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Background: One possible factor contributing to low back pain is hip range of motion (ROM). However, there is inconstancy in published studies, which may be due to the heterogeneity of patients. Therefore, the present study focuses on the relationship between hip ROM and lower lumbar disc herniation (LLDH)., Method: A cross-sectional study involved 52 participants between 18 and 65 years old. Two digital inclinometers were utilized to measure the ROM of the lumbar and hip joints in all study participants. For each outcome, 2 measurements were conducted, and the mean of the 2 measurements was utilized for analysis. The level of statistical significance was established at P ≤ .05., Results: The difference in all ROM between the 2 groups is significant except for dominant hip flexion (P < .05). Lumbar flexion was reduced in LLDH compared with healthy individuals (P = .003). The findings manifested a significant correlation between right lumbar rotation and nondominant hip abduction (P = .05, R = .388) and between left lumbar lateral bending and nondominant hip flexion (P = .008, R = .510)., Conclusion: Patients with LLDH have reduced hip ROM and lumbar flexion compared with healthy individuals. The study showed correlations between hip and lumbar ROM and emphasized the significance of evaluating hip ROM in LLDH for assessment and treatment planning.

Introduction: Standing balance is essential for physical functioning. Therefore, improving balance control is a key priority in the management of knee osteoarthritis (OA), underscoring the importance of accurately assessing standing balance., Purpose: To assess reliability, construct validity and responsiveness of common clinical balance tests, including Step Test, Single-Leg Stance Test, and Functional Reach Test, in patients with knee OA., Methods: In the initial session, 100 participants underwent balance tests and completed Persian-version of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Timed Up and Go Test (TUG) as comparators for evaluating the construct validity of balance tests. For test-retest reliability, a subset of 70 participants repeated balance tests 1 week after initial assessment. To examine responsiveness, a subset of 90 participants underwent tests and completed WOMAC and TUG at baseline and after completing intervention. At post-intervention assessment, participants also completed global rating of change scale., Results: Three balance tests showed excellent test-retest reliability (intra-class correlation coefficient >0.75). All balance tests were considered valid and responsive because they confirmed 100% of priori hypotheses. Minimal detectable change (MDC) values were 2.71 steps for Step Test, 7.15 seconds for Single-Leg Stance Test, and 4.90 centimeters for Functional Reach Test. Minimal important change (MIC) values were 4.5 steps for Step Test, 13.10 seconds for Single-Leg Stance Test, and 5.5 centimeters for Functional Reach Test., Conclusion: Three tests are reliable, valid and responsive for measuring balance in patients with knee OA. The MIC values aid clinicians and researchers in assessing the clinical relevance of changes in balance for these patients.

Purpose: We investigate and compare responsiveness of the physical function subscales of patient-reported measures of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score (OKS), and performance-based measures of the timed up-and-go test and 6-min walk test and determine the minimal clinically important change (MCIC) values in knee osteoarthritis (OA) patients following physiotherapy intervention., Methods: One hundred patients were asked to complete the WOMAC and OKS and to perform the timed up-and-go test and 6-min walk test once pre-intervention and again after 4-week physiotherapy intervention (post-intervention). Responsiveness was determined by correlation analysis and receiver operating characteristics (ROC) curve., Results: The WOMAC-physical function subscale (WOMAC-PF), OKS-functional component score (OKS-FCS), timed up-and-go test, and 6-min walk test showed moderate-to-good relationships with the patients' global rating scale (Spearman correlation ranges = 0.51-0.56). All outcome measures of physical function showed the area under the curve (AUC) >0.70 (AUC ranges = 0.78-0.82). The MCIC values were 12.5 points for WOMAC-PF, 17.5 points for OKS-FCS, 2.82 s for timed up-and-go test, 61 m for 6-min walk test., Conclusions: All outcome measures have adequate responsiveness to detect clinical improvements over time in functional status following the physiotherapy intervention in patients with knee OA. The MCIC values can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status.

Introduction: The International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament - Quality of Life Questionnaire (ACL-QOL) are frequently used patient-reported instruments designed for individuals with anterior cruciate ligament reconstruction (ACL-R)., Purpose: To evaluate responsiveness and determine minimal important change (MIC) for the Persian-version of IKDC and ACL-QOL in athletes with ACL-R following physiotherapy intervention., Method: One hundred athletes with ACL-R, undergoing 16-week physiotherapy completed IKDC and ACL-QOL at weeks 4 and 20 post ACL-R. Participants also rated their overall changes on a 7-point global rating of change at follow-up. Responsiveness was evaluated using the receiver operating characteristics (ROC) curve and correlation analysis. In addition, the minimal important change (MIC) was determined on the ROC curve., Results: Acceptable responsiveness was reached by the IKDC and most of the subscales of ACL-QOL (area under the ROC curve (AUC) of 0.72-0.79). Also, the subscale of Lifestyle issues of ACL-QOL (AUC of 0.81 (95% CI = 0.72-0.89) and the overall of ACL-QOL (AUC of 0.87 (95% CI = 0.80-0.93) showed the good level of responsiveness. The MIC scores of IKDC and the Overall ACL-QOL were determined 25 and 26 points, respectively., Conclusion: The IKDC and ACL-QOL questionnaires have adequate responsiveness and are able to measure the change in athletes with ACL-R following a 16-week physiotherapy intervention.

Background: Rotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence., Purpose: This study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR)., Study Design: Two arms, parallel-group, randomized controlled trial, with concealed allocation METHODS: This parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used., Results: Trial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges' g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: -17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: -19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = -25.4 to 0.56; active ROM: confidence interval = -20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated "much improved" in the comprehensive group than in the conventional. No adverse effects were reported., Conclusions: Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR., Competing Interests: Declaration of competing interest None of the authors have any financial or other interests relating to the manuscript to be submitted for publication in the Journal of Hand Therapy., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: To translate, cross-culturally adapt, and psychometric testing the Western Ontario Shoulder Instability index (WOSI) into Persian., Methods: Seventy-two patients diagnosed with shoulder instability participated in reliability, construct validity, and responsiveness analysis. All the patients filled out the WOSI with an interval of two weeks to assess reliability. The shortened Disability of Arm, Shoulder and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI), and the 36-Item Short-Form Survey (SF-36) were assessed to evaluate construct validity. In order to assess responsiveness patients filled out WOSI before and after the physiotherapy and global rating of change scale at last session of physiotherapy. Reliability was assessed by intra-class correlation coefficient (ICC (1,2) ), construct validity by two tailed Pearson (r), and responsiveness by longitudinal validity and receiver operating characteristics (ROC) curve analysis., Results: The ICC (1,2) was 0.90 and correlation analysis revealed high level of correlation with: Quick-DASH (r = 0.82); SPADI (r = 0.72); physical SF-36 (r = -0.52); and mental SF-36 (r = -0.48). Responsiveness analysis demonstrated the area under curve was 0.90, with minimal clinical important difference 46.87., Conclusion: We found the Persian-WOSI as a valid, reliable, and responsive questionnaire to evaluate quality of life of patients with shoulder instability.

Purpose: The Osteoarthritis Research Society International has recommended a core set of performance-based tests of physical function for use in knee osteoarthritis (OA) patients. The core set includes 30-second chair stand test (30-s CST), 4 × 10 m fast-paced walk test (40-m FPWT), and a stair climb test. This study aimed to evaluate responsiveness and minimal important changes (MICs) of these performance-based measures in knee OA patients following physiotherapy., Methods: Sixty patients with knee OA, undergoing 4-week physiotherapy performed 30-s CST, 40-m FPWT, and 4-step stair climb test (4-step SCT) at pre- and post-intervention. Patients also completed the 7-point global rating scale as an external anchor at post-intervention. Responsiveness was evaluated using receiver operating characteristics curve and correlation analysis., Results: All three performance-based measures of physical function showed area under the curve > 0.70. Correlation analysis showed relationship of 30-s CST, 40-m FPWT, and 4-Step SCT with the external anchor fell within moderate to good range (Spearman = 0.43-0.63). Furthermore, MIC values reflecting improvement for 30-s CST, 40-m FPWT, and 4-Step SCT were 2.5, 0.21, and 3.21, respectively., Conclusion: Our findings demonstrated all three performance-based measures have good responsiveness to measure improvement in physical functions of knee OA patients following physiotherapy. The MIC reflecting improvement can help clinicians and researchers to make a decision based on the clinical significance of improvements in patients' functional status.

Purpose: The aims of this study were to evaluate the diagnostic accuracy of common physical examination and functional evaluation tests, and to determine a set of tests with the highest diagnostic accuracy for diagnosing patellofemoral pain syndrome (PFPS) in patients with anterior knee pain., Methods: Based on careful evaluation of clinical findings and imaging methods by orthopedic physicians, 162 patients with anterior knee pain were classified into two groups of PFPS and non-PFPS. The physical examination and functional tests were performed by two physiotherapists. The accuracy of these measures was determined by calculating sensitivity, specificity, area under the receiver operating characteristic (ROC) curve (AUC), likelihood ratio (LR), and predictive value (PV)., Results: Our results showed the most sensitive tests in identifying patients with PFPS were as follows: eccentric step test [0.82 (95%CI: 0.72-0.89)]; palpation test [0.81(95%CI: 0.70-0.88)]; and prolonged sitting [0.73 (95%CI: 0.62-0.82)]. The palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending tests had an acceptable accuracy (AUC ≥ 70). The strongest combination of the physical examination and functional tests included pain severity between 3 and 10 during stair descending test and pain severity between 6 and 10 during prolonged sitting test. This combination showed a positive LR of 19.47 (95% CI: 6.36-59.65) and a posttest probability of 95%., Conclusion: Our findings provide evidence for the good accuracy of the palpation test, patellar tilt test, eccentric step test, navicular drop test, squatting, and stair descending and prolonged sitting tests for diagnosing PFPS. Also, the combination of stair descending test and prolonged sitting test could be very useful for ruling in PFPS patients.

Purpose: To evaluate the accuracy of and determine the best cutoff point for craniovertebral angle (CVA) and forward shoulder angle (FSA) in discriminating between two groups of individuals with different severities of forward head posture (FHP)., Methods: A sample of 90 subjects aged 20-50 who had different severities of FHP was recruited. Participants were categorized into two groups based on observational method, namely individuals with slight FHP and those with moderate-to-severe FHP. The CVA and FSA were assessed using the photographic device. The accuracy of these measures was determined by calculation of sensitivity, specificity, area under the receiver operating characteristic curve, likelihood ratio (LR), and predictive value (PV)., Results: Our results show that CVA has high sensitivity (0.93) and acceptable area under the curve (0.88) in discriminating between the two groups of FHP (P < .01), but FSA cannot discriminate between the two groups of FHP (P = .06). The LR and PV results show that the CVA has a low negative LR (0.13) and a large negative PV (0.93). The best cutoff point for CVA was determined at 45.5 degrees., Conclusion: Overall, the results of the present study showed that CVA has a good accuracy in discriminating between two groups of individuals with slight and moderate-to-severe FHP. It can be valuable in correctly identifying the slight FHP and screening the moderate and severe grades of the FHP. Researchers and clinicians can also use the optimal cutoff point for the CVA obtained in this study to accurately quantify and classify the severity of the FHP.

Anterior cruciate ligament (ACL) rupture can impair balance performance, particularly during cognitive motor dual-tasks. This study aimed to determine the effects of various modalities of cognitive load (working memory, and visuospatial and executive function) on postural control parameters in individuals with ACL injury. Twenty-seven ACL-injured and 27 healthy participants were evaluated doing different cognitive tasks (silent backward counting, Benton's judgment of line orientation, and Stroop color-word test) while standing on a rigid surface or a foam. Each task was repeated three times and then averaged. Center of pressure variables used to measure postural performance included sway area and sway velocity in anterior-posterior and medial-lateral directions. Cognitive performance was also assessed by calculating errors and the score of cognitive tasks. A mixed model analysis of variance for center of pressure parameters indicated that patients had more sways than the healthy group. The interaction of group by postural difficulty by cognitive tasks was statistically significant for cognitive errors (p < .01), and patients with ACL injury indicated more cognitive errors compared to healthy controls while standing on the foam. The main effect of cognitive task was statistically significant for all postural parameters, representing reduced postural sways in both groups with all cognitive tasks. However, ACL-injured patients showed more cognitive errors in difficult postural conditions, suggesting that individuals with ACL injury may prioritize postural control over cognitive task accuracy and adopt the posture-first strategy to maintain balance under dual-task conditions.

Objectives: The present study aimed to investigate the responsiveness of the Persian version of the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Quebec Back Pain Disability Scale (QBPDS) and detect minimal clinically important changes (MCICs) of these questionnaires in people with lumbar disc herniation., Methods: Ninety-two patients with lumbar herniated disc completed the Persianversion of the ODI, RMDQ, and QBPDS before and after the physiotherapy intervention. Additionally, they completed a global rating of change scale after the final physiotherapy session to give an account of non-improved and improved outcomes. The responsiveness of these three disability questionnaires was represented by Receiver Operating Characteristic (ROC) and correlation analyses. The MCIC was defined as the best cut-off when sensitivity and specificity were optimally balanced., Results: Area under the ROC curves are in the acceptable range for ODI and QBPDS (0.78 and 0.70, respectively). Moreover, ODI, RMDQ, and QBPDS have significant positive fair to moderate correlation with the external anchor (P<0.001). The MCIC values for ODI, RMDQ, and QBPDS were 13, 5.5, and 14.5 points, respectively., Conclusion: Our results revealed that the ODI and QBPDS questionnaires have adequate responsiveness to detect improvements in the functional status of lumbar herniated disc patients following a physiotherapy treatment. Therefore, the ODI and QBPDS seem to be superior to the RMDQ for use in randomized clinical trials and clinical settings in patients with herniated lumbar discs. The MCIC scores of 13 and 14.5 obtained for the ODI and QBPDS can help to identify important changes in the clinical status of an individual patient and treatment efficacy., Competing Interests: None of the authors have any financial or other interests relating to the manuscript to be submitted for publication in Archives of Bone & Joint Surgery.

Introduction: Fear avoidance beliefs questionnaire (FABQ), Tampa scale of kinesiophobia (TSK), and pain catastrophizing scale (PCS) are tools widely used to measure fear-avoidance beliefs, fear of movement, and pain-related catastrophic thinking in people with chronic spinal disorders., Purpose: To evaluate responsiveness and minimal important change (MIC) for the Persian version of FABQ, TSK, and PCS., Method: One hundred people with chronic non-specific neck pain participated in an intervention program including routine physiotherapy plus pain neuroscience education. They fulfilled FABQ, TSK, and PCS questionnaires at baseline and 4-week follow-up. The 7-point global rating of change (GRC) as the external anchor was also completed in follow-up by patients. Responsiveness was evaluated using receiver operating characteristic (ROC) curve analysis and correlation analysis. According to GRC, patients were classified into two groups (improved vs. unimproved). The best cutoff or MIC was estimated via the ROC curve., Results: Acceptable responsiveness obtained for FABQ, TSK, and PCS with the area under the curve ranging from 0.84 to 0.94 and spearman coefficient > 0.6. The MIC values reflecting improvement were 9.5, 10.5, and 12.5 points, respectively, for FABQ, TSK, and PCS., Conclusions: The results of this study demonstrated that the Persian version of FABQ, TSK, and PCS have sufficient responsiveness and good ability to measure meaningful clinical changes in people with patient CNNP. The MIC scores of the FABQ, TSK, and PCS can help clinicians and researchers to detect changes significant to the patient following a rehabilitation program., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This study aimed to compare sensory organization test and postural control strategies between individuals with mild and moderate-to-severe forward head posture (FHP)., Methods: A sensory organization test (SOT) was performed in 6 conditions using computerized dynamic posturography, to assess postural control. Equilibrium scores representing overall balance, strategy analysis to assess ankle vs hip strategy dominance, and sensory analysis (Somatosensory, visual, vestibular, visual preference ratio) as an indicator of the use of sensory systems were obtained., Results: Our results revealed a significant difference between the 2 groups in terms of equilibrium score (P < .05) and strategy scores (P < .05) in conditions of 4 to 6 of the SOT. The results of sensory analysis of SOT showed visual and vestibular ratios were significantly different between the 2 study groups (P < .05), but somatosensory and visual preference ratios were not significantly different between these 2 groups (P > .05)., Conclusion: Individuals with moderate-to-severe FHP swayed more in comparison with mild FHP ones in conditions with the Sway-referenced platform of the SOT. They tended to rely on the hip strategy more than the ankle strategy excessively when sensory difficulty increased. Overall, it can be concluded that individuals with moderate-to-severe FHP are more likely to have postural deficits., (Copyright © 2024. Published by Elsevier Inc.)

Background: The Anterior Cruciate Ligament-Return to Sport after Injury scale (ACL-RSI) is used to measure athletes' psychological readiness in terms of their emotions, confidence in performance, and risk appraisal with respect to return to sport after ACL reconstruction., Objective: To translate and cross-culturally adapt the ACL-RSI to the Persian version and evaluate the reliability and validity of this scale in patients with ACL reconstruction., Study Design: Clinical measurement study (psychometric analysis)., Methods: To assess test-retest reliability, 100 participants were asked to complete the Persian version of the ACL-RSI 2 times with a 7- to 10-day interval. In the first assessment, the patients also filled the Injury-Psychological Readiness to Return to Sport Questionnaire, Tampa Scale of Kinesiophobia, International Knee Documentation Committee Subjective Knee Form, and Knee Injury and Osteoarthritis Outcome Score. Internal consistency (Cronbach alpha, α), test-retest reliability (intraclass correlation coefficients), measurement error (standard error of measurement and minimum detectable change), and construct validity (Pearson r) were determined., Results: Our results showed good internal consistency (Cronbach alpha = .94) and excellent test-retest reliability (intraclass correlation coefficients = .90 (.85-.93)]. Standard error of measurement and minimum detectable change were 4.64 and 12.85, respectively. No significant bias was observed between test and retest. In addition, based on the results of correlation analysis, all hypotheses of this study were confirmed. The Persian version of the ACL-RSI had a strong correlation with Injury-Psychological Readiness to Return to Sport (I-PPR) (P < .001, r = .76) and Tampa scale of Kinesiophobia (TKS) (P < .001, r = -.68). Furthermore, a moderate correlation was observed between the Persian version of the ACL-RSI and the International Knee Documentation Committee Subjective Knee Form (P < .001, r = .44) and between this version of the ACL-RSI and the subscales of Knee Injury and Osteoarthritis Outcome Score (P < .001, r = .30-.55)., Conclusion: Given its acceptable reliability and validity, the Persian version of the ACL-RSI seems to be a suitable tool for evaluating psychological readiness to return to sport after ACL reconstruction.

Introduction: Knee injury and Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported outcome measure designed for patients with knee osteoarthritis., Purpose: To evaluate responsiveness and determine minimal important change (MIC) for Persian-version of KOOS in patients with knee osteoarthritis following physiotherapy intervention., Method: One hundred and forty-six consecutive patients with knee osteoarthritis, undergoing 4-week physiotherapy completed KOOS alongside Oxford Knee Score at baseline and at 4-week follow-up. Patients also rated their overall changes on an external anchor at follow-up. Responsiveness was examined in two ways: by testing four hypotheses regarding pre-defined correlations between change scores of KOOS subscales and Oxford Knee Score and external anchor, and by calculating receiver operating characteristic (ROC) curve. MIC was determined by identifying an optimal cutoff on ROC curve., Results: KOOS appeared to be responsive, as all expected hypotheses were accepted. Also, all subscales showed area under the curve (AUC) > 0.70. The MIC values reflecting improvement for Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation (Sport/Rec), and Quality of Life (QoL) subscales were 15, 12.5, 15.5, 17.5, 12.5 points, respectively., Conclusions: All subscales of KOOS have adequate responsiveness and are able to measure the change in patients with knee osteoarthritis following a 4-week physiotherapy intervention.

Background: Evaluating responsiveness and calculating minimally important change (MIC) for the Persian-version of the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire following physiotherapy in patients with lateral elbow tendinopathy (LET)., Methods: We enrolled 82 patients with LET to complete the PRTEE. After completing four weeks of physiotherapy, all patients were reevaluated by the PRTEE. The patients also rated their changes on a 7-point global rating of change scale (GRoC). The receiver operating characteristic (ROC) curve and correlation analysis were used for evaluating the responsiveness. The MIC was determined by determining a desirable cutoff on the ROC curve., Results: The results showed a moderate relationship (Spearman's correlation coefficient= 0.43-0.56) of total PRTEE, pain subscale, and function subscale with the GRoC scale. The total PRTEE, pain subscale, and function subscale revealed an area under the curve of 0.87, 0.82, and 0.83, respectively. We found the MICs 31.33, 14.5, and 15.5 points for total PRTEE, pain subscale, and function subscale, respectively., Conclusion: The Persian-version of the PRTEE questionnaire has acceptable responsiveness and can measure changes in patients with LET following physiotherapy. We advocate using the PRTEE questionnaire in both clinical settings and research.

Background: Knee osteoarthritis (OA) is a common musculoskeletal disorder that is associated with balance impairment. Recent studies have used balance exercises for improvement of balance and functional performance among knee OA patients. The purpose of this study was analyzing the effects of balance training in patients with knee OA. Methods: This review included clinical trials in which the effect of balance training on functional measures was assessed compared to other physiotherapy interventions or control groups in patients with knee OA. To this aim, Electronic databases (PubMed, SCOPUS, EMBASE, PEDro, CINAHL, and WOS) were searched from 1 January 1990 to 30 June 2021. Two independent reviewers selected the studies, extracted the data, and assessed the quality of the studies. Results: Fifteen articles of clinical trials were eligible to include in this review. Most studies used patient-reported outcome measures, and some studies used performance-based functional outcome measures for the evaluation of functional outcomes. The findings of studies showed that physical function in knee OA patients could have clinical improvements significantly after receiving balance training. However, studies assessing the effect of balance training on muscle strength of the quadriceps and the hamstring had conflicting results. Also, the finding of studies showed that more significant improvement in postural stability and balance in the balance training group rather than the control group. Conclusion: The results of the current systematic review demonstrate balance exercises significantly improve balance and functionality in knee OA patients. However, the effect of balance training on muscle strength was not clearly revealed due to few studies., Competing Interests: The authors declare that they have no competing interests., (© 2022 Iran University of Medical Sciences.)

Background: Previous studies have suggested that weakening of shoulder and scapula muscles have been associated with increased pain, and decreased functional abilities in patients with lateral elbow tendinopathy (LET)., Purpose: To compare the effects of shoulder and scapula muscle training plus conventional physiotherapy with conventional physiotherapy only., Methods: A group of 48 patients with LET was randomly allocated into two groups: shoulder and scapula muscle training plus conventional physiotherapy ( n = 24), and conventional physiotherapy ( n = 24). All patients received 12 sessions of treatment for 4 weeks. Furthermore, both groups were instructed to continue their own exercise program at home until four months after the end of treatment. Pain intensity, grip strength, and functional status were measured preintervention, postintervention, and 4 months after the end of intervention (4-month follow-up)., Results: The shoulder and scapula muscle training plus conventional physiotherapy group showed significantly more reduction in pain and greater improvement in functional status compared with conventional physiotherapy group, but there was no significant difference in pain-free grip strength for two groups., Conclusion: Conventional physiotherapy combined with shoulder and scapula muscle training could be more effective in improving the pain and functional abilities of patients with LET compared with conventional physiotherapy only.

Background: This study aimed to translate the shortened Western Ontario Rotator Cuff (Short-WORC) questionnaire into Persian and determine the psychometric features of WORC and Persian-Short-WORC in patients with shoulder pain., Methods: A total of 130 patients completed Persian-WORC and -Short-WORC, Shoulder Pain And Disability Index (SPADI), shortened Disability of Arm, Shoulder, and Hand (Quick-DASH), WORC, as well as Short-Form health survey (SF-36), in the evaluation and re-evaluation sessions with an interval of 5-7 days to assess reliability and validity. To determine responsiveness, all patients completed questionnaires and a global rating of change scale before and after the 4-week physiotherapy. Intra-class correlation coefficient (ICC) was used for assessing reliability, two-tailed Pearson ( r) for validity, as well as longitudinal validity, and receiver operating characteristics (ROC) curve analysis for responsiveness., Results: The ICC was 0.95 (confidence interval: 0.93-0.96) for Short-WORC. A strong correlation was found between Short-WORC, SPADI (r=-0.82), Quick-DASH (r=-0.79), WORC (r=0.92), SF-36 physical (r=0.76), and SF-36 mental (r=0.71). Floor and ceiling effects were not detected. The responsiveness of Short-WORC and WORC was proven with an area under the curve of >0.90, and their minimal important change was 28.56 and 26.28 points, respectively., Conclusion: The Persian version of WORC has good psychometric properties to measure disability and health-related quality of life in patients with shoulder pain.

Objective: The purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle., Method: Ninety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position., Results: A 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005)., Conclusion: The craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle., (Copyright © 2022. Published by Elsevier Inc.)

Background and Purpose: Balance impairment and fear of falling are two common risk factors for falls in people with multiple sclerosis (PwMS). Clinicians should use valid, reliable, and responsive tools to assess these risk factors and identify individuals at increased risk for falls. So, this study aimed to examine psychometric properties of the Persian-version of the Activities-specific Balance Confidence (ABC) scale and Fall Efficacy Scale-International (FES-I) in Iranian PwMS., Methods: One hundred and fifty-three PwMS completed the Persian versions of ABC, FES-I, Multiple Sclerosis Walking Scale-12 (MSWS-12), and Berg Balance Scale (BBS) in the first session. To assess the test-retest reliability, 50 PwMS filled out ABC, and FES-I in retest session with an interval of 2-7 days. Also, for evaluating responsiveness, 50 PwMS completed ABC and FES-I before and after a 4-week treatment., Results: Intra-class Correlation Coefficients were 0.96 and 0.93 and Cronbach's alpha coefficients were 0.96 and 0.99 for the ABC and FES-I, respectively. There were significant correlations ( p < .001) between ABC and BBS (r = 0.55), FES-I and BBS (r = -0.56), ABC and MSWS-12 (r = -0.72), and FES-I and MSWS-12 (r = 0.76). No floor or ceiling effect was found. ABC and FES-I had acceptable responsiveness (AUC > 0.70), and their minimally important difference (MID) were 10.5 and 9.5 points, respectively., Conclusion: The Persian-versions of ABC and FES-I are reliable, valid, and responsive measures to quantify balance confidence and fear of falling in PwMS at both clinical and research settings. The MID can help clinicians to make a decision based on the clinical significance of changes in patients' status.

Purpose: To evaluate the responsiveness and determine the minimal clinically important changes (MCICs), anchored by the patient response to a 7-point global rating scale, for Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity scale in athletes undergoing physiotherapy treatment after anterior cruciate ligament reconstruction (ACL-R). Methods: Fifty-four patients undergoing physiotherapy completed the Persian versions of KOOS and Tegner scales at weeks 6 and 10 post ACL-R. The 7-point global rating of change was also completed at week 10. Responsiveness was calculated via receiver operating characteristic curve and correlation analysis. Results: Acceptable responsiveness was reached by the KOOS sports and recreation subscale (Sport/Rec) (area under the curve (AUC) = 0.72; Gamma = 0.37) and Tegner scale (AUC = 0.75; Gamma = 0.59). The MCIC scores of KOOS subscales and Tegner scale were reported. Conclusion: Our findings demonstrated that the KOOS Sport/Rec subscale and Tegner scale have adequate responsiveness between weeks 6 and 10 of physiotherapy. Therefore, these scales should be used to evaluate the effects of physiotherapy treatment and the changes in activity levels in this population. The MCIC scores of the KOOS and Tegner scale can be used to detect changes significant to the patient while avoiding limitations of other methods.

In this article, we present a theoretical comparison of local adaptation between diploid and autotetraploid populations when fitness is determined by either additive or epistatic interactions between alleles at 2 loci. A continent-island model of local adaptation is derived, with 1-way migration from the continent to the island and distinct genotypes adaptive on the continent versus the island. The meiotic component of the model accounts for multivalent formation and the processes of chromosomal gametic disequilibrium and double reduction, which are unique to autotetraploids. Both the adaptability and efficiency of adaptation are investigated, where adaptability asks whether a population adapts and efficiency is the rate of adaptation. With an additive genetic basis to fitness, diploids experience better adaptability and efficiency than autotetraploids. With epistasis, our results indicate a limited parameter space in which autotetraploids have greater adaptability than diploids, but results indicate an interesting difference between adaptability and efficiency of adaptation. Oftentimes, diploids exhibit greater adaptability whereas autotetraploids exhibit greater efficiency of adaptation. These findings provide evidence for the advantage of epistasis within autotetraploids when efficiency of adaptation is of interest. Although autotetraploids are more efficient, under the same conditions and at equilibrium, diploid populations often have higher mean local fitness. Overall, the most ideal situation for autotetraploid local adaptation compared to diploids is when epistasis is strong, mutation is weak, recombination is high, selection is strong, deleterious selection is additive, chromosomal gametic disequilibrium is present, and double reduction is absent., (© The American Genetic Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Clinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA)., Research Question: This study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA., Methods: A total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs)., Results: Our results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively., Significance: Our findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Introduction: Evaluating responsiveness has an important role in design and interpretation of the interventional studies. The aim was to estimate the responsiveness and minimally important difference (MID) of postural performance measures following balance rehabilitation in patients with Multiple Sclerosis (MS, n = 38)., Methods: Postural measures were evaluated at baseline and after 4 weeks intervention. Laboratory-based measures were center of pressure parameters. Clinically-based measures were Activities-specific Balance Confidence (ABC), Berg Balance Scale (BBS), Functional Gait Assessment (FGA); and walking measures 2 Minute Walk (2 MW), 10 Meter Timed Walk (10 MTW) and Timed Up and Go (TUG) performed under single and dual-task conditions. To evaluate responsiveness, we calculated the Receiver Operating Characteristics (ROC) and the Area Under the ROC Curve (AUC). The optimal values for the MID were the cutoffs corresponding to the upper left corner of the ROC curve., Results: The AUCs for mean and standard deviation of sway velocity were above the cutoff of 0.50 in most conditions. For the clinically-based measures, the highest AUCs were found for the ABC, and cognitive-2MW, followed by the BBS and 10 MTW., Conclusions: In this preliminary study, the most appropriate postural performance measures and the MID values for detecting meaningful changes in MS undergoing balance rehabilitation have been provided., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The main goal of physiotherapy for patients with anterior cruciate ligament reconstruction (ACL-R) is to improve postural control and retain knee function. Therefore, clinicians need to use evaluative tools that assess postural changes during physiotherapy. To maximize the clinical utility of the results of these tools, the extracted measures should have appropriate psychometric properties of reliability, validity and responsiveness. No study has yet addressed responsiveness of postural measures in these patients. This study was designed to investigate the responsiveness and determine the minimal clinically important changes (MCIC) of static and dynamic postural measures in patients with (ACL-R) following physiotherapy., Methods: Static and dynamic postural measures were evaluated at first occasion and again after four weeks physiotherapy. The static measures consisted of center of pressure (COP) parameters while dynamic measures included the stability indices. Correlation analysis and ROC curve were applied for assessing the responsiveness., Results: The meanand SD velocity of COP had acceptable responsiveness in both conditions of standing on injured leg with open-eyes and on uninjured leg with closed-eyes, both with nocognitive task. For dynamic measures, stability indices in double-leg standing with closed-eyes with cognitive task condition attained acceptable responsiveness. MCICs for mean and SD velocity in anteroposterior and mediolateral directions were 0.28cm/s, 0.008cm/s, 0.02cm/s, respectively in standing on injured leg with open-eyes; and 0.14cm/s, 0.07cm/s, 0.06cm/s, respectively in uninjured leg with closed-eyes condition. Also, MCICs for anteroposterior, mediolateral and total stability indices were 0.51°, 0.37°, 0.34°, respectively in DCT condition., Conclusion: Our findings provide evidence for selection of appropriate static and dynamic postural measures for assessment of changes in these patients. MCICs for these measures were determined, which provide practical information for clinicians to make decision on clinical significance of changes in patients' status.

Purpose: To evaluate the responsiveness of two outcome measures of participation restriction [as measured by the Community Integration Questionnaire (CIQ)] and quality of life [as measured by the Multiple Sclerosis Quality of Life (MSQOL)] following a physiotherapy intervention in patients with multiple sclerosis (MS)., Method: A sample of 265 patients completed both instruments first at the time of initial visit and then after 4-6 weeks physiotherapy. In addition, patients were asked to complete the 7-point global rating scale as an external criterion of change at the post-intervention time. The responsiveness was evaluated using the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics were area under the ROC curve (AUC) and the minimally clinically important difference (MCID). The AUC and correlation coefficient greater than 0.70 were considered as acceptable responsiveness., Results: The CIQ achieved the acceptable responsiveness with an AUC of 0.81. However, the AUCs of 0.61 and 0.66 were obtained for the MSQOL physical and mental, respectively. Moreover, good correlation coefficient was obtained for the CIQ (Gamma = 0.76) while fair correlations of 0.28 and 0.33 were obtained for the MSQOL physical and mental, respectively. The MCIDs were approximately 0.50, 1.5 and 2.5 points for the CIQ, MSQOL physical and mental, respectively., Conclusions: In contrast to the MSQOL, the CIQ was responsive outcome measure in detecting changes in participation restriction of patients with MS. Moreover, the MCID values obtained in this study will help the clinicians and researchers to determine if a patient with MS has experienced a true change following physiotherapy intervention., Implications for Rehabilitation: The results provide valuable information regarding to the ability of two outcome measures (i.e. the CIQ and MSQOL) to detect treatment effects in patients with MS. In contrast to the MSQOL, the CIQ is a responsive measure to changes in participation restriction due to physiotherapy. A patient with MS had to change at least 0.50 point on the CIQ, 1.5 points on the MSQOL physical and 2.5 points on the MSQOL mental to be judged as having clinically changed.

Purpose: To investigate the responsiveness and determine the minimally important differences (MID) of Persian versions of the Kujala patellofemoral scale (KPS), lower extremity functional scale (LEFS), and functional index questionnaire (FIQ) in patients with patellofemoral pain syndrome (PFPS)., Method: Outcome measures including the Persian KPS, LEFS, and FIQ were administered to 233 patients at baseline and then again 4 weeks after physiotherapy. Moreover, the 7-point global rating scale was completed by the patients at 4 weeks. Responsiveness was evaluated using the correlation analysis and the receiver operating characteristics (ROC) method., Results: Correlation analysis showed that the relationship of all outcome measures with the global rating scale falls within the fair range of relationship (Gamma = 0.26-0.40). Moreover, the results of ROC analysis showed that the all outcome measures have acceptable high responsiveness index. Furthermore, the MIDs of 9.5, 4.5, and 1.5 points were obtained for the Persian KPS, LEFS, and FIQ, respectively., Conclusions: The Persian-versions of all outcome measures are responsive for evaluating change following physiotherapy intervention. The MID values obtained in this study will help the clinicians and researchers to determine if a patient with PFPS has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Persian-versions of the KPS, LEFS, and FIQ can be used as three "responsive" outcome measures in clinical studies of patients with patellofemoral pain syndrome (PFPS). These assessment tools have clinical relevance for rehabilitation specialists working on patients with PFPS. The minimally important differences provide valuable information for the clinicians and researchers to make decision about the identification of a clinical change in health status of patients with PFPS.

Purpose: The aims of this study were to culturally translate and validate the Persian version of Tegner and Marx activity rating scales and to investigate their psychometric properties in a sample of patients (n = 100) with anterior cruciate ligament (ACL) injury., Method: Four questionnaires were completed by the respondents: Tegner and Marx activity scales, Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form 12 Health Survey (SF-12). The Tegner and Marx were re-administered to 45 patients in the retest session, with time interval of 2-6 days between the two sessions. Test-retest reliability and internal consistency were assessed using intra-class correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate construct validity of Tegner and Marx compared to similar and dissimilar concepts of KOOS and SF-12, the Spearman's rank correlation was used., Results: Both Tegner and Marx activity scales have a high ICC level. The minimum Cronbach's alpha level of 0.70 was exceeded by Marx scale. In terms of construct validity, most of a priori hypotheses were confirmed., Conclusions: The Persian version of Tegner and Marx seems to be suitable for Iranian patients with ACL injury. Future studies are needed to investigate the psychometric properties of these questionnaires for Iranian patients with different knee problems.