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Importance: Stroke is a leading cause of disability worldwide and is often accompanied by complications such as spasticity. Static stretching (SS) is a common physiotherapy intervention for reducing spasticity, whereas dry needling (DN) is a novel approach. However, the combined effects of DN and SS on spasticity have not been thoroughly investigated. Given the pivotal effect of spasticity on daily activities, mitigating spasticity can significantly contribute to restoring patient independence.Objective: This study will explore the impact of DN plus SS on spasticity, alpha motor neuron excitability, overall function, and quality of life in patients with chronic stroke.Design, Setting, and Population: A double-blind, randomized, sham-controlled trial will be conducted in patients with post-stroke spasticity in the plantar flexor muscles. Twentyeight participants will be randomly assigned to either an intervention or control group. The intervention group will receive DN (60s × 3 days/week; 1 week) plus SS (20 min × 5 days/ week; 1 week). The control group will undergo sham DN (60s × 3 days/week; 1 week) and SS (20 min × 5 days/week; 1 week).Exposures: DN plus SS or sham DN plus SS.Main Outcomes and Measures: Both groups will be assessed at baseline, immediately post-treatment, and after 1 week of follow-up. Outcome measures will include the Modified Modified Ashworth Scale, H-reflex latency, Hmax/Mmax ratio, active and passive ankle dorsiflexion range of motion, timed up and go test, and the EuroQol questionnaire.Results : : Results : from this randomized, sham-controlled study will provide evidence for the effectiveness of DN in combination with SS for spasticity.Conclusion : s and Relevance: The additional impact of DN in conjunction with SS, a widely used method for reducing muscle tone, remains unclear and warrants investigation. This study, with a high level of evidence, aims to address this knowledge gap.

Importance: Neuromodulation may be one of the underlying mechanisms of dry needling (DN); however, the mechanism has not yet been fully clarified.Objective: This randomized controlled trial is designed to evaluate DN stimulation of the tibialis anterior and peroneus longus muscles in chronic ankle instability (CAI) and healthy subjects, employing functional magnetic resonance imaging (fMRI).Design: Clinical study protocol, SPIRIT compliant.Setting: Brain Mapping Laboratory.Population: A total of thirty participants aged between 18 and 40 years old will be included in this study. Twenty healthy participants will be randomized into 2 groups (real DN and sham DN). Ten patients with CAI will also be recruited to the third group and receive only real DN for comparison.Exposures: Real and sham DN.Main Outcomes and Measures: The voxel count, coordinates of peak activation, and peak intensity will be obtained as primary outcomes to report brain map activation. Measurements will be taken before, during, and after DN treatment. The strength of the ankle dorsiflexors, active dorsiflexion range of motion, and McGill pain questionnaire short-form will be used as secondary outcome measures.Results : : The results from this study will be published in peer-reviewed journals and disseminated as presentations at national and international congresses.Conclusion : : This trial will explore brain responses to real and sham DN in healthy participants and to real DN in CAI patients. Overall, our results will provide preliminary evidence of the neural mechanism of DN.

Background: Years of life lost (YLL) is commonly used to determine the social and economic burden of loss due to premature mortality. The present study estimated YLL based on general mortality groups in Golestan Province, Iran, in 2018. Methods: In this cross-sectional study, by referring to the province death registration system information and using standard expected years of life lost (SEYLL) of the World Health Organization (WHO), YLL was calculated due to premature mortality based on general mortality groups in ICD-10 (international classification of diseases 10th revision). Results: The total number of deaths in Golestan Province was 8543 in 2018. The overall YLL due to premature mortality was 129838 years, of which 57.4% occurred among men. The major causes of YLL due to premature mortality (YLL%) were diseases of the circulatory system (I00-I99) (32.3%), external causes (V01-Y89) (17.3%), certain conditions originating in the perinatal period (P00-P96) (14.5%), and cancers (C00-D48) (13.9%). After diseases of the circulatory system, the most common cause of YLL due to premature mortality is external causes (22.9%) among men and cancers (16.2%) among women. In general, the highest YLL rate occurred due to circulatory system diseases (22.5 per 1000 people). Conclusion: According to the results of our study, most years of life lost in both sexes are related to diseases of the circulatory system, followed by external causes of morbidity and mortality. Therefore, it is important to pay attention to the diseases of the circulatory system and its causes, as well as external causes of morbidity and mortality.

Abstract Background Dry needling is an intervention used by physiotherapists to manage muscle spasticity. We report the effects of three sessions of dry needling on ankle plantar flexor muscle spasticity and cortical excitability in a patient with multiple sclerosis. Case presentation The patient was a 40-year-old Iranian woman with an 11-year history of multiple sclerosis. The study outcomes were measured by the modified modified Ashworth scale, transcranial magnetic stimulation parameters, and active and passive ankle range of motion. They were assessed before (T0), after three sessions of dry needling (T1), and at 2-week follow-up (T2). Our result showed: the modified modified Ashworth scale was improved at T2 from, 2 to 1. The resting motor threshold decreased from 63 to 61 and 57 at T1 and T2, respectively. The single test motor evokes potential increased from 76.2 to 78.3. The short intracortical inhibition increased from 23.6 to 35.4 at T2. The intracortical facilitation increased from 52 to 76 at T2. The ankle active and passive dorsiflexion ROM increased ~ 10° and ~ 6° at T2, respectively. Conclusion This case study presented a patient with multiple sclerosis who underwent dry needling of ankle plantar flexors with severe spasticity, and highlighted the successful use of dry needling in the management of spasticity, ankle dorsiflexion, and cortical excitability. Further rigorous investigations are warranted, employing randomized controlled trials with a sufficient sample of patients with multiple sclerosis. Trial registration IRCT20230206057343N1, registered 9 February 2023, https://en.irct.ir/trial/68454

No study has evaluated the effects of dry needling on Paralympic athletes. Therefore, in this study, we will evaluate the effect of dry needling on lower limb spasticity and motor performance, as well as the range of motion of Paralympic athletes. The study will be a triple-blinded, randomised controlled trial. Twenty-four athletes aged 18–45 in T35–T38 groups of the International Paralympic Committee classification will be included in the study. Twelve participants will receive dry needling of the quadriceps and gastrocnemius muscles, and 12 will receive placebo treatment with sham needles at similar points. We will assess the spasticity of the quadriceps and gastrocnemius muscles using the Modified Ashworth Scale, evaluate motor function using the Selective Control Assessment of the Lower Extremity Scale and measure ankle range of motion (ROM) with a goniometer. Considering our hypothesis, the athletes who will undergo the dry needling are supposed to achieve better improvements in spasticity, ROM and motor performance. This study can provide useful information to help better decide on managing complications in Paralympics and its long-term outcomes, to cover the current lack in the literature.

Background : Dry needling (DN) is recommended as a therapeutic modality for various neuromusculoskeletal disorders. No study has been performed on the impact of DN on arthrogenic muscle inhibition (AMI) after anterior cruciate ligament reconstruction (ACLR). This study protocol is aimed to investigate the impacts of DN on AMI of quadriceps femoris, corticomotor, and spinal reflex excitability in patients with ACLR. Methods : A double-blind, between-subject, randomized, controlled trial will be conducted to measure changes in AMI after DN. Twenty-four subjects with ACLR will be recruited to receive a DN or a sham DN, providing that they met the inclusion criteria. Three sessions of DN on the quadriceps femoris will be applied during a one-week period. The primary outcome measures are the active motor threshold, motor evoked potential, and Hmax - Mmax ratio. The secondary outcomes are the International Knee Documentation Committee subjective knee form questionnaire score and maximum quadriceps isometric torque. Data will be collected at baseline, immediately after the first session, after the third session, and at the one-month follow-up visit. Discussion: The results of this study will provide preliminary evidence regarding the effects of DN on AMI of quadriceps femoris in patients with ACLR.

Diseases affecting the nervous system are diverse [...]

BACKGROUND: Psychological distress, as a key indicator, describes a person’s emotional problems and psychological reactions to adapt to the environment. This study aimed to investigate the relationship between psychological distress and coping strategies used by individuals during the crisis caused by COVID-19. MATERIALS AND METHODS: The current research is an analytical cross-sectional study that was designed in 2021. The sampling area included the three cities of Lar, Gerash, and Evaz in the south of Fars province in the south of Iran. The study population was the residents of these three cities during the COVID-19 pandemic. The final sample size in the present study was 384 people. Individuals were selected through available sampling. By answering questions from the self-assessment system of COVID-19 disease, the Ministry of Health and Medical Education filled out the necessary information for individual screening and registration of the symptoms of COVID-19 disease. Then, they completed the Coping Methods Questionnaire and the Psychological Distress Questionnaire. RESULTS: The mean age of the participants was 40.90 years. One hundred sixty-seven (43.5%) participants were male, and 217 (56.5%) were female. The mean score of problem-oriented coping style was significantly different between the levels of education (P = 0.001). The mean score of problem-solving coping style for the participants suspected of being infected with COVID-19 was 6.18 scores lower than others, and the difference was statistically significant (P = 0.001). Multiple regression with a forward selection also showed that among the studied variables, age, problem-oriented, and emotion-oriented coping strategies were important variables affecting mental distress. CONCLUSION: People who were not suspected of having COVID-19 symptoms had a higher mean problem-oriented coping score than those who were suspected of having COVID-19. Therefore, early identification of suspects and the implementation of counseling and training programs can be very effective.

Introduction. As a complementary tool in health, the design of mobile applications to influence care and increase awareness of patients has grown a lot. The purpose of this study is to design and validate the content model of a mobile-based application for managing patients with low-back and neck pain. Methods. This descriptive-analytical study was conducted in two main stages to determine the content model of the application. The first stage consisted of three steps: finding the right exercise, determining the right scale to assess the pain intensity, and determining the appropriate features of the application. In the second stage, data elements collected from the previous stage were prepared in the form of a questionnaire that was given to 12 experts in physical therapy and sports medicine for validation. After collecting the questionnaire, data elements in all parts were analyzed based on the content validity ratio (CVR) and descriptive statistics indicators. Result. The content of the application was prepared in the three axes of exercises for low-back and neck pain, assessment of pain intensity, and features of the application. In the axis of sports exercises, 8 exercises for back pain and 3 exercises for neck pain were included according to the reference books. A Functional Rating Index (FRI) scale with 10 elements was selected in the axis of determining pain intensity. Also, 12 features such as the daily exercise section, using the animation, and using an audio file to explain how to do exercises were included in the model. Conclusion. According to the gaps identified in the existing applications, determining the content model of the application that is based on evidence and according to the opinion of experts is useful in improving the apps. The content model of this study was presented in 3 axes to increase the patient’s willingness to do exercises, the correct way to perform exercises, conservative treatment, and check the progress of the treatment. The software developers can use these findings as a basis for designing new apps to manage low-back pain and neck pain.

As air pollution escalates, the need for air filters increases. It is better that the filters used be based on natural fibers, such as non-wood fibers, which cause low damage to the environment. However, the short fiber lengths, low apparent densities, and high volumes of non-wood materials can make it challenging to prepare filter paper with the required mechanical and physical properties. In that context, this study focused on utilizing bamboo fibers to fabricate filter paper by employing the anthraquinone soda pulping method. The pulp underwent bleaching and oxidation processes, with the incorporation of cationic starch (CS) and polyvinyl alcohol (PVA) to enhance resistance properties, resulting in the creation of handmade filter papers. The findings revealed that the tear, burst, and tensile strength of filter paper increased with the oxidation and addition of CS and PVA. Air permeability increased with addition of PVA and combination of CS and PVA. FTIR demonstrated the conversion of hydroxyl groups in cellulose chains to carboxyl groups due to oxidation. SEM images illustrated alterations in the fiber structure post-oxidation treatment, with CS reducing pores while PVA and the CS-PVA combination enlarged pore size and enhanced porosity. The BET surface area surface area expanded with oxidation and the addition of the CS-PVA blend, indicating heightened filter paper porosity. Notably, the combined inclusion of CS and PVA not only augmented mechanical strength but also increased porosity while maintaining pore size.

Chemical surface modification is one method for enhancing the mechanical and barrier properties of packaging paper. The NaOH/urea solvent system has been deemed an effective, inexpensive, and cost-effective solvent for paper modification and cellulose dissolution due to its unique self-reinforcing qualities and the fact that it can be utilized on an industrial scale, although it is ineffective for porous paper and requires pre- or post-treatment. This study examined the influence of acid as a post-treatment on the surface modification of paper with NaOH/urea to improve properties relative to packaging uses. The results indicated that NaOH/urea modification on OCC as a semi-crystalline material did not result in materials with superior resistance and barrier qualities. While acid treatment increased tensile and burst strength and air permeability, it was ineffective at increasing tear strength. Properties of control, NaOH/urea treatment, and acidic post treatment papers were respectively 33.31, 29.4, and 37.46 mn/g in the tensile index, 1.7, 1.58, and 1.74 Kpa.m2/g in burst index, 9.94, 9.07 and 8.87 mn.m2/g in tear index, 2.04, 1.34 and 1.32 s-1 in smoothness, 37.2, 38.2 and 45.4 s in air resistance, and 77.5, 90.8 and 80.5 water absorption. Therefore, with or without acidic post-treatment, the sheets became hydrophilic.

Abstract Objective To re-explore the responsiveness of the Persian version of Multiple Sclerosis Walking Scale-12 (MSWS-12p) to physiotherapy intervention and determine the minimally clinically important change (MCIC). This study followed a prospective cohort design. Patients with MS (PwMS) underwent physiotherapy treatment for 10 sessions. The outcome measures were the MSWS-12p and Timed 25-Foot Walk test (T25-FW). Data was collected before and after ten sessions of physiotherapy. The effect sizes and the area under receiver operating characteristics curve (AUC) and MCIC were calculated. Results Thirty PwMS (16 female, mean age 43.07 years) participated in the study. The effect sizes for MSWS-12p were moderate (0.52, 0.64). The change scores of MSWS-12p showed excellent correlation with the dichotomized smallest detectable change (SDC) criterion (Eta coefficient test = 0.84). There was no correlation between the MSWS-12p total change scores and the T25-FW (r = − 0.14, p = 0.45). The AUC was perfect and the MCIC for the MSWS-12p was calculated 10.0 points. The MSWS-12p is responsive and demonstrates changes after physiotherapy. Changes > 10.0 points on MSWS-12p total score should be considered as true improvement after physiotherapy.

Background: Safety culture is the basis and dominant part of patient's safety, and is considered as the main axis of safety promotion programs and service quality. The purpose of this study was to explain the challenges of safety culture in Iranian educational centers with a qualitative approach. Methods: This study was a contractual qualitative content analysis which conducted in 1400. The study population consisted of people who had 5 years of experience in taking care patient or working in the patient's safety and quality control unit in teaching and medical centers affiliated to Tehran University of Medical Sciences. Study data were saturated by purposeful snowball sampling and in-depth and semi-structured interviews with 25 participants. “Granheim and Landman approaches” and “Goba and Lincoln criteria” were used to analyze the data and solidify the research. The process of coding and analyzing research data was performed simultaneously; Finally, the extracted categories and subcategories were confirmed by the interviewees. MaxQDA 10 was used to analyze data. Results: By analyzing the interviews, 331 codes, 7 categories and 20 subcategories were extracted. Lack of reporting errors, poor culture regarding no-blame, staffing issues, low understanding of patient safety, poor management support for patient safety, poor teamwork between units, and lack of open organizational communication were the main categories found and the most important challenges of safety culture in teaching and medical hospitals. Conclusion: According to the findings of the research, developing codified and continuous educational programs, strengthening teamwork and communication, adopting a comprehensive approach to increase the presence of all members of the treatment team in the process of reporting, and analyzing and implementing error prevention programs are among the requirements for improving and promoting the safety culture and quality of service to patients.

Background : Stroke is the leading cause of disability in adults worldwide, with spasticity after stroke being one of the more common complications. Dry needling (DN) has been demonstrated to decrease spasticity in stroke patients, although its effects on improving function remain unclear. The purpose of this study protocol is to compare the short-term effects of DN versus acupoint DN on wrist flexor spasticity and upper extremity function in patients with stroke. Methods : A double-blind, randomized clinical trial will be conducted to include patients with stroke and upper extremity spasticity and functional disability. Twenty-four patients with stroke will be randomly assigned to either the DN or acupoint DN (DNap) group. These groups will receive three DN sessions during a one-week period of the wrist flexor muscles or at the LI4 & TE5 acupoints, respectively. The primary outcome measure is the Modified Modified Ashworth Scale (MMAS) of spasticity. The secondary outcomes are the Fugl-Meyer Assessment of motor function (FMA) and the goniometry to assess the active and passive range of motion of the wrist. Data will be collected at baseline, immediately after the end of three sessions DN, and at a one-week follow-up visit. Discussion: The results of this comparative study will help to determine the more effective method for reducing spasticity and improving motor function in patients with stroke.

Introduction: Outcome measures using telerehabilitation (TR) in the context of post-stroke rehabilitation are an area of emerging research. The current review assesses the literature related to TR for patients requiring post-stroke rehabilitation. The purpose of this study is to survey the outcome measures used in TR studies and to define which parts of the International Organization of Functioning are measured in trials. Methods: TR studies were searched in Cochrane Central Register of Controlled Trials, PubMed, Embase, Scopus, Google Scholar, and Web of Science, The Cochrane Central Register of Controlled Trials (Cochrane Library), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Physiotherapy Evidence Database (PEDro) from 2016 to June 2023. Two reviewers individually assessed the full text. Discrepancies regarding inclusion or exclusion were resolved by an additional reviewer. Results: A total of 24 studies were included in the current review. The findings were synthesized and presented taking into account their implications within clinical practice, areas of investigation, and strategic implementation. Conclusions: The scoping review has recognized a broad range of outcome measures utilized in TR studies, shedding light on gaps in the current literature. Furthermore, this review serves as a valuable resource for researchers and end users (such as clinicians and policymakers), providing insights into the most appropriate outcome measures for TR. There is a lack of studies examining the required follow-up after TR, emphasizing the need for future research in this area.

This study aimed to translate and culturally adapt the BESTest to the Persian language and evaluate its intra-rater reliability in Iranian patients with stroke. A forward-backward translation and expert panel review method was followed. Eighteen patients post-stroke (15 men, 3 female) were included which were assessed by a physiotherapist two times with a one-week interval. The mean total score for the test and retest were 83.66 (SD = 11.98) and 82 (SD = 13.23), respectively. There were no floor and ceiling effects. The intra-rater ICC for the total score was 0.88 (95% CI = 0.73–0.95). The ICC for the BESTest sections ranged from 0.55 (95% CI = 0.12–0.80) to 0.89 (95% CI = 0.55–0.96). The standard error of measurement and the smallest detectable change of the BESTest total score were 8.33 and 22.82, respectively. Our findings confirm the intra-rater reliability of the Persian BESTest for balance assessment of patients with chronic stroke.

Aim: Spasticity is one of the most common symptoms in post-stroke patients. Dry needling (DN) is a relatively new method for the management of muscle spasticity. A multimodal treatment may be more effective in spasticity management. The purpose of this study was to explore the short-term combined effects of DN and exercise therapy on wrist flexor spasticity, motor function, and motor neuron excitability in patients with chronic stroke. Methods: Ten patients with stroke and a mean age of 52 ± 4.9 years participated in this pretest-posttest pilot study. Patients received four sessions of DN and exercise therapy. Affected flexor carpi radialis and flexor carpi ulnaris muscles were needled each for 1 min. Patients underwent exercise therapy for about 30 min, once a week after DN. The outcome measures were the Modified Modified Ashworth Scale (MMAS), the maximal amplitude of H wave/maximal amplitude of M wave ratio (Hmax/Mmax Ratio), H-reflex latency, wrist extension active and passive range of motion (ROM), Action Research Arm Test (ARAT), and Fugl-Meyer Assessment (FMA). Assessments were performed at baseline, after four sessions of treatment, and three weeks after treatment. Results: After treatment, significant improvements in MMAS, wrist passive ROM, ARAT, and FMA were obtained (P ≤ 0.05). Conclusions: DN combined with exercise therapy improved muscle spasticity and motor function in patients with chronic stroke. Further investigations with a randomized controlled trial design with a comparator group of DN only are warranted (https://www.irct.ir/ identifier: IRCT20180611040061N1).

Abstract Background The Lumbar Spine Instability Questionnaire (LSIQ) is a self-reported measure of clinical instability of the lumbar spine. This study aimed to translate and culturally adapt the LSIQ into Persian language (LSIQ-P) and to evaluate its reliability and validity in a sample of patients with chronic non-specific low back pain (LBP). Methods In a cross-sectional study, the LSIQ was translated using guidelines. Participants with chronic non-specific LBP, aged ≥ 18 years old, answered an online survey consisting of LSIQ-P, the Persian Functional Rating Index (FRI), and the pain Numeric Rating Scale (NRS). Construct validity, internal consistency reliability, test–retest reliability, standard error of measurement (SEM), smallest detectable change (SDC), discriminant validity, and factor analysis were evaluated. Results The LSIQ was successfully adapted into Persian. A sample of 100 participants with LBP and 100 healthy subjects completed the survey. Floor and ceiling effects were not observed. Cronbach’s alpha = 0.767 and ICCagreement = 0.78 indicated good internal consistency and test–retest reliability. The SEM and SDC were 1.53 and 4.24, respectively. Construct validity of LSIQ-P was confirmed with significant correlation with Persian FRI (r = 0.44, p

Introduction ... [1-5]. Following the increase among the elderly population, mental and emotional issues are considered as the basic needs of this period. [6]. One of the most important issues in old ages is the quality of life [7]. .... [8-13]. One of the basic components of interpersonal relationships is the concept of interpersonal sensitivity and it refers carefully to the perceptions, judgments and responses that people show towards each other [14-18]. ... [19]. Panaghi et al. believe that factors such as health, family health and personal relationships affect the quality of life [9]. Monika et al. In 2017 showed that there is a positive relation between interpersonal sensitivity, social support and quality of life in the elderly, and on the other hand, the role of social support as a mediator is evident between interpersonal sensitivity and quality of life [20]. Aim (s) The present study was conducted to investigate the relation between interpersonal sensitivity and the quality of life of Armed Forces retirees in Tehran, Iran. Research Type The present study is cross-sectional and correlational with an analytical approach. Research Society, Place and Time This study was conducted among the retirees of the Armed Forces living in Tehran, Iran in 2019-2020. The area of this research was the retirement centers of the Armed Forces of Tehran province. Sampling Method and Number 373 people were selected as the sample by available sampling method. Used Devices & Materials Demographic Profile and Boyce and Parker Interpersonal Sensitivity questionnaires [19] with confirmed validity and reliability [14, 20-22] and elderly quality of life questionnaire (CAPS-19) [23, 24] with confirmed validity and reliability [23] were used to collect data. Ethical Permissions All participants in the study were fully assured that their identity information would remain strictly confidential and they had full authority not to participate in the study or to withdraw from the study at any stage they wished. Statistical Analysis Data normality was checked using one-sample T-test and Pearson correlation coefficient test was used to investigate the relationship between different variables. The software used in this study was SPSS 22. Finding by Text Among 373 people who participated in the study, 91.42% (341) were male and 8.57% (32) were female. 75.6% (280 people) of the samples were 65-70 years old. Also, 61.4% of them were married (Table 1). The total mean score of interpersonal sensitivity was 57.17± 35.83 which was evaluated at a weak level. Mean score of interpersonal sensitivity subscales including interpersonal awareness, need for approval, separation anxiety, shyness, and fragile self-esteem, were respectively 10.02 ± 19.1, 13.06±14.18, 12± 15/30 and 7.04 ±13.21, which were lower than their specified maximum score and were assessed at a poor level. Subscale of need for approval was evaluated in an average level with score of 15.03±12.23. The total mean score of quality of life of the elderly was 58.00±26.34 which were evaluated at a good level in terms of quality of life. The mean scores of elderly quality of life subscales including control, independence, self-fulfillment and success were respectively 12.06±9.14, 15.21±16.28, 14.39±14.34 and 15.83±20.80 that they were close to their maximum score and at a good level. The results of Pearson correlation test showed that the significance level of Pearson correlation coefficient was equal to 0.41 (P-value

Statement of the Problem. The mandibular condyle position is important in temporomandibular joint (TMJ) disorders. The bite force is a mechanical force that may affect the condylar position. Purpose. To investigate the relationship between condylar position in the glenoid fossa and maximum bite force in adults with normal temporomandibular joint. Materials and Methods. In this cross-sectional study, 23 subjects (21 females and 2 males; mean age 38.88±11.7 years) with 41 joints participated. Right and left joints were examined using cone-beam computed tomography. Maximum bite force was measured using the strain gauge transducer in the regions of right molar, left molar, and incisors. Pearson correlation coefficient, paired sample t-test, and binary logistic regression were employed for analysis. Results. The mean maximum bite force was 169.09 ± 87.7 N. The most common position of the condyle was anterior (n = 36) and inferior (n = 31). The mean of mandibular condyle joint spaces for right and left sides were not statistically significant (P>0.05). There were no relationships between the condylar positions and the mean maximum bite force (P>0.05). Conclusion. The condylar positions in the glenoid fossa are not related to the bite force in the people with normal temporomandibular joint.

Despite the tremendous technologic advancements of recent years, the prevalence of stroke has increased significantly worldwide from 1990 to 2019 (a 70 [...]

Introduction: Millions of patients suffer from stroke every year, and it is very important for physiotherapists to keep in touch with patients through models that provide physiotherapy over a distance, especially at the time of the COVID-19 pandemic. One key topic within the realm of provision of distance physiotherapy services is "TeleRehab" technology, short form for telerehabilitation. Moreover, the analysis of the gathered stroke data needs business intelligence (BI) technologies, which can help to gain insights into risk factors and improve medical decision-making. Methods: This research consists two sections: (a) an online web-based intelligence dashboard was implemented, which provides analyzing the clinical data of 1219 patients and investigating risk the factors of ischemic versus hemorrhagic stroke; and (b) designing a mobile application that can be run on both Android and iOS operating systems, which was successfully tested, as an TeleRehab solution. Results: The designed intelligence dashboard was equipped with a geographical information system (GIS) system that provided the possibility for the analysis of stroke status in any geographical location and discovering the relationships between patient-related contributors in each type of stroke. Conclusions: Both of these products can help patients undergoing medical rehabilitation, especially during COVID-19 conditions. The TeleRehab program is considered as a facilitator, especially at this time when keeping a social distance is necessary, to prevent exacerbation of patients’ complications and reduce the work burden on health personnel. The intelligence dashboard also provided a user-friendly tool for the analysis and running of queries about stroke for decision-making.

Background : Spasticity is a common motor disorder in adult stroke patients. Injury to the corticospinal tract (CST) is associated with spasticity. Dry needling (DN) has positive impacts on spasticity reduction and improvement in the range of motion (ROM) in stroke patients. This study aims to investigate the effectiveness of DN on the connectivity of the CST and the level of spasticity in adult stroke patients. Methods : This double-blind randomized controlled trial will enroll and randomly assign stroke patients to either the experimental group, for receiving three sessions of DN for the spastic wrist flexors, or the control group, for sham needling. The primary outcome measures will be diffusion tensor imaging and the Modified Modified Ashworth Scale score to assess CST connectivity and wrist flexor spasticity, respectively. The Box and Block Test and standard goniometry are the secondary outcome measures to assess hand dexterity and active and passive wrist ROM, respectively. Measurements will be taken both before and after the intervention. Discussion: The results of this study will provide important evidence of the effects of DN on CST connectivity, spasticity, and arm function in adult stroke patients. Trial registration: This trial is registered in the Iranian Registry of Clinical Trials (IRCT) (https://www.irct.ir; IRCT20191208045649N1).

Background: Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke. Methods: We will use a single-blind randomized controlled trial (RCT) in accordance with the CONSORT guidelines. A total of 24 patients with stroke will be included from the University Rehabilitation Clinics. The outcome measures will include Modified Modified Ashworth Scale, Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test, Fugl-Meyer Assessment, and wrist extension active and passive range of motion. Patients in the DN and exercise therapy group will undergo 4 sessions of deep DN in flexor carpi radialis and flexor carpi ulnaris muscles on the affected upper limb and exercise therapy. Participants in the DN group will only receive DN for target muscles. Clinical and neurophysiological tests will be performed at baseline, after four therapy sessions, and at three weeks’ follow-up. Discussion: This study will provide evidence for additional effects of exercise therapy to DN in comparison to DN alone on wrist flexors spasticity, motor neuron excitability, upper-limb motor function, and ROM in patients with chronic stroke.

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Background : Spasticity is a common symptom in multiple sclerosis (MS). Dry needling (DN) has been considered a useful method for the treatment of spasticity; however, there are no studies on the effects of DN on spasticity in patients with MS. We propose a study protocol aiming to investigate the effects of DN on spasticity in patients with MS. Methods : MS patients with plantar flexor spasticity will be recruited. Participants will be randomly assigned to the DN group, where they will be receiving a single session of DN, one minute for each head of gastrocnemius muscle, or to the waiting list control group with no intervention. Primary outcome measures are the Modified Ashworth Scale (MAS) for gastrocnemius spasticity, passive resistive torque, and podography for foot pressure distribution. The ankle active and passive range of dorsiflexion and Timed Up and Go tests are the secondary outcome measures. All outcomes will be measured at baseline, immediately after the intervention, and one week later. A mixed-model, general linear model, and two-way repeated-measures ANOVA will be used to compare the quantitative variables between groups and within groups at the measurement time points. The MAS ordinal measure of spasticity will be compared between groups using the Kruskal-Wallis test, and both the Friedman test and Wilcoxon test will be used for within-group changes. Discussion: This study will provide primary evidence on the effects of DN on gastrocnemius muscle spasticity and gait in patients with MS. Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20190617043918N1.

Objectives: It is essential to have a suitable instrument for the accurate assessments of pain and disability outcomes during interventions; such tools also help to guide hand surgery and rehabilitation programs in distal radius or scaphoid fracture. This study aimed to evaluate the psychometric features of the Patient-rated Wrist Evaluation (PRWE) questionnaire in Iranians with a history of scaphoid and distal radius fractures. Methods: One hundred and fifty subjects with a history of scaphoid and distal radius fractures were recruited from hospital-based outpatient hand clinics and completed the PRWE, 2 and 7 days after the occurrence of fracture. Additionally, the Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH), the percentage of Wrist Range of Motion (%ROM), Visual Analog Scale Pain/Disability (VAS-P, VAS-D), Short-form Health Survey (SF-36) questionnaires, and pinch and grip strength (%) were conducted in the study participants. Cronbach’s alpha (α) coefficient and Intraclass Correlation Coefficient (ICC) were used to evaluate the internal consistency and test-retest reliability of the scale, respectively. Pearson or Spearman correlation coefficient was calculated for assessing the test’s construct validity. Results: No floor or ceiling effect was found. A very high test-retest reliability was obtained for the PRWE’s total score and subscores (ICC≥0.92). Cronbach’s α coefficient was obtained as ≥0.78 for the PRWE and its subscales. The PRWE total score presented a weak to strong (0.24-0.74) correlation with the average values of %ROM, %power grip, %pinch strength, VAS-P, VAS-D, SF-36, and Quick-DASH. The standard error of the measurement of PRWE total score equaled 3.93; its smallest real difference was 10.86. Discussion: The PRWE presented acceptable validity and excellent reliability for measuring disability and pain in individuals with the scaphoid and distal radius fractures in Iran.

Abstract Background It is unknown how diaphragm training combined with electrical stimulation affects pain, function, static stability, and balance in athletes with chronic low back pain (CLBP). This study aimed to explore the effects of combining diaphragm training with electrical stimulation on pain, function, static stability, and dynamic balance in athletes with nonspecific CLBP. Methods The design was a randomized clinical trial. A total of 24 amateur athletes (12 women, 12 men, mean age: 35.2 ± 9.8) with nonspecific CLBP were randomly allocated into two groups. The experimental group (n = 12) received diaphragm training plus Transcutaneous Electrical Nerve Stimulation (TENS), while the control group (n = 12) received TENS alone. Both groups underwent 12 sessions over a four-week period. Static stability, dynamic balance, pain, and function were measured pre- and post-intervention. Results Analysis of variance 2 × 2 revealed greater improvements in pain (p

Background and purpose: Brain function can be networked, and these networks typically present drastic changes after having suffered a stroke. The objective of this systematic review was to compare EEG-related outcomes in adults with stroke and healthy individuals with a complex network approach. Methods: The literature search was performed in the electronic databases PubMed, Cochrane and ScienceDirect from their inception until October 2021. Results: Ten studies were selected, nine of which were cohort studies. Five of them were of good quality, whereas four were of fair quality. Six studies showed a low risk of bias, whereas the other three studies presented a moderate risk of bias. In the network analysis, different parameters such as the path length, cluster coefficient, small-world index, cohesion and functional connection were used. The effect size was small and not significant in favor of the group of healthy subjects (Hedges’g = 0.189 [−0.714, 1.093], Z = 0.582, p = 0.592). Conclusions: The systematic review found that there are structural differences between the brain network of post-stroke patients and healthy individuals as well as similarities. However, there was no specific distribution network to allows us to differentiate them and, therefore, more specialized and integrated studies are needed.

Background: Studies have shown that 75% of men and 35% of women over the age of 10 have hamstring tightness. Hamstring tightness is one of the major causes of hamstring injury and loss of function. Dry needling which is a common intervention used by physiotherapists for the treatment of common various conditions can improve hamstring flexibility in less time than other interventions. So, the present study aimed to investigate the effect of dry needling on flexibility and electrophysiological indices in healthy men with hamstring tightness. Methods: In this two-way blind clinical trial with a control group, which was performed from November 2018 to February 2019 in the laboratory of the Faculty of Rehabilitation of Tehran University of Medical Sciences, 30 healthy men with hamstring tightness were randomly divided into two groups of dry needling (n=15) and sham needle (n=15). In both groups, dry needling and sham needle, three points of hamstring muscle were needled, each point for one minute during a single session. Outcome measures included flexibility based on passive knee extension test, H-reflex latency, and motor neuron excitability, which were measured three times: before the intervention, immediately after the intervention, and one week after the intervention. Results: The results revealed that the mean of passive knee extension test (P=0.54), the mean delay time of H-reflex (P=0.84) and the mean of excitability of the motor neuron (P=0.41) didn’t have significant different between two groups after intervention. Conclusion: The findings of this study showed that dry needling had no effect on hamstring flexibility and electrophysiological indices recorded in the soleus muscle of healthy individuals with hamstring tightness.

Background: Oxford Shoulder Score (OSS) is a specific questionnaire for the assessment of pain and function in subjects with shoulder pain. The reliability and validity of the Persian version of this questionnaire have been shown previously. But its responsiveness has not been investigated yet. This study aimed to determine the Persian OSS responsiveness in subjects with shoulder pain. Methods: This was a prospective cohort study design conducted in the Physiotherapy Clinic, School of Rehabilitation, Tehran University of Medical Sciences in 2018. Thirty-one subjects with shoulder pain (20 females and 11 males) with a mean age of 50±15.3 participated in this study. They completed the Persian OSS, Disability of Arm, Shoulder & Hand (DASH) questionnaire, and Visual Analog Scale (VAS) before and after 10 physiotherapy sessions. After the 10th session, the Global Rating of Change (GRC) was also completed. The statistical analysis included the Effect Size (ES), Standardized Response Mean (SRM), and the Spearman or Pearson correlation coefficients. Results: The results showed that the ES and SRM of the Persian OSS were 1.73 and 1.79, respectively. The correlation between the Persian OSS and the VAS scores was 0.69 and between the Persian OSS and the DASH scores was 0.89. The correlation between the Persian OSS changes and GRC was not statistically significant (r=0.25, P=0.18). However, a significant moderate correlation was identified between the VAS and DASH with the GRC scores (r=0.43, r=0.42, respectively). Conclusion: The Persian OSS has internal and external responsiveness for the assessment of subjects with shoulder pain. The Persian OSS, as a responsive instrument, can be used to investigate the effectiveness of interventions in the clinical settings and research to detect the changes in patients with shoulder pain. Further study with larger sample of patients with shoulder pain is warranted to confirm the findings and to estimate the minimally clinically important change.

Abstract Background Stroke can cause balance disorders, which often lead to falls and fall-related injuries. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a balance test that has been recently translated into Persian. The reliability and validity of the Persian version of Mini-BESTest have not been assessed in patients with stroke. Objectives To assess the reliability and validity of the Persian version of the Mini-BESTest in patients with stroke. Methods A cross-sectional study was designed. Thirty patients with stroke participated in this study. Patients were tested using the Mini-BESTest according to the Persian instructions, and two raters independently rated each patient’s performance. Each patient was matched with a healthy adult in the terms of age and gender. Healthy subjects were also tested for discriminative validity. Results There was excellent correlation between two raters on the Persian version of the Mini-BESTest total scores (r Pearson = 0.98, P 0.9). There was a significant difference between stroke patients and healthy subjects confirming the discriminative validity of the Persian version of the Mini-BESTest (19.4 ± 5.4 vs. 24.8 ± 2.3, P

Abstract Background The Western Ontario Meniscal Evaluation Tool (WOMET) is the only questionnaire available to assess quality of life in patients with isolated meniscal injuries. The aims of this study were to prepare the Persian version of the WOMET (PWOMET) and validate it in Iranian patients with isolated meniscal tears. Methods In the first stage, the English version of WOMET was translated into Persian. Content validity, and qualitative and quantitative (impact score) face validity were tested by specialists and in a sample of 30 patients. In the second stage, PWOMET was assessed for the evaluation of psychometric properties in 100 patients with isolated meniscal injury and 50 healthy people based on the COSMIN checklist. Construct validity was tested based on structural validity (factor analysis) and hypothesis testing. Correlation with the total scores on the SF-36, IKDC and KOOS were used for concurrent criterion validity. Test-retest reliability and internal consistency were calculated using intraclass correlation coefficient (ICC) and Cronbach’s alpha, respectively. In addition the standard error of measurement (SEM) and smallest detectable change were calculated. Interpretability was investigated as the ceiling and floor effects and minimal important difference. Results The PWOMET had acceptable qualitative face validity and content validity. The impact score (quantitative face validity) was more than 1.5 for all items. For construct validity, structural validity (factor analysis) and hypothesis testing ability were confirmed. Correlations between the PWOMET total score and IKDC, SF-36, KOOS scores were 0.61, 0.54 and 0.63, respectively (p

Background: Spasticity is one of the most important symptoms of stroke, which leads to movement constraints and disability. The presence of spasticity in the ankle and toe plantar flexor muscles disturbs the balance and gait of patients with stroke. Dry needling has been introduced as a new method for the treatment of spasticity. The aim of this study was to investigate the immediate effects of the ankle and toe plantar flexors dry needling on spasticity and balance in patients with stroke. Methods: This study was a clinical pretest-posttest study. Twenty patients with stroke (12 males and 8 females), the mean age of 56.5±13 years were included. The assessments were performed before dry needling, immediately after dry needling and 15 minutes after that. Dry needling was used to treat gastrocnemius (ankle plantar flexor) muscles, flexor digitorum longus, and flexor digitorum brevis of the affected lower limb of the patients, for one session. Each muscle was needled for one minute with fast in-fast out technique. The outcome measures of the study were modified modified Ashworth scale (MMAS) for the assessment of the severity of muscle spasticity, timed up and go test and one leg stance test, for balance evaluation. The study was conducted in neurological physical therapy, Clinic of Rehabilitation School, Tehran University of Medical Sciences in Iran, from April 2017 to April 2018. Results: The results showed a significant decrease in the ankle and toe plantar flexor muscles spasticity both immediately after dry needling and at 15 minutes follow-up (P=0.001). The duration of timed up and go test (P=0.001) and one leg stance test (P=0.001) improved significantly after dry needling and this improvement persisted for 15 minutes after dry needling. The effect size for timed up and go test and one leg stance test was small (Cohen'sd=0.33 and 0.32 respectively). Conclusion: This study suggests that dry needling is effective in improving spasticity of ankle and toe plantar flexor muscles and the balance of patients with stroke. Further research with larger sample size and control group is necessary.

Introduction: Swallowing disorder or dysphagia is a common complication after conventional total thyroidectomy. Traditional dysphagia therapy (TDT) has long been a routine rehabilitation program for patients with dysphagia; however, there is no evidence to support the efficacy of this approach in patients with post-thyroidectomy dysphagia. Regarding this, the purpose of the current study was to explore the effectiveness of TDT in swallowing dysfunction in patients suffering from post-thyroidectomy dysphagia. Materials and Methods: This pilot clinical trial was conducted on 21 patients with post-thyroidectomy dysphagia. The study population was randomly assigned into two groups of TDT and control. The patients in the TDT group received 18 treatment sessions for 6 weeks, 3 times a week. The Swallowing Impairment Score (SIS-6), Functional Oral Intake Scale (FOIS), and Persian Dysphagia Handicap Index (P-DHI) were the outcome measures. The outcome variables were assessed at the baseline, at the end of the treatment, and after a 6-week follow-up. The main effects of time and group and their interaction effect on SIS-6 and P-DHI scores were examined using repeated measures ANOVA. In addition, the intergroup comparison in terms of the FOIS score was analyzed using the Mann-Whitney U test. The Cohen's d effect size was also measured to ascertain the effects of the treatment. Results: According to the results, the TDT group showed a significant improvement in the SIS-6, FOIS and P-DHI scores over time (P

Background: Lower limb spasticity after stroke is common that can affect the balance, increase the risk of falling, and reduces the quality of life.Objective: First, evaluate the effects of spasticity severity of ankle plantar flexors on balance of patients after stroke. Second, to determine the relationship between the spasticity severity with ankle proprioception, passive ankle dorsiflexion range of motion (ROM), and balance confidence.Methods: Twenty-eight patients with stroke based on the Modified Modified Ashworth Scale (MMAS) were divided into two groups: High Spasticity Group (HSG) (MMAS > 2) (n = 14) or a Low Spasticity Group (LSG) (MMAS ≤ 2) (n = 14). The MMAS scores, Activities-Specific Balance Confidence Questionnaire, postural sway of both affected and non-affected limbs under the eyes open and eyes closed conditions, timed up and go (TUG) test, passive ankle dorsiflexion ROM, and ankle joint proprioception were measured.Results: The ankle joint proprioception was significantly better in the LSG compared to the HSG (p = 0.01). No significant differences were found between the LSG and HSG on all other outcome measures. There were no significant relationships between the spasticity severity and passive ankle dorsiflexion ROM, and balance confidence.Conclusion: The severity of ankle plantar flexor spasticity had no effects on balance of patients with stroke. However, the ankle joint proprioception was better in patients with low spasticity. Our findings suggest that the balance is affected regardless of the severity of the ankle plantar flexor spasticity in this group of participants with stroke.

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Study Design A prospective, within-group cohort study of 46 patients with chronic low-back pain (CLBP). Purpose To assess the responsiveness of the Persian Functional Rating Index (PFRI) and to determine the minimal clinically important change (MCIC) of the PFRI in a cohort of patients with CLBP. Overview of Literature The FRI is an instrument for assessing pain and disability in patients with low-back pain. No study so far has examined the responsiveness of the PFRI. Methods Forty-six patients with CLBP with a mean age of 50.33±14.28 completed the PFRI, the Persian Roland–Morris Disability Questionnaire (PRMDQ), and a Visual Analog Scale (VAS) before and after 10 physiotherapy sessions. A Global Rating of Change Scale (GRCS) was completed after treatment. Results The changes in PFRI scores were statistically significant using the paired t-test (p

Background: Copenhagen hip and groin outcome score (HAGOS) is the only valid and reliable self-reported questionnaire for assessing symptoms and activity limitations of subjects with hip and groin problems. The aim of this study was to translate and culturally adapt the English version of the HAGOS to Persian and to evaluate its reliability in young athletes with hip and groin pain. Methods: This cross-sectional study was performed in Tehran University of Medical Sciences, School of Rehabilitation, Iran, from June 2014 to May 2015. In order to develop the Persian HAGOS, the English HAGOS was translated and culturally adapted into Persian language based on the standard forward-backward translation and expert committee review. Then, for the test-retest reliability investigation, young male athletes suffering from hip and groin pain, recruited from sport physical therapy clinics, completed the Persian HAGOS two times with 1-2 weeks interval. Independent samples t‐test and Intraclass correlation coefficient (ICC) was used to determine the test-retest reliability of the six subscales and the total score of Persian HAGOS. The SPSS statistical software (IBM SPSS, Armonk, NY, USA) was used for all analyses. Results: Fifty young male athletes, mean age 26.12±3.37 years (range: 18-33), participated in this study. ICC value for test retest reliability of total score was 0.74 (95% CI: 0.59-0.84). ICC values for subscales scores ranged from 0.6 for participation in physical activities subscale to 0.79 (P0.05). Conclusion: The HAGOS was successfully translated and cross-culturally adapted from English into Persian language. The Persian version of HAGOS is a reliable questionnaire for the evaluation of young athletes with hip and groin pain in clinics and research.

Background: It is important to use reliable, valid, and responsive instruments to assess the treatment outcomes. The functional rating index (FRI) is a patient reported outcome measure to assess the pain and function in patients with neck and low back pain. The FRI has been translated and culturally adapted into Persian language. The purpose of this study was to investigate the responsiveness of Persian functional rating index in patients with chronic non-specific neck pain (CNSNP). Methods: The adult patients with CNSNP recruited from Shariati Hospital in Tehran and filled the Persian functional rating index (PFRI), Persian neck disability index (PNDI), and pain numerical rating scale (NRS) before and after 10 physiotherapy sessions, from March to July 2017. The patients completed the global rating change scale after treatment. For statistical analyses, the effect size (ES), standardized response mean (SRM), Guyatt response index (GRI) were used. The Spearman or Pearson test was used for correlation analyses. The area under the receiver operating curve (ROC) and minimal clinically important difference (MCID) were calculated. Results: In this study, 30 patients (female 17) with a mean of age 45.6 years [standard deviation (SD) 13.8] participated. The mean duration of neck pain was 14.7 months (SD 12.8). Significant strong and moderate correlations were identified between PFRI with PNDI and GRC scores (r= 0.78 and r= 0.69). The respective ES and SRM values were 0.73 and 0.78 for PFRI. The GRI was 5.58. The AUC was 0.89 (P= 0.001). MCID was 11.7%. Conclusion: This study confirms that the Persian functional rating index is responsive for assessing disability in Persian speaking patients with chronic non-specific neck pain.

Background. Chronic nonspecific low back pain (LBP) is one of the common health issues. Hamstring tightness contributes to the development of LBP. This study aimed to investigate the acute and short-term effects of deep dry needling (DN) in patients with chronic nonspecific LBP and hamstring muscle tightness. Methods. A single-group pretest-posttest clinical study design was followed. The outcome measures were the visual analog scale (VAS), passive knee extension (PKE) test, finger-floor distance (FFD) test, and functional rating index (FRI). Patients underwent one session of deep DN of three points on both hamstring muscles, each point for one minute. Patients were assessed before (T0), immediately after (T1), and one week after DN (T2). The FRI was assessed at T0 and T2. Results. Ten women with a mean age of 21.1 years (SD = 1.6) participated in the study. Significant large effect sizes in VAS pain reduction (d = 1.25) and PKE hamstring tightness were obtained (hamstring: right, d = 0.82; left, d = 0.88) at T2. Medium effect sizes were obtained for FFD (d = 0.45) and FRI (d = 0.72) at T2. Conclusion. A single session of deep DN improved pain and function and increased hamstring flexibility. This pilot study supports the use of DN in patients with LBP and hamstring tightness; however, future research with a rigorous study design of randomized controlled trial is required to confirm the findings. This trial is registered with IRCT20180511039612N1.

Background. Illness perceptions may influence coping behaviors as well as treatment and recovery among patients with chronic pain including low back pain (LBP). These perceptions may vary across different conditions. The Brief Illness Perception Questionnaire (BIPQ) is used as an instrument to assess the patients’ perception of illness. Although the BIPQ has been previously translated into Persian, its psychometric properties have not been evaluated among patients with chronic nonspecific LBP. The aim of this study was to determine the reliability and validity of the Persian BIPQ in patients with chronic nonspecific LBP. Methods. 116 patients with chronic nonspecific LBP with a mean (standard deviation) age of 36.4 years (10.7) participated in this cross-sectional study. Fifty patients were reexamined after 10 to 12 days for test-retest reliability. Internal consistency reliability, construct validity, concurrent criterion validity, and structural validity were evaluated. The concurrent validity was examined by using the Short Form-36 Health Survey. Results. There were no floor and ceiling effects. Cronbach’s alpha for the total score was 0.90. The intraclass correlation coefficient (ICC) for test-retest reliability was 0.90. The standard error of measurement and the minimal detectable change was found to be 3.26 and 9.04, respectively. The convergent correlations confirmed the construct validity. The concurrent criterion validity was demonstrated by significant negative correlations with the SF-36. The Exploratory Factor Analysis produced the 2 factors (emotional illness representations and cognitive illness representations) with an eigenvalue >1.0 that jointly accounted for 58.86% of the total variance. Conclusion. The Persian BIPQ is a reliable and 2-factor instrument and can be used for assessing illness perception in patients with chronic nonspecific LBP.

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Background and Aim: Balance disorder is a common problem in post stroke patients. Vibration therapy is one of the interventions that is used to treat this impairment in physiotherapy. There are several studies on the effects of more affected foot plantar vibration on balance, however according to the researchers this cerebral lesion causes bilateral side effects in the body. So the aim of this study was to investigate the short-term effects of both feet plantar vibration on the balance of post stroke patients. Methods: This pretest-posttest clinical study included 12 post stroke patients (8 male and 4 female, mean age 52.41 ± 9.03 years). The participants received one session of 5-min vibration stimuli (frequency, 100 Hz) to the plantar region on both feet. Mini-Balance Evaluation Systems Test (Mini-BESTest) score and plantar cutaneous sensation by Semmes Weinstein monofilament examination (SWME) were assessed before and immediately after the intervention. Results: Mini-BESTest mean total score improved significantly (p ≤ 0.001) after both feet vibration and these results were supported by a large effect size (Cohen d = 2.83). Mean number of detected points by SWME decreased after vibration therapy (p = 0.06) but it was not statistically significant. Conclusion: The findings suggest that local vibration applied directly to the plantar region of both feet in post-stroke patients could be an appropriate physiotherapy intervention to improve their balance.

Introduction: Use of patient-based voice assessment scales is an appropriate method that is frequently used to demonstrate effectiveness of voice therapy. This study was aimed at determining the effectiveness ofvoice therapy among patients with secondary muscle tension dysphonia (MTD) and vocal mass lesions. Materials and Methods: The study design was prospective, with within-participant repeated measures. Thirty-three patients with secondary MTD and vocal mass lesions participated in the study, selected on the basis of voice history, laryngeal palpation, and videostroboscopy examination. An experienced otolaryngologist and one experienced speech language pathologist undertook the diagnostic process. Voice therapy included both direct and indirect techniques and lasted approximately 2 months for all included patients. The voice handicap index (VHI) was used to evaluate the effectiveness ofvoice therapy among included patients. Paired t-test, size of the standardized effect (ESI),and mean standardized response (ESII) were used to analyze effectiveness of the target voice therapy. Results: The findings of this study indicate astatistically significant improvement after the voice therapy protocol (P1.96). Results of ESI and ESII demonstrate that the VHI scale is sufficiently responsive to detect voice therapy change (ES>0.8). Conclusion: This study recommends a combination of direct and indirect voice therapy in the vocal rehabilitation of patients with secondary MTD and vocal mass lesions. Furthormore, we recommend use of the VHI scale to show voice therapy changes for both clinical and research purposes.

Current research was conducted to investigate the physical properties and internal bonding of High-Density Fiberboard (HDF) made from oxidized fibers and different amount of glue. In order to surface modification, fiber was treated with 40% nitric acid. After fibers gluing with urea-formaldehyde (7% and 9% based on the dry weight of fibers), the boards with a density of 0.9 g/cm3 were made by hot pressing at 175°C and 4 minutes. The results of spectroscopy were confirmed the reduction of hydroxyl functional groups and the increase of the carboxylic group due to oxidation. The results of short term immersion test in water showed that in boards containing oxide-modified fibers and 9% urea-formaldehyde glue were measured the minimum water absorption and thickness swelling with mean of 78.5 and 28.65%, respectively.Spring back of modified boards containing less glue was affected by the stresses release and debonding of the wood elements that resulted in internal bonding loss.