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Background and Objectives: Chronic functional constipation is a prevalent and symptom-based disorder of the gastrointestinal tract. Constipation takes several different forms among patients. The Wexner Constipation Scoring System (WCSS) was developed to present a uniform tool for the assessment of chronic functional constipation. The purpose of this study was to provide the Persian version of WCSS and assess its validity and reliability. Methods: WCSS was translated into Farsi. After being linguistically validated, the Persian version of the WCSS was administered to a sample of 76 patients with chronic functional constipation. Reliability tests were used to evaluate the internal consistency (the Cronbach alpha) and reproducibility (Intraclass Coefficient Correlation [ICC]) of the tool. The validation studies were conducted to assess the convergent validity (Correlated with the Patient Assessment of Constipation Symptom [PAC-SYM]) and Concurrent Validity (Correlated with Patient Assessment of Constipation Quality of Life [PAC-QOL]) of the tool, too. Results: The Cronbach alpha for total scores was 0.66 and the ICC was 0.85 (0.77-0.90, 95% CI). The total score of WCSS was significantly correlated with the total scores of PAC-SYM (r=0.67) and PAC-QOL (r=0.61). Conclusion: The linguistic and psychometric evaluation demonstrated good validity and reproducibility of the Persian version of WCSS.

Background: The evaluation of balance measures can help identify postural control processes, but traditional data collection for the center of pressure (COP) may not reveal differences in postural control mechanisms. This study aimed to evaluate the reliability of the frequency component of postural sway using wavelet analysis of COP signals. Methods: Fifteen healthy male subjects (average age: 39.16±7.2 years, average weight: 72±11.06 kg, average height: 171±6.31 cm) participated in this project. They were requested to perform three trials of single-leg and tandem stance conditions for 20-second with and without vision on a force plate. The frequency content of COP signals, including the energy, root mean square (RMS), and velocity of the COP in four frequency bandwidths of postural sway, was evaluated. The test-retest reliability of COP parameters was tested using the intraclass correlation coefficient (ICC). Results: Among different COP parameters, the energy of the COP within a moderate (1.56–6.25 Hz) frequency band (.79≤ ICC ≤.97) with standard error measurement (SEM) ranged from .14 to .23, the RMS of COP within low (.39–1.56Hz) (.79≤ ICC ≤.93) and ultralow (< .10 Hz) (SEM ranged from .000 to .002) (.78≤ ICC ≤.94) in a tandem stance and the RMS of COP in a bandwidth of < .10 Hz (SEM=.00) in a single-leg stance (.70≤ ICC ≤.99) with the eyes closed and open showed good to excellent reliability. Conclusion: The results of this study showed moderate to excellent reliability of wavelet-based COP measures; therefore, these parameters can be used for the identification of postural control mechanisms.

To clarify the significance of mechanical impairments, pain, and func-tional limitations as predictors of chronic low back pain (LBP). Ninety patients with chronic nonspecific low back pain (CNSLBP) were pro-spectively studied with clinical tests and questionnaires. Changes in muscle extensibility and endurance tests were evaluated and changes assessed in LBP intensity on numeric rating scale 0–10 and severity with Oswestry Disability Index (ODI) 0–100. In the present study we found significant associations between the 4 muscle extensibility and 2 endurance tests and pain at nonspecific patients with chronic LBP (P

Objective The purpose of this study was to determine the immediate effect of elastic therapeutic taping and sham taping of the abdominal musculature on maximum hold time of endurance tests in patients with chronic nonspecific low back pain (CNLBP). Methods Twenty-six people with CNLBP and 26 asymptomatic individuals were included in this study. The CNLBP participants were allocated to an elastic therapeutic tape group or a sham tape group. Standard adhesive elastic therapeutic tape was utilized for facilitatory application in the elastic therapeutic tape group. The elastic therapeutic tape group received real elastic therapeutic taping on the transversus abdominis and internal obliques, and the sham tape group received sham elastic therapeutic taping application. For the sham group, the elastic therapeutic tape was positioned horizontally above the navel and applied without tension. After a wash-out period, each CNLBP participant was switched to the other group. Outcome measures included maximum hold time of supine isometric chest raise, supine double straight-leg raise, and abdominal drawing in maneuver. Results The CNLBP participants had lower maximum hold time compared to the asymptomatic individuals (P ≤ .01). Following taping, both groups showed an increase in the maximum hold time (mean difference = 4.43 – 50.69 seconds; P ≤ .02). Although there was no difference between the results of both groups (P ≥ .12), effect sizes were large for the elastic therapeutic tape group (Cohen’s d = –1.93 to –1.00). Conclusions The results suggest that the maximum hold time of endurance tests was decreased in CNLBP patients compared to healthy participants. The application of both elastic therapeutic tape and sham tape to the transversus abdominis and internal obliques produced short-term improvement in abdominal endurance. There was no statistically significant difference between the results of elastic therapeutic tape and sham tape.

OBJECTIVE: The purpose of this study was to investigate the effect of posterior pelvic tilt taping (PPTT) on lumbar lordosis, pain, disability, and abdominal muscle thickness in individuals with nonspecific chronic low back pain with hyperlordosis. METHODS: A prospective, single-group, repeated-measures design was conducted with 31 individuals with nonspecific chronic low back pain (16 men, 15 women) with hyperlordosis (mean ± SD = 59.3° ± 2.9°). Participants’ mean age, pain, disability, and lumbar lordosis were, respectively, 35.7 ± 9.9 years, 5.1 ± 1.3, 26.8 ± 11.5, and 59.3° ± 2.9°. The thickness of the abdominal muscles on both sides was measured in the crook lying position by ultrasound imaging. PPTT was performed on both sides. Pain intensity, functional disability, lumbar lordosis angle, and abdominal muscle thickness were measured before PPTT (W0), 1 week after PPTT (W1), and 1 week after PPTT removal (W2). RESULTS: Analysis revealed significant reductions in lumbar lordosis, pain, and disability, and increased abdominal muscle thickness, at W1 and W2 compared with W0 (P < .001). There were no significant differences in lumbar lordosis or abdominal muscle thickness between W1 and W2. CONCLUSION: The current study showed in a small group of participants that 1 week of PPTT may improve lumbar lordosis, pain, disability, and abdominal muscle thickness in individuals with nonspecific chronic low back pain with hyperlordosis.

Objective: To evaluate evidence on the effectiveness of Mulligan techniques on low back pain. Data sources: PubMed/Medline, Scopus, Ovid, CINAHL, Embase, PEDro, Google Scholar, and Cochrane Library were searched from inception to 31 March 2018 for randomized clinical trials reporting outcomes of pain or disability in adult patients (⩾18 years) with low back pain. Review methods: Two authors screened the results and extracted data for use in this review. The risk of bias was evaluated using the Cochrane criteria. Basic information and treatment protocols were also extracted. In addition, the level of evidence of each study and strength of conclusion for pain and disability were determined. Results: A total of 20 studies with 693 patients were included. Nine trials focused on sustained natural apophyseal glide, three on spinal mobilization with limb movement and seven on bent leg raise. The results showed that Mulligan techniques can decrease pain and disability and increase range of motion in patients with low back pain; however, the strength of conclusion for pain and disability was moderate. Furthermore, inconclusive results were observed for the effectiveness of Mulligan techniques on movement speed. In this review, eight studies were categorized as low risk of bias, while 12 studies had high risk of bias. Level of evidence analysis revealed that 17 studies were classified as level of evidence B, while three studies were classified as level of evidence A2. Conclusion: Current evidence is insufficient in supporting the benefits of Mulligan techniques on pain, disability, and range of motion in low back pain patients.

Objective This study aimed to evaluate lumbar lordosis during sit-to-stand (STS) and stand-to-sit (SIT) in individuals with and without chronic nonspecific low back pain (CNLBP). The second objective was to investigate sex-related differences in lumbar lordosis. Methods Twenty-six patients with CNLBP and 26 controls were recruited. Controls were matched with cases using a frequency matching method. Reflective markers were placed over the spinous process of T12, L3, S2, and the anterior and posterior superior iliac spines. The participants were instructed to stand up at a self-selected pace and maintain their normal upright standing posture for 3 seconds, and then sit down. Kinematic data were recorded at a sampling frequency of 100 Hz using a motion capture system. Lumbar lordosis angle was calculated from the intersection between the line joining T12 and L3, and the line joining L3 to S2. Results Lumbar lordosis was decreased in patients with CNLBP during STS and SIT compared with the asymptomatic group (mean difference = 2.68°-9.32°; P ≤ .005). Furthermore, no differences were seen in lumbar lordosis at starting position between CNLBP and asymptomatic groups during STS and SIT (mean difference = 2.68°-3.75°; P ≥ .099). Interestingly, the magnitude of the effect size suggested that the difference in lumbar lordosis values between female and male participants was relatively large (Cohen's d = -1.81 to 0.20). Conclusion Decreased lumbar lordosis in patients with CNLBP during STS and SIT could be considered as an important point during rehabilitation. Moreover, the present study showed that there is a sex-related difference among women and men in lumbar lordosis during STS and SIT tasks.

Introduction: The prevalence of Anterior Knee Pain (ANP) has been reported between 15% and 45% in Europe. Muscle weakness is a predisposing factor for ANP. The purpose of this study was to investigate and compare the effect of McKenzie and common exercises on quadriceps and hamstring muscles strengthening and consequently relieving anterior knee pain. Materials and Methods: A total of 22 patients with ANP (Mean [SD] age: 29.191 [1.658]y) were randomly assigned into control and experiment groups. Each group consisted of 11 subjects. The treatment program included hot pack and acupuncture like TENS modalities for 10 sessions. From the third session, the exercise was added to each group’s treatment program separately. The control group exercises consisted of strengthening exercises of the knee, thigh and trunk muscles. In the experiment group, the subjects were initially classified according to mechanical diagnostic tests of McKenzie. This classification is based on patient’s response to repetitive movements or constant positions at their end range of motion. The exercise was prescribed according to directional preference which was specific for each case. The strength of quadriceps and hamstring muscles were assessed in three stages with hand held dynamometer. The repeated measure ANOVA test was used to compare variables between two groups. The ANOVA and the Tukey post hoc test were used for intra-group comparisons. All statistical analyses were performed in SPSS V. 21. Results: The strength of quadriceps muscle in both groups showed a significant improvement (P

OBJECTIVE The purpose of this study was to determine the prevalence of and risk factors for neck pain in dentists of Tehran province and to analyze the association of neck pain with individual and occupational characteristics. DESIGN Following ethical approval, a cross sectional study was conducted on 300 randomly selected dentists at Tehran city. Different questionnaires were used to collect personal and occupational characteristics as well as the prevalence and risk factors of neck pain. The Iranian validated version of visual analogue scale and neck disability questionnaires were also used to assess the pain intensity and functional disability of neck, respectively. RESULTS Point, last month, last year and lifetime prevalence of neck pain were 19.3%, 27.3%, 29.9% and 34.7%, respectively. The prevalence of neck pain was significantly correlated with regular exercise, general health condition and having an assistant (P< 0.05 in all instances) and was not significantly correlated with body mass index, age and gender. Prolonged sitting, awkward postures and repeated movements were the most significant aggravating factors. CONCLUSIONS Results indicated that the prevalence of neck pain in dentists appears to be high. Therefore, further studies on different preventive strategies in dentists' population seem necessary.

Shoulder sports injuries are relatively common in athletes who perform highly repetitive motions. The purposes of this study were to determine the prevalence of and risk factors for shoulder injuries and to analyze how individual and other sport characteristics contribute to the risk of shoulder injuries among 6 overhead sports, those being swimming, rowing, wrestling, basketball, volleyball, and handball.A cross-sectional study was carried out on 613 Iranian overhead sports athletes in different collegiate sport fields. Data were collected using different questionnaires. A structured questionnaire including demographics, sport characteristics, and also prevalence and risk factors of shoulder pain was used. Visual analogue scale and Disability of the Arm, Shoulder, and Hand questionnaires were used to determine the pain intensity and functional disability, respectively.Point, last 6-month, last year, and lifetime prevalences of shoulder pain were 21.4%, 29%, 38.8%, and 41.6%, respectively. The highest point prevalence was related to the rowing athletes with 31.9% and the lowest for swimming athletes (12.3%). Sex, body mass index, sport level, days of practice per week, and satisfaction with income were found to be significantly correlated with the prevalence of shoulder pain (P.05 in all instances). For those with shoulder pain, the mean pain intensity and functional disability were 53.8 mm and 15.46%, respectively.The prevalence of shoulder pain in athletes with highly repetitive overhead motions seems to be high.

Background and objectives: Neck pain is a disabling condition associated with pain and proprioceptive disturbances. There is limited evidence on the efficacy of treatments for chronic neck pain (CNP). The aim of this study is to conduct a randomized, controlled trial to compare the effect of galvanic vestibular stimulation (GVS) with that of cervical proprioception training (CPT) on pain and proprioception acuity in patients with chronic neck pain. Subjects and methods: Forty-eight patients with CNP enrolled in this prospective, single-blind, randomized, controlled study will be randomly allocated to one of four groups: GVS, CPT, GVS + CPT, and control. The GVS group will receive galvanic stimulation, three sessions per week, for 6 weeks. The CPT group will perform proprioceptive exercises daily for 6 weeks. The GVS + CPT group will receive both interventions. The control group will have no intervention for 6 weeks, but 6 weeks later, they will receive physical therapy. In addition, 12 healthy subjects will be recruited. This study protocol has been approved by the Ethics Review Board of Iran University of Medical Sciences, with permission number IR.IUMS.REC 1395.9211342210 on August 8, 2016. Patient recruitment began in October 2016 and ended in October 2018. Data analysis will be performed in March 2019 and the study will be completed in May 2019. Outcome measures: The primary outcome measures will be intensity of pain, pressure pain threshold, and joint position error. The secondary outcome measures will be disability and health-related quality of life. Outcomes will be assessed at baseline and at the end of sessions 1 and 18. Discussion: Findings from the trial are expected to help assess the effectiveness of GVS, compared with CPT in patients with CNP. If this protocol is proven to be effective, it can be implemented in a clinical setting to manage chronic pain in patients with CNP. We expect this study to offer information about the positive effects of GVS and CPT. Findings from this study will be helpful in progressing GVS from science to practice and in managing disturbances in CNP. Trial registration: The study was registered at the Iranian Registry of Clinical Trials on September 26, 2016 (IRCT2016060121459N2).

Background: Chronic nonspecific low back pain (CNLBP) is among the most prevalent health problems. Lumbar spine and hips kinematics and coordination can be affected in CNLBP. The effects of exercises on the kinematics and coordination of lumbar spine and hips during sit-to-stand (STS) and its reverse have not been evaluated. Objective: The aim of this study is to investigate the effect of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in CNLBP patients. Methods: COSCIOUS is a parallel randomized double-blind controlled trial. A total of 30 CNLBP patients and 15 asymptomatic participants will be included. The kinematics and joint coordination of the lumbar spine and hips will be evaluated during STS and its reverse using a motion capture system. The participants will be asked to sit in their usual posture on a stool. Reflective markers will be placed over the T12, S2, anterior and posterior superior iliac spines, greater trochanters, and lateral femoral epicondyles of both legs. The participants will be instructed to stand up at natural speed, remain in the erect posture for 3 seconds, and then sit down. Kinematic variables of the lumbar spine and hip will be computed. Afterward, the CNLBP participants will be allocated at random to receive one of 2 interventions: core stabilization or general exercise. Treatment sessions will be held 3 times per week for 16 sessions. After intervention, CNLBP participants will be assessed again. Results: Funding for the study was provided in 2016 by Iran University of Medical Sciences. The study is expected to last approximately 12 months, depending on recruitment. Findings on the study’s primary outcomes are expected to be finalized by December 2017. The results of the study will be published in a peer-reviewed journal. Conclusions: This investigation will evaluate the effects of core stabilization exercise on the kinematics and joint coordination of the lumbar spine and hip during STS and its reverse in patients with CNLBP. In addition, the effects of CNLBP on STS and its reverse will be investigated in COSCIOUS. Trial Registration: Iranian Registry of Clinical Trials IRCT2016080812953N2; http://en.search.irct.ir/view/32003?format=xml (Archived by WebCite at http://www.webcitation.org/6qjTWd4Az) [JMIR Res Protoc 2017;6(6):e109]