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Introduction. Coronavirus disease 2019 (COVID-19) is an emerging pandemic disease caused by the severe acute respiratory syndrome. Back pain could be triggered by the COVID-19 virus either directly or indirectly. However, to our knowledge, limited studies are addressing the development of chronic back pain or new-onset of back pain among COVID-19 survivors. Therefore, the purpose of this study was to investigate the potential health consequences of COVID-19 on back pain among the COVID-19 survivors. Methods. We used an electronically distributed survey targeting adult Jordanian citizens and residents who recovered from COVID-19 virus infection. The questionnaire composed questions regarding demographic characteristics, COVID-19 and spine injury-related information. Results. 27.2% of participants reported increase of back pain with COVID during the episode and 16% of participants reported increased back pain after COVID with pain lasted less than 3 months in 16.6% and more than 3 months in 17.8% of them. There was significant increase on back pain level during COVID compared to pre COVID. At the same time there was significant increase on back pain post COVID compared to pre COVID. Conclusion. The COVID-19 virus resulted in a significant increase in spine pain among COVID-19 survivors and it lead to chronic back pain among patients with risk factors and some develop new spine pain.

A power conversion system based on a diode rectifier, three-level (3L) boost converter and 3L neutral-point clamped (NPC) inverter is a cost effective and reliable solution in contrast to the back-to-back connected NPC converter for the medium-voltage permanent magnet synchronous generator-based wind turbines. This paper investigates a novel predictive control scheme to operate the 3L boost converter and an NPC inverter with fixed switching frequency, high-speed tracking, and accurate locking in steady state. A dual decoupled control loop consisting of deadbeat current control and modulated model predictive current control has been developed for the 3L boost converter and NPC inverter, respectively. The controller for three-level boost converter performs dual functions such as neutral-point voltage control and inductor current control. The controller of NPC inverter regulates the grid currents in stationary frame for the simultaneous control of active and reactive powers.

Little is known about the quality of primary care in Saudi Arabia, despite the central role of primary care centers in Saudi health strategy. Good access and effective care were reported for certain services including: immunization, maternal health care, and control of epidemic diseases. Poor access and effectiveness were reported for chronic disease management programs, prescribing patterns, health education, referral patterns, and some aspects of interpersonal care including those caused by language barriers. Several factors were identified as determining whether high-quality care was delivered. These included management and organizational factors, implementation of evidence-based practice, professional development, use of referrals to secondary care, and organizational culture.in terms of quality service consumer satisfaction to evaluate the quality of primary care in Saudi Arabia, and to distinguish factors impeding the achievement of quality, with the aim of determining how the quality of Saudi primary care could be improved. Keywords: primary health care, quality of life, maternal health care, effectiveness, performance improvement in primary health care, quality in Saudi Arabia.

BACKGROUND It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

Background: The hamstrings play a major role in body posture. Shortening or tightness of the hamstrings affects postural alignment and results in possible musculoskeletal pain. Objectives: The aim of this study was to develop a novel approach to improve hamstring flexibility in young adults. Method: A single-blinded randomised clinical trial included 60 participants aged 18–24 with shortened hamstrings recruited from the Hashemite University, Zarqa, Jordan. The range of motion of knee extension was measured with the hip at 90° flexion using a simple goniometer to detect the level of hamstring flexibility. Participants received either a passive hamstring stretch (PS), followed by two sets of 10 tibial nerve neurodynamic technique (ND), or PS followed by three sets of 10 repetitions of active knee extension–quadriceps activation (QA), or PS only. Results: There was a significant improvement of hamstring flexibility in the QA group compared to the PS group (13.4 ± 12.1° vs. 6.2 ± 6.4°, p = 0.05). There was a significant improvement in hamstring flexibility post-intervention compared to pre-intervention in the PS group by 6.2 ± 6.4 (30.5 ± 10.8° vs. 36.6 ± 9.5°, p = 0.001), ND group by 9.3 ± 6.2 (26.7 ± 10.9° vs. 36.0 ± 9.5°, p = 0.001) and QA group by 13.4 ± 12.1 (20.3 ± 9.0° vs. 33.4 ± 8.9°, p = 0.001). Conclusion: Quadriceps muscle activation following passive stretching of the hamstrings appears to be superior to the PS and ND techniques in improving hamstring muscle flexibility. Clinical implications: Quadriceps activation following passive hamstring stretching can be used in physiotherapy settings to improve hamstring muscle flexibility.

Aims: To find out if the use of heat at home between physical therapy sessions results in better therapy outcomes in people with acute, non-specific back pain. Setting: Longitudinal, single-blind study at physical therapy outpatient rehabilitation centres. Methods: A total of 144 people with acute, non-specific back pain underwent 45 minutes to 1 hour of therapy, twice a week for 2 weeks. Participants were instructed to accomplish 30 minutes of therapeutic exercise at home daily. Half of the participants used ThermaCare heat wraps for 6 hours before home therapy. The measures were the OSWESTRY, Roland-Morris and Visual Analogue Pain scales, range of motion of the lower back, strength of the lower back and home exercise compliance. Results: In the heat group, compared to the non-heat group, the OSWESTRY reduced (3 times), strength increased (twice), range of motion increased (3 times), pain reduced (twice) and compliance for home exercise doubled. All differences were significant (p=Conclusions: Using heat at home before home exercise sessions and between therapy sessions was associated with faster recovery from acute, non-specific back pain and better home exercise compliance than was seen in the non-heat group.

Michael.Laymon@tun.touro.edu This is an Open-Access article distributed under the terms of t he Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright © 2013 Korean Academy of Physical Therapy Rehabilitation Science

Objective: To assess the effect of vitamin D administration on the skin blood flow response to occlusion and heat. Design: Cross-sectional study. Methods: Twenty age matched subjects; 10 who had diabetes and 10 who were controls were administered 4,000 IU of vitamin D3 for 3 weeks at breakfast. The function of the endothelial cells was evaluated in 2 ways; first, the response to 4 minutes of vascular occlusion of the skin was measured with a laser Doppler flow meter. Second, the skin blood flow response to local heat at 42 degrees C for 6 minutes was examined. Results: The results of the experiments showed that the blood flow response to heat was reduced after 3 weeks administration of vitamin D in the subjects with diabetes and in the control subjects (p

Background Vitamin D is a modulator of the immune system. There is some limited evidence that it also increases local blood flow in response to stress. Material and methods In the present study, we examined 20 age matched subjects; 10 whom were from India and 10 Caucasians from the United States. Subjects were administered 4000 IU of Vitamin D3 for 3 weeks at breakfast. The function of the endothelial cells was evaluated in 2 ways; first, the response to 4 minutes of vascular occlusion was measured with a laser Doppler flow meter and second, the blood flow response to local heat at 42°C for 6 minutes. Results The results of the experiments showed that, as reported previously, the endothelial function in people from India was less than their Caucasian counterparts. The blood flow response to heat was reduced after 3 weeks administration of vitamin D in both groups and the response to vascular occlusion in the Caucasian group. But there was only a 20% reduction in the blood flow response to heat in the Caucasian group and a 50% reduction in the group from India. Conclusions Thus acute doses of vitamin D may increase vascular tone and reduce blood flow to tissue during stressors. Dosages administered for a longer duration may have beneficial effects on endothelial function but this was not examined here.

Balance is sensed through peripheral and central receptors and mediated by central control through the brain and spinal cord. Although some evidence exists as to the areas of the brain involved and how processing of data occurs in young individuals, nothing has been published on people with diabetes. The purpose of this study was to examine the electroencephalogram (EEG) during common sensorimotor and balance training tasks and to relate these to task difficulty.Postural sway and EEG change of alpha, beta, and sigma wave bands were measured in 17 young subjects, 10 older subjects, and 10 subjects with diabetes during eight progressively more difficult balance tasks with eyes open and closed, feet in tandem or apart, and on foam or a firm surface.EEG power of beta and sigma wave bands showed significant increases on the cortical and parietal areas of the brain relative to the control tasks when eyes were open (P0.05). The cortical involvement decreased as the task became more difficult with vision and somatosensory information reduced, whereas that of the parietal area increased with task difficulty. The greatest increase was in subjects with diabetes, and the least was in younger people. Individuals with diabetes had increased sigma and beta EEG power in all regions of the brain examined with increased complexity of the balance task.This study demonstrated cortical and parietal involvement in static balance tasks commonly used in sensorimotor training. The results support the proposal that there was increased subcortical control with increase in task difficulty in the young subjects, but in subjects with diabetes, there was a major increase in activity across the brain.

Endothelial function is known to be impaired in response to heat in people with diabetes, but little has been done to see how air humidity alters the skin blood flow response to heat.Seventeen male and female subjects were divided in two groups, one with type 2 diabetes and the other the control subjects without diabetes, age-matched to the diabetes group. All subjects participated in a series of experiments to determine the effect of the warming of the skin by air on skin temperature and skin blood flow. On different days, skin temperature was warmed with air that was 38°C, 40°C, or 42°C for 20 min. Also, on different days, at each temperature, the air humidity was adjusted to 0%, 25%, 50%, 75%, or 100% humidity. Skin blood flow and temperature were measured throughout the exposure period. This allowed the interactions between air humidity and temperature to be assessed.For the control subjects, the moisture in the air had no different effect on skin blood flow at air temperatures of 38°C and 40°C (analysis of variance, P0.05), although skin blood flow progressively increased at each air temperature that was applied. But for the warmest air temperature, 42°C, although the four lower humidities had the same effect on skin blood flow, air at 100% humidity caused the largest increase in skin blood flow. In contrast, in the subjects with diabetes, blood flow was always significantly less at any air temperature applied to the skin than was observed in the control subjects (P0.05), and skin blood flow was significantly higher for the two higher humidities for the two higher air temperatures. Skin temperature paralleled these findings.These data show that individuals with diabetes do not tolerate moist, warm air above 50% humidity as well as controls without diabetes.

Summary Background Most studies of the skin and how it responds to local heat have been conducted with either water, thermodes, or dry heat packs. Very little has been accomplished to look at the interaction between air humidity and temperature on skin temperature and blood flow. With variable air temperatures and humidity’s around the world, this, in many ways, is a more realistic assessment of environmental impact than previous water bath studies. Material/Methods Eight young and 8 older subjects were examined in an extensive series of experiments where on different days, air temperature was 38, 40, or 42°C. and at each temperature, humidity was either 0%, 25%, 50%, 75%, or 100% humidity. Over a 20 minute period of exposure, the response of the skin in terms of its temperature and blood flow was assessed. Results For both younger and older subjects, for air temperatures of 38 and 40°C., the humidity of the air had no effect on the blood flow response of the skin, while skin temperature at the highest humidity was elevated slightly. However, for air temperatures of 42°C., at 100% humidity, there was a significant elevation in skin blood flow and skin temperature above the other four air humidity’s (p

Summary Background When heat is applied to the skin, it is dissipated due to conductive heat flow in the tissue and the blood. While heat flow has been studied after applying a single heat exposure, the physiology of repeated exposures to local heat has not been well investigated. Material/Methods Twenty male and female subjects in the age range of 20–65 years old participated in a series of experiments during which a thermode was placed on their leg above the quadriceps muscle for 20 minutes, and on 3 sequential days, to see the effect of repeated local heat on skin blood flow, skin temperature, and on caloric transfer from a thermode used to raise skin temperature. Results The results of the experiment showed that, for young subjects, to raise skin temperature to 40 degrees C required more than double the calories required in older subjects. Further, in the younger subjects, the blood flow response in the first 20 minutes of heat exposure was over 30% higher than that seen in the older subjects. However, on the 2nd and 3rd day, the blood flow response of the younger subjects, was not significantly different between day 2 and 3, but was significantly less than day 1. There was no statistical difference in the blood flow response between day 1, 2 and 3 in the older subjects. In the younger subjects, in the 2 and 3rd day, the number of calories needed to warm the skin was also significantly less than that seen in the first day. Conclusions In younger subjects but not older subjects, there appears to be some degree of acclimatization with an enhanced blood flow response in the first day that was protective to the skin which was not seen in repeated heat exposure.

Objective A national survey was conducted to determine the current status of physical therapy practice in the intensive care units (ICUs) of Jordanian hospitals. Methods An online survey was sent via email to physical therapists working at Jordanian hospitals. Questions of the survey addressed the physical therapy demographics, staffing, education, training, and barriers of practice. The responses were compared among four different hospital sectors in the country. Results The response rate was 31% (50/161). Thirty-six percent of participants had more than 10 years of experience in physical therapy, and 26% had less than 1 year of experience in the intensive care practice. Staffing of physical therapists working in ICUs relative to the total ICU beds was the highest in public hospitals compared with other hospital sectors. Among all participants, only 4% had received specialized postgraduate ICU training. The barriers to ICU physical therapy practice in Jordan included insufficient staffing, inadequate training, and lack of understanding of physical therapy role for ICU patients. Conclusion The study showed the main barriers to ICU physical therapy practice in Jordan. There is a need for well-structured strategies to overcome these barriers to help improve the delivery of physical therapy services in Jordan.

Plantar Fasciitis is a possible complication in runners and even people who walk a lot. There have been numerous proposed therapies to treat this disorder but the independent effect of heat, cold and NSAIDS have not been examined without the concomitant use of other modalities. Here we examined the effect of heat, cold and Advil independently of other therapies on plantar fasciitis. Objective: Subjects with plantar fasciitis either had no intervention, cold applied 20 minutes at night before bed, or 20 minutes in the morning upon wakening or either moist heat at night or in the morning (1 hour) or dry heat (4 hours) at night for 1 day or 3 days with and without Advil. Plantar fascia swelling, tenderness and pain were evaluated. Methods: Visual analog pain scale, plantar facial thickness was measured by ultrasound as a measure of inflammation, the pressure tolerated by force on the plantar fascia from an algometer were measured first thing in the morning. An activity of Daily Living Subscale of the Foot and Ankle Ability Measure (FAAM-ADL) questionnaire was used for assessing disability. There were 99 subjects in 9 groups. All post intervention measurements were taken first thing in the morning before activity. Results: The greatest relief of symptoms was with the application of cold used at bedtime the night before the measurements, cold used in the morning was not as effective as was heat. Cold use reduced the thickness of the plantar fascia and pain. Cold plus Ibuprofen were significantly better at reducing plantar fascia symptoms than cold alone. Conclusion: Cold applied for 20 minutes prior bedtime was the most effective treatment for reduced symptomology caused by plantar fascia inflammation. Advil further reduces pain when used with cold.

Background It is well established that there is a reduction in the skin blood flow (SBF) in response to heat with age and diabetes. While it is known that high BMI creates a stress on the cardiovascular system and increases the risk of all cause of morbidity and mortality, little is known of the effect of high BMI on SBF response to heat. Since diabetes is associated with age and a higher BMI, the interrelationship between age, BMI and SBF needs to be investigated to better understand the contribution diabetes alone has to endothelial impairment. Material/Methods This study examined the SBF to heat in young and old people with low and high BMI and people with diabetes with high BMI to determine the contribution these variables have on SBF. Subjects were ten young and older people with BMI 20 and ten subjects with diabetes with BMI >20. The SBF response, above the quadriceps, was determined during a 6 minutes exposure to heat at 44°C. Results Even in young people, SBF after the stress of heat exposure was reduced in subjects with a high BMI. The effect of BMI was greatest in young people and lowest in older people and people with diabetes; in people with diabetes, BMI was a more significant variable than diabetes in causing impairment of blood flow to heat. BMI, for example, was responsible for 49% of the reduction in blood flow after stress heat exposure (R=−0.7) while ageing only accounted for 16% of the blood flow reduction (R=−0.397). Conclusions These results would suggest the importance of keeping BMI low not only in people with diabetes to minimize further circulatory vascular damage, but also in young people to diminish long term circulatory vascular compromise.

When heat is applied to the skin, heat is conducted away because of the latent heat transfer properties of the skin and an increase in skin circulation, but little attention has been paid to the heat transfer properties of skin in different areas of the body and in people with diabetes. research design: Thirty subjects in the age range of 20-75 years had a thermode (44°C) applied to the skin of their arm, leg, foot, and back for 6 min to assess the heat transfer characteristics of skin in these four areas of the body. Skin blood flow and skin temperature were monitored over the 6-min period.For the younger subjects, blood flow was not statistically different in response to heat in three areas of the body, starting at less than 200 flux measured by a laser Doppler imager and ending at approximately 1,200 flux after heat exposure. The foot had higher resting blood flow and higher blood flow in response to heat. Temperature and the rate of rise of temperature were also not different in any of the areas. The heat added to raise temperature, however, varied by body region. The arm required the least, whereas the leg and foot required the most. For the older group and subjects with diabetes, the heat required for any region of the body was much less to achieve the same increase in skin temperature, and blood flows were also much less; the subjects with diabetes showed the least blood flow and required the fewest calories to heat the skin. Whereas the foot required the greatest number of calories to heat the tissue in younger and older subjects, in subjects with diabetes, the foot took proportionally fewer calories.Thus, specific areas of the body are damaged more by diabetes than other areas.

Numerous studies have examined the blood flow of the skin at rest and in response to sustained heat and shown that, in older people and people with diabetes, the skin blood flow response to heat is diminished compared to younger people. It is not sustained heat, however, that usually causes burns; it is a more rapid application of heat.Ten younger subjects, 10 older subjects, and 10 subjects with diabetes were examined before and after applying a water-filled thermode to the skin above the quadriceps muscle to observe the changes in skin temperature and skin blood flow and the ability of the skin to absorb heat after a 2-min heat exposure with water at 44°C.Skin temperature rose from 31.2°C at rest to 38.3°C after 2 min of heat application in all subjects (P 0.05 between groups). The calories required in the younger group of subjects was 2.26 times the calories required in the older group of subjects for the same change in skin temperature and 13.8 times the calories needed to increase skin temperature in the subjects with diabetes. Furthermore, the blood flow at rest was lower in people with diabetes than older subjects and both groups less than that seen in younger subjects. The blood flow response to heat was slower in the subjects with diabetes compared to the older subjects and much slower than that seen in the younger subjects.Reduced skin blood flow of older and subjects with diabetes, decreased thickness of the dermal layer, and increased subcutaneous fat, as well as damage to transient receptor potential vanilloid 1 receptors, may account for some of the differences between the groups.

As predicted by the Pennes equation, skin blood flow is a major contributor to the removal of heat from an external heat source. This protects the skin from erythema and burns. But, for a person in a thermally neutral room, the skin is normally much cooler than arterial blood. Therefore, if skin blood flow (BF) increases, it should initially warm the skin paradoxically. To examine this phenomenon, 10 young male and female subjects participated in a series of experiments to examine the contribution of skin blood flow in the initial warming the skin after the application of local heat. Heat flow was measured by the use of a thermode above the brachioradialis muscle. The thermode was warmed by constant temperature water at 44°C entering the thermode at a water flow rate of 100 cm(3)/min. Skin temperature was measured by a thermistor and blood flow in the underlying skin was measured by a laser Doppler imager in single point mode. The results of the experiments showed that, when skin temperature is cool (31-32°C), the number of calories being transferred to the skin from the thermode cannot account for the rise in skin temperature alone. A significant portion of the rise in skin temperature is due to the warm arterialized blood traversing the skin from the core areas of the body. However, as skin temperature approaches central core temperature, it becomes less of a heat source and more of a heat sync such that when skin temperature is at or above core temperature, the blood flow to the skin, as predicted by Pennes, becomes a heat sync pulling heat from the thermode.