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Abstract Background Urinary incontinence (UI) is a common and debilitating condition among people with multiple sclerosis (MS) and is more prevalent among women. Over the past decade, numerous studies have investigated the effects of pelvic floor muscle training (PFMT) as a treatment for UI in people with MS. MS negatively impacts pulmonary function even in the early stages of the disease and people with MS may experience respiratory muscle weakness. Considering the synergy between the pelvic floor muscle (PFM) and respiratory muscles, this trial will evaluate the effects of PFMT and breathing exercises on PFM activity and strength, diaphragm activity, and urinary symptoms in women with MS who experience UI. Methods Fifty women with MS and UI will participate in this parallel randomized controlled trial, comprising 32 treatment sessions. The intervention group consists of PFMT and breathing exercises, and the control group includes PFMT. The severity of UI symptoms, PFM activity, diaphragm activity, and PFM strength will be evaluated using the International Consultation on Incontinence Questionnaire–Urinary Incontinence Short Form, ultrasound imaging, and modified Oxford grading scale, respectively before and after the intervention. Discussion The current trial is designed to examine the effects of a combined exercise program for UI in women with MS. It is hypothesized that using breathing exercises in conjunction with PFM exercises will improve patient symptoms compared to PFMT alone. Trial registration The trial was registered in the Iranian Registry of Clinical Trials with code IRCT20180916041051N3 and was approved on 23 May 2024. Graphical Abstract

Abstract As PI-LL mismatch is an effective index for spinal surgery and PI-LL less than 10 probably indicates better quality of life, this study aimed to assess spinopelvic parameters, lumbar instability, and lumbar muscle morphology in patients with chronic low back pain (CLBP) with different PI-LL mismatches. This cross-sectional study included 158 CLBP patients. The association between lumbar extensor muscle morphology (measured from magnetic resonance imaging) and spinopelvic parameters (measured from standing lateral radiographs) and lumbar instability (measured from lumbar flexion/extension radiographs) was compared between two groups of patients with different PI-LL mismatch. PI-LL mismatch showed a significant medium association with lumbar spine stability (χ2 = 8.06, p-value = 0.005, OR = 0.26, 95% CI = 0.10 to 0.69). Total cross-sectional area (TCSA) (OR =

Abstract Background Rotator cuff repair (RCR) is one of the most prevalent procedures to manage rotator cuff tears (RCT). Postoperative shoulder pain is a common complication following RCR and may be aggravated by activation of myofascial trigger points (MTrP) associated with the injury to the soft tissues surrounding the surgical incision. This study aimed to describe a preliminary, randomized, sham-controlled trial to evaluate the effectiveness of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) as a muscle treatment approach along with 10 sessions of multimodal rehabilitation protocol (MRh) consisting of therapeutic exercise, manual therapy, and electrotherapy on postoperative shoulder pain, range of motion (ROM), strength, and functional outcome scores for patients following RCR surgery. Methods Forty-six patients aged 40–75 following RCR surgery were recruited and randomly allocated into 2 groups: (1) MTrP-DN plus MRh (experimental group), and (2) sham dry needling (S-DN) plus MRh (control group). This trial had a 4-week intervention period. The primary outcome was the Numeric Pain Rating Scale (NPRS) for postoperative shoulder pain. Secondary outcomes were the Shoulder Pain and Disability Index (SPADI), ROM, and strength. The mentioned outcomes were measured at baseline and week 4. In the current study, adverse events were recorded as well. Results No statistically significant differences were observed between groups when adding MTrP-DN to MRh for postoperative shoulder pain after 4 weeks of intervention (mean difference 0.32, [95% CI -0.41,1.05], p = 0.37). However, this trial found a small effect size for postoperative shoulder pain. No significant between-group differences were detected in any of the secondary outcomes (p > 0.05) either. We found significant within-group changes in all studied outcome measures. (p

Introduction Postpartum lumbopelvic pain (LPP) is a prevalent condition among women following childbirth. Due to the importance of respiratory muscles in lumbopelvic stability, and the changes they undergo during pregnancy, this study aims to assess the effects of motor control training and breathing exercises on pain, disability and core muscle activity in women suffering from LPP after childbirth.Methods and analysis 52 women with postpartum LPP will participate in this two-parallel-armed, superiority randomised controlled trial, comprising 24 treatment sessions. The intervention group consists of motor control training and breathing exercises, and the control group includes motor control training. The diaphragm excursion, pelvic floor and abdominal muscle activity, pain and disability will be evaluated using ultrasound imaging, visual analogue scale and Oswestry Disability Index, before and after the intervention, respectively.Ethics and dissemination Ethical approval was obtained from the human research ethics committee of the Iran University of Medical Sciences (IR.IUMS.REC.1403.017). The study results will be submitted to a relevant journal and conferences.Trial registration number This clinical trial has been registered in the Iranian Registry of Clinical Trials on 21 May 2024 (registration number: IRCT20180916041051N2).

Abstract Background The postural control and abdominal muscles’ automatic activity were found to be impaired in subjects with low back pain (LBP) during static activities. However, the studies are predominantly conducted on younger adults and a limited number of studies have evaluated abdominal muscles’ automatic activity during dynamic standing activities in subjects with LBP. The present study investigated the automatic activity of abdominal muscles during stable and unstable standing postural tasks in older adults with and without LBP. Methods Twenty subjects with and 20 subjects without LBP were included. The thickness of the transversus abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles was measured during rest (in supine), static, and dynamic standing postural tasks. To estimate automatic muscle activity, each muscle’s thickness during a standing task was normalized to its thickness during the rest. Standing postural tasks were performed using the Biodex Balance System. Results The mixed-model analysis of variance revealed that task dynamicity significantly affected thickness change only in the TrA muscle (P = 0.02), but the main effect for the group and the interaction were not significantly different (P > 0.05). There were no significant main effects of the group, task dynamicity, or their interaction for the IO and EO muscles (P > 0.05). During dynamic standing, only the TrA muscle in the control group showed greater thickness changes than during the static standing task (P

Abstract Background Rotator cuff tear (RCT) is one of the main causes of shoulder pain and dysfunction. Rotator cuff repair (RCR) is a common surgical procedure for the management of RCTs. Presence of myofascial trigger points (MTrP) as a result of surgical procedure can aggravate postoperative shoulder pain. The purpose of this protocol is to describe a randomized controlled trial design to evaluate the effect of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) within a multimodal rehabilitation protocol following RCR surgery. Methods Forty-six participants aged 40–75 will be recruited having postoperative shoulder pain after RCR and meeting the inclusion criteria. Participants will be randomly divided into 2 groups: One group will undergo MTrP-DN, manual therapy, exercise therapy and electrotherapy and the other will receive sham dry needling (S-DN), manual therapy, exercise therapy and electrotherapy. This protocol will cover 4 weeks of intervention. The primary outcome measure will be the Numeric Pain Rating Scale (NPRS) for pain. Secondary outcome measures will be Shoulder Pain and Disability Index (SPDI), range of motion (ROM), strength and adverse events. Discussion This is the first study to investigate the use of 4 sessions of MTrP-DN in combination with a multimodal rehabilitation protocol for postoperative shoulder pain, restriction, weakness and dysfunction following RCR. The results of this study may help to determine the effect of MTrP-DN on various outcomes after RCR surgery. Trial registration This trial was registered at the ( https://www.irct.ir ), (IRCT20211005052677N1) on 19/2/2022.

Background: Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (DM). DPN is the primary risk factor for diabetic foot ulcers that can cause amputation. Although several observational studies have investigated the morphological and biomechanical characteristics of peripheral nerves in DPN, interventional studies regarding the effectiveness of neurodynamic techniques (NDT) in DPN patients are confined to a handful. The effects of NDT on neuropathy severity, nerve conduction parameters, quality of life (QoL), and mechanosensitivity have not been explored yet in this population. Materials and Methods: Forty type 2 DPN (T2DPN) patients, diagnosed based on an electrodiagnosis study, will be recruited into two groups. The experimental group will receive the tibial nerve’s real proximal and distal slider techniques in addition to DPN standard treatment as a basic treatment, and the control group will receive the tibial nerve’s sham proximal and distal slider techniques along with the basic treatment for eight sessions twice a week. Baseline and post-intervention assessments will be based on the Michigan diabetic neuropathy score (MDNS) (primary outcome), tibial nerve conduction parameters, neuropathy-specific quality of life (Neuro QoL) questionnaire, and straight leg raising range of motion (SLR ROM) (secondary outcomes). Results: This study is expected to last approximately seven months, depending on recruitment. The results of the study will be published in a peer-reviewed journal. Conclusions: The present study will evaluate the efficacy of NDT on the primary and secondary outcome measurements in DPN patients.

Abstract Background Multiple sclerosis is a chronic and disabling neurological disease among young people. One of the major complaints in patients with multiple sclerosis (PWMS) is falling. There are a number of factors that risk factors for falling, including balance disorder and spasticity. Core stability (CS) exercises such as trunk muscle strengthening exercises can improve balance and mobility and reduce falling. Dynamic neuromuscular stabilization (DNS) exercise is a new functional rehabilitation strategy that optimizes motor function based on the principles of developmental kinesiology. This trial will evaluate the effectiveness of DNS in comparison to CS on balance, spasticity, and falling in PWMS. Methods A total of 64 PWMS, between 30 and 50 years old and expanded disability status scale (EDSS) between 2 to 5, will be recruited from neurophysiotherapy clinic, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences to participate in this 2-armed parallel study. Participants will be randomly divided into two groups to receive CS exercise or DNS exercise. All participants will receive exercise treatment for 15 sessions during a period of 5 weeks (3 sessions per week). Primary outcome measures will be balance. Falling rate, fear of falling, patient mobility, as well as spasticity, will be measured as secondary outcomes. All outcome measures will be measured at baseline, the day after the completion of the 15th session, and after 17 weeks. Discussion Dynamic neurostabilization exercises utilize the subconscious stimulation of special zones to reflexively mediate the diaphragm and other core stabilization muscles, which is extremely effective for individuals with reduced somatosensory or movement awareness. Findings from the proposed study are expected to benefit the knowledge base of the physiotherapist, and it can be a good alternative for the rehabilitation program and even reduce medication use in patients with multiple sclerosis. These exercises are easy to understand and applicable for these patients and their partners as well. Trial registration The trial was registered in the Iran registry organization with code IRCT20140222016680N5 and was approved on April 7th, 2020. Address: IRCT administration team, Central Library Building, Iran University Campus, Hemmat Freeway, next to Milad tower, Tehran, Iran. postal code:14496-14535.

Background and Objectives: The complications and motor disorders caused by multiple sclerosis (MS) not only affect the individual’s movement abilities but also play a crucial and valuable role in how these individuals carry out their daily activities. In this way, patients with MS use certain compensatory methods, depending on individual differences, their environment, and their family’s support, to help with the complications of this disorder. For this reason, this study aims to identify the compensatory strategies that people with MS use to adapt to their mobility limitations. Methods: In this study, 13 patients with MS (7 women and 6 men), with informed consent, an average age of 43 years, and a qualitative content analysis approach, were included in the study. The sampling was performed purposefully with maximum variation, and the data was collected via quasi-structured in-depth interviews. Immediately after each interview, the data was analyzed using Cheevakumjorn`s method. Results: After analyzing the data and extracting the resulting codes, the codes were classified according to their similarities and differences. Ultimately, three main components of “compensatory strategies for home mobility”, “compensatory strategies for outdoor mobility”, and “compensatory strategies for carrying out daily activities” were formed. Conclusion: Although families play a major role in compensating for the mobility problems of these patients, it is necessary for health providers to reduce the burden placed on their families, and to educate MS people on self-care and adjust their living environment. Furthermore, providing mobility assistive devices for the patients should be done according to their differences and their environment.

Background and Objectives: Musculoskeletal pains due to COVID-19 have disrupted the daily activities of infected people. Investigating these complications can give us more information to diagnose and treat patients early. This study aims to investigate the effects of this virus on the incidence of musculoskeletal disorders in students or employees with COVID-19 at Iran University of Medical Sciences (IUMS), using the Extended Nordic Musculoskeletal Questionnaire (ENMQ). Methods: This cross-sectional questionnaire-based study was conducted in 2021 on 107 people. The study participants were selected by convenience sampling from students and employees at IUMS. The inclusion criteria were testing positive for COVID-19, confirmed by a physician, and at least three weeks passed since the onset of symptoms. The exclusion criteria were having a history of an accident or events influencing the musculoskeletal system and being reluctant to participate in the study. We used a researcher-made questionnaire and ENMQ for data collection. Musculoskeletal disorders before infection and the incidence or worsening of these problems after infection were also recorded using ENMQ. Data were analyzed in SPSS software, version 26, using the Mann-Whitney U test and the Kruskal-Wallis test. Results: The highest pain frequencies before COVID-19 were in the shoulders, knees, and back, in this order. Also, the highest pain frequencies after COVID-19 were in the back, neck, shoulders, and leg, in this order. According to the study results, most patients had low pain in their back, mild pain in their neck and back, and severe pain in their knees before being infected with COVID-19. After the COVID-19 infection, low pain in the knee and mild and severe pain in the back were observed in most patients. In assessing the “pain impact on the functioning“ before COVID-19, the highest effects on daily activities were found in the back, neck, and pelvis, in this order. After the COVID-19 infection, the daily activities related to the back, neck, shoulders, and pelvis were reduced. Conclusion: Based on this study, the difference in right elbow function by gender, the difference in the intensity of right elbow pain by age, the difference in the intensity of ankle and finger pain, and the difference in the function of ankle and fingers on both sides by age before and after suffering from coronavirus were the significant variables of this research.

Background and Objectives: This study aimed to identify the experiences of women with Multiple Sclerosis (MS) about urinary dysfunctions consequences. Methods: This qualitative study with the content analysis approach included 10 women with MS (age range: 29 to 59 years), who were recruited using a purposive sampling method with maximum variation. Through semi-structured in-depth interviews, the participants explained their experiences of urinary dysfunctions consequences. The obtained data were analyzed based on the content analysis method of Graneheim and Lundman. Results: The content analysis revealed three key themes: Physical consequences, psycho-emotional consequences, and economic consequences. Conclusion: Urinary dysfunctions cause widespread physical, psychological, and economic problems for women with MS. Therefore, treatment staff should address the MS patient’s concerns caused by urinary dysfunctions, in a non-threatening atmosphere, and help them to fearlessly manage their urinary problems.

Background: Malalignment in the pelvic and spinal column disturbs the balance and decreases the postural control ability. Malalignment is known as one of the main causes of back pain particularly the nonspecific chronic low back pain (NSCLBP). The aim of the study is to compare the effect of muscle energy technique (MET), craniosacral therapy (CST), and sensorimotor training (SMT) on postural control in patients with NSCLBP. Materials and Methods: In this randomized clinical trial study, 45 NSCLBP patients were accidentally allocated in three groups including CST (n = 15), MET (n = 15), and SMT (n = 15). Clinical interventions including CST, MET, and SMT were performed in 10 sessions in 5 weeks (2 sessions per week). The parameters of center of pressure (COP) were assessed in 8 positions such as standing position on double or single leg with open or closed eyes or half squat position on double or single leg with open or closed eyes. Results: The results of this study showed that all three methods of CST, MET, and SMT are effective in postural control in patients with NSCLBP, although it seems that CST is effective on more balance factors. CST has a greater effect on balance in standing position on a single leg with closed eye. It was also found that the effect of CST was continuous after follow-up. Conclusion: Moreover, MET and SMT methods were effective in balance control in NSCLBP patients and postural control was more affected by CST.

Background: Muscle fatigue affects the precision of the subjects' performance and limits the range of physical and sports activities. There is limited scientific evidence to support the use of soft tissue manipulation for enhancing muscle performance and its recovery. The aim of this study is to compare the effects of soft tissue manipulation and rest on the knee extensor muscle fatigue after maximal isokinetic contractions. Methods: Fifteen healthy females 20–30 years of age were selected for this research. This study implemented a semi-experimental test–retest measurement method. The subjects then either rested or received soft tissue manipulation on the knee extensors for a duration of 15 min. After intervention (soft tissue manipulation or rest), the parameters were evaluated for the third time. Results: The stability of the average of peak torque (APT), average power (AP), and visual analog scale (VAS) before performing fatigue protocol was 85%, 83%, and 31.9%, respectively. The stability after fatigue was 43%, 50%, and 93%, respectively. After maximal fatigue and a decrease in torque output to below 50% maximal torque, 15 min of soft tissue manipulation could change the APT after fatigue from a mean of 58.3 (nm) to 91.5 (nm), the AP from 39.4 to 63.6 (nm/s), and the VAS, from 90.0 to 12 (mm). But 15 min of rest could change the APT from 52.5 to 68.1 (nm), the AP from 37.6 to 48 (nm/s), and the VAS from 90.0 to 27.3 (mm). Conclusion: The study showed that soft tissue manipulation was more effective than rest as a strategy to return muscles to a normal state and caused more relief in perceived fatigue.

Objectives: Clinical education in medical sciences is essential, because of its important role in the education of specialist skills. Physiotherapy specialization is among the main branches of medical sciences, which requires high academic and professional skills. One of the most important and effective methods to assess the quality of clinical education in physiotherapy is to review it from a student’s perspective. Therefore, this study attempted to recognize the barriers of clinical education in physiotherapy students from their own perspective. Methods: This qualitative study used content analysis method. Data were collected using semi-structured interviews and the samples were selected by purposeful sampling method. We have considered maximum variation (gender, semester, educational level, place of residence) of persons in the sample selection. The data collection continued until saturation was reached. Participants included 13 physiotherapy undergraduate students who had completed at least 6 clinical education units. Results: We extracted 182 original codes from interviews analysis. By eliminating and matching the data, we finally developed 4 categories, as follows: 1. Personal and professional characteristics of clinical educators; 2. Personal characteristics of students; 3. Inadequate education system; 4. The inappropriate clinical education environment. Discussion: Clinical incompetency, inadequate clinical skills, and failure to observe professional ethics are the most frequent problems of clinical supervisors. Moreover, student’s irresponsibility, inadequate participation, the lack of self-esteem in some students, and inappropriate planning and the implementation of clinical education of PT department and inappropriate interpersonal communication and facilities in clinical settings, can be considered as barriers for clinical education. Considering the obstacles and attempts to resolve them, reviewing the clinical education process can improve its quality. Reviewing the clinical education process seems to help recognize its barriers and attempt to resolving them. It seems to improve the quality of clinical education.

Background and Objectives: Cervicogenic headache is considered to be one of the most controversial headaches because of its diagnostic challenges. It has several pathogeneses resulting in different signs and symptoms that make therapists prone to misdiagnosis. The aim of this study was to estimate the prevalence of diagnostic errors in cervicogenic headache patients. Methods: In this study that was conducted in the physiotherapy ward of the Ministry of Cooperatives, Labour, and Social Welfare clinic in summer 2018, 60 patients with chronic headache were examined using the International Headache Society Diagnostic criteria and five physical tests. The aim of this study was to determine the number of the patients with cervicogenic headache who were not diagnosed or were misdiagnosed before this study. Results: Fifty-three of the volunteers had cervicogenic headache. Only four of them were diagnosed correctly before this study, indicating that 92% of the cervicogenic headache patients were not diagnosed properly in this study. Conclusion: There is a significantly high rate of misdiagnosis in patients with cervicogenic headache. Because of the physical mechanisms that induce this type of headache, applying valid and reliable physical tests together with diagnostic criteria may lead to accurate diagnosis of cervicogenic headache.

Background & Objectives: The purpose of this study was to identify the experiences of people with multiple sclerosis (MS) from mobility barriers they are faced with. Methods: This study included 13 patients with MS (7 women and 6 men), with informed consent, whose average age is 43 years. A qualitative content analysis approach was used. According to the EDSS criteria, the severity of their disability was between 8-4. The sampling was carried out purposefully with maximum variation, and the data was collected through semi-structured in-depth interviews. Immediately after each interview, the data was analyzed using the Cheevakumjorn`s method. Results: After analyzing the obtained data and categorizing the resulting codes; three main categories were observed: “disease-affected barriers”, “personal barriers” and “environmental barriers”. The data of each theme were classified as subthemes. Conclusion: Based on research findings and experiences of the participants, rehabilitation specialists during the assessment, management and treatment of patients with MS should alert and educate patients about personal mobility barriers and try to help them fit in their physical environment.

ObjectiveTo evaluate test-retest reliability of trunk kinematics relative to the pelvis during gait in two groups (males and females) of patients with non-specific chronic low back pain (NCLBP) using three-dimensional motion capture system.MethodsA convenience sample of 40 NCLBP participants (20 males and 20 females) was evaluated in two sessions. Participants were asked to walk with self-selected speed and kinematics of thorax and lumbar spine were captured using a 6-infrared-cameras motion-analyzer system. Peak amplitude of displacement and its measurement errors and minimal detectable change (MDC) were then calculated.ResultsIntraclass correlation coefficients (ICCs) were relatively constant but small for certain variables (lower lumbar peak flexion in female: inter-session ICC=0.51 and intra-session ICC=0.68; peak extension in male: inter-session ICC=0.67 and intra-session ICC=0.66). The measurement error remained constant and standard error of measurement (SEM) difference was large between males (generally ≤4.8°) and females (generally ≤5.3°). Standard deviation (SD) was higher in females. In most segments, females exhibited higher MDCs except for lower lumbar sagittal movements.ConclusionAlthough ICCs were sufficiently reliable and constant in both genders during gait, there was difference in SEM due to difference in SD between genders caused by different gait disturbance in chronic low back pain. Due to the increasing tendency of measurement error in other areas of men and women, attention is needed when measuring lumbar motion using the method described in this study.

Background: Spasticity is one of the impairments in patients with stroke which cause more disability and secondary problems. Now, there are some ways to reduce spasticity such as drugs, exercise, heat, massage, and sensory level electrical stimulation. This study assessed the immediate effect of sensory level stimulation on spasticity in plantar flexor muscles in patients with post-stroke hemiplegia. Methods: In this study, 10 patients received 10 sessions of treatment. Protocol was 30 minutes electrical stimulation and 30 minutes proprioceptive neuromuscular facilitation techniques to improve initiation and controlling of movement. Level of the spasticity was measured carefully before and after the stimulation using Modified Ashworth scale. Findings: Electrical stimulation reduced the spasticity in two women and one man. Stimulation had not effect on seven patients. Electrical stimulation had not effect on grades one and three spasticity; it had effect on grades one-plus and two but not in all of the patients. The stimulation had effect on patients with good cognition who did their exercises carefully. Conclusion: Sensory level electrical stimulation has temporary effect only on middle-grade spasticity in middle exercise sessions. There is not any effect in next session and efficacy of stimulation reduces and stops. This electrical stimulation cannot disappear the spasticity and does not have any effect on high-grade spasticity.

Introduction: Evaluating the educational programs in various Medical Science disciplines is a highly sensitive matter and of great importance. Physiotherapy (PT) is an important field of Rehabilitation Sciences, which requires distinguished scientific and professional skills. One of the practical ways to assess the quality of clinical education in PT is to study the students’ perspective in this field, because they are the main target audience for education. Therefore, this study was conducted to determine the problems in clinical training of PT students, from the medical students’ perspective, in different universities of Tehran City. Materials and Methods: The present study was conducted using a qualitative content analysis approach, through individual interviews with 13 PT undergraduate students in Tehran. They were recruited through targeted sampling with maximum variation. Results: After analyzing the obtained data, a total of 4 themes were derived, which included characteristics of clinical supervision, training schedules and training, setting of clinical training, and general characteristics of the learners. Furthermore, 22 subthemes were obtained; some of them included lack of clinical teaching experience among the faculty members, no supervision in clinical teaching, for example, theory and clinical courses being held in one day, short duration of clinical teaching, inappropriate facilities, and the disorganisation and laziness of some students. Conclusion: Perhaps changing the clinical teaching methods, employing experienced and effective instructors, taking courses more seriously by students, establishing appropriate facilities for clinical training, supervision of the PT department over the performance of the teachers and the events during internships, and increasing the duration of theory and clinical courses, can all be effective in improving the quality of clinical training.

Background & Aims: The Modified Tardieu Scale (MTS) is a clinical scale for measuring the degree of muscle spasticity. The aim of this study was to evaluate the validity of the MTS in measuring poststroke knee extensorspasticity. Methods: This was a cross-sectional study performed in 2012 at a university clinic of neurological physiotherapy in Tehran, Iran, with repeated measurements. In the present study, 15 poststroke patients with a mean age of 53.8 ± 14.0 years and mean time since stroke of 40.0 ± 32.2 months participated. The knee extensor muscle spasticity was assessed using the MTS to calculate the R2-R1 as the main clinical measure. To calculate the work, an isokinetic dynamometer was used to quantify torque-angle data during passive movements at 4 speeds (60°, 120°, 180°, and 240°/sec). The linear regression was used to calculate the slope for the work-velocity data [Joule/(degree/sec)]. Results: There were significant differences between works done by the dynamometer at four speeds; as the speed increased the work decreased (P < 0.01). Mean (standard deviation) slope for the work-velocity data was-0.76 (0.78). There was no significant correlation between the dynamic component of MTS (R2-R1) and slope for the work-velocity data. Conclusion: The results indicate that the MTS might not be a valid measure for assessing knee extensor muscle spasticity in thissample of patients afterstroke

Background: The objectives of this study were to compare manual dexterity (gross and fine) and coordination performance of the ipsilateral upper extremity of the right hemisphere stroke patients with the same side of a healthy group, and to determine the relationship of ipsilateral upper extremity dexterity and disability. Methods: In a non-randomized analytical study, 30 individuals with a unilateral first-ever stroke from outpatient rehabilitation clinics and 30 age and sex-matched adults without history of neurological disorders were enrolled. Purdue Pegboard, Box and Block, and Finger to Nose tests were used to measure dexterity (fine and gross) and coordination performance of the stroke group compared with the same hand of the healthy group. The Barthel index was also used to assess disability or dependency of stroke patients in basic activities of daily living. Results: Results showed that stroke individuals with involvement of ipsilateral hand had less coordination and dexterity when compared to the same hand of normal subjects (P=0.001). In addition, the relationship of gross and fine manual dexterity performance of the ipsilateral upper extremity with disability, including dependence in basic activities of daily living, were significant respectively (r=0.376, r=0.391). Conclusion: People with right stroke had significant ipsilateral upper extremity impairments (manual dexterity and coordination tasks), and this hand dexterity deterioration had an impact on their dependence in basic activities of daily living.

Background: The complications associated with spastic cerebral palsy can affect the physical ability and quality of life of individuals suffering from this motor disorder. The aim of this study was to assess the relationship between quality of life and hypertonia in adults with spastic cerebral palsy. Methods: In an analytical cross sectional study, 70 subjects with the diagnosis of spastic cerebral palsy from three Ra’ad Rehabilitation Goodwill complexes in Tehran and Karaj cities took part in this study through convenient sampling. The severity of spasticity and contracture of the knee flexors were measured by Modified Tardieu Scale. Also the quality of life was assessed through World Health Organization quality of life-BREF questionnaire. To analyze data, Pearson and spearman correlation coefficient were used. Results: Participants of this study were 42.90% male, 57.10% female with mean age 26.24±5 years. No correlation existed between quality of life with knee flexor muscles spasticity. However, psychological and environmental domains showed low correlations with knee extension range (respectively r=0.26 and r=0.28; P

Purpose: Individuals’ personal awareness and learning after spinal cord injury is one of the most important factors in patients’ confrontation with subsequent disabilities and new life style which affects their ultimate independence. This article is an abstracted result of a qualitative study on effective factors of independence among patients with spinal cord injury. Methods: This study adopts a phenomenological qualitative approach and chooses its research samples from individuals with spinal cord injury including four women and seven men with paraplegic and tetraplegic SCI who live in Tehran. The data gathered trough Indepth semi-structural interviews and interpreted using Coliazzi’s method. Results: The data divided into 10 categories and 38 subcategories arranging in three general domains: the individual, familial and social. Knowledge and learning are important categories in the individual domain which includes five subcategories: Initial knowledge level, searching for information, learning from similar pattern, needs based learning, learning from experience and repetition. Conclusion: The research shows that the amount of information about the spinal cord injury before and learning more information after the injury influences on the sense of independence, and individuals who trying more to learn about their subsequent difficulties and needs are more successful in their future life.

Objective: The purpose of this study was the association between urinary disorder (UD), spastic hypertonia and assistive device with falling. Methods: In this analytical cross sectional study, 140 participants with Expanded Disability Status Scale (EDSS) score below 7 aged 20 to 55 years were divided into two groups according to their reports of falls in the past 6 months. Participants selected from Tehran outpatient clinics by convenient sampling. The presence or absence of UD, fall history and using assistive device was recorded by self-report. In addition, spastic hypertonia was assessed by Ashworth scale in knee extensors and ankle plantar flexors muscles for lower extremities. Finally, we used Mann whitney, chi-square test and Spearman correlation coefficient for analyzing. Results: We found more UD, spastic hypertonia and using assistive device in MS with history of falling compared with MS without history of falls (P < 0.05). Additionally, the direct and significant relationship existed between UD, spastic hypertonia and using assistive device with falls. Conclusion: MS people with history of falls that have UD, spastic hypertonia and using assistive device are in risk of falling than MS patients without history of falling.

Introduction: Evidence-Based Practice (EBP) and Research Utilization (RU) were introduced to physiotherapy more than two decades ago. Physiotherapists with their professional responsibility to provide the best care, will find practical evidence-based physiotherapy a veritable goldmine of useful information. Recently, evidence-based physiotherapy, as a means to improve the quality of physical therapy intervention, has become an interesting topic for the researchers all over the world. However, few studies have researched EBP in Iranian community of physiotherapists. This study was conducted to investigate the perceptions and experiences of EBP among Iranian physiotherapists and the resources of evidence for a duration of 8 months, from 2015 to 2016. Material and Methods: In this qualitative study, 15 physiotherapists holding at least a BSc. degree and with two years of relevant work experience, participated. Purposeful sampling method was used to recruit the samples. The data were collected via semi-organized in-depth interviews. Content analysis was used to analyze the data according to Cheevakumjorn’s method. Results: The collected data were divided into two groups containing the definition of EBP and evidence resources for physiotherapists. The participants were divided into two groups. The first group contained the physiotherapists who became familiar with EBP at university. The contributors who had not passed this course at university were included in the second group. The first group provided more detailed definitions and implemented evidence into their clinical work with greater certainty. The data related to the nature of evidence were put into 4 subgroups; experiences of colleagues, acquired knowledge, therapist’s experience, and obtained knowledge through the patients. Conclusion: Most physiotherapists participating in this study were somewhat familiar with EBP. Since there are some impediments such as poor clinical training, lack of role models during university education, weak research skills and critical evaluation of research, as well as ignoring the importance of life-long learning, most physiotherapists are not able to fully apply evidence in their clinical practice. A comprehensive program for educating the physiotherapists can be an effective method to improve the physiotherapists’ overall level of knowledge as well as the quality of the health care services they provide.

Introduction: Consequences of cerebral palsy can cause significant influences on physical and psychological capabilities of adults with cerebral palsy and affect on their quality of life. The purpose of this study was to investigate the relationship between quality of life with hypertonia and ambulation status in young adults with spastic cerebral palsy. Materials and Methods: In an analytical cross sectional study, 70 participants (40 women ،30 men, age range 20 to 40 years, mean age + SD, 26.24 ± 5.07) with spastic cerebral palsy were recruited in this study. They were selected from three Ra’ad Rehabilitation Goodwill Complexes in Tehran and Karaj cities. Quality of life (QOL), ambulation status, knee extension, and ankle dorsi flexion range of motion were measured by World Health Organization Qualit of life questionnaire (WHOQOL- BREF), functional ambulation category and manual goniometer, respectively. To analyze the data, Pearson and spearman correlation coefficient, Mann-Whitney U test, Independent sample T test were used. Results: We found no correlation between ambulation status and ankle dorsi flexion range of motion with quality of life domains. However, psychological and environmental domains showed low correlations with knee extension range of motion (respectively r = 0.26 and r = 0.28). Also, no significant difference was found between males and females in QOL domain scores. Conclusion: Probably knee extension range of motion could affect on psychological and environmental domains in adults with spastic cerebral palsy. Also, impairments and physical limitations seems to have a less pronounced effect on health-related quality of life in adults with cerebral palsy. Keywords: Quality of life, Ambulation status, Range of motion, Cerebral palsy

Abstract Background: Consequences of cerebral palsy in adulthood can affect physical, psychological capabilities and quality of life. The purpose of this study was to investigate the relationship between quality of life with spasticity and level of motor function in Iranian young adults with spastic cerebral palsy who were community dweller. Methods: In an analytical cross sectional study, 77 participants with spastic cerebral palsy (44 women، 33 men) with age range of 20 to 40 years; (mean age 26.19±5 yr) took part in this study. They were enrolled from three Raad Rehabilitation Goodwill complexes in Tehran and Karaj cities. All subjects were recruited through convenient sampling. Severity of Spasticity for knee flexors was measured with Modified Tardieu Scale. In addition, the level of motor function, and quality of life were assessed respectively through Gross Motor Function Classification System and World Health Organization Quality of life questionnaire (WHOQOL- BREF). To analyze data, Pearson and spearman correlation coefficient was used. Results: No correlation found between quality of life with knee flexor muscles spasticity and level of motor function (p> 0.05). Conclusion: Quality of life as a multi dimensional concept has been impacted by many factors such as physical status, environmental issues and culture. Possibly, severity of spasticity and level of function have a less pronounced effect on quality of life in community dwelling adults with cerebral palsy.

Background: The Motricity Index was used to measure strength in upper and lower extremities after stroke. The weighted score based on the ordinal 6 point scale of Medical Research Council was used to measure maximal isometric muscle strength. There is dearth of articles dealing with the reliability of this method. Therefore, the aim of this study was to determine the test retest reliability of Motricity Index strength assessments for paretic lower limb in 20 chronic stroke patients with one week interval. Methods: In a cross sectional study, intrarater reliability of lower extremity Motricity Index strength assessments with one week interval were measured. Result: The SPSS 18 was used for analysis of data. Two-way random-consistency model of ICC was used for assessment of test-retest reliability. The ICC values showed high reliability of strength measurement of Motricity Index (ICC=0.93). Conclusion: The Motricity Index can be a reliable instrument for measuring the strength of involved lower extremity when assessment is done by one rater following chronic stroke.