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Objectives: It seems that psycho-physical factors of stroke patients undergoing Transcranial direct current stimulation (tDCS) treatment can affect implicit motor learning process in patient with stroke. The aim of this study was to determine the effects and adverse effects of tDCS on motor learning process in chronic unilateral stroke patients. Methods & Materials: This crossover, sham-controlled, randomized, blinded study was conducted in 2020 on 12 patients with chronic unilateral stroke (Mean±SD age, 60.33±1.87 years), (The Mean±SD time elapsed since the onset of the disease, 1.96±1.36 years) referred to Mobasher Kashani clinic in Hamadan, Iran who were selected using a convenience sampling technique. Patients were randomly divided in to 2 groups: experimental (dual tDCS+SRTT) (n=6) and sham (sham tDCS+SRTT) (n=6) groups. After 3 weeks of washing out period, patients in each group were treated in other brain stimulation group again. Data were collected using the record of reaction time and error of sequenced blocks by related software. Also, adverse effects of tDCS, pain or discomfort, attention and fatigue of patients were assessed by visual analogue scale (VAS) questionnaire. The data were analyzed using linear mixed effects. Results: Data analysis showed a considerable improvement in implicit motor learning in both brain stimulation groups. The most reported sensations were itching and tingling, which continued during all stimulation sessions. The pain or discomfort of the patients was negligible during the intervention sessions. Moreover, the type of brain stimulation, the time and their interaction had no significant effect on the fatigue, attention and pain of the patients (P>0.05). Conclusion: Dual-tDCS technique does not cause serious adverse effects in patients with stroke. It can be used as an effective and useful therapeutic strategy for increase in implicit motor learning in chronic stroke patients.

To determine the intra-rater reliability of modified-modified Schober's test for measuring lumbar flexion and extension in patients of lumbar radiculopathy.The case-control reliability study was conducted at the University of Lahore Teaching Hospital, Lahore, Pakistan, from March to September 2020, and comprised lumbar radiculopathy patients of either gender aged 35-60 years in group A and healthy controls in group B. Lumbar flexion and extension were measured by the same examiner on three different occasions. A non-stretching measuring tape was used in which the first two measurements were taken using the modified-modified Schober's test on the same day with a difference of 5 minutes, and the third measurement was taken three days later to assess reliability. To assess the test-retest reliability, intraclass correlation coefficient was calculated through two-way random analysis of variance. Standard error of measurement and minimal detectable change were also calculated. Data was analysed using SPSS 25.Of the 40 subjects, 20(50%) were in group A with a mean age of 45.00±6.72 years, and 20(50%) were in group B with a mean age of 49.60±6.65 years. Overall, there were 16(40%) male and 24(60%) female subjects. Within-day lumbar flexion and extension measurements were highly reliable in controls (intraclass correlation coefficient 0.93 for flexion and 0.96 for extension) as well as in patients (intraclass correlation coefficient 0.94 for flexion and 0.95 for extension). The high values of intraclass correlation coefficient 0.91 for flexion and 0.94 for extension in the controls and 0.83 for flexion and 0.92 for extension in the patients showed high reliability also for between-days measurements.The modified-modified Schober's test appeared to be a highly reliable technique for the measurement of lumbar flexion and extension in patients of lumbar radiculopathy as well as in healthy controls.

Introduction Fatigue is one of the most common disabling symptoms in patients with multiple sclerosis (MS) which is present in 75% of these patients and is usually associated with functional disabilities. According to the literature, there is no general agreement on the effectiveness of the existing treatments for fatigue in patients with MS. As transcranial direct current stimulation (tDCS) is a relatively new method in the treatment of fatigue symptoms in patients with MS, the purpose of this study was to systematically review published evidence conducted to assess the effects of tDCS on fatigue in patients with MS. Material & methods A thorough literature search of published articles was conducted from 1996 to 2019 in different databases including PubMed, Science Direct, OVID, Google Scholar, Cochrane Library, Scopus, Embase, ProQuest and web of science with keywords of “tDCS”, “multiple Sclerosis” and “Fatigue”. Results yielded 1017 studies, which after excluding articles based on duplication and title and abstract, 8 of them were selected for review in this study. Results The results from the literature revealed that six studies indicated positive effects of tDCS stimulation on fatigue reduction. In four studies stimulation was over the right dorsolateral prefrontal cortex (DLPFC); in three studies stimulation placed over the whole body’s primary somatosensory cortex (S1); and in one study stimulation applied over the posterior parietal cortex. In most studies, no serious side effects were reported. Conclusion Most studies revealed that tDCS can reduce the adverse effects of MS-related fatigue in particular cognitive type. As follow-ups were either absent or short period, as well as the application of treatment protocols and measurement instruments were different, it was very difficult to draw strong conclusion on the effects of tDCS in patients with MS. However, further large scale studies with long term follow-up are still recommended.

Introduction: Low-level laser is a pain-free and non-invasive treatment modality. It is used in many acute and chronic painful conditions. This study aimed to determine the correlation between pain intensity, functional disability, and range of motion using low-level laser therapy (LLLT) in patients with discogenic lumbar radiculopathy. Methods: This cross-sectional study was conducted as a part of a randomized controlled trial of LLLT to treat patients with discogenic lumbar radiculopathy in physical therapy departments of three different hospitals in Islamabad, Pakistan, from August 2021 to September 2021. The study was conducted according to STROBE guidelines. Fifty-Five patients from the experimental group of the trial were invited to participate in this study. The outcomes of the treatment were recorded on a semi-structured questionnaire on the first day and last day of their treatment from each patient’s pain intensity, functional disability, and Lumbar range of motion (L-ROM) (flexion and extension) by using the visual analogue scale (VAS) for pain intensity, Oswestry Disability Index (ODI) for functional disability, and dual inclinometer for L-ROM. The data were analyzed through SPSS version 26.0. Results: The results of the correlation coefficient/Pearson’s correlation of VAS, ODI, and dual inclinometer were varied. The strength of correlation between variables was weak to moderate (r=0.033 to 0.425) with statistically insignificant correlation coefficient (P > 0.05, 95% CI) except for lumbar flexion (P

Objective: To compare the effects of Virtual Reality exercises and routine physical therapy on pain and functional disability in patients with chronic low-back pain. Methods: The single-blind randomised controlled trial was conducted from April to October 2020 at the Physiotherapy Department of the Government Services Hospital, Lahore, Pakistan, and comprised patients of either gender, aged 25-50 years with chronic non-radiating low-back pain who were randomised into two equal groups. Group A received routine physical therapy, while group B received Virtual Reality exercises with routine physical therapy. Visual Analogue Scale and Modified Oswestry Disability Index were used to measure outcomes at baseline and after 4th, 8th and 12th sessions. Data was analysed using SPSS 24. Results: Of the 84 patients, there were 42(50%) in each of the two groups. There were 28((33%) males and 56(66.6%) females. The mean age in group A was 37.5+12.5 years and in group B it was 38.2+11.8 years. Pain score at baseline was 6.62+1.04 in group A and 6.50+1.24 in group B which decreased to 3.32+0.81 and 1.00+0.60 respectively after the 12th session (p

Purpose: To measure the intra-rater and inter-rater reliability of active lumbar extension and flexion movements using dual inclinometer with two different landmarking techniques. Method: The reliability study was conducted at the Physical Therapy Department of the University Teaching Hospital, The University of Lahore, Pakistan, in January 2020, and comprised patients of either gender aged >18 years with mild or symptomatic lower back pain, and healthy subjects s controls. Repeated measurements with dual inclinometer were taken by two examiners and data was recorded by two separate observers. A set of three active lumbar extension and flexion movements were performed for an initial warm-up. The examiners repeated a palpation of bony landmarks prior to each trial. The two different landmarking techniques were applied on the lumbar spine to identify the start and end points. Both the examiners measured each participant thrice. For each examiner and each landmarking technique, the three data sets were acquired for active lumbar extension and flexion for a total of 120 sets per session per examiner per landmarking. Each set comprised three alternating active lumbar extension and flexion movements. Data was analysed using 26. Results: Of the 40 subjects with mean age 27.8+11.0 years, 19(48%) were males and 21(52%) were females. There were 15(38%) cases; 6(40%) males and 9(60%) females. The remaining 25(62%) were controls. The two landmarking techniques with dual inclinometer produced a high to very high intra-rater reliability (intraclass correlation coefficient:0.73-0.91) ---Continue

Background Context. In recent times, the use of low-intensity lasers for physical therapy has been shown to significantly reduce pain with a variety of causes. Purpose. To determine the effectiveness of low-level laser therapy (LLLT) in patients with discogenic lumbar radiculopathy and correlation among pain intensity, functional disability, and lumbar range of motion (LROM). Study Design/Setting. A double-blind RCT was conducted at physical therapy departments of different hospitals of Islamabad, Pakistan. The study period was March 2020 to August 2021. Patient Sample. The study comprised 110 patients with acute LBP and unilateral discogenic lumbar radiculopathy. Outcome Measures. The outcomes of the treatment were measured on the first day and then after 18 sessions from each patient’s pain intensity, functional disability, L-ROM, and straight leg raise by using visual analogue scale, Oswestry disability index, dual inclinometer, and straight leg raise test. Methods. A total of 110 participants with a mean age of 38 ± 7.4 years were randomly assigned into two groups of 55 each. The experimental group of 55 patients was treated with LLLT and conventional physical therapy. The control group of 55 patients was treated with conventional physical therapy alone. Both groups had received 18 treatment sessions. The data were analyzed through SPSS-21.0. Results. The results of the Wilcoxon signed-rank test score as well as Mann–Whitney U test indicated a statistically significant difference in values ( p

Objective Spinopelvic alignment is increasingly considered as an essential factor for maintaining an energy-efficient posture in individuals with normal or pathological status. Although several previous studies have shown that changes in the sagittal spinopelvic alignment may occur in patients undergoing total hip arthroplasty (THA), no review of this area has been completed so far. Thus, the objective of this scoping review was to summarize the evidence investigating changes in spinopelvic alignment and low back pain (LBP) following THA. Data sources We adhered to the established methodology for scoping reviews. Four electronic databases were systematically searched from inception-December 31, 2021. Study selection We selected prospective or retrospective observational or intervention studies that included patients with THA. Data extraction Data extraction and levels of evidence were independently performed using standardized checklists. Data synthesis A total of 45 papers were included in this scoping review, involving 5185 participants with THA. Pelvic tilt was the most common parameter measured in the eligible studies (n = 26). The results were not consistent across all studies; however, it was demonstrated that the distribution of pelvic tilt following THA had a range of 25° posterior to 20° anterior. Moreover, decreased sacral slope and lower pelvic incidence were associated with increased risk of dislocation in patients with THA. Lumbar spine scoliosis did not change significantly after THA in patients with bilateral hip osteoarthritis (5.50°(1.16°) vs. 3.73°(1.16°); P-value = 0.29). Finally, one study indicated that LBP improvement was not correlated with postoperative changes in spinopelvic alignment parameters. Several methodological issues were addressed in this study, including no sample size calculation and no type-I error adjustment for outcome multiplicity. Conclusions Changes in spinopelvic alignment may occur after THA and may improve with time. Patients with a THA dislocation usually show abnormal spinopelvic alignment compared to patients without a THA dislocation. LBP usually improves markedly over time following THA.

The aim of this study was to determine the asymmetry of cervical multifidus (MF) and longus colli (LC) muscles in patients with unilateral chronic radicular neck pain (CRNP) and healthy subjects using ultrasonography.Ninety five individuals (50 patients with unilateral CRNP and 45 healthy subjects) participated in this study. The size of the cervical MF and LC muscles; anterior posterior dimension (APD) and lateral dimension (LD); were bilaterally measured in a relaxed state using ultrasonography.Patients with CRNP showed greater asymmetry in the cervical MF and LC muscles size than the healthy subjects. The mean percentages differences between sides for MF and LC muscles size was higher in patients than that of healthy subjects (for both APD and LD; P0.05). The ratio of smaller to larger dimensions of the cervical MF and LC muscles for patients were significantly less than that of healthy controls (for both APD and LD; P0.05).The results indicated that cervical MF and LC muscles showed higher asymmetry between sides and lesser ratio of smaller size to larger size in patients with CRNP as compared with healthy subjects. Current results confirmed the presence of MF and LC muscles atrophy in subjects with CRNP.

BACKGROUND: This study aimed to estimate the within-day and between-day reliabilities of sonoelastography to measure the strain ratios of lumbopelvic muscles, including multifidus (MF), piriformis (P), quadratus lumborum (QL), and gluteus medius (GM), in a resting position by the sonoelastography device in both patients with unilateral discogenic lumbar pain and healthy individuals. Failthe treatment of deep infection of peri-articular fracture fixation. METHODS: First of all, the participants (n=25) were enrolled in this study, including patients (n=15) and healthy subjects (n=10). In the first session, an examiner estimated the strain ratio of lumbopelvic muscle three times by sonoelastography. The last session was held at a one-week interval. The collected data were analyzed using an intraclass correlation coefficient (ICC) and a standard error of measurement. RESULTS: The ICC calculated for MF, P, QL, and GM measurements indicated good to excellent reliabilities in both healthy and patient groups for within- and between-intra-examiner reliabilities, which were obtained at 0.94-0.91 and 0.86-0.86, 0.87-0.89 and 0.82-0.82, 0.88-0.86 and 0.86-0.86, 0.88-0.84 and 0.84-0.84, respectively. Furthermore, the standard errors of intra-examiner reliability for MF, P, QL, and GM strain ratio measurements in both healthy and subject groups were estimated at the ranges of 0.52-0.51 and 0.64-0.65, 0.60-0.62 and 0.77-0.78, 0.23-0.25 and 0.25-0.25, 0.25-026 and 0.30-0.35, respectively. CONCLUSION: The results revealed that sonoelastography seemed to be a reliable instrument to measure MF, P, QL, and GM muscle strain ratios in healthy subjects and patients with unilateral lumbar radicular pain. However, further studies are recommended to support the findings of the present study in other patients.

Objective Dry needling is a treatment technique used by clinicians to relieve symptoms in patients with tension-type headache (TTH), cervicogenic headache (CGH), or migraine. This systematic review’s main objective was to assess the effectiveness of dry needling on headache pain intensity and related disability in patients with TTH, CGH, or migraine. Methods Medline/PubMed, Scopus, Embase, PEDro, Web of Science, Ovid, Allied and Complementary Medicine Database/EBSCO, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and trial registries were searched until April 1, 2020, along with reference lists of eligible studies and related reviews. Randomized clinical trials or observational studies that compared the effectiveness of dry needling with any other interventions were eligible for inclusion. Three reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects meta-analyses were performed to produce pooled-effect estimates (Morris dppc2) and their respective CIs. Results Of 2715 identified studies, 11 randomized clinical trials were eligible for qualitative synthesis and 9 for meta-analysis. Only 4 trials were of high quality. Very low-quality evidence suggested that dry needling is not statistically better than other interventions for improving headache pain intensity in the short term in patients with TTH (SMD −1.27, 95% CI = −3.56 to 1.03, n = 230), CGH (SMD −0.41, 95% CI = −4.69 to 3.87, n = 104), or mixed headache (TTH and migraine; SMD 0.03; 95% CI = −0.42 to 0.48, n = 90). Dry needling provided significantly greater improvement in related disability in the short term in patients with TTH (SMD −2.28, 95% CI = −2.66 to −1.91, n = 160) and CGH (SMD −0.72, 95% CI = −1.09 to −0.34, n = 144). The synthesis of results showed that dry needling could significantly improve headache frequency, health-related quality of life, trigger point tenderness, and cervical range of motion in TTH and CGH. Conclusions Dry needling produces similar effects to other interventions for short-term headache pain relief, whereas dry needling seems to be better than other therapies for improvement in related disability in the short term. Impact Although further high-methodological quality studies are warranted to provide a more robust conclusion, our systematic review suggested that for every 1 or 2 patients with TTH treated by dry needling, 1 patient will likely show decreased headache intensity (number needed to treat [NNT] = 2; large effect) and improved related disability (NNT = 1; very large effect). In CGH, for every 3 or 4 patients treated by dry needling, 1 patient will likely exhibit decreased headache intensity (NNT = 4; small effect) and improved related disability (NNT = 3; medium effect).

BACKGROUND: To evaluate intra and intersession reliability of the Center of Pressure (COP) parameters in Anterior Cruciate Ligament Reconstructed (ACLR) athletes with and without ankle vibration using a dual-task paradigm. METHODS: Postural sway of 14 ACLR individuals was assessed during a single-leg stance on a force platform. COP parameters were assessed with manipulating sensory inputs via vision and ankle vibration under single and dual-task conditions. The outcome variables included COP displacement in medial-lateral (ML) and anterior-posterior (AP) range, mean velocity (mV), and area. During dual-task conditions, the auditory Stroop Task was applied. Intraclass correlation coefficient (ICC) values and standard error of measurement (SEM) were assessed for relative and absolute reliability. RESULTS: The COP measures had moderate to very high intrasession reliability (ICC range: 0.51-0.93) for conditions with vibration and cognitive task, with the highest ICCs for mV and the lowest for area, regardless of eyes being open or closed. The intersession reliability was moderate to high for mV (ICC range: 0.60-0.82) and little to very high (ICC range: 0.21-0.97) for the range of ML and AP, as well as an area in conditions with vibration and cognitive task. CONCLUSION: The mV is the most reliable COP parameter for assessing postural control under ankle vibration and dual-task conditions for both operated and non-operated sides. During closed-eye conditions, the application of vibration affected the intersession reliability with decreased ICCs on the operated side and increased ICCs on the non-operated side.

Background Oswestry Disability Index (ODI) is broadly used in clinical and research settings for assessing the disability level in patients with lumbar radiculopathy but it has not been translated into Urdu language according to the pre-established translation guidelines as well as the validity and reliability of ODI Urdu version has not been tested yet. The aim of this study was to translate ODI in native Urdu language (ODI-U) according to recommended guidelines and to measure its psychometric properties in Urdu speaking patients suffering from lumber radiculopathy. Methods Out of 108 participants, 54 were healthy (who filled ODI-U) and 54 were patients of lumber radiculopathy. The patients were administered through ODI-U, visual analogue scales for disability (VAS disability), pain intensity (VAS pain) and SF-36 at baseline and after 3 days. Reliability was investigated through test-retest method, internal consistency, standard error of measurement (SEM) and smallest detectable change (SDC). ODI-U was assessed for exploratory factor analysis, construct (convergent and discriminative) validity and content validity. Alpha level Results ODI-U revealed excellent test-retest reliability for total score (ICC2,1 = 0.95) and for all item (ICC2,1 = 0.72–0.98). Cronbach’s alpha of 0.89 showed excellent internal consistency and moderate correlation between ODI-U total score and each item through spearman’s correlation coefficient (r = 0.51–0.76). One factor structure was created, explaining 52.5% variance. There was no floor and ceiling effect of total ODI-U score. Content validity was assessed through conducting interviews with patients and incorporating expert’s opinions. The discriminative validity was measured by independent sample t-test, where significant difference between healthy and patients (P r = 0.49) and VAS disability (r = 0.51) but moderate negative correlation with all SF-36 domains (r = − 0.43to − 0.63). Conclusion ODI-U showed adequate psychometric properties. ODI-U was found to be a reliable and a valid tool to measure the level of disability in Urdu-speaking patients with lumber radiculopathy.

BACKGROUND: Trunk muscles play an important role in providing both mobility and stability during dynamic tasks in athletes. The purpose of this study was to evaluate the within-day and between-day reliability of ultrasound (US) in measuring abdominal and lumbar multifidus muscle (MF) thickness in athletes with and without hamstring strain injury (HSI). METHODS: Fifteen male soccer players (18-30 years old) with and without HSI were evaluated using two US probes (50 mm linear 7.5 MHZ and 70 mm curvilinear 5 MHz). The abdominal muscle thickness as well as the cross sectional area (CSA) of the MF was measured. To determine within and between days reliabilities, the second and third measurements were repeated with two hours and one week intervals, respectively. RESULTS: Intraclass correlation coefficients for athletes with and without HSI demonstrated good to high reliability for the abdominal muscle thickness (0.82 and 0.93) and CSA of the MF muscle (0.84 and 0.89, respectively). CONCLUSION: Our results indicated that US seemed to be a reliable instrument to measure abdominal and lumbar multifidus muscle thickness in soccer players with and without HSI. However, further studies are recommended to support the present study findings in other athletes.

Objectives: Sensory neuropathy is the major cause of ulceration in diabetic patients. Periodical sensory examination is an appropriate method to detect neuropathy and decrease the risk of diabetic foot ulcer. Semmes–Weinstein Monofilaments (SWM) and tuning fork on/off test are widely used to assess pressure and vibration sensitivity. The present study evaluated the inter- and intra-rater reliability of SWM and tuning fork to measure pressure and vibration sensations in diabetic patients. Methods: Following ethical approval, 34 diabetic patients without foot ulceration were recruited. Feet kit SWM and tuning fork were used for pressure and vibration sensation evaluation, respectively. Measurements were performed twice on the first session with an hour interval to assess within-day reliability and the third one was demonstrated 7 days later to assess between-days reliability. Results: Within-day Intra-class Correlation Coefficient (ICC) analysis indicated excellent levels of inter- and intra- rater reliability (ICC>0.75) for feet kit SWM in all foot regions and 128 Hz and 256 Hz tuning forks. Excellent between-days intra-rater reliability (ICC>0.75) was also obtained for SWM; however, the ICC of tuning fork was moderate. Between-days inter-rater reliability of SWM and tuning fork were high and poor, respectively. Discussion: The obtained results indicated that SWM and tuning fork seemed to be highly reliable to measure pressure and vibration sensations in diabetic patients. However, further studies are required to support the results of current study.

Objective The purpose of the present study was to compare the reliability of sonography in the evaluation of abdominal and multifidus muscles size between healthy subjects and patients with scoliosis. Methods In this study, 20 healthy males and 20 male patients with scoliosis (20–50 years old) were recruited. Multifidus and abdominal muscles (transversus abdominis, internal and external oblique) size were assessed by sonography. Three images were recorded; the first and second images were taken on the same day with an hour interval to evaluate within-day reliability, and the third image was taken one-week later to assess between-day reliability. Results Intraclass correlation coefficient (ICC = 0.82–0.91) demonstrated high within-day reliability of sonography in the assessment of abdominal muscle thickness in both groups. In addition, high between-day reliability was observed for these muscles in both healthy and patient groups (ICC = 0.80–0.89). Within-day and also between-day reliability of multifidus muscle were shown to be high in the healthy group (ICC = 0.81–0.88) and the patient group (ICC = 0.78–0.85). Overall, within-day reliability was higher than between-day reliability and also the reliability of sonography in healthy subjects was greater than of those suffering from scoliosis. Conclusions According to the results, sonography was shown to be a highly reliable imaging technique for assessment of abdominal and multifidus muscle size in healthy males and those suffering from scoliosis.

Background The first aim of this study was to determine the effect of a vibro-medical insole on pressure sensation and the second was to measure the effects of a vibro-medical insole with and without random noise on plantar pressure distribution in diabetic patients with mild-to-moderate peripheral neuropathy. Methods Twenty patients with mild-to-moderate diabetic neuropathy were recruited in the clinical trial pre-test, post-test study. A medical insole was made for each participant and a vibratory system was inserted into it. Pressure sensation was evaluated before and after the 30-min walk using the vibro-medical insole with added random noise by Semmes-Weinstein Monofilaments. Peak pressure data was measured before and after 30-min walking with a vibro-medical insole with and without random noise by the Pedar-x system. Findings Pressure sensations showed improvement after 30-min walking with the vibro-medical insole with added random noise at the heel, metatarsophalangeal heads and hallux of both feet in all participants (p Interpretation Thirty minute walking with a vibro-medical insole seems to improve pressure sensation and alter peak pressure in diabetic patients with mild-to-moderate peripheral neuropathy. This work suggests that vibro-medical insoles can be used for daily living activities and possibly decreases the risk of ulceration in diabetic neuropathy patients.

Rehabilitative ultrasound (US) imaging is one of the popular methods for investigating muscle morphologic characteristics and dimensions in recent years. The reliability of this method has been investigated in different studies. As studies have been performed with different designs and quality, reported values of rehabilitative US have a wide range. The objective of this study was to systematically review the literature conducted on the reliability of rehabilitative US imaging for the assessment of deep abdominal and lumbar trunk muscle dimensions. The PubMed/MEDLINE, Scopus, Google Scholar, Science Direct, Embase, Physiotherapy Evidence, Ovid, and CINAHL databases were searched to identify original research articles conducted on the reliability of rehabilitative US imaging published from June 2007 to August 2017. The articles were qualitatively assessed; reliability data were extracted; and the methodological quality was evaluated by 2 independent reviewers. Of the 26 included studies, 16 were considered of high methodological quality. Except for 2 studies, all high-quality studies reported intraclass correlation coefficients (ICCs) for intra-rater reliability of 0.70 or greater. Also, ICCs reported for inter-rater reliability in high-quality studies were generally greater than 0.70. Among low-quality studies, reported ICCs ranged from 0.26 to 0.99 and 0.68 to 0.97 for intra- and inter-rater reliability, respectively. Also, the reported standard error of measurement and minimal detectable change for rehabilitative US were generally in an acceptable range. Generally, the results of the reviewed studies indicate that rehabilitative US imaging has good levels of both inter- and intra-rater reliability.

Peripheral sensory neuropathy seems to be the main risk factor for diabetic foot ulceration. Previous studies demonstrated that stochastic resonance can improve the vibrotactile sensation of diabetic patients. The aim of this study was to evaluate the effects of Vibro-medical insole on pressure and vibration sensation in diabetic patients with mild-to-moderate peripheral neuropathy. A total of 20 patients with mild-to-moderate diabetic neuropathy were included in the pre-test and post-test clinical trial study. Vibro-medical insole consists of medical insole and vibratory system. Medical insole was made independently for each participant and vibratory system was inserted in it. Pressure and vibration sensation were evaluated before and after 30-min walking with Vibro-medical insole. Semmes-Weinstein monofilaments and tuning fork were used to evaluate pressure and vibration sensation, respectively. Pressure sensation showed significantly improvement using Vibro-medical insole at the heel, first and fifth metatarsophalangeal heads, and hallux of both feet in all participants (p 0.001). Vibration sensation also improved at the big toe of both feet with 256 Hz tuning fork (p 0.05) but no statistically significant effect was found with 128 Hz tuning fork (p 0.05). Vibro-medical insole significantly improved pressure and vibration sensation of the foot in diabetic patients with mild-to-moderate peripheral neuropathy. The results suggest that Vibro-medical insole can be used for daily living activities to overcome sensory loss in diabetic neuropathy patients.

Background Context Measurement of cervical spine range of motion (ROM) is often considered to be an essential component of cervical spine physiotherapy assessment. Purpose This study aimed to investigate the reliability and validity of an iPhone application (app) (Goniometer Pro) for measuring active craniocervical ROM (ACCROM) in patients with non-specific neck pain. Study Design/Setting A cross-sectional study was conducted at the musculoskeletal biomechanics laboratory located at Iran University of Medical Sciences. Patient Sample Forty non-specific neck pain patients participated in this study. Outcome Measures The outcome measure was the ACCROM, including flexion, extension, lateral flexion, and rotation. Method Following the recruitment process, ACCROM was measured using a universal goniometer (UG) and iPhone 7 app. Two blinded examiners each used the UG and iPhone to measure ACCROM in the following sequences: flexion, extension, lateral flexion, and rotation. The second (2 hours later) and third (48 hours later) sessions were carried out in the same manner as the first session. Intraclass correlation coefficient (ICC) models were used to determine the intra-rater and inter-rater reliability. The Pearson correlation coefficients were used to establish concurrent validity of the iPhone app. Minimum detectable change at the 95% confidence level (MDC95) was also computed. Results Good intra-rater and inter-rater reliability was demonstrated for the goniometer with ICC values of ≥0.66 and ≥0.70 and the iPhone app with ICC values of ≥0.62 and ≥0.65, respectively. The MDC95 ranged from 2.21° to 12.50° for the intra-rater analysis and from 3.40° to 12.61° for the inter-rater analysis. The concurrent validity between the two instruments was high, with r valuesof ≥0.63. The magnitude of the differences between the UG and iPhone app values (effect sizes) was small, with Cohen d values of ≤0.17. Conclusions The iPhone app possesses good reliability and high validity. It seems that this app can be used for measuring ACCROM.

To determine the effect of mobilization and routine physiotherapy on pain, disability, neck range of motion (ROM) and neck muscle endurance (NME) in patients having chronic mechanical neck pain (NP).Sixty eight patients with chronic mechanical NP were randomly allocated into two groups by using a computer generated random sequence table with 34 patients in the multi-modal mobilization group and 34 patients in the routine physiotherapy group. Baseline values for pain, disability, NME, and neck ROM were recorded using visual analogue scale (VAS), neck disability index (NDI), neck flexor muscle endurance test and universal goniometer respectively, before the treatment. Each patient received 10 treatment sessions over a period of four weeks and at the end of four weeks all the outcome measures were recorded again.A paired t-test revealed significant pre to post treatment differences for all outcome measures in both groups (p ≤ 0.001 in all instances). An independent t-test revealed statistically significant differences for pain, disability, NME, and neck ROM in favor of the multi-modal mobilization group with a between group difference of 1.57 cm for VAS (p 0.001), 11.74 points for NDI (p = 0.001), 18.45 s for NME (p 0.001) and 6.06-8.24° for neck ROM (p 0.05).The results suggest that a combination of cervical mobilization with routine physiotherapy is more effective for reducing pain and disability and improving NME and neck ROM in patients with chronic mechanical NP compared to routine physiotherapy alone.

Neck pain (NP) is a common occupational health problem associated with a number of professions. Many studies indicate that NP is common among teachers, yet no published study was found to address the prevalence and risk factors of NP in Iranian school teachers. The purpose of the current study was to assess the prevalence and risk factors for NP among school teachers in Iran. A cross-sectional study was conducted on 586 randomly selected primary and high schools teachers from 22 schools in Tehran, Iran. Point, last month, last 6 months, annual, and lifetime prevalence rates of NP were 24%, 29%, 33%, 37%, and 43%, respectively. There was a significant association and increased prevalence of NP with a number of risk factors such as; being female, age, general health, length of employment, regular exercise and job satisfaction (P < 0.05 in all instances). Therefore, some individual and occupational factors may make conditions relevant for the development of NP among teachers.

OBJECTIVES Low back pain (LBP) is a common musculoskeletal disorder among different age groups, including adolescents. The purpose of this study was to compare the abdominal muscle thickness between healthy adolescents and those with LBP. METHODS One hundred sixty healthy high school adolescents and 80 high school adolescents with LBP participated in the study. All participants were asked to complete a demographic questionnaire and also a visual analog scale and the Oswestry Disability Questionnaire to evaluate the pain intensity and functional disability. Then abdominal muscle thickness was examined with ultrasonography. RESULTS The healthy high adolescents included 80 boys and 80 girls, and the adolescents with LBP included 40 boys and 40 girls. The results showed a significant difference between healthy adolescents and those with LBP in terms of abdominal muscle thickness (P .05). CONCLUSIONS The thickness of abdominal muscles was lower in adolescents with LBP. Future studies with a larger sample and a wider age range are recommended to support the results of this study.

Neck pain is one of the major public health problems, which has a great impact on people's lives. The purpose of this study was to systematically review published studies conducted on the effect of different exercise programs on activity, size, endurance, and strength of deep cervical flexor (DCF) muscles in patients with chronic neck pain. The PubMed, Science Direct, OVID, Google scholar, Cochrane Library, and Physiotherapy Evidence Databases were searched to determine relevant articles published from 1990 to March 2016. The articles were qualitatively assessed based on the Physiotherapy Evidence Databases scale for randomized controlled trials studies. Nine articles were identified and evaluated in the final analysis. Four studies had moderate quality, and five studies had good quality. From those nine studies, eight studies gave support to the effectiveness of specific low-load exercise training on DCF muscles parameters, while one study reported no significant difference between this exercise and other cervical exercise programs. The results of reviewed studies are in favor of specific low-load craniocervical flexion exercise, which seems to be a highly effective exercise regimen compared to other types of exercises in improving DCF muscles impairments in patients with chronic neck pain.

Objectives To evaluate Ultrasound Imaging (USI) reliability for measurement of lumbar multifidus (LMF) muscle thickness and cross sectional area (CSA) at rest and during contraction in patients with unilateral lumbar disc herniation. Setting Laboratory. Design Reliability Study. Participants Thirty patients, aged 25–50 years (37.55 ± 9.55), with unilateral L4-L5 lumbar disc herniation participated in this study. Main outcome measures Thickness and CSA of LMF were measured using B-mode ultrasound by two raters in prone position. Results Same day and multiple day inter-rater and same day intra-rater reliability showed good to excellent reliability (intraclass correlation coefficients ranged from 0.70 to 0.91). Also standard error of measurement and minimal detectable change for USI reliabilities ranged from 0.06 to 0.57 and 0.16 to 1.31, respectively. Conclusions Reliability of USI for measurements of LMF muscle thickness and CSA was high, and consistent with previous studies conducted on reliability of USI to measure LMF dimensions in other populations.

Objective: To evaluate the eligibility of the movement-based classification systems in the diagnosis of patients with low back pain. Methods: The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta -Analysis guidelines. Different databases including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest and Google Scholar were searched from January 1990 to December 2017. All studies assessed the reliability and validity of the movement-based classification systems to diagnose patients with low back pain were included. The keywords used to search the studies were: �reliability�, �validity�, �classification�, �movement impairment� and �low back pain�. Study selection and data extraction were performed by two independent reviewers. Results: Sixteen articles were met the inclusion criteria. Of these articles, 13 studies assessed the reliability and validity of movement-based classification systems to categorize patients with low back pain. Two out of 16 articles compared patients with low back pain and healthy subjects and one article had no control group. Conclusions: The results of the reviewed studies demonstrated that movement-based classification systems are valid and reliable enough to categorize patients with low back pain. © 2020 Elsevier Ltd

[Purpose] The purpose of this study was to assess intra-rater and inter-rater reliability of musculoskeletal ultrasound (MSKUS) as a tool to measure supraspinatus tendon thickness in healthy subjects. [Subjects and Methods] Twenty healthy subjects were assessed in similar sitting position. Two experienced musculoskeletal ultrasound specialists measured supraspinatus tendon thickness. Tendon was measured twice in one day by each of two raters with an interval of one hour for within day reliability and was re-measured following one week for between days reliability. Data analysis was performed using the intraclass correlation coefficient (ICC) and standard error of measurement (SEM). [Results] Results reflected excellent within day intra-rater and inter-rater reliability with Mean ± standard deviation (SD)=5.14 ± 0.83 and 5.17 ± 0.78, ICC (2,1)=0.89-0.93 and ICC (2,2)=0.98 (0.95-0.99) and SEM=0.18-0.18 and 0.17 while between days intra-rater rater and inter-rater reliability with Mean ± SD=5.14 ± 0.83 and 5.17 ± 0.78, ICC(2,1)=0.88-0.90 and ICC(2,2)=0.95 (0.88-0.98), SEM=0.17-0.38 and 0.17 [Conclusion] The results of the current study indicate that MSKUS is a reliable tool for measuring supraspinatus tendon thickness in healthy subjects.

Ankle-foot orthoses could be utilized both with and without shoes. While several studies have shown that ankle-foot orthoses improve gait abilities in hemiplegic patients, it remains unclear whether they should be used with shoes or without.The study purpose was to compare the effect of standard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle-foot orthosis.Randomized clinical study.Thirty post-stroke hemiplegic patients participated in this study randomly assigned to two groups. Group I received standard shoes + ankle-foot orthosis and group II were provided with rocker shoes + ankle-foot orthosis. Their functional mobility and energy expenditure parameters including timed up and go, timed up stairs, timed down stairs, preferred walking speed, and oxygen (O2) cost (mL/kg/m) were measured.In group I, no significant changes were seen in outcome measures after wearing standard shoes. While in group II, O2 cost and timed up and go time significantly decreased, and preferred walking speed increased when patients wore rocker shoes. Also, there was a significant difference between rocker shoes and standard shoes in improvement of timed up and go, preferred walking speed, and O2 cost.When patients using ankle-foot orthosis wore rocker shoes, their functional mobility improved and oxygen cost diminished. Also, rocker shoes was significantly more effective than standard shoes in improving functional mobility parameters.This study suggests that in post-stroke hemiplegic patients using ankle-foot orthosis, wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle-foot orthosis only. Thus, in stroke patients, the combination of ankle-foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle-foot orthosis efficacy investigations.

Introduction: Ultrasound imaging is a non-invasive method for observing changes in muscle thickness of the abdominal muscles. Accurate measurements depend on the control of all potential sources of error. In this study we investigated whether the level of stomach fullness might be a source of error not only in the resting thickness but also in contractile thickness (abdominal hallowing maneuver) abdominal muscles. Materials and Methods: Thirty healthy male subjects ranging in age from 18 to 26 years volunteered for this study. Ultrasound image of the four abdominal muscles on both sides were obtained at rest (at the end of exhalation) and during abdominal hallowing maneuver before and after food consumption. Abdominal muscle thickness was assessed using a 3.5 MHZ linear head transducer in B-mode condition. Results: The mean thickness for right and left rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles at rest before food consumption were 10.8-10.7, 6.2-6.1, 8.6-8.3, 4.1-4.1 mm, respectively and after food consumption were 10.3-10.3, 5.6-5.5, 7.3-7.3, 3.4-3.6 mm, respectively. The mean thickness for right and left rectus abdominis, external oblique, internal oblique, and transversus abdominis muscles during Abdominal Hollowing Maneuver before food consumption were 11-10.8, 6.1-6.3, 10-10. 5.3-5.5 mm, respectively and after food consumption were 10.5-10.6, 5.7-5.7, 8.8-8.7, 4.4-4.5 mm, respectively. Conclusion: After food consumption the thicknesses of all abdominal muscles in both sides are decreased, and therefore, food consumption must be considered when measuring abdominal muscle thickness using sonography

The purpose of this study was to investigate the effects of a total-contact insole with and without subthreshold mechanical random noise on the balance control in diabetic patients with mild-to-moderate peripheral neuropathy. Twenty diabetic patients with mild-to-moderate neuropathy was recruited to this study. A total-contact insole was prototyped and vibratory motors were embedded into it. The parameters of the center of pressure (amplitude, velocity, and phase plane portrait) were analyzed after 30-minute walks with the shoe only, the shoe with vibro-medical insole with and without vibrations in eyes open and closed condition. The center of pressure amplitude, velocity, and phase plane portrait in the anterior-posterior and medio-lateral directions were significantly decreased using a vibro-medical insole without vibration in the eyes open condition (p 0.05), as compared to the shoe, and with vibro- medical insole with vibration in both eyes open and closed conditions (p 0.05) compared to the shoe. A significant drop was observed in the center of pressure amplitude, velocity and phase plane portrait parameters when the vibro-medical insole with vibration was used compared to vibro- medical insole without vibration in eyes closed condition (p 0.05). The use of vibro-medical insoles was found to improve the patient's balance control, as compared to the shoe. In the eyes closed condition, an improvement in the balance control was observed only with vibro-medical insole with vibration rather than vibro-medical insole without vibration or the shoe. Current finding suggest that a combination of the total-contact insole with vibration may improve the balance control remarkably in diabetic patients with mild-to-moderate neuropathy.

The aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions.Twenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography.The size of multifidus was smaller in patients than healthy individuals at rest state (P 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P 0.001) and neck movements (P 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P 0.05).Results of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.

Background: Plantar fascia is a thick connective tissue on the plantar side of the foot, which provides the normal shape of the longitudinal arch. Plantar fasciitis is an inflammation on the medial tuberosity of calcaneus on the inferior side that may cause heel pain. Imaging plays an important role in the diagnosis of heel pain. Ultrasonography has been recognized as an effective imaging tool for assessing plantar fascia thickness, monitoring the effect of different interventions and guiding therapeutic interventions in patients with plantar fasciitis. Operator dependency is a major limitation for the common use of ultrasound. Objectives: The purpose of the present study was to evaluate intra and inter-rater reliability of ultrasound in measurements of the thickness of plantar fascia in different points of plantar fascia. Patients and Methods: Twelve healthy (without any lower extremity disorder) young (above 18) volunteers were recruited. Both heels were scanned in the sagittal plane by two raters. Subjects lied prone. Thickness of the plantar fascia was measured at the insertion point of the calcaneus, 5 and 10 mm from insertion of the calcaneus. For statistical analysis, intraclass correlation coefficients (ICC), 95% confidence intervals (CI), and linear mixed model ANOVA effects were run. Results: Our results showed that both intra and inter-rater reliability of plantar fascia thickness, measured by ultrasound, have high reproducibility (ICC > 0.821, ICC > 0.849). The linear mixed model suggested that neither rater nor time had a significant effect on the rater’s measurements. Conclusion: The results of the present study indicate that both intra and inter-rater of measuring plantar fascia thickness at three points using ultrasound seemed to be high.

This review compared knee muscle activity between ACL-deficient (ACLD) patients and healthy controls during gait, to find out whether the available electromyography (EMG) studies support Quadriceps (Q-ceps) inhibition or hamstring facilitation during gait in ACLD patients. A systematic review was conducted to retrieve the EMG studies of knee muscles during gait in ACLD patients. Cochrane library, PubMed, Medline, Ovid, CINAHL and Science Direct databases were searched entries from 1995 through October 2014 using the terms “anterior cruciate ligament” OR “ACL”, “electromyography” Or “EMG” “gait” Or “walking”. Articles that assessed subjects with ACL rupture that used surface EMG to assess the knee muscle activity were included. The quality of the included papers was assessed using the Critical Appraisal Skills Programme tool for observational studies. In total, 13 studies met the inclusion criteria. Seven studies consistently found no significant difference in magnitude of activity or timing of Q-ceps muscle between the chronic ACLD patients and control subjects. Two studies on acute ACLD patients and three studies on ACLD patients with unstable knee found the significantly reduced Q-ceps activity compared to control subjects. Six studies showed the significantly greater hamstring activity, and three studies found prolonged duration of activity in ACLD patients compared to the control subjects. This review highlighted that the results of the studies are in favour of increased hamstring muscular activity. However, decreased Q-ceps activation exists in the acute stage and in ACLD patients that experience knee instability (non-copers). III.

Objectives:Stroke is the leading cause of long-term disability. Hand motor impairment resulting from chronic stroke may have extensive physical, psychological, financial, and social implications despite available rehabilitative treatments. The best time to start treatment for stroke, is in sub-acute period. Repetitive transcranial magnetic stimulation (rTMS) is a method of stimulating and augmenting the neurophysiology of the motor cortex in order to promote the neuroplastic changes that are associated with motor recovery. The purpose of this study was to compare the effects of repetitive transcranial magnetic stimulation protocols plus routine rehabilitation on hand motor functions and hand corticomotor excitability in stroke patients with hemiplegia with pure routine rehabilitation programs. Methods: This study was a randomized clinical trial which was performed on 24 patients with hemiplegia who were randomly divided in to three groups. One group (n=7), received high frequency repetitive transcranial magnetic stimulation (Hf rTMS) on lesioned M1 with routine rehabilitation program, and the other group (n=7), received rehabilitation program with low frequency repetitive transcranial magnetic stimulation stimulation (Lf rTMS) on nonlesined M1, and a control group (n=10), who were given only routine rehabilitation programs. The treatment was performed for 10 sessions, three times peri-test, Post and follow-up about neurophysiological contralesional hemisphere evaluations using record of MEP wave indices by single pulse TMS, and assessing functional wolf test and hand grip power of disabled hand by dynamometer. Results: The results demonstrated that the rest MEP threshold reduction in experimental group which received high frequency magnetic stimulation was statistically significant (P

The purpose of this study was to systematically review published studies (2000-2014) carried out on the application of ultrasonography (US) to evaluation of skeletal muscle size in children with and without neuromuscular disorders. Different databases including PubMed, Science Direct, OVID, MEDLINE, CINAHL, EMBASE, ProQuest and Google Scholar were searched. The key words used were: "children," "ultrasound," "skeletal muscles," "neuromuscular disease," "neurogenic disorders," "spina bifida," "myelomeningocele" and "reliability." Eighteen articles were found to be relevant. Eight studies applied US in combination with additional methods of assessment. Four of the 18 studies did not have a control group. Ten studies applied only US in the assessment of skeletal muscles in children with and without neuromuscular diseases. In 9 studies, there were children ranging widely in age, and in 3 studies US was used to determine normal values for skeletal muscles. According to the results of these 18 reviewed articles, US is an appropriate, reliable and highly predictive method for assessment of skeletal muscles in children.