigate the relationship between the MTS and the slope of the work-velocity curve as a biomechanical measure in assessing knee extensor muscle spasticity in patients with stroke.

METHODS

Thirty patients with stroke (22 female, 8 male; mean age 55.4 ± 12.0 years) participated in this study. The knee extensor spasticity was assessed with the MTS. An isokinetic dynamometer was used to move the knee passively from full extension to 90° flexion at speeds of 60°/s, 120°/s, 180°/s, and 240°/s to collect torque-angle data. The slope of the work-velocity curve was calculated using linear regression [J/(°/s)].

RESULTS

The mean of R2-R1 component of MTS was 19.73 (SD 29.85). The mean work significantly decreased as the speed increased (p < .001). The mean (SD) slope for the work-velocity curve was -0.83 (SD 0.73, range -2.6-0.3). There was no significant relationship between the R₂ -R₁ and the slope of work-velocity curve (r = 0.09, p = .62).

CONCLUSIONS

The lack of significant relationship between the MTS and the slope of work-velocity curve may question the usefulness of the MTS as a valid measure of muscle spasticity after stroke.

Single item presenteeism question: Reliability and validity of Persian version in participants with low back pain

BACKGROUND

Single item presenteeism question (SIPQ) is a rating scale to assess the impact of low back pain (LBP) on presenteeism.

OBJECTIVE

To translate the SIPQ into Persian language (SIPQ-P) and evaluate the reliability and validity of the SIPQ-P in participants with LBP.

METHODS

In the first stage, the English SIPQ was translated into Persian language in a cross-sectional design following standard forward-backward approach with expert panel review and pilot testing. In the second stage with a prospective cohort design, 100 participants with LBP (84 male and 16 female, mean age±SD: 33.9±11.2 years) participated. Participants were asked to answer the SIPQ-P and rate their LBP from 0 to 10 according to the numerical pain rating scale (NPRS) for concurrent criterion validity. To evaluate the convergent construct validity of SIPQ, participants completed Persian Functional Rating Index (PFRI). For the divergent validity, the Spearman's correlation test was used to evaluate the association between the SIPQ-P and education. For the test-retest reliability, 50 participants answered the SIPQ-P after 7 days. Fifty healthy participants (mean age±SD: 24.24±8.07 years) answered the SIPQ-P for evaluating discriminant validity.

RESULTS

There was a significant difference between the SIPQ-P score of participants and the healthy participants (p <  0.001). The concurrent criterion validity was demonstrated by a significant correlation between the SIPQ-P and pain NPRS (Spearman's rho = 0.46, p <  0.001). The Spearman correlation coefficient showed a significant correlation between the SIPQ-P scores and the Persian FRI (r = 0.56, p <  0.001). There was no correlation between the SIPQ-P score and the education level (r = -0.001, p = 0.99). The ICCagreement was 0.77 indicating a very good test-retest reliability.

CONCLUSIONS

This study showed that the Persian version of SIPQ is a reliable and valid scale to assess the effect of LBP on presenteeism in Persian speakers with LBP.

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.

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.

A Randomized Controlled Pilot Study to Investigate the Effect of Whole-Body Vibration on Lower-Extremity Fatigue

CONTEXT

Whole-body vibration (WBV) is a type of weight-bearing exercise used in the field of sport and rehabilitation. There is no study on the effects of WBV on muscle recovery after a fatiguing activity.

OBJECTIVE

To determine the effects of a single WBV session on lower-extremity fatigue.

DESIGN

Randomized controlled pilot study.

SETTING

University Physiotherapy Clinic.

SUBJECTS

A total of 13 healthy young men volunteered to participate in this study. Subjects were randomly assigned into the WBV group (n = 7, mean age: 21 y) or control group (CG; n = 6, mean age: 20 y).

INTERVENTION

Subjects in the WBV group participated in a single-session WBV (30 Hz, amplitude 4 mm, 2 min) after lower-extremity fatigue.

MAIN OUTCOME MEASURES

Peak force of quadriceps muscle, single leg hop test, and Y-test were measured before inducing muscle fatigue (T0), immediately after completing the fatigue protocol (T1), after WBV (T2), and 15 min following the application of WBV (T3). The same method was applied in the CG while the WBV machine was turned off.

RESULTS

Repeated-measure ANOVA revealed no significant differences between groups in any of the outcomes.

CONCLUSIONS

The findings indicated that WBV was not effective in the recovery of lower-extremity fatigue in healthy young men.

The Spinal Cord Injury Spasticity Evaluation Tool: A Persian adaptation and validation study

OBJECTIVE

To adapt the Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET) into the Persian language (SCI-SETp) and to examine the reliability and validity of the SCI-SETp in patients with spinal cord injury (SCI).

DESIGN

A cross-sectional and prospective cohort validation study.

SETTING

University Neurological Physiotherapy Clinic.

PARTICIPANTS

Adult patients with SCI.

MAIN OUTCOME MEASURES

SCI-SET.

RESULTS

There was no missing data. No floor or ceiling effect was observed. Cronbach's α coefficient was 0.862. Factor analysis suggested 1 factor structure (Eigenvalue = 8.49) explained 24.27% of the total variance. The ICC_agreement for test-retest reliability was 0.84. The standard error of measurement and the smallest detectable change was 0.30 and 0.82, respectively. The divergent relationships demonstrated the SCI-SETp uniqueness construct.

CONCLUSION

The results support the reliability and validity of the SCI-SETp for assessing the impact of spasticity on daily life of patients with SCI.

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.

Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial

Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340 mJ/mm², 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T₀), immediately after treatment (T₁) and one hour after the end of the treatment (T₂). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T₁, but there was no significant effect on H_max/M_max ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability. Implications for Rehabilitation One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability. The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT. The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus. The rESWT had no significant effects on alpha motorneuron excitability.